[Urinary specific gravity--comparative measurements using reagent strips and refractometer in 340 morning urine samples]

The specific gravity of urine (SG) indicates the number and weight of solute particles in urine; its measurement is helpful in interpreting proteinuria detected by dipstick tests and in monitoring adequate hydration in patients with nephrolithiasis. Four methods for measuring SG or osmolality of urine are currently available (depression of the freezing-point, urometry, refractometry, cation exchange on a reagent strip). Using a recently developed reagent strip, we have measured SG in morning urines of 340 non-selected outpatients and compared the results with SG measurements by refractometry of the same urines. In 86.2% of all urines, a good positive correlation between SG measured by reagent strip and refractometry was noted (r = 0.913, p = 0.0001). In 13.8% of the urines, however, the SG measured by reagent strip deviated by more than +/- 5 from the value obtained by refractometry; in 90% of these urines, glucosuria (reagent strip values too low or too high), proteinuria (values too high), or bacteriuria/leukocyturia (values too low or too high) could be found. In alkaline urine (pH > 7.0), SG values obtained by reagent strip have to be corrected by +5.

Endoscopically assisted decompression of the median nerve in the pronator and Kiloh-Nevin syndrome: Surgical technique

STATE OF THE ART The proximal median nerve compression syndrome includes the pronator teres and the Kiloh-Nevin syndrome. This article presents a new surgical technique of endoscopic assisted median nerve decompression. MATERIAL AND SURGICAL TECHNIQUE Endoscopic scissor decompression of the median nerve is always performed under plexus anaesthesia. It includes 6 key steps documented in this article. We review the indications and limitations of the surgical technique. RESULTS Since 2011, three clinical series have highlighted the advantages of this technique. Functional and subjective results are discussed. We also review the limitations of the technique and its potential for future development. CONCLUSION Although clinical results after endoscopic assisted decompression of the median nerve appear excellent they still need to be compared with conventional techniques. Clinical studies are likely to develop primarily due to the mini-invasive nature of this new surgical technique.

The median forehead flap reviewed: a histologic study on vascular anatomy

Local skin flaps can be divided into two types: random flaps and axial flaps. An axial flap is defined as a flap containing a named artery in its pedicle. For the paramedian forehead flap (PMFF) a lot of surgeons insist on the point that the pedicle must contain the supratrochlear artery. To demonstrate that median forehead flaps (MFF) need not contain a named artery, we selected first 8 patients with a PMFF and further 12 patients who had undergone reconstructive surgery using a MFF. After division, we analysed the pedicle of the flap histologically and measured the diameter of the arteries or arterioles and compared them to anatomical descriptions of the frontal arteries. In none of the 12 cases could we find a functional artery of approximately 1 mm in diameter that could correspond to the supratrochlear artery. The MFF is an axial flap but not in accordance with the current definition of this term. In contrast to published literature, we show that only in a part of cases a named artery was present in the pedicle. Despite this fact, the MFF is a secure flap for full thickness defect repair on the nose.

Confidence Bands for Isotonic Median Curves using Sign-Tests

Suppose that one observes independent random variables (X1, Y1), (X2, Y2), …, (Xn, Yn) in R2 with unknown distributions, except that Median(Yi | Xi = M(x) for some unknown isotonic function M. We describe an explicit algorithm for the computation of confidence bands for the median function M whose running time is of order O(n2). The bands rely on multiscale sign tests and are shown to have desirable asymptotic properties.

Does Full Wound Rupture following Median Pilonidal Closure Alter Long-Term Recurrence Rate?

OBJECTIVE The purpose of this study was to examine the recurrence rate of wound rupture in primary pilonidal sinus disease (PSD) after median closure. SUBJECTS AND METHODS A total of 583 patients from the German military cohort were interviewed. We compared the choice of surgical therapy, wound dehiscence (if present) and long-term recurrence-free survival for patients with primary open treatment, marsupialization and primary median treatment (closed vs. secondary open, respectively). Actuarial recurrence rate was determined using the Kaplan-Meier calculation with a follow-up of up to 20 years after primary PSD surgery. RESULTS Patients with excision followed by primary open wound treatment showed a significantly lower 5- than 10-year recurrence rate (8.3 vs. 11.2%) compared to the patients with primary midline closure (17.4 vs. 20.5%, p = 0.03). The 20-year recurrence rate was 28% in primary open wound treatment versus 44% in primary midline closure without wound rupture. In contrast to these findings, long-term recurrence rates following secondary open wound treatment (12.2% at 5 years vs. 17.1% at 10 years) tended to be higher (although not significantly, p = 0.57) compared to primary open treatment (8.3% at 5 years vs. 11.2% at 10 years). There was no statistical difference in long-term recurrence rates between secondary open and primary midline closure (p = 0.7). Hence, despite only a short wound closure time experienced before wound rupture, the patient does not fully benefit from an open wound treatment in terms of recurrence rate. CONCLUSION The postoperative pilonidal sinus wound rupture of primary midline closures did not significantly increase the 5- and 10-year long-term recurrence rates compared to uneventfully healing primary midline closures.

Accelerated magnetic resonance diffusion tensor imaging of the median nerve using simultaneous multi-slice echo planar imaging with blipped CAIPIRINHA.

