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Purpose The decision to continue immobilization of a nondisplaced scaphoid waist fracture is often based on radiographic appearance (despite evidence that radiographs are unreliable and inaccurate for diagnosing scaphoid union 6–12 weeks after fracture) and fracture tenderness (even though it is influenced by cognitive biases on pain). This may result in unhelpful additional immobilization. We studied nondisplaced scaphoid waist fractures to determine the factors associated with (1) the surgeon’s decision to continue cast or splint immobilization at the first visit when cast removal was being considered; (2) greater pain on examination; and (3) the surgeon’s concern about radiographic consolidation. Methods We prospectively included 46 patients with a nondisplaced scaphoid waist fracture treated nonoperatively. At the first visit when cast removal was considered – after an average of 6 weeks of immobilization – patients rated pain during 4 examination maneuvers. The treating surgeon assessed union on radiographs and decided whether to continue or discontinue immobilization. Patients completed measures of the following: (1) the degree to which pain limits activities (Patient-Reported Outcome Measure Interactive System [PROMIS] Pain Interference Computer Adaptive Test [CAT], Pain Self-Efficacy Questionnaire-2); (2) symptoms of depression (PROMIS Depression CAT); and (3) upper extremity function (PROMIS Upper Extremity Function CAT). We used multivariable regression analysis to investigate the factors associated with each outcome. Results Perceived inadequate radiographic healing and greater symptoms of depression were independently associated with continued immobilization. Pain during the examination was not associated with continued immobilization. Patient age was associated with pain on examination. Shorter immobilization duration was the only factor associated with the surgeon’s perception of inadequate radiographic consolidation. Conclusions Inadequate radiographic healing and greater symptoms of depression are associated with a surgeon’s decision to continue cast or splint immobilization of a nondisplaced scaphoid waist fracture. Clinical relevance Overreliance on radiographs and inadequate accounting for psychological distress may hinder the adoption of shorter immobilization times for nondisplaced waist fractures.

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one. Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months). Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups. Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts. Keywords: Clubfoot; Congenital talipes equinovarus; Ponseti; Accelerated; Cast.

Purpose Forearm and distal radius fractures are among the most common fractures in children. Many fractures are definitively treated with closed reduction and casting, however, the risk for re-displacement is high (7% to 39%). Proper cast application and the three-point moulding technique are modifiable factors that improve the ability of a cast to maintain the fracture reduction. Many providers univalve the cast to accommodate swelling. This study describes how the location of the univalve cut impacts the pressure at three-point mould sites for a typical dorsally displaced distal radius fracture. Methods We placed nine force-sensing resistors on an arm model to collect pressure data at the three-point mould sites. Sensory inputs were sampled at 15 Hz. Cast padding and a three-point moulded short arm fibreglass cast was applied. The cast was then univalved on the dorsal, volar, radial or ulnar aspect. Pressure recordings were obtained throughout the procedure. Results A total of 24 casts were analyzed. Casts univalved in the sagittal plane (dorsal or volar surface) retained up to 16% more pressure across the three moulding sites compared with casts univalved in the coronal plane (radial or ulnar border). Conclusion Maintaining pressure at the three-point mould prevents loss of reduction at the fracture site. This study shows that univalving the cast dorsally or volarly results in less pressure loss at moulding sites. This should improve the chances of maintaining fracture reductions when compared with radial or ulnar cuts in the cast. Sagittal plane univalving of forearm casts is recommended.

Background: Unripe green betel nuts (Areca catechu) are usually consumed as herbal medicines by some inhabitants in several regions of Indonesia. It is considered that the nuts contain Arecoline hydrobromide that can cause damages in a kidney tubule, although it needs further studies about effects of the nuts. Objective: This study aims to determine the effects of the unripe green betel nuts on kidney tissues of rats in a long-term treatment. Methods: Twenty rats used in this study were Sprague-Dawley strain, male, 2-3 months old, and 150-200 gram of weight. They were randomly divided into four groups. Group I was control group, given distilled water once a day; group II, III, and IV were served by juice of the unripe green betel nuts with a dose of 250 mg/kgBW, 1,000 mg/kgBW, and 10,000 mg/kgBW, respectively. Histopathology examination by staining of Haematoxylin Eosin was conducted by an anatomic pathologist using blind methods including glomerulus, tubulus, and interstitial tissues. Result: The tested kidney tissues showed mild interstitial congestion, tubular cast, and tubular degeneration in groups that received unripe green betel nuts. There were no glomerulus abnormality and interstitial inflammation. The highest percentage of rats suffering injury in their kidney was the group IV, with p value

Background: Forearm diaphyseal fractures constitute around 6% of all other children's fractures. Despite conservative management is proven and gold standard but still operative management is on rise. Aims and Objective: The aim of this study was to evaluate the outcome in conservative and surgical management of both-bone forearm fractures in children. Materials and Methods: This prospective study was conducted in children aged 3–12 years. Clinical and radiological features, time for union, angular correction over a period of management, and functional outcome were assessed. Data were entered and analyzed with Epi Info software. Results: There were 48 males (72.7%) and 18 (27.3%) females, with a mean age of 85 months (±29.7). In the present study, 34 (51.2%) at middle third was the most common site of diaphyseal fracture followed by distal third 28 (42.2) and proximal one-third. Conclusion: Fractures treated conservatively had greater healing potential and faster healing, whereas functional outcome was comparable in both conservatively and surgically treated patients.

In 2019, aviation was responsible for 2.6% of the world CO2 emissions as well as additional climate impacts such as contrails. Like all industrial sectors, the aviation sector must implement measures to reduce its climate impact. This paper focuses on the simulation and the evaluation of climatic scenarios for the aviation industry. For this purpose, a specific tool (CAST for "Climate and Aviation - Sustainable Trajectories") has been developed. This tool follows a methodology adapted to aviation using the concept of carbon budget and models of the main levers of action such as the level of air traffic, reduction of aircraft energy consumption or energy decarbonisation. These models are based on trend projections from historical data or assumptions from the literature. Several scenario analyses are performed in this paper using CAST and allow several conclusions to be drawn. For instance, the modelling of the scenarios based on the ATAG (Air Transport Action Group) commitments shows that aviation would consume between 2.9% and 3.5% of the world carbon budget to limit global warming to 2{\deg}C and between 6.5% and 8.1% for 1.5{\deg}C. Also, some illustrative scenarios are proposed. By allocating 2.6% of the carbon budget to aviation, it is shown that air transport is compatible with a +2{\deg}C trajectory when the annual growth rate of air traffic varies between -1.8% and +2.6%, depending on the considered technological improvements. However, in the case of a +1.5{\deg}C trajectory, the growth rate would have to be reduced drastically. Finally, analyses including non-CO2 effects compel to emphasize the implementation of specific strategies for mitigating contrails., Comment: 41 pages, 14 figures, 4 tables, Research paper

Introduction There are no established risk classification for post-cardiac arrest syndrome (PCAS) patients at the Emergency Department (ED) undergoing targeted temperature management (TTM). The aim of this study was to externally validate a simplified version of our prognostic score, the “post-Cardiac Arrest Syndrome for Therapeutic hypothermia score” (revised CAST [rCAST]) and estimate the predictive accuracy of the risk classification based on it. Methods For the external validation, we used data from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multicenter, prospective registry of OHCA patients across Japan. Eligible patients were PCAS patients treated with TTM at 33–36 °C between June 2014 and December 2015. We validated the accuracy of rCAST for predicting the neurological outcomes at 30 and 90 days. Results Among the 12,024 OHCA patients, the data of 460 PCAS patients treated by TTM were eligible for the validation. The areas under the curve of rCAST for predicting the neurological outcomes at 30 and 90 days were 0.892 and 0.895, respectively. The estimated sensitivity and specificity of the risk categories for the outcomes were as follows: 0.95 (95% CI: 0.92–0.98) and 0.47 (0.40–0.55) for the low (rCAST: ≤5.5), 0.62 (0.56–0.68) and 0.48 (0.40–0.55) for the moderate (rCAST: 6.0–14.0), and 0.57 (0.51–0.63) and 0.95 (0.91–0.98) for the high severity category (rCAST: ≥14.5). Conclusions The rCAST was useful for predicting the neurological outcomes with high accuracy in PCAS patients, and the three grades was developed for a risk classification based on the rCAST.

