Effectiveness of yearly, register based screening for chlamydia in the Netherlands: controlled trial with randomised stepped wedge implementation

To evaluate the effectiveness of register based, yearly chlamydia screening.

Stepped osteotomy of the trochanter for stable, anatomic refixation

Refixation of a trochanteric osteotomy carries a high complication rate. To enhance stability and facilitate anatomic reduction of the trochanteric fragment, we have introduced a stepped osteotomy. Between April 2006 and June 2007, we performed surgical hip dislocations using the modified trochanteric osteotomy combined with a relatively aggressive rehabilitation program. Full weightbearing was allowed at a mean of 42 days (range, 33-54 days). The minimum followup was 8 months (median, 13 months; range, 8-24 months). Postoperative radiographs were assessed prospectively for consolidation or the appearance of malreduction/nonunion/malunion of the osteotomy and heterotopic ossification. In 110 of 113 hips, the trochanteric osteotomy healed in the anatomic position. Two patients had a trochanteric delayed union with loss of anatomic position, and one additional patient underwent revision surgery for a pseudarthrosis and cranial migration of the trochanteric fragment. All three complications related to healing occurred in the first 60 patients when the step height was 3 to 4 mm. After increasing the step heights to 6 mm, we observed no healing complications. Despite more aggressive postoperative mobilization, the incidence of malunion or nonunion related to the new stepped osteotomy is low and approaches zero for steps of 6 mm. It is now our technique of choice.

Treatment issues in spontaneous cervicocephalic artery dissections

The management of cervicocephalic arterial dissections raises many unsolved issues such as: how to best acutely treat patients who present with ischemic stroke or occasionally with sub-arachnoid hemorrhage? How to best prevent ischemic stroke in patients who present with purely local signs such as headache, painful Horner Syndrome or neck pain? How long and how should patients be treated after cervicocephalic arterial dissections? Can patients resume their sports activities and when? The consensus is that, given the well-established initial thromboembolic risk, an urgent antithrombotic treatment is required in patients with a recent nonhemorrhagic cervicocephalic arterial dissection, but the type of antithrombotic treatment - anticoagulants or aspirin - as well as the indication for a local arterial treatment such as angioplasty/stenting remain debated. Evidence from a randomized clinical trial would be welcome but such a trial raises major issues of methodology, feasibility and funding. Meanwhile, cervicocephalic arterial dissection remains a situation when a bedside clinician should use, on a case-by-case basis, best clinical judgment and adopt a stepped care approach in the minority of patients who deteriorate despite initial treatment.

Electro-oxidation of Au(1 1 1) in contact with aqueous electrolytes: New insight from in situ vibration spectroscopy

We carried out a comprehensive study of Au(1 1 1) oxidation–reduction in the presence of (hydrogen-) sulfate ions on ideally smooth and stepped Au(S)[n(1 1 1)-(1 1 1)] single crystal electrodes using cyclic voltammetry, in situ scanning tunneling microscopy (STM) and vibration spectroscopy, such as surface-enhanced infrared absorption spectroscopy (SEIRAS) and shell-isolated nanoparticle-enhanced Raman spectroscopy (SHINERS). Surface structure changes and the role of surface defects in the potential regions of double layer charging and gold oxidation/reduction are discussed based on cyclic voltammetry and in situ STM data. SEIRAS and SHINERS provide complementary information on the chemical nature of adsorbates. In particular, the potential-dependent formation and stability ranges of adsorbed sulfate, hydroxide-species and of gold surface oxide could be resolved in detail. Based on our experimental observations, we proposed new and extended mechanisms of gold surface oxidation and reduction in 1.0 M H2SO4 and 1.0 M Na2SO4.