PURPOSE To investigate the feasibility of MR diffusion tensor imaging (DTI) of the median nerve using simultaneous multi-slice echo planar imaging (EPI) with blipped CAIPIRINHA. MATERIALS AND METHODS After federal ethics board approval, MR imaging of the median nerves of eight healthy volunteers (mean age, 29.4 years; range, 25-32) was performed at 3 T using a 16-channel hand/wrist coil. An EPI sequence (b-value, 1,000 s/mm(2); 20 gradient directions) was acquired without acceleration as well as with twofold and threefold slice acceleration. Fractional anisotropy (FA), mean diffusivity (MD) and quality of nerve tractography (number of tracks, average track length, track homogeneity, anatomical accuracy) were compared between the acquisitions using multivariate ANOVA and the Kruskal-Wallis test. RESULTS Acquisition time was 6:08 min for standard DTI, 3:38 min for twofold and 2:31 min for threefold acceleration. No differences were found regarding FA (standard DTI: 0.620 ± 0.058; twofold acceleration: 0.642 ± 0.058; threefold acceleration: 0.644 ± 0.061; p ≥ 0.217) and MD (standard DTI: 1.076 ± 0.080 mm(2)/s; twofold acceleration: 1.016 ± 0.123 mm(2)/s; threefold acceleration: 0.979 ± 0.153 mm(2)/s; p ≥ 0.074). Twofold acceleration yielded similar tractography quality compared to standard DTI (p > 0.05). With threefold acceleration, however, average track length and track homogeneity decreased (p = 0.004-0.021). CONCLUSION Accelerated DTI of the median nerve is feasible. Twofold acceleration yields similar results to standard DTI. KEY POINTS • Standard DTI of the median nerve is limited by its long acquisition time. • Simultaneous multi-slice acquisition is a new technique for accelerated DTI. • Accelerated DTI of the median nerve yields similar results to standard DTI.

A Median Voter Theorem for Postelection Politics

We analyze a model of 'postelection politics', in which (unlike in the more common Downsian models of 'preelection politics') politicians cannot make binding commitments prior to elections. The game begins with an incumbent politician in office, and voters adopt reelection strategies that are contingent on the policies implemented by the incumbent. We generalize previous models of this type by introducing heterogeneity in voters' ideological preferences, and analyze how voters' reelection strategies constrain the policies chosen by a rent-maximizing incumbent. We first show that virtually any policy (and any feasible level of rent for the incumbent) can be sustained in a Nash equilibrium. Then, we derive a 'median voter theorem': the ideal point of the median voter, and the minimum feasible level of rent, are the unique outcomes in any strong Nash equilibrium. We then introduce alternative refinements that are less restrictive. In particular, Ideologically Loyal Coalition-proof equilibrium also leads uniquely to the median outcome.

Is the Median Voter Decisive? Evidence of 'Ends Against the Middle' From Referenda Voting Patterns

This paper examines whether the voter with the median income is decisive in local spending decisions. Previous tests have relied on cross-sectional data while we make use of a pair of California referenda to estimate a first difference specification. The referenda proposed to lower the required vote share for passing local educational bonding initiatives from 67 to 50 percent and 67 to 55 percent, respectively. We find that voters rationally consider future public service decisions when deciding how to vote on voting rules, but the empirical evidence strongly suggests that an income percentile below the median is decisive for majority voting rules. This finding is consistent with high income voters with weak demand for public educational services voting with the poor against increases in public spending on education.

(Tables 1-2) Heavy mineral composition and median grain size of sediments obtained near 'Rote Kliff' west of Sylt, North Sea

The interpretation of 19 bore cores from the sea floor west of Rote Kliff (Isle of Sylt, North-Frisian Islands) gave information about the thickness of Holocene sand and the sediments below it; especially regarding their resistance to erosion in the area seaward of the beach-barrier. At the Same time, additional knowledge was obtained about the development of Sylt.

Median grain size and distribution of sand in ODP Hole 108-660A (Fig. 5)

50 m of Middle Eocene pure radiolarian ooze were drilled at ODP Site 660 in the equatorial East Atlantic, 80 km northeast of the Kane Gap. The oozes comprise a 10 m high and 2 km broad mound of seismic reverberations, covered by manganese-rich sediment, and contain trace amounts of sponge spicules and diatoms, negligible organic carbon (0.15%), clay, and variable amounts of pyrite. The yellow to pale brown silty sediments are relatively coarse-grained (30-45% coarser than 6 µm), little bioturbated, and commonly massive or laminated on a cm-scale. The unlithified radiolarian ooze may indicate an interval of high oceanic productivity, probably linked to a palaeoposition of Site 660 close to the equatorial upwelling belt during Middle Eocene time. The absence of organic matter, however, and both the laminated bedding and the mound-like structure of the deposit on the lower slope of a continental rise indicate deposition by relatively intense contour currents of oxygen-rich deep water, which passed through the Kane Gap, winnowed the fine clay fraction, and prevented the preservation of organic carbon. The ooze may be either a contourite-lag deposit, or a contourite accumulation of displaced radiolarians, originating south of the Kane Gap and being deposited in its northern lee, thus documenting the passage of a strong cross-equatorial bottom-water current formed near Antarctica. These Eocene contourites may be an analogue for ancient radiolarites in the Tethyan Ocean.