Background Postoperative management regimes vary following open reduction and internal fixation (ORIF) of unstable ankle fractures. There is an evolving understanding that extended periods of immobilisation and weight-bearing limitation may lead to poorer clinical outcomes. Traditional non-weight-bearing cast immobilisation may prevent loss of fixation, and this practice continues in many centres. The purpose of this trial is to investigate the safety and efficacy of immediate weight-bearing (IWB) and range of motion (ROM) exercise regimes following ORIF of unstable ankle fractures with a particular focus on functional outcomes and complication rates. Methods A pragmatic randomised controlled multicentre trial, comparing IWB in a walking boot and ROM within 24 h versus non-weight-bearing (NWB) and immobilisation in a cast for 6 weeks, following ORIF of all types of unstable adult ankle fractures (lateral malleolar, bimalleolar, trimalleolar with or without syndesmotic injury) is proposed. All patients presenting to three trauma units will be included. The exclusion criteria will be skeletal immaturity and tibial plafond fractures. The three institutional review boards have granted ethical approval. The primary outcome measure will be the functional Olerud-Molander Ankle Score (OMAS). Secondary outcomes include wound infection (deep and superficial), displacement of osteosynthesis, the full arc of ankle motion (plantar flexion and dorsal flection), RAND-36 Item Short Form Survey (SF-36) scoring, time to return to work and postoperative hospital length of stay. The trial will be reported in accordance with the CONSORT statement for reporting a pragmatic trial, and this protocol will follow the SPIRIT guidance. Discussion Traditional management of operatively treated ankle fractures includes an extended period of non-weight-bearing. There is emerging evidence that earlier weight-bearing may have equivocal outcomes and favourable patient satisfaction but higher wound-related complications. These studies often preclude more complicated fracture patterns or patient-related factors. To our knowledge, immediate weight-bearing (IWB) following ORIF of all types of unstable ankle fractures has not been investigated in a controlled prospective manner in recent decades. This pragmatic randomised-controlled multicentre trial will investigate immediate weight-bearing following ORIF of all ankle fracture patterns in the usual care condition. It is hoped that these results will contribute to the modern management of ankle fractures. Trial registration ISRCTN Registry ISRCTN76410775. Retrospectively registered on 30 June 2019.

Background There is no consensus concerning the optimal casting technique for displaced distal radius fractures (DRFs) following closed reduction. This study evaluates whether a splint or a circumferential cast is most optimal to prevent fracture redisplacement in adult patients with a reduced DRF. Additionally, the cost-effectiveness of both cast types will be calculated. Methods/design This multicenter cluster randomized controlled trial will compare initial immobilization with a circumferential below-elbow cast versus a below-elbow plaster splint in reduced DRFs. Randomization will take place on hospital-level (cluster, n = 10) with a cross-over point halfway the inclusion of the needed number of patients per hospital. Inclusion criteria comprise adult patients (≥ 18 years) with a primary displaced DRF which is treated conservatively after closed reduction. Multiple trauma patients (Injury Severity Score ≥ 16), concomitant ulnar fractures (except styloid process fractures) and patients with concomitant injury on the ipsilateral arm or inability to complete study forms will be excluded. Primary study outcome is fracture redisplacement of the initial reduced DRF. Secondary outcomes are patient-reported outcomes assessed with the Disability Arm Shoulder Hand score (DASH) and Patient-Rated Wrist Evaluation score (PRWE), comfort of the cast, quality of life assessed with the EQ-5D-5L questionnaire, analgesics use, cost-effectiveness and (serious) adverse events occurence. In total, 560 patients will be included and followed for 1 year. The estimated time required for inclusion will be 18 months. Discussion The CAST study will provide evidence whether the type of cast immobilization is of influence on fracture redisplacement in distal radius fractures. Extensive follow-up during one year concerning radiographic, functional and patient reported outcomes will give a broad view on DRF recovery. Trial registration Registered in the Dutch Trial Registry on January 14th 2020. Registration number: NL8311.

Transcatheter ablation was increasingly and successfully used to treat symptomatic drug refractory patients affected by supraventricular arrhythmias. Antiarrhythmic drug treatment still plays a major role in patient management, alone or combined with non-pharmacological therapies. Flecainide is an IC antiarrhythmic drug approved in 1984 from the Food and Drug Administration for the suppression of sustained ventricular tachycardia and later for acute cardioversion of atrial fibrillation and for sinus rhythm maintenance. Currently, flecainide is mostly used for sinus rhythm maintenance in atrial fibrillation (AF) patients without structural cardiomyopathy although recent studies enrolling different patient populations have demonstrated a good effectiveness and safety profile. How should we interpret the results of the CAST after the latest evidence? Is it possible to expand the indications of flecainide, and therefore, its use? This review aims to highlight the main characteristics of flecainide, as well as its optimal clinical use, delineating drug indications and contraindications and appropriate monitoring, based on the most recent evidence.

Objective To analyze the association between positive urinary casts on microscopic examination and urinary microprotein concentration in the case of negative urinary protein test results. This study also investigated the diagnostic value of urinary microprotein examination. Subjects A total of 949 samples that were analyzed with a UF‐1000i Urine Analyzer and returned cast alarm results were categorized into two groups, a positive and negative group, according to qualitative urinary protein sulfosalicylic acid test results. Then, 54 samples with negative protein test results but positive cast results according to microscopic examination were selected as the study group; 60 normal people with healthy physical examination results were selected as the control group. Both groups underwent urinary microprotein tests, including urinary microalbumin (mAlb), α1‐microglobulin (A1M), transferrin (TRU), and immunoglobulin G (IgG). T tests were used to evaluate mean differences between groups and chi‐square tests were used to calculate ratio differences between groups. Results (a) Microscopic examinations of the positive and negative protein groups revealed no statistically significant difference in cast detection rate (P = .421). (b) Among the 54 samples in the study group, 37 were found to have abnormal casts, while in the remaining 17 samples, only hyaline casts were detected. (c) The detection levels of mAlb, A1M, and IgG in the study group were significantly higher than the control group (P values, Our study shown microscopic examinations of the positive and negative protein groups revealed no statistically significant difference in cast detection rate, in the case of negative dry chemical urinary protein results, the diagnosis of the presence of casts has a certain value. So urinary microprotein test should be included in the reexamination rules for routine tests for patients with negative protein results and positive casts under microscopic examination. This would improve the detection rate of casts and reduce delays in appropriate treatment.

Pediatric fractures are a common injury, and treatment often includes cast immobilization. For pediatric patients being treated in a cast, cast damage is among the most common reasons patients return to the emergency room. The figure-of-eight wrapping technique interdigitates layers of fiberglass which may create a stronger cast. The aim of this study was to assess the strength of the figure-of-eight wrapping technique in comparison to the spiral wrapping technique. A total of 10 casts were wrapped with a three-inch fiberglass using the spiral technique and 10 casts were wrapped using the figure-of-eight technique. Each cast was then subjected to a three-point bending test and loaded until failure using an Instron machine. The figure-of-eight technique had an average load to failure of 278.2 + 27.6 N/mm which was similar to the spiral technique's load to failure of 281.2 + 25.4 N/mm (p=0.795). Prior to normalizing for thickness, the load to failure of the figure-of-eight technique was 949.8 + 109.5 N, which was significantly higher than the spiral technique of 868.2 + 65.1 N (p=0.038). The figure-of-eight casts were slightly thicker than the spiral casts (average 0.3 mm, p=0.004). This suggests that the thickness of the fiberglass cast may improve the strength. The figure-of-eight wrapping technique had similar biomechanical characteristics to spiral wrapping techniques. Providers should wrap in whichever technique they feel most comfortable performing as there is no difference in strength of the cast. If a stronger cast is desired, then thickness of the cast can be increased.

The International Working Group on the Diabetic Foot (IWGDF) has published evidence-based guidelines on the prevention and management of diabetic foot disease since 1999. This guideline is on the use of offloading interventions to promote the healing of foot ulcers in people with diabetes and updates the previous IWGDF guideline. We followed the GRADE methodology to devise clinical questions and critically important outcomes in the PICO format, to conduct a systematic review of the medical-scientific literature, and to write recommendations and their rationale. The recommendations are based on the quality of evidence found in the systematic review, expert opinion where evidence was not available, and a weighing of the benefits and harms, patient preferences, feasibility and applicability, and costs related to the intervention. For healing a neuropathic plantar forefoot or midfoot ulcer in a person with diabetes, we recommend that a nonremovable knee-high offloading device is the first choice of offloading treatment. A removable knee-high and removable ankle-high offloading device are to be considered as the second- and third-choice offloading treatment, respectively, if contraindications or patient intolerance to nonremovable offloading exist. Appropriately, fitting footwear combined with felted foam can be considered as the fourth-choice offloading treatment. If non-surgical offloading fails, we recommend to consider surgical offloading interventions for healing metatarsal head and digital ulcers. We have added new recommendations for the use of offloading treatment for healing ulcers that are complicated with infection or ischaemia and for healing plantar heel ulcers. Offloading is arguably the most important of multiple interventions needed to heal a neuropathic plantar foot ulcer in a person with diabetes. Following these recommendations will help health care professionals and teams provide better care for diabetic patients who have a foot ulcer and are at risk for infection, hospitalization, and amputation.

