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Purpose: Plain radiographs are frequently used to select appropriately sized meniscal allografts, of which the width and length cannot be always perfectly matched. The objective of this study was to decide which of these dimensions should be matched with a more priority considering proper position of the lateral meniscal transplants.Methods: The positions of 34 lateral, fresh-frozen meniscal allografts, transplanted using the central bone bridge method, were evaluated by magnetic resonance imaging (MRI) 2 days after surgery. A size mismatch was defined as a difference between preoperative radiographic size and a real dimension of the transplants. The lateral subluxation of the mid-body on the coronal plane and the anterior and posterior horn positions on the sagittal plane were estimated on the MRIs. It was evaluated whether size mismatches were associated with the meniscal subluxation beyond articular cartilage margin on each plane.Results: The mean lateral subluxation of the mid-body on the center of coronal sections was 1.7 ± 1.8 mm. The anterior and posterior horns were located 2.0 ± 2.1 mm and -3.8 ± 2.7 mm from the articular edge, respectively, in the center of sagittal images. Lateral subluxation was significantly associated with width mismatch (r = 0.415-0.486, P < 0.05), but length mismatch was not significantly correlated with the anterior or posterior horn position on sagittal images (n.s.).Conclusion: The results of this study suggest that width matching using plain radiographs would be more reliable than length matching when it is sought to assure adequate positioning of meniscal transplants, if both dimensions cannot be simultaneously matched.Level Of Evidence: II. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To investigate the effect of increased sympathetic outflow to muscle (by means of elevated intrathoracic pressure) on painful-area electrical activity. DESIGN: In six subjects with myofascial painful areas in trapezius muscles during normal respiration and during elevated intrathoracic pressure, electromyographic epochs were recorded from a monopolar needle electrode inserted over the painful area and advanced until action potentials were detected, a second needle electrode inserted to the same depth over a nontender control area, and surface electrodes placed nearby. RESULTS: The painful-area electromyographic activity increased (P < 0.05) from 49 +/- 53 microV during normal respiration to 121 +/- 80 microV during elevated intrathoracic pressure. The control-area electromyographic activity and the surface-electrode electromyographic activity did not increase significantly. CONCLUSION: The significant electromyographic increase from painful areas and no significant increase from control channels are consistent with the view that sympathetic neural outflow increases painful-area electrical activity. [ABSTRACT FROM AUTHOR]

Intravenous cannulation is a nursing procedure carried out in some clinical units that may induce trauma and discomfort. Nurses should be well prepared before practising the procedure with clients. Conventionally, a plastic arm was used for practice but, with innovative developments in technology, a computer program called the CathSim Intravenous Training System (CathSim ITS) is available for this purpose. This study was conducted to compare the effectiveness of learning using a plastic arm with the CathSim ITS. Twenty-eight nurses were divided into two groups and randomly assigned to the two different methods: plastic arm (control group) or CathSim ITS (experimental group). Both groups were provided with 1 hour of theory input and 2 hours of nursing laboratory work. When the nurses felt ready to practise on clients, their performances were assessed by researchers with an intravenous cannulation qualification using a validated checklist. Prior to the assessment, trait and state anxiety levels were measured using the State-Trait Anxiety Inventory (Hong Kong Chinese adaptation) to check whether anxiety would affect the performance. Following the assessment, a semi-structured interview was conducted to reveal my knowledge acquired through using the selected method. Both the control and CathSim ITS groups demonstrated a high success rate, scoring 100% and 92.86%, respectively, with their first client. The semi-structured interviews revealed that the CathSim ITS group appreciated several features of their assigned method. However, there is room for further development. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the effect of botulinum toxin type A on nocturnal bruxism. DESIGN: Twelve subjects reporting nocturnal bruxism were recruited for a double-blind, randomized clinical trial. Six bruxers were injected with botulinum toxin in both masseters, and six with saline. Nocturnal electromyographic activity was recorded in the subject's natural sleeping environment from masseter and temporalis muscles before injection, and 4, 8, and 12 wks after injection and then used to calculate bruxism events. Bruxism symptoms were investigated using questionnaires. RESULTS: Bruxism events in the masseter muscle decreased significantly in the botulinum toxin injection group (P = 0.027). In the temporalis muscle, bruxism events did not differ between groups or among times. Subjective bruxism symptoms decreased in both groups after injection (P < 0.001). CONCLUSIONS: Our results suggest that botulinum toxin injection reduced the number of bruxism events, most likely mediated its effect through a decrease in muscle activity rather than the central nervous system. We controlled for placebo effects by randomizing the interventions between groups, obtaining subjective and objective outcome measures, using the temporalis muscle as a control, and collecting data at three postinjection times. Our controlled study supports the use of botulinum toxin injection as an effective treatment for nocturnal bruxism. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether adding rifampicin to vancomycin could cure more patients with nosocomial methicillin-resistant Staphylococcus aureus pneumonia compared with vancomycin-only.Design: Prospective randomized open-label study.Setting: Medical intensive care unit in Seoul, Korea.Patients: Ninety-three of 183 patients with Gram-positive nosocomial pneumonia.Interventions: The enrolled patients with subsequently documented methicillin-resistant Staphylococcus aureus pneumonia (modified intention-to-treat population) were treated with vancomycin (1 g intravenous every 12 hrs) plus rifampicin (300 mg twice daily by mouth) (n = 41) or with vancomycin-only (n = 42). The intended treatment (at least 5 days) was completed in 30 patients in the vancomycin plus rifampicin group and 34 patients in the vancomycin-only group (per protocol population).Measurements and Main Results: The primary outcome was the clinical cure rate on day 14 of treatment. The secondary outcomes were intensive care unit mortality on days 28 and 60, and microbiological eradication on day 14. The clinical cure rate in the modified intention-to-treat population was 53.7% (22 of 41) in the vancomycin plus rifampicin group, and 31.0% (13 of 42) in the vancomycin-only group (p = .047), and the respective rates in the per protocol population were 63.3% (19 of 30) and 38.2% (13 of 34) (p = .079). The respective mortality rates were nine (22.0%) of 41 and 16 (38.1%) of 42 on day 28 (p = .151), and 11 (26.8%) of 41 and 21 (50.0%) of 42 on day 60 (p = .042). The microbiological eradication rate did not differ between groups (p = .472).Conclusions: Vancomycin plus rifampicin seems to be more effective than vancomycin alone in the treatment of nosocomial methicillin-resistant Staphylococcus aureus pneumonia. [ABSTRACT FROM AUTHOR]

