Standard Examination System for Laparoscopy in Penetrating Abdominal Trauma

Background: The high missed occult small bowel injuries (SBI) associated with laparoscopy in trauma (LIT) is a major reason why some surgeons still preclude LIT today. No standardized laparoscopic examination for evaluation of the peritoneal cavity is described for trauma. The objective of this article is to verify if a systematic standardized laparoscopic approach could correctly identify SBI in the peritoneal cavity for penetrating abdominal trauma (PAT). Methods: Victims with PAT were evaluated in a prospective, nonrandomized study. A total of 75 hemodynamically stable patients with suspected abdominal injuries were operated by LIT and converted to laparotomy if criteria were met: SBI and lesions to blind spot zones-retroperitoneal hematoma, injuries to segments VI or VII of the liver, or injuries to the posterior area of the spleen. Inclusion criteria were equivocal evidence of abdominal injuries or peritonea] penetration; systolic blood pressure >90 mm Hg and <3 L of IV fluids in the first hour of admission; Glasgow Coma Scale score >12; and age >12 years. Exclusion criteria were back injuries; pregnancy; previous laparotomy; and chronic cardiorespiratory disease. Results: Sixty patients were males and there were 38 stab wounds and 37 gunshot wounds. No SBI was missed, but a pancreatic lesion was undiagnosed due to a retroperitoneal hematoma. Twenty patients (26.6%) were converted. Unnecessary laparotomies were avoided in 73.33%. Therapeutic LIT was possible in 22.7%. Accuracy was 98.66% with 97.61% sensitivity and 100% specificity. Conclusions: Standard systematic laparoscopic exploration was 100% effective to detect SBI in the peritoneal cavity. Conversion from LIT to laparotomy should be done if injuries to blind spot zones are found which are poorly evaluated by LIT. Therapeutic LIT is feasible in PAT.

Detection of nosocomial malnutrition is improved in Amazon region by a standard clinical nutrition education program

Background: In Brazil hospital malnutrition is highly prevalent. physician awareness of malnutrition is low, and nutrition therapy is underprescribed. One alternative to approach this problem is to educate health care providers in clinical nutrition. The present study aims to evaluate the effect of an intensive education course given to health care professionals and students on the diagnosis ability concerning to hospital malnutrition. Materials and methods: An intervention study based on a clinical nutrition educational program, offered to medical and nursing students and professionals, was held in a hospital of the Amazon region. Participants were evaluated through improvement of diagnostic ability, according to agreement of malnutrition diagnosis using Subjective Global Assessment before and after the workshop, as compared to independent evaluations (Kappa Index, k). To evaluate the impact of the educational intervention on the hospital malnutrition diagnosis, medical records were reviewed for documentation of parameters associated with nutritional status of in-patients. The SPSS statistical software package was used for data analysis. Results: A total of 165 participants concluded the program. The majority (76.4%) were medical and nursing students. Malnutrition diagnosis improved after the course (before k = 0.5; after k = 0.64; p < 0.05). A reduction of false negatives from 50% to 33.3% was observed. During the course, concern of nutritional diagnosis was increased W = 17.57; p < 0.001) and even after the course, improvement on the height measurement was detected chi(2) 12.87;p < 0.001). Conclusions: Clinical nutrition education improved the ability of diagnosing malnutrition; however the primary impact was on medical and nursing students. To sustain diagnostic capacity a clinical nutrition program should be part of health professional curricula and be coupled with continuing education for health care providers.

Assessment of psychosocial adjustment in patients with temporal lobe epilepsy using a standard measure

Despite the growing evidence of poor psychosocial adjustment, at present there is no formal method of assessment of social adjustment in patients with temporal lobe epilepsy (TLE). First, we assessed social adjustment in patients with TLE using a self-report questionnaire and compared the results with those from quality-of-life (QOL) scales. Second, we verified the influence of cognitive performance and clinical variables of epilepsy on social adjustment and QOL We evaluated 35 people with TLE and 38 healthy controls. Patients had worse social adjustment, and it was correlated with worse perception of cognitive function. Attention and verbal memory dysfunctions were negatively correlated with social adjustment. However, there was no significant correlation between cognitive performance and QOL Regarding clinical variables, persons with left TLE showed worse social adjustment and patients with frequent seizures showed worse QOL These findings indicate the relevance of evaluating social adjustment and emphasize the importance of cognitive rehabilitation to improved social adjustment. (c) 2010 Elsevier Inc. All rights reserved.