Distal forearm fracture is the most common fracture in childhood. Patients with this type of injury suffer from meaningful pain after Emergency Department (ED) discharge. Previous studies demonstrated that short arm (below-the-elbow) casts perform as well as long arm (above-the-elbow) casts for maintaining the reduction of distal forearm fractures, with a similar rate of complications. Consequently, short casts are the commonly used method of immobilization after closed reduction of a distal forearm fractures in children older than 4 years. However, short casts carry a potential disadvantage; since they cannot prevent supination in a wrist that is held in pronation, and vice versa, their use might be associated with pain.We initiated this study to examine the effect of the type of casting on post discharge pain. We will conduct an open-label randomized, controlled trial comparing short cast immobilization with long cast immobilization in children who had a reduction of distal forearm fracture in the ED. Our hypothesis is that children with distal forearm fractures who are treated with a long cast, experience less pain during the first 48 h after ED discharge than children who are treated with a short cast. Keywords: Pain, Children, Fracture, Cast

The purpose of this study was to investigate the intensity-specific regenerative effects of microcurrent therapy on gastrocnemius muscle atrophy induced by cast-immobilization in rabbits. Fifteen rabbits were randomly allocated to 3 groups after cast removal: cast-immobilization and sham microcurrent therapy for 2 weeks (group 1); cast-immobilization and microcurrent therapy (25 μA) for 2 weeks (group 2); cast-immobilization and microcurrent therapy (5,000 μA) for 2 weeks (group 3). Clinical parameters [calf circumference, compound muscle action potential (CMAP) of the tibial nerve, thickness of gastrocnemius muscle], cross sectional area of gastrocnemius muscle fibres, and immunohistochemistry was evaluated. The clinical parameters representing mean atrophic changes in group 2 were significantly lower than those in group 3. The cross sectional area of the gastrocnemius muscle fibres and immunohistochemical parameters in group 2 were significantly greater than those in group 3. The results showed that low-intensity microcurrent therapy can more effectively promote regeneration in atrophied gastrocnemius muscle than high-intensity microcurrent therapy.

Purpose To investigate paediatric orthopaedists’ cast practices for early onset scoliosis regarding patient selection, cast application, radiographic evaluation, treatment cessation and adjunctive bracing. Methods A casting survey was distributed to all paediatric orthopaedists in Children's Spine and Growing Spine Study Groups (n = 92). Questions included physician and patient characteristics, technique, treatment, outcomes, radiographic measurements and comparison to other treatments. A total of 55 orthopaedists (60%) responded, and descriptive statistics were calculated on the subset who cast (n = 45). Results A majority of respondents use cast treatment for idiopathic and syndromic scoliosis patients, but not for neuromuscular or congenital scoliosis patients. Major curve angle ranked most important in orthopaedists’ decision to commence cast treatment, in comparison with rib-vertebra angle difference or clinical observations. The major curve angle threshold to initiate casting was a median of 30° (20° to 70°), and the minimum patient age was median ten months (3 to 24). First in-cast and out-of-cast radiographs are taken standing, supine, awake, under anesthesia and/or in traction. In all, 58% consistently cast over or under the arm, while 44% vary position by patient. Respondents were divided about the use of a brace after cast treatment: 22% do not prescribe a brace, 31% always do and 36% do in some patients. Conclusions Future multicentre research studies must standardize radiographic practices and consider age and major curve angle at cast initiation and termination, scoliosis aetiology, shoulder position and treatment duration. Practices need to be aligned or compared in these areas in order to distinguish what makes for the best cast treatment possible. Level of Evidence V, Expert opinion

Background Distal radius fractures (DRF) account for nearly one-fifth of all fractures in older adults, and women experience them 5× as often as men. Most DRF occur with low impact injuries to the wrist with an outstretched hand, and are often managed via closed treatment and cast immobilization. Women sustaining a DRF are at risk for upper limb immobility, sensorimotor changes, edema and type I complex regional pain syndrome (CRPS). Since CRPS onset is likely influenced by alterations in the brain’s somatosensory region, a rehabilitation intervention, Graded Motor Imagery (GMI), aims to restore cortical representation, including sensory and motor function, of the affected limb. To date, there are no studies on the use of GMI in reducing risk of or preventing the onset of type I CRPS in women with DRF treated with cast immobilization. Due to a higher likelihood of women with this injury developing type I CRPS, it is important to early intervention is needed. Methods/design This article describes a six-week randomized comparative effectiveness trial, where the outcomes of a modified GMI program (mGMI) + standard of care (SOC) group (n = 33) are compared to a SOC only control group (n = 33). Immediately following cast immobilization, both groups participate in four 1-h clinic-based sessions, and a home program for 10 min three times daily until cast removal. Blinded assessments occur within 1 week of cast immobilization (baseline), at three weeks post cast immbolization, cast removal, and at three months post cast removal. The primary outcomes are patient reported wrist/hand function and symptomology on the Patient Rated Wristand Hand Evaluation, McGill Pain Questionnaire, and Budapest CRPS Criteria. The secondary outcomes are grip strength, active range of motion as per goniometry, circumferential edema measurements, and joint position sense. Discussion This study will investigate the early effects of mGMI + SOC hand therapy compared to SOC alone. We intend to investigate whether an intervention, specifically mGMI, used to treat preexisiting pain and motor dysfunction might also be used to mitigate these problems prior to their onset. If positive effects are observed, mGMI + SOC may be considered for incorporation into early rehabilitation program. Trial registration This trial is registered at ClinicalTrials.gov with identifier NCT02957240 (Approval date: April 20, 2017).

Flecainide is an IC antiarrhythmic drug (AAD) that received in 1984 Food and Drug Administration approval for the treatment of sustained ventricular tachycardia (VT) and subsequently for rhythm control of atrial fibrillation (AF). Currently, flecainide is mainly employed for sinus rhythm maintenance in AF and the treatment of idiopathic ventricular arrhythmias (IVA) in absence of ischaemic and structural heart disease on the basis of CAST data. Recent studies enrolling patients with different structural heart diseases demonstrated good effectiveness and safety profile of flecainide. The purpose of this review is to assess current evidence for appropriate and safe use of flecainide, 30 years after CAST data, in the light of new diagnostic and therapeutic tools in the field of ischaemic and non-ischaemic heart disease.

Aim: This study aimed to evaluate the post—operative presence, clinical severity and course of acne vulgaris and seborrheic dermatitis among rhinoplasty patients. Material and Method: Fifty-six patients who were planned to have rhinoplasty were administered either pored or non-pored plaster cast for one week in the postoperative period.The patients in the rhinoplasty group were randomizedinto four groups according to the application of pored or nonpored plaster cast and adhesive strips for further one-week. Forty patients that had undergone closed technique-septoplasty were included in the control group. The self-assessments of the patients in the rhinoplasty and septoplasty groups were recorded in terms of acne,seborrhea and erythema via visual analog scale (VAS). The clinical severity of acne vulgaris andseborrheic dermatitis were compared via Global Acne Grading Score (GAGS) and Seborrheic Dermatitis Area and Severity Index (SDASI) in both groupsat postoperative months 1, and 6. Results: In the rhinoplasty group, the VAS acne, VAS seborrhea, VAS erythema, GAGS, and SDASI values increased significantly at postoperative month and decreased significantly at postoperative month compared to the pre-operative values. At all visits, the GAGS values of patients that had undergone rhinoplasty were found statistically significantly higher than those that had received septoplasty. At postoperative month 6, the GAGS values were significantly decreased in the group treated with non-pored plaster cast and adhesive strips for one more week. The SDASI values statistically significantly decreased only in the group treated with pored plaster cast. However, at all visits, the mean values of GAGS and SDASI were similar in the four rhinoplasty groups according to the different types of plaster cast duration of nasal bandages. Conclusion: We concluded that in post-rhinoplasty patients, the plaster cast type and duration of nasal bandage application do not affect the severity of acne vulgaris and seborrheic dermatitis. Amaç: Bu çalışmada, rinoplasti hastalarında postoperatif dönemde akne vulgaris ve seboreik dermatit varlığı, klinik şiddetleri ve seyirlerinin değerlendirilmesi amaçlanmıştır. Gereç ve yöntem: Rinoplasti planlanan 56 hastaya postoperatif dönemde bir hafta süreyle porlu veya porsuz alçı uygulandı. Rinoplasti grubundaki hastalar porlu veya porsuz alçı ve bir hafta süresince yapışkan bandaj uygulanmasına göre dört gruba rastgele dağıtıldı. Kapalı teknik septoplasti uygulanan 40 hasta ise kontrol grubuna alındı. Rinoplasti ve septoplasti gruplarındaki hastaların akne, sebore ve eritem bakımından kendi değerlendirmeleri görsel analog skala (GAS) ile kaydedildi. Her iki guptaki hastaların Global Akne Derecelendirme Ölçeği (GADÖ) ve Seboreik Dermatit Alan ve Şiddet İndeksi (SDASI) ile akne vulgaris ve seboreik dermatit klinik şiddeti postoperatif 1, ve 6. aylarda karşılaştırıldı. Bulgular: Rinoplasti grubunda VAS akne, VAS sebore, VAS eritem, GADÖ ve SDASI değerleri preoperatif döneme oranla postoperatif 1. ayda anlamlı oranda artmış, post--operatif 6. ayda anlamlı oranda azalmış idi. Tüm takiplerde rinoplasti geçiren hastaların GADÖ değerleri septoplasti olanlardan istatistiksel olarak anlamlı oranda daha yüksek bulundu. Postoperatif 6. ayda GADÖ değerleri porsuz alçı ve ek bir hafta süresince yapışkan bandaj ile tedavi edilen grupta anlamlı oranda azalmıştı. SDASI değerlerinin ise sadece porlu alçı ile tedavi edilen grupta anlamlı oranda azaldığı görüldü. Ancak, ortalama GADÖ ve SDASI değerleri farklı alçı tipleri ve burun bandaj sürelerine göre dört farklı rinoplasti grubunda da tüm takiplerde benzerdi. Sonuç: Bu çalışmada alçı tipi ve burun bandaj süresinin rinoplasti sonrası hastalarda akne vulgaris ve seboreik dermatit şiddetini etkilemediği sonucuna vardık.