BACKGROUND: In-vitro and animal experiments have shown that the cyclo-oxygenase 2 inhibitor celecoxib can reduce formation of neointima within stents. We aimed to test whether celecoxib has similar effects in a clinical setting. METHODS: In a randomised two-centre trial, we enrolled 274 patients who had angina pectoris or a positive stress test and who had native coronary artery lesions for which implantation of paclitaxel-eluting stents was feasible. All patients were given aspirin (100 mg daily) and clopidogrel (75 mg daily). 136 patients were randomly assigned to receive celecoxib (400 mg before the intervention, and 200 mg twice daily for 6 months after the procedure). The primary endpoint was late luminal loss on quantitative coronary angiography at 6 months after the intervention. Secondary endpoints were cardiac death, non-fatal myocardial infarction, and revascularisation of the target lesion. Analysis was done on a modified intention-to-treat basis. This study is registered with ClinicalTrials.gov, number NCT00292721. FINDINGS: At 6 months, mean in-stent late luminal loss was lower in the celecoxib group (0.49 mm, SD 0.47) than in the control group (0.75 mm, 0.60) (absolute difference 0.26 mm; 95% CI 0.12-0.40). Frequency of secondary outcomes at 6 months was also lower in the celecoxib group, mainly because of a reduced need for revascularisation of the target lesion. INTERPRETATION: These data suggest that the adjunctive use of celecoxib for 6 months after stent implantation in patients with coronary artery disease is safe and can reduce the need for revascularisation of the target lesion. [ABSTRACT FROM AUTHOR]

Conclusion. After a noise-induced transient threshold shift, hypoxia occurred in the central nervous system, especially in the auditory cortex, the hippocampus, and the inferior colliculus. Objectives. Noise-induced inner ear hypoxia was shown by measurement of an increase in hypoxia-inducible factor-1 alpha, which is expressed? in the nucleus under hypoxic conditions. This study uses pimonidazole to localize site-specific hypoxic changes occurring in the mouse central auditory pathway during noise-induced auditory threshold shift. Method. BALB/c hybrid mice with normal hearing were exposed to 122 dB SPL white noise for 3 h. Immediately after exposure to the noise, and 7 d after noise exposure, the brains of mice were collected. Brains were cryosectioned into slices 15 um thick and examined by immunofluorescence after staining with pimonidazole HCl. Results. After 3 h of exposure to 120 dB SPL noise, the hearing thresholds of mice decreased to 51.1±8.6 dB SPL (n =14), but hearing recovered in 7 d. After noise exposure, pimonidazole signal increased in the auditory cortex, the hippocampus, and the inferior colliculus. The pimonidazole signal remained elevated after 7 d. In control mice, pimonidazole did not stain any brain region. [ABSTRACT FROM AUTHOR]