Effect of PaCO(2) variation on standard base excess value in critically ill patients

Purpose: The aim of this study was to investigate the impact of acute PaCO(2) temporal variation on the standard base excess (SBE) value in critically ill patients. Methods: A total of 265 patients were prospectively observed; 158 were allocated to the modeling group, and 107 were allocated to the validation group. Two models were developed in the modeling group (one including and one excluding PaCO(2) as a variable determinant of SBE), and both were tested in the validation group. Results: In the modeling group, the mathematical model including SIDai, SIG, L-lactate, albumin, phosphate, and PaCO(2) had a predictive superiority in comparison with the model without PaCO(2) (R(2) = 0.978 and 0.916, respectively). In the validation group, the results were confirmed with significant F change statistics (R(2) change = 0.059, P < .001) between the model with and without PaCO(2). A high correlation (R = 0.99, P < .001) and agreement (bias = -0.25 mEq/L, limits of agreement 95% = -0.72 to 0.22 mEq/L) were found between the model-predicted SBE value and the SBE calculated using the Van Slyke equation. Conclusions: Acute PaCO(2), temporal variation is related to SBE changes in critically ill patients. (C) 2009 Elsevier Inc. All rights reserved.

Comparative Study of the Standard Fluorescent Antibody to Membrane Antigen (FAMA) Assay and a Flow Cytometry-Adapted FAMA Assay To Assess Immunity to Varicella-Zoster Virus

A flow cytometry-adapted fluorescent antibody to membrane antigen (FAMA) assay to detect IgG antibodies against varicella-zoster virus (VZV) was developed and tested in 62 serum samples, showing 90.32% accuracy obtained from a receiver operating characteristic (ROC) curve with a 0.9125 (95% confidence interval [CI], 0.829 to 1.00) area below the curve compared to the result with standard FAMA.

Management of Common Bile Duct Stones in Cirrhotic Patients with Coagulopathy: A Comparison of Supra-Papillary Puncture and Standard Cannulation Technique

Bleeding is not uncommon following endoscopic sphincterotomy. Supra-papillary puncture (SPP) might be safer than standard cannulation (SC) techniques in patients with coagulopathy. The aim of the study was to compare the safety and effectiveness of SPP and SC. This was a prospective case control intervention study. Decompensated cirrhotic patients with coagulopathy and choledocolithiasis underwent SC and SPP methods for biliary access. One hundred five patients (56 [53.3%] men, mean [SD] age 56 [15.8]) underwent ERCP. SC and SPP were performed in 63 and 42 patients, respectively. Biliary access was achieved in 56/63 (89%) and 40/42 (95%) of patients undergoing SC and SPP, respectively (P = 0.13; 95% CI [-0.16; 0.03]). Complications occurred in 10/63 (15.8%) patients undergoing SC and 5/42 (11.9%) SPP (P = 0.28; 95% CI [-0.17, 0.16]). Five (7.9%) and two (3.2%) episodes of post-sphincterotomy bleeding was seen in the SC and SPP groups, respectively (P = 0.36; 95% CI [-0.16, 0.05]). In contrast, three (4.8%) episodes of pancreatitis were seen in the SC and none in the SPP group (P = 0.05; 95% CI [0.001; 0.004]). A cost-effectiveness analysis demonstrated that SPP is an acceptable alternative at an ICER of US$ 5,974.92 per additional successful procedure. SPP is a safe and effective technique for the management of common bile duct stones in decompensated cirrhotic patients. Conditional to the willingness-to-pay and to the local ERCP-related costs, SPP is also a cost-effective alternative to the SC methods. SPP is associated with a lower rate of complications but larger studies to validate these findings are necessary.

Accuracy of Periapical Radiography and Cone-Beam Computed Tomography Scans in Diagnosing Apical Periodontitis Using Histopathological Findings as a Gold Standard

Introduction: The aim of this study was to evaluate the accuracy of two imaging methods in diagnosing apical periodontitis (AP) using histopathological findings as a gold standard. Methods: The periapex of 83 treated or untreated roots of dogs` teeth was examined using periapical radiography (PR), cone-beam computed tomography (CBCT) scans, and histology. Sensitivity, specificity, predictive values, and accuracy of PR and CBCT diagnosis were calculated. Results: PR detected AP in 71% of roots, a CBCT scan detected AP in 84%, and AP was histologically diagnosed in 93% (p = 0.001). Overall, sensitivity was 0.77 and 0.91 for PR and CBCT, respectively. Specificity was 1 for both. Negative predictive value was 0.25 and 0.46 for PR and CBCT, respectively. Positive predictive value was 1 for both. Diagnostic accuracy (true positives + true negatives) was 0.78 and 0.92 for PR and CBCT (p = 0.028), respectively. Conclusion: A CBCT scan was more sensitive in detecting AP compared with PR, which was more likely to miss AP when it was still present. (J Endod 2009;35:1009-1012)

The embedded cluster DBSB 48 in the nebula Hoffleit 18: Comparison with Trumpler 14