Background: H1 antihistamines are important drugs for the treatment of urticaria and are commonly well tolerated. Cases of hypersensitivity reactions to antihistamines have rarely been reported, the underlying pathomechanism is unknown yet. Case report: We report the case of a 28-year-old female patient suffering from chronic spontaneous urticaria who experienced severe episodes of wheals and flares induced by different H1 antihistamines. Methods: We performed skin prick tests (SPT) with a diversity of H1 antihistamines and CAST and FlowCAST analyses. Moreover, a placebo controlled oral challenge test to mizolastin was done. Results: We saw positive SPT reactions to nearly all H1 antihistamines tested with the exception of mizolastin. We observed neither a release of sulfidoleukotrienes nor an upregulation of basophil activation markers in the CAST and FlowCAST analyses. The oral challenge test with mizolastine resulted in the development of generalized wheals and flares. Conclusion: H1 antihistamines are effective drugs for the treatment of urticaria, but they may lead to hypersensitivity reactions in rare cases. Because of the negative CAST and FlowCAST results, an IgE-mediated pathomechanism is improbable. We propose that hypersensitivity reactions to H1 antihistamines may be induced by a paradox H1 receptor activation.

Resumo O CAST (Caries Assessment Spectrum and Treatment) é um instrumento desenvolvido para a detecção de cárie a ser utilizado em levantamentos epidemiológicos. Foi validado e tem se mostrado efetivo, fornecendo um diagnóstico mais preciso do estado de saúde bucal do que o critério OMS, recomendado pela Organização Mundial da Saúde. O objetivo deste artigo é comparar a apresentação dos resultados de cárie dentária utilizando o instrumento CAST e o critério OMS, numa mesma população. Foram avaliados por dois examinadores treinados na utilização do instrumento CAST 680 escolares de 6 a 8 anos do Distrito Federal, Brasil. A avaliação constou do índice de placa visível (IPV) e do índice de sangramento gengival (ISG). Os escores CAST dente foram convertidos em componentes ceo/CPO e calculados os ceod/CPOD. Os pais responderam a um questionário sociodemográfico. A idade média foi 7,45 anos (± 0,91). A prevalência de cárie na dentição decídua foi de 65,44% e 61,61%, considerando o CAST e o critério da OMS, respectivamente; na dentição permanente: 38,19% e 10,2%, respectivamente. A média do ceod foi de 2.4 (± 2.7) e a média do CPOD 0.16 (± 0.53). o IPV foi associado a maiores CAST máximos p < 0,005. O instrumento CAST demonstrou maior sensibilidade em identificar a presença e gravidade de lesões cariosas quando comparado ao critério OMS. Abstract Caries Assessment Spectrum and Treatment (CAST) is an instrument developed for caries detection to be used in epidemiological surveys; it has been validated and is believed to provide a clearer picture of the oral health status than the criteria provided by the World Health Organization (WHO). This article aims to compare the epidemiological survey results using the CAST instrument and the WHO criteria in the same population. 680 schoolchildren aged 6-8 years from Federal District, Brazil, were evaluated by two examiners trained to use the CAST. The visible plaque index (VPI) and gingival bleeding index (GBI) were also evaluated. The maximum CAST codes per tooth were converted into the dmf/DMF, the mean scores for primary and permanent dentition were calculated. The mean age was 7.45(± 0.91) years. The prevalence of caries differed when CAST and the WHO criteria were applied. In the primary dentition, it was 65.44% and 61.61%, and for the permanent dentition, 38.19% and 10.2%, respectively. It was possible to calculate the mean dmft [2.4(± 2.7)] and the DMFT [0.16(± 0.53)] using CAST. VPI was associated with higher maximum CAST scores p < 0,005. The way CAST results are presented showed a higher sensibility to identify the presence and severity of carious lesions in comparison to the WHO criteria.

Venous thromboembolism (VTE) is a major complication following lower-leg cast immobilization and knee arthroscopic surgery. In this review, we aimed to give a comprehensive overview of the literature on the epidemiology, prevention and prediction of VTE in these patients. First, the cumulative incidence of VTE was estimated by performing a meta-analysis in untreated patients only. In lower leg-cast patients with various injuries, asymptomatic VTE occurred in 18.0% (95%CI 12.9 to 23.1) and symptomatic VTE in 2.0% (95%CI 1.3 to 2.7). In knee-arthroscopy patients, asymptomatic VTE was seen in 5.9% (95%CI 3.9 to 7.9) versus a symptomatic rate of 0.6% (95%CI 0.4 to 0.7) following heterogeneous types of arthroscopic knee procedures. Second, the efficacy of thromboprophylaxis was determined by performing a meta-analysis of all RCTs that have been performed till date. Following knee-arthroscopy, there was no clear benefit of thromboprophylaxis on the prevention of symptomatic VTE (RR 0.65, 95%CI 0.23 to 1.81), while in contrast, this seemed to prevent asymptomatic DVT. In lower-leg cast patients, thromboprophylaxis appeared to reduce symptomatic VTE (OR 0.31, 95%CI 0.13 to 0.73). However, the validity of these results may be questioned as many trials had several methodological weaknesses. Concerning the bleeding risk (and costs) of thromboprophylaxis, treatment seems only prompted in high risk patients. Such patients could be identified based on individual risk factors such as higher age, obesity or presence of Factor V Leiden. In conclusion, we propose to use risk assessment models to identify patients at risk and to decide on individualized thromboprophylactic therapy, rather than one standard treatment for all patients.

ObjectiveTo determine whether treatment of isolated stable Weber B type ankle fractures with a cast or a simple orthotic device for three weeks produces non-inferior outcomes compared with conventional immobilisation in a cast for six weeks.DesignRandomised, pragmatic, non-inferiority, clinical trial with blinded outcome assessment.SettingTwo major trauma centres in Finland, 22 December 2012 to 6 June 2016.Participants247 skeletally mature patients aged 16 years or older with an isolated Weber B type fibula fracture and congruent ankle mortise in static ankle radiographs.InterventionsParticipants were randomly allocated to conventional six week cast immobilisation (n=84) or three week treatment either in a cast (n=83) or in a simple orthosis (n=80).Main outcome measuresThe primary, non-inferiority, intention-to-treat outcome was the Olerud-Molander Ankle Score at 12 months (OMAS; range 0-100; higher scores indicate better outcomes and fewer symptoms). The predefined non-inferiority margin for the primary outcome was −8.8 points. Secondary outcomes were ankle function, pain, quality of life, ankle motion, and radiographic outcome. Follow-up assessments were performed at 6, 12, and 52 weeks.Results212 of 247 randomised participants (86%) completed the study. At 52 weeks, the mean OMAS was 87.6 (SD 18.3) in the six week cast group, 91.7 (SD 12.9) in the three week cast group, and 89.8 (SD 18.4) in the three week orthosis group. The between group difference at 52 weeks for the three week cast versus six week cast was 3.6 points (95% confidence interval −1.9 to 9.1, P=0.20), and for the three week orthosis versus six week cast was 1.7 points (−4.0 to 7.3, P=0.56). In both comparisons, the confidence intervals did not include the predefined inferiority margin of −8.8 points. The only statistically significant between group differences observed in the secondary outcomes and harms in the two primary comparisons were slight improvement in ankle plantar flexion and incidence of deep vein thrombosis, both in the three week orthosis group versus six week cast group.ConclusionImmobilisation for three weeks with a cast or orthosis was non-inferior to conventional cast immobilisation for six weeks in the treatment of an isolated stable Weber B type fracture.Trial registrationClinicalTrials.govNCT01758835.

Caries measurement methods vary considerably in terms of the stages of lesion considered making the comparison problematic among different surveys. In this cross-sectional study, four caries measurement methods, the WHO-DMFT, the International Caries Detection and Assessment System (ICDAS), the Caries Assessment Spectrum and Treatment (CAST), and the Nyvad Criteria were tested in a sample of children. Five-hundred 12-year old children (236 males and 264 females) were examined four times by four calibrated examiners. The calibration process showed that Cohen&rsquo, s Kappa exceeded the criterion of K = 0.75 and K = 0.80 for inter/intra-examiner agreement, respectively. In the survey, the total number of misclassification errors for the four methods amounted to 312 observations (67.94% regarding enamel lesions). The greatest difference among methods was shown by number of sound teeth (p &lt, 0.01): WHO-DMFT n = 9505, 74.14%, ICDAS n = 2628, 20.49%, CAST n = 5053, 39.41%, and Nyvad Criteria n = 4117, 32.11%. At the level of dentinal Distinct/Active Cavity lesions, no statistically significant difference was observed (p = 0.40) between ICDAS (n = 1373, 10.71%), CAST (n = 1371, 0.69%), and Nyvad Criteria (n = 1720, 13.41%). In the severe caries levels, all methods were partially in agreement, while no accordance was found for the initial (enamel) lesions. A common language in caries detection is critical when different studies are compared.

Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.

Background Bone fractures are one of the most common injuries in the USA. Fiberglass tape is a commonly used casting material, and many medical professionals apply adjuvants including liquid hand soap, foam sanitizers, and ultrasound gel in the hopes of improving outcomes relating to ease of molding and eventual strength, lamination, and smoothness of cast material. However, the efficacy of these agents to improve fiberglass cast mechanics has not been scientifically evaluated. The purpose of this study was to assess the mechanical effects of commonly used adjuvants on fiberglass cast materials. Methods Studies compared regularly shaped samples of water-activated, untreated fiberglass tape (Ossur Techform Premium) to water-activated fiberglass tape treated with one of three commonly used adjuvants (liquid soap, foam hand sanitizer, or ultrasound gel) during lamination. Material stiffness, yield stress, and ultimate load were measured by 3-point bending. Results These studies demonstrated that that liquid soap and ultrasound gel did not affect fiberglass tape mechanical properties, but alcohol-based foam sanitizer significantly reduced stiffness (− 32.8%), yield stress (− 33.6%), and ultimate load (− 31.0%) of the cast material as compared to the control group. Regression slopes were not significantly different between groups, suggesting that no adjuvants improved material curing time. Conclusions These data suggest that the application of adjuvants is not beneficial and potentially harmful to fiberglass cast behavior. Despite the widespread practice of adjuvant application by medical professionals during casting, results from the current study suggest that use of these agents for structural enhancement of fiberglass casts is not beneficial and should largely be discouraged. Electronic supplementary material The online version of this article (10.1186/s13018-019-1202-1) contains supplementary material, which is available to authorized users.

Background Although dental caries is a globally widespread disease, there is no consensus regarding the method that should be used for their detection. In recent decades, a variety of new methods have been proposed for measuring caries in a population. Three caries detection methods, the decayed, missing and filled (DMF) index, the International Caries Detection and Assessment System (ICDAS) and the Caries Assessment Spectrum and Treatment (CAST), were compared to provide information to guide future method choices. Methods This was a descriptive, cross-sectional study in which three methods were used to measure caries in students, staff and their dependents at UNEB (State University of Bahia), Salvador, Brazil. We compared the mean application time of each method and the frequencies obtained by each method using the following indicators: the most severe caries lesion per individual; the mean number of missing, filled and decayed teeth; and the disease extent. Results The mean time taken to apply the DMF was 3.8 min; for ICDAS, it took 8.9 min, and for CAST, 4.7 min. When calculating the indicator the most severe caries lesion per individual, the prevalence rates were as follows: 28.1% for DMF, 84.0% for ICDAS and 75.0% for CAST. The mean numbers of decayed, missing and filled teeth were 6.0 according to the DMF, 6.2 according to ICDAS and 5.9 according to CAST. When the disease extension indicator was used, the following percentages of teeth were affected by caries: DMF 22.12%, ICDAS 49.11% and CAST 33.2%. Conclusions The DMF underestimated the occurrence of caries lesions in individuals but was the fastest method to apply. ICDAS obtained detailed information regarding lesion severity, but it was a time-consuming method and difficult to analyse. CAST described disease distributions very well and identified lesion severities and preventive and curative needs in the examined group, and the time required to apply CAST was similar to that of the DMF. Electronic supplementary material The online version of this article (10.1186/s12903-018-0583-6) contains supplementary material, which is available to authorized users.

Casting is routinely used for acute andpost-operative immobilization and remains a cornerstone in the non-operative management of fractures and deformities. Theapplication of a properly fitted and well-molded cast, especially for a trainee, can bechallenging. We present a simple method ofprolonging cure time of fiberglass cast — placing ice in the dip water. Eight-ply, five-inch fiberglass cast was circumferentially applied to an aluminum-wrapped cardboard cylinder. An electronic, 2-channel temperature sensor (TR-71wf Temp Logger, T&D Corporation, Matsumoto, Japan), accurateto 0.1ºC and accurate to ±0.3ºC, was placed between the fourth and fifth layers of fiberglass. Thirty total casts were tested using 9±1ºC (cold), 22±1ºC (ambient), and 36±1ºC (warm) dip water. Room temperature was maintained at 24±1ºC. Cast temperatures were measured during theexothermic reaction generated by the castcuring. Peak temperatures and cure timeswere recorded. Cure time was defined as the point of downward deflection on the time-temperature curve immediately after peak. Cure and peak temperatures were compared among groups using analysis of variance. Mean cure time was 3.5±0.1 minutes forwarm water, 5.0±0.4 minutes for ambient water and 7.0±0.5 minutes for cold water. Peak temperature, measured between layers 4 and 5 of the cast material, was 36.6±0.8ºC for warm water, 31.1±1.4ºC for ambient water and 25.2±0.5ºC for cold water. Cold afforded, on average, an additional 2 minutes (40% increase) in cure time compared to ambient water and an additional 3.5 minutes (100% increase) compared to warm water. Cure time differences were significant (P

Previous studies reported that the prevalence of Autism Spectrum Conditions (ASC) in mainland China is much lower than estimates from developed countries (around 1%). The aim of the study is to apply current screening and standardized diagnostic instruments to a Chinese population to establish a prevalence estimate of ASC in an undiagnosed population in mainland China. We followed the design development used previously in the UK published in 2009 by Baron-Cohen and colleagues. The Mandarin Childhood Autism Spectrum Test (CAST) was validated by screening primary school pupils (n = 737 children age 6-10 years old) in Beijing and by conducting diagnostic assessments using the Autism Diagnostic Observation Schedule and the Autism Diagnostic Interview-Revised. The prevalence estimate was generated after adjusting and imputing for missing values using the inverse probability weighting. Response was high (97%). Using the UK cutoff (≥15), CAST performance has 84% sensitivity and 96% specificity (95% confidence interval [CI]: 46, 98, and 96, 97, respectively). Six out of 103 children, not previously diagnosed, were found to the meet diagnostic criteria (8.5 after adjustment, 95% CI: 1.6, 15.4). The preliminary prevalence in an undiagnosed primary school population in mainland China was 119 per 10,000 (95% CI: 53, 265). The utility of CAST is acceptable as a screening instrument for ASC in large epidemiological studies in China. Using a comparable method, the preliminary prevalence estimate of ASC in mainland China is similar to that of those from developed countries. Autism Res 2015, ●●: ●●-●●. © 2015 The Authors. Autism Research published by Wiley Periodicals, Inc. on behalf of International Society for Autism Research.