We derive fundamental parameters of the embedded cluster DBSB 48 in the southern nebula Hoffleit 18 and the very young open cluster Trumpler 14, by means of deep JHK(s) infrared photometry. We build colour-magnitude and colour-colour diagrams to derive reddening and age, based on main sequence and pre-main sequence distributions. Radial stellar density profiles are used to study cluster structure and guide photometric diagram extractions. Field-star decontamination is applied to uncover the intrinsic cluster sequences in the diagrams. Ages are inferred from K-excess fractions. A prominent pre-main sequence population is present in DBSB 48, and the K-excess fraction f(K) = 55 +/- 6% gives an age of 1.1 +/- 0.5 Myr. A mean reddening of A(Ks) = 0.9 +/- 0.03 was found, corresponding to A(v) = 8.2 +/- 0.3. The cluster CMD is consistent with the far kinematic distance of 5 kpc for Hoffleit 18. For Trumpler 14 we derived similar parameters as in previous studies in the optical, in particular an age of 1.7 +/- 0.7 Myr. The fraction of stars with infrared excess in Trumpler 14 is f(K) = 28 +/- 4%. Despite the young ages, both clusters are described by a King profile with core radii R-core = 0.46 +/- 0.05 pc and R-core = 0.35 +/- 0.04 pc, respectively, for DBSB 48 and Trumpler 14. Such cores are smaller than those of typical open clusters. Small cores are probably related to the cluster formation and/or parent molecular cloud fragmentation. In DBSB 48, the magnitude extent of the upper main sequence is Delta K-s approximate to 2 mag, while in Trumpler 14 it is Delta K-s approximate to 5 mag, consistent with the estimated ages. (c) 2008 Elsevier B.V. All rights reserved.

Towards the main sequence: detailed analysis of weak line and post-T Tauri stars

A detailed study was performed for a sample of low-mass pre-main-sequence (PMS) stars, previously identified as weak-line T Tauri stars, which are compared to members of the Tucanae and Horologium Associations. Aiming to verify if there is any pattern of abundances when comparing the young stars at different phases, we selected objects in the range from 1 to 100 Myr, which covers most of PMS evolution. High-resolution optical spectra were acquired at European Southern Observatory and Observatorio do Pico dos Dias. The stellar fundamental parameters effective temperature and gravity were calculated by excitation and ionization equilibria of iron absorption lines. Chemical abundances were obtained via equivalent width calculations and spectral synthesis for 44 per cent of the sample, which shows metallicities within 0.5 dex solar. A classification was developed based on equivalent width of Li I 6708 angstrom and Ha lines and spectral types of the studied stars. This classification allowed a separation of the sample into categories that correspond to different evolutive stages in the PMS. The position of these stars in the Hertzsprung-Russell diagram was also inspected in order to estimate their ages and masses. Among the studied objects, it was verified that our sample actually contains seven weak-line T Tauri stars, three are Classical T Tauri, 12 are Fe/Ge PMS stars and 21 are post-T Tauri or young main-sequence stars. An estimation of circumstellar luminosity was obtained using a disc model to reproduce the observed spectral energy distribution. Most of the stars show low levels of circumstellar emission, corresponding to less than 30 per cent of the total emission.

HI aperture synthesis and optical observations of the pair of galaxies NGC 6907 and 6908

NGC 6908, an S0 galaxy situated in the direction of NGC 6907, was only recently recognized as a distinct galaxy, instead of only a part of NGC 6907. We present 21-cm radio synthesis observations obtained with the Giant Metrewave Radio Telescope (GMRT) and optical images and spectroscopy obtained with the Gemini-North telescope of this pair of interacting galaxies. From the radio observations, we obtained the velocity field and the H I column density map of the whole region containing the NGC 6907/8 pair, and by means of the Gemini multi-object spectroscopy we obtained high-quality photometric images and 5 angstrom resolution spectra sampling the two galaxies. By comparing the rotation curve of NGC 6907 obtained from the two opposite sides around the main kinematic axis, we were able to distinguish the normal rotational velocity field from the velocity components produced by the interaction between the two galaxies. Taking into account the rotational velocity of NGC 6907 and the velocity derived from the absorption lines for NGC 6908, we verified that the relative velocity between these systems is lower than 60 km s(-1). The emission lines observed in the direction of NGC 6908, not typical of S0 galaxies, have the same velocity expected for the NGC 6907 rotation curve. Some emission lines are superimposed on a broader absorption profile, which suggests that they were not formed in NGC 6908. Finally, the H I profile exhibits details of the interaction, showing three components: one for NGC 6908, another for the excited gas in the NGC 6907 disc and a last one for the gas with higher relative velocities left behind NGC 6908 by dynamical friction, used to estimate the time when the interaction started in (3.4 +/- 0.6) x 10(7) yr ago.