Background: Fractures of distal radius continue to be the most common skeletal injury treated by orthopedic surgeons. The treatment of distal end radius fracture has changed over period. The aim of treatment of distal radius fracture is to obtain a good anatomical reduction and fixation and finally a good functional outcome. Objective: To study comparative evaluation in the measurement of the radial height, radial inclination and ulnar variance in fracture distal end radius treated conservatively by closed reduction and cast and closed reduction, Kirschner wire and cast. Materials and Methods: In the present prospective study, we are reporting our experience in 30 cases where comparative evaluation in the measurement of the radial height, radial inclination, and ulnar variance was done in fractures distal end radius treated conservatively by closed reduction and cast and closed reduction, K- wire, and cast technique. Results: As measured by Mayo functional score, we had 14 satisfactory and 1 poor result in the Group 1 (closed reduction and cast) while 8 excellent results and 7 good results in the Group 2 (closed reduction, Kirschner wire and cast). As measured with the modified demerit point system of Saito, in the Group 1 (closed reduction and cast), 11 had average results and 4 had fair results; and in our Group 2 (closed reduction, Kirschner wire and cast), 9 had excellent results and 6 had good results.

This article’s aim is to publish a cast Istrian ‘wheel coin’ found at the Koshary site. The site is located on the northern shore of the Black Sea on the right bank of the Tiligulskii Liman and consists of a settlement, a sacral zone around an open air altar (eschara) and a necropolis. The settlement existed between the end of the 5th and the middle of the 3rd centuries BC. Among other artifacts, 55 coins have been found at the site during regular archaeological excavations. Apart from a bronze coin of Tyras and the discussed Istrian piece, all the other coins found at Koshary are Olbian. The ‘wheel coin’ was discovered in a dugout located in the southern part of the sacral area around the eschara. The cast ‘wheel coins’ were produced in the 5th-4th centuries BC in Istros and were in circulation in a wide area covering a great part of the western and northwestern Black Sea shore. The find at Koshary, when combined with other finds in Luzanivka and Ochakov, marks a trade route between Istros, Nikonion and Olbia. As it was found in the eschara area, one can suppose that the Istrian coin was not used as currency, but possessed a sacral nature instead.

Background\ud Ankle fractures account for 9% of all fractures with a quarter of these occurring in adults over 60 years. The short term disability and long-term consequences of this injury can be considerable. Current opinion favours open reduction and internal fixation (ORIF) over non-operative treatment (fracture manipulation and the application of a standard moulded cast) for older people. Both techniques are associated with complications but the limited published research indicates higher complication rates of fracture malunion (poor position at healing) with casting. The aim of this study is to compare ORIF with a modification of existing casting techniques, Close Contact Casting (CCC). We propose that CCC may offer an equivalent functional outcome to ORIF and avoid the risks associated with surgery.\ud \ud Methods/Design\ud This study is a pragmatic multi-centre equivalence randomised controlled trial. 620 participants will be randomised to receive ORIF or CCC after sustaining an isolated displaced unstable ankle fracture. Participants will be recruited from a minimum of 20 National Health Service (NHS) acute hospitals throughout England and Wales. Participants will be aged over 60 years and be ambulatory prior to injury. Follow-up will be at six weeks and six months after randomisation. The primary outcome is the Olerud and Molander Ankle Score, a functional patient reported outcome measure, at 6 months. Follow-up will also include assessments of mobility, ankle range of movement, health related quality of life and complications. The six-month follow-up will be conducted face-to-face by an assessor blinded to the allocated intervention. A parallel economic evaluation will consider both a health service and a broader societal perspective including the individual and their family. In order to explore patient experience of their treatment and recovery, a purposive sample of 40 patients will also be interviewed using a semi-structured interview schedule between 6-10 weeks post treatment.\ud \ud Discussion\ud This multicentre study was open to recruitment July 2010 and recruitment is due to be completed in December 2013.

Aim. To evaluate effectiveness of unloading immobilization bandages manufactured from Soft Cast and Scotchcast materials. Materials and methods. The study included all patients (n=39) with diabetic foot ulcers treated with the use of total-contact cast technology (TCC)from 01.10.2007 to 01.03.2009. 31 patients presented with neuropathic foot ulcers and 8 with neuroischemic ulcers (in the absence of critical foot ischemia).26 and 13 were managed using non-removable and removable casts respectively. All were given standard local treatment of ulcers, supplementedby antibacterial therapy in 20 patients. Results. Treatment resulted in the healing of ulcers in 31 (79%) patients during 40.5?32.9 days (M?SD) (median 27, min 7, max 11 days). In 28(72%) of them, healing required 12 weeks to complete. TCC had to be removed in 8 (21%) patients because of low efficiency or complications. Newulcers or abrasions related to the use of TCC developed in 10 patients but treatment was discontinued only in one of them. We distinguished a subgroupof 12 patients comparable in terms of major characteristics (plantar stage 1A and 2A neuropathic ulcers according to Texas University classification)and unloading method (non-removable cast throughout the treatment period) with patients included in earlier randomized studies. In this subgroup,healing of 100% ulcers was completed within 12 weeks (median 22 (13-74) days). Conclusion. 1. Efficiency of TCC in our practice is comparable with that in earlier publications. 2. The use of TCC is indicated not only for thetreatment of uninfected plantar neuropathic ulcers but also in some cases of neuroischemic and non-plantar ulcers. 3. Skin lesions from TCC is oflittle clinical significance and can be avoided by specialized education of the medical personnel involved in TCC manufacture.

Two genes ( PRKAG3 and CAST ) were screened for genotype incidence and their effect on green ham traits in pigs suitable for dry-cured ham production from three commercial crosses (in three countries France, Slovenia and Spain). Hams were genotyped for PRKAG3 Ile199Val , CAST Lys249Arg and CAST Ser638Arg polymorphisms and the traits of interest (green ham weight and fat thickness, pH in M. semimembranosus (SM), M. gluteus medius (GM) colour) were measured. The genotype frequencies as well as the effect of the studied genes varied according to the country, which used different genetic crosses and selection criteria for dry-cured ham processes. Regarding the association with traits of interest, we observed a significant effect of PRKAG3 Ile199Val polymorphism on green ham weight and colour grade in the French cross, on green ham fat thickness, colour grade and GM Minolta L ⁎ and a ⁎ values in the Slovenian cross, and on SM pH in the Spanish cross. The CAST Lys249Arg polymorphism affected green ham weight in Slovenian cross, whereas CAST Ser638Arg affected green ham colour grade in French cross. No effect of CAST polymorphisms on the traits of interest was found in Spanish cross. According to our results, PRKAG3 gene seems to be more influential on green ham traits important for dry ham production than CAST gene. However the results were different for each country, indicating possible interaction with other genetic or environmental factors.

BackgroundSurgical repair of acute Achilles tendon ruptures is considered superior to nonoperative treatment, but complications other than rerupture range up to 34%. Nonoperative treatment by functional bracing seems a promising alternative.HypothesisNonoperative treatment of acute Achilles tendon rupture with functional bracing reduces the number of complications compared with surgical treatment with a minimally invasive technique.Study DesignRandomized controlled clinical trial; Level of evidence, 2.MethodUsing concealed random allocation, 83 patients with acute Achilles tendon rupture were assigned to nonoperative treatment by functional bracing or minimally invasive surgical treatment followed by tape bandage. Patients were allowed full weightbearing, and follow-up was 1 year.ResultsComplications risk other than rerupture by intention-to-treat basis was 9 in 42 patients (21 %) for surgical treatment and 15 in 41 patients (36%) for nonoperative treatment (risk ratio, 0.59; 95% confidence interval, 0.29-1.19). Reruptures risk was 5 in 41 patients after nonoperative treatment and 3 in 42 patients for surgical treatment (risk ratio, 0.59; 95% confidence interval, 0.15-2.29). The mean time to work was 59 days (SD, 82) after surgical treatment and 108 days (SD, 115) after nonoperative treatment (difference, 49 days; 95% confidence interval, 4-94; P < .05). The difference between treatments for return to sports (risk ratio, 0.55; 95% confidence interval, 0.23-1.29), pain, and treatment satisfaction did not reach statistical significance.ConclusionThere appears to be a clinically important difference in the risk of complications between minimally invasive surgical treatment and nonoperative treatment for acute Achilles tendon ruptures, but this was not statistically significant.

Aim :The aim of the study is to compare immediate weight bearing with below-knee cast or immobilization with plaster splint in 6 weeks in patients after operative treatment for ankle bimalleolar fractures.Methods :Fifty-three patients with ankle bimalleolar fractures were treated operatively in 2005 to 2010 and then were randomly allocated to two groups. Immediately weight bearing in a below-knee cast (26 patients) and immobilization in a plaster splint for the first six postoperative weeks (27 patients). A mean age 37.9 (min 17; max 72). An average follow-up 26.1 months. (min 14; max 55). All fractures were classified with Lauge-Hansen classification. Functional results of both groups were evaluated with AOFAS for the postoperative one year after surgical treatment.Results :According to the AOFAS scoring system, results were excellent and good in 17 patients in group 1. On the other hand, results were excellent and good in 14 patients in group 2.Conclusion :As a result we think that weight bearing protocol should be advantaged for patients with ankle bimalleolar fractures after surgical treatment immediately.

This paper presents the results of six-year studies that were conducted in an iron foundry. The research consisted in effectiveness assessment of the quality assurance system. Determinants of three groups of estimation criteria were characterized. In technological criterion the required values of dimensional tolerance, the value of required hardness, raggedness, the required values of coefficients of the scattering process and also acceptable fractions of the products were taken into consideration. The economic criteria included the assumed values of internal and external costs of product defects. The exploitation criteria comprised the required level of reliability or durability and the required value of products repairability. The obtained results point to too high costs of lacks in technological criteria. The undertakings were proposed in order to decrease them.

The purposes of this study are to determine the faciolingual inclinations of tooth crowns in Class I normal occlusion of Iraqi adolescent in Mosul City, investigate the possible significant differences between genders, and determine the cor-relation of the faciolingual inclination of teeth crown with each others.The sample of this study consisted from 35 Iraqi adolescents (19 males and 16 females) aged 12–16 years selected according to certain criteria from Mosul City. Stone casts were taken for each subject, the faciolingual inclinations were made on the dental models of the subjects by using torque angle gauge.The data were analyzed with the Statistical Package for Social Sciences prog-ram and it was found that each tooth dist-ally to the central incisor had more lingual inclination than did its neighbor. The females had more labial inclination of upper lateral incisor and more lingual inclination of the lower canine, premolars and first molar as compared with the males. Most intraarch teeth torque correlation were positive and decreased with remoteness while most interarch teeth correlation showed weak negative correlation.

Aim To determine if complete, split casts and backslabs [plaster of Paris (POP) and fiberglass] generate different intracast pressures and pain. Methods Increased swelling within casts was modeled by a closed water system attached to an expandable bag placed directly under different types of casts applied to a healthy lower limb. Complete fiberglass and POP casts, split casts and backslabs were applied. Twenty-five milliliter aliquots of saline were injected into the system and the generated intracast pressures were measured using a sphygmomanometer. The subject was blinded to the pressure scores to avoid bias. All casts were applied to the same right limb on the same subject to avoid the effects of variations in anatomy or physiology on intracast pressures. Pain levels were evaluated using the Visual Analogue Score after each sequential saline injection. Each type of cast was reapplied four times and the measurements were repeated on four separate occasions. Sample sizes were determined by a pre-study 90% power calculation to detect a 20% difference in intracast pressures between cast groups. Results A significant difference between the various types of casts was noted when the saline volume was greater than 100 mL (P = 0.009). The greatest intracast pressure was generated by complete fiberglass casts, which were significantly higher than complete POP casts or backslabs (P = 0.018 and P = 0.008 respectively) at intracast saline volumes of 100 mL and higher. Backslabs produced a significantly lower intracast pressure compared to complete POP only once the saline volume within casts exceeded 225 mL (P = 0.009). Intracast pressures were significantly lower in split casts (P = 0.003). Split POP and fiberglass casts produced the lowest intracast pressures, even compared to backslabs (P = 0.009). Complete fiberglass casts generated the highest pain levels at manometer pressures of 75 mmHg and greater (P = 0.001). Split fiberglass casts had significantly reduced pain levels (P = 0.001). In contrast, a split complete POP cast did not produce significantly reduced pain levels at pressures between 25-150 mmHg. There was no difference in pain generated by complete POP and backslabs at manometer pressures of 200 mmHg and lower. Conclusion Fibreglass casts generate significantly higher intracast pressures and pain than POP casts. Split casts cause lower intracast pressures regardless of material, than complete casts and backslabs.

IntroductionCannabis is Europe's most commonly used illicit drug. Some users do not develop dependence or other problems, whereas others do. Many factors are associated with the occurrence of cannabis-related disorders. This makes it difficult to identify key risk factors and markers to profile at-risk cannabis users using traditional hypothesis-driven approaches. Therefore, the use of a data-mining technique called binary recursive partitioning is demonstrated in this study by creating a classification tree to profile at-risk users.Methods59 variables on cannabis use and drug market experiences were extracted from an internet-based survey dataset collected in four European countries (Czech Republic, Italy, Netherlands and Sweden), n = 2617. These 59 potential predictors of problematic cannabis use were used to partition individual respondents into subgroups with low and high risk of having a cannabis use disorder, based on their responses on the Cannabis Abuse Screening Test. Both a generic model for the four countries combined and four country-specific models were constructed.ResultsOf the 59 variables included in the first analysis step, only three variables were required to construct a generic partitioning model to classify high risk cannabis users with 65-73% accuracy. Based on the generic model for the four countries combined, the highest risk for cannabis use disorder is seen in participants reporting a cannabis use on more than 200 days in the last 12 months. In comparison to the generic model, the country-specific models led to modest, non-significant improvements in classification accuracy, with an exception for Italy (p = 0.01).ConclusionUsing recursive partitioning, it is feasible to construct classification trees based on only a few variables with acceptable performance to classify cannabis users into groups with low or high risk of meeting criteria for cannabis use disorder. The number of cannabis use days in the last 12 months is the most relevant variable. The identified variables may be considered for use in future screeners for cannabis use disorders.

This work was funded by FEDER funds through the COMPETE 2020 Program and National Funds through FCT - Portuguese Foundation for Science and Technology under the Projects No, PTDC/FIS-NAN/0117/2014, and PTDC/CTM-BIO/6178/2014. S.N.F. acknowledges the Minister of Science, Technology and Higher Education for National Funds, European Social Funds and FCT for fellowship number SFRH/BDP/78430/2011. The authors also acknowledge FAPESP, CNPq, INCT-FCx from Brazil. Researchers reported a new cellulose-based photonic structure, which reflected both right circularly polarized (RCP) and left circularly polarized (LCP) light that can be tuned by temperature variation and the application of an external electric field. The optical properties of the cellulose nanocrystal (CNC) samples were investigated both in terms of their microstructure by scanning electron microscopy (SEM), small-angle X-ray scattering (SAXS) and spectroscopically, using circularly and linear polarized light coupled with a polarized optical microscope (POM). The nanocrystals used in this work were prepared by acid hydrolysis of microcrystalline cellulose. Aqueous suspensions of CNCs in the acid form were used, resulting in freestanding iridescent films after drying with colors depending on the viewing angle. authorsversion published

The recent release of standards for vehicular communications will hasten the development of smart cities in the following years. Many applications for vehicular networks, such as blocked road warnings or advertising, will require multi-hop dissemination of information to all vehicles in a region of interest. However, these networks present special features and difficulties that may require special measures. The dissemination of information may cause broadcast storms. Urban scenarios are especially sensitive to broadcast storms because of the high density of vehicles in downtown areas. They also present numerous crossroads and signal blocking due to buildings, which make dissemination more difficult than in open, almost straight interurban roadways. In this article, we discuss several options to avoid the broadcast storm problem while trying to achieve the maximum coverage of the region of interest. Specifically, we evaluate through simulations different ways to detect and take advantage of intersections and a strategy based on store-carry-forward to overcome short disconnections between groups of vehicles. Our conclusions are varied, and we propose two different solutions, depending on the requirements of the application. This work was partially founded by the Spanish Ministry of Science and Innovation within the framework of projects TEC2010-20572-C02-01 “CONSEQUENCE” and TEC2014-54335-C4-2-R “INRISCO” and by the Regional Government of Madrid within the “eMadrid” project under Grants S2009/TIC-1650 and S2013/ICE-2715, including the costs to publish in open access.