On the mass distribution of neutron stars

The distribution of masses for neutron stars is analysed using the Bayesian statistical inference, evaluating the likelihood of the proposed Gaussian peaks by using 54 measured points obtained in a variety of systems. The results strongly suggest the existence of a bimodal distribution of the masses, with the first peak around 1.37 M(circle dot) and a much wider second peak at 1.73 M(circle dot). The results support earlier views related to the different evolutionary histories of the members for the first two peaks, which produces a natural separation (even if no attempt to `label` the systems has been made here). They also accommodate the recent findings of similar to M(circle dot) masses quite naturally. Finally, we explore the existence of a subgroup around 1.25 M(circle dot), finding weak, if any, evidence for it. This recently claimed low-mass subgroup, possibly related to the O-Mg-Ne core collapse events, has a monotonically decreasing likelihood and does not stand out clearly from the rest of the sample.

The supernova remnant CTB 37B and its associated magnetar CXOU J171405.7-381031: evidence for a magnetar-driven remnant

We discuss the association between the candidate magnetar CXOU J171405.7-381031 and the supernova remnant CTB 37B. The recent detection of the period derivative of the object allowed an estimation of a young characteristic age of only similar to 1000 yr. This value is too small to be compatible even with the minimum radius of the remnant being >= 10 pc, the value corresponding to the lower limit of the estimated distance of 10.2 +/- 3.5 kpc, unless the true distance happens to be even smaller than the lower limit. We argue that a consistent scenario for the remnant`s origin, in which the latter is powered by the energy injected by a young magnetar, is indeed more accurate to explain the young age, and demonstrates its non-standard (i.e. magnetar-driven) nature.

Photometric redshifts and k-corrections for the Sloan Digital Sky Survey Data Release 7

We present a catalogue of galaxy photometric redshifts and k-corrections for the Sloan Digital Sky Survey Data Release 7 (SDSS-DR7), available on the World Wide Web. The photometric redshifts were estimated with an artificial neural network using five ugriz bands, concentration indices and Petrosian radii in the g and r bands. We have explored our redshift estimates with different training sets, thus concluding that the best choice for improving redshift accuracy comprises the main galaxy sample (MGS), the luminous red galaxies and the galaxies of active galactic nuclei covering the redshift range 0 < z < 0.3. For the MGS, the photometric redshift estimates agree with the spectroscopic values within rms = 0.0227. The distribution of photometric redshifts derived in the range 0 < z(phot) < 0.6 agrees well with the model predictions. k-corrections were derived by calibration of the k-correct_v4.2 code results for the MGS with the reference-frame (z = 0.1) (g - r) colours. We adopt a linear dependence of k-corrections on redshift and (g - r) colours that provide suitable distributions of luminosity and colours for galaxies up to redshift z(phot) = 0.6 comparable to the results in the literature. Thus, our k-correction estimate procedure is a powerful, low computational time algorithm capable of reproducing suitable results that can be used for testing galaxy properties at intermediate redshifts using the large SDSS data base.

Imprints of fast-rotating massive stars in the Galactic Bulge

The first stars that formed after the Big Bang were probably massive(1), and they provided the Universe with the first elements heavier than helium (`metals`), which were incorporated into low-mass stars that have survived to the present(2,3). Eight stars in the oldest globular cluster in the Galaxy, NGC 6522, were found to have surface abundances consistent with the gas from which they formed being enriched by massive stars(4) (that is, with higher alpha-element/Fe and Eu/Fe ratios than those of the Sun). However, the same stars have anomalously high abundances of Ba and La with respect to Fe(4), which usually arises through nucleosynthesis in low-mass stars(5) (via the slow-neutron-capture process, or s-process). Recent theory suggests that metal-poor fast-rotating massive stars are able to boost the s-process yields by up to four orders of magnitude(6), which might provide a solution to this contradiction. Here we report a reanalysis of the earlier spectra, which reveals that Y and Sr are also over-abundant with respect to Fe, showing a large scatter similar to that observed in extremely metal-poor stars(7), whereas C abundances are not enhanced. This pattern is best explained as originating in metal-poor fast-rotating massive stars, which might point to a common property of the first stellar generations and even of the `first stars`.

On the use of rotational splitting asymmetries to probe the internal rotation profile of stars: Application to beta Cephei stars

Rotationally-split modes can provide valuable information about the internal rotation profile of stars. This has been used for years to infer the internal rotation behavior of the Sun. The present work discusses the potential additional information that rotationally splitting asymmetries may provide when studying the internal rotation profile of stars. We present here some preliminary results of a method, currently under development, which intends: 1) to understand the variation of the rotational splitting asymmetries in terms of physical processes acting on the angular momentum distribution in the stellar interior, and 2) how this information can be used to better constrain the internal rotation profile of the stars. The accomplishment of these two objectives should allow us to better use asteroseismology as a test-bench of the different theories describing the angular momentum distribution and evolution in the stellar interiors. (C) 2010 WILEY-VCH Verlag GmbH&Co. KGaA, Weinheim