AIM To assess several associated factors on the recurrence of clubfoot after successful correction by the Ponseti method. METHODS A total of 115 children with 196 clubfeet deformities, treated by the Ponseti method, were evaluated. Demographic data, family history of clubfoot in first-degree relatives, maternal educational level and brace compliance were enquired. Based on their medical files, the characteristics of the patients at the time of presentation such as age, possible associated neuromuscular disease or especial syndrome, severity of the deformity according to the Dimeglio grade and Pirani score, residual deformity after previous Ponseti method and number of casts needed for the correction were recorded. RESULTS There were 83 boys (72.2%) and 32 girls (27.8%) with a male to female ratio of 2.6. The mean age at the initiation of treatment was 5.4 d (range: 1 to 60 d). The average number of casts applied to achieve complete correction of all clubfoot deformities was 4.2. Follow-up range was 11 to 60 mo. In total, 39 feet had recurrence with a minimum Dimeglio grade of 1 or Pirani score of 0.5 at the follow-up visit. More recurrence was observed in non-idiopathic clubfoot deformities (P = 0.001), non-compliance to wear braces (P < 0.001), low educational level of mother (P = 0.033), increased number of casts (P < 0.001), and more follow-up periods (P < 0.001). No increase in the possibility of recurrence was observed when the previous unsuccessful casting was further treated using the Ponseti method (P = 0.091). Also, no significant correlation was found for variables of age (P = 0.763), Dimeglio grade (P = 0.875), and Pirani score (P = 0.624) obtaining at the beginning of the serial casting. CONCLUSION Using the Ponseti method, non-idiopathic clubfoot, non-compliance to wear braces, low educational level of mother, increased number of casts and more follow-up periods had more association to possible increase in recurrence rate after correction of clubfoot deformity.

International audience; This study aimed to evaluate the effects of PRKAG3 Ile199Val and CAST Arg249Lys and CAST Ser638Arg polymorphisms on the quality traits of the French dry-cured ham Jambon de Bayonne and their interaction with salt reduction. Significant (p

BackgroundIt has been estimated that approximately 20% of all Swedish children grow up with parents having alcohol problems, which may result in negative outcomes among these children. Therefore, most Swedish municipalities provide resources for support, but at the same time figures reveal that not even 2% receive support, mainly due to difficulties in identifying and recruiting these children into support programs. Delivering intervention programs to children and adolescentsviathe Internet seems a promising strategy, but to date, the number of web-based interventions aimed at this target group is very scarce. We have therefore developed a novel internet-delivered therapist assisted self-management intervention called the web-ICAIP (Individual Coping and Alcohol Intervention Program) for adolescents having parents with alcohol problems. The purpose of the program is to strengthen adolescents' coping behavior, improve their mental health, and postponing the onset or decreasing risky alcohol consumption. This paper describes the web-ICAIP and the design of a randomized controlled trial (RCT) to measure the efficacy of this intervention.Methods/DesignThe RCT will include at least 183 adolescents (15-19 year old) who will be randomly allocated to two conditions where one group has access to the web-ICAIP and the other is a waiting list control group. Participants will be recruited from websites containing information and facts for adolescents about alcohol and other drugs. Possible participants will be screened using the short version of the Children of Alcoholics Screening Test (CAST-6). The assessment consists of a baseline and two follow-up measurements taking place after two and six months, respectively. The primary outcomes include the Center for Epidemiological Studies Depression Scale (CES-DC), a coping behavior scale, and also the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). Additional outcomes include the "Ladder of life" which measures overall life satisfaction and questions concerning program adherence.DiscussionThere is an urgent need for developing and evaluating web-based intervention programs which target children having parents with alcohol problems. This study will therefore make an important contribution to this novel field of research.Trial registrationISRCTN41545712

The last generation of micromegas, called microbulk, are ahead of classical gas detectors (or even other kind of micro-pattern gas detectors) in gain stability, efficiency (by operation at high pressure), simplicity, robustness, energy resolution, readout features and radiopurity. This makes them a competent solution in the field of Rare Event Searches, a field where low background is the most appreciated feature of a detector. The CAST (CERN Axion Solar Telescope) experiment is the best example of their application in the X-rays range. In CAST, these detectors have achieved background rates as low as 6 × 10−6 counts keV−1 cm−2 s−1. Beyond this nominal operation, there have been several periods where the background has been reduced to a level of 2 × 10−7 counts keV−1 cm−2 s−1, due to reasons which are under investigation. The CAST experiment will be presented, paying special attention to their microbulk micromegas, as well as the procedures to achieve low background. Latest news about the operation of these kinds of detectors for the first time in underground conditions will be advanced here. Copyright © 2011 John Wiley & Sons, Ltd.

Background Numerous designs are used to the treatment of Early Onset Scoliosis. For example, a Thoraco-Lumbo-Sacral Orthosis (TLSO) is constructed using Polyethylene (PE). In addition, a series of castings has been implemented using cast material (3M, BSN Medical). The cast material has some significant advantages over the PE design including: growth preserving, improved compliance, decreased invasiveness, delaying or avoiding surgery, and the ability to allow the skin to breathe. However, the mechanical effectiveness of the cast material brace as compared to the TLSO is unknown, thus providing the objective of this study. Methods A total of 23 standardized tensile tests were performed on the Delta-Cast Soft® and 3MTM ScotchcastTM Plus Casting Tape in order to obtain mechanical properties (Young’s and shear moduli and Poisson ratios). Using a radiograph of a thoracic spine, the size of twelve vertebrae and eleven intervertebral discs were measured and used to create a finite element spine model. Simulations using this model were used to establish mechanical loads which were then applied to finite element models of the TLSO and cast jacket. The thicknesses and number of material layers was varied in these models. Multiple simulations were performed. Results It was found that a 6.6.mm thick cast jacket made of Delta-Cast Soft® had a maximum deformation of 4.7 mm, a maximum stress of 2.9 MPa and a structural factor of safety of 5.71. On the other hand, a 4 mm thick jacket made of PE had a maximum deformation of 2 mm, a maximum stress of 8.9 MPa and a structural factor of safety of 2.70. The cast jacket was 3.5 times lighter and had a material of cost 1/5 of the PE brace. Conclusions Based on the results, either design will generate the proper constraint forces to maintain spinal correction. But, based on the design parameters (thickness, mechanical properties, structural factor of safety and cost) the brace made of cast material, though slightly thicker has superior structural and cost benefits. Thus, from the biomechanical point of view, the cast brace is more efficient than the PE brace.

Development of biliary casts is very unusual, especially in patients who have not undergone liver transplantation. Variable causes of biliary cast formation in nonliver transplantation patients have been suggested. However, stasis of bile flow and/or gallbladder hypocontractility is known to eventually result in the promotion of biliary sludge and subsequent cast formation. Here we present one case of biliary cast syndrome, which developed in a nonliver transplant patient who had biliary sludge for a long period of time, providing evidence that long-standing biliary sludge may lead to cast formation.

Contact urticaria syndrome is a rare but potentially serious problem for hospital staff that handle antibiotics and other agents. While the cause is immunologic, little is known about the mediators involved. To investigate these mediators, three nurses with contact urticaria syndrome caused by exposure to cefotiam hydrochloride (CTM), and five normal controls were evaluated. IgE antibodies specific for CTM were detected by the radioallergosorbent technique (RAST). In response to CTM, cytokines were released from peripheral blood mononuclear cells (PBMC), and sulfidoleukotrienes were released from peripheral blood leukocytes. RAST counts in the three nurses with this syndrome exceeded those in the normal controls. The stimulation index of the leukotrienes released from the peripheral blood leukocytes in response to CTM also exceeded those in the normal controls. Higher levels of granulocyte-macrophage colony-stimulating factor (GM-CSF) were also detected in the supernatant of the patients' PBMC. The results suggest that contact urticaria syndrome caused by exposure to CTM was induced by an immunologic mechanism via IgE antibodies, and that GM-CSF and leukotrienes may be involved in this reaction.

Background To evaluate the functional and radiographic outcomes, as well as the treatment costs, of closed displaced intra-articular distal radius fractures treated with either open reduction internal fixation (ORIF) with volar locking plates or nonoperative treatment with plaster cast immobilisation. Materials and methods A total of 60 patients (32 receiving ORIF, 28 receiving nonoperative treatment) with closed intra-articular distal radius fractures were included. The mean age was 52.1 and 57.4, respectively. Functional and radiographic assessments were carried out at 12 months post-injury. Patients’ treatment costs, median salaries and lengths of medical leave were obtained. Results DASH and MAYO wrist score in the ORIF group did not differ significantly from those in the nonoperative group. Apart from superior ulnar deviation in the ORIF group (p = 0.0096), differences in the range of motion of the injured wrists were not significant. Similarly, there were no significant differences in grip strength and visual analog scale for pain. Volar tilt (p = 0.0399), radial height (p = 0.0087), radial inclination (p = 0.0051) and articular step-off (p = 0.0002) were all significantly superior in the ORIF group. There was a 37-fold difference in mean treatment costs between ORIF (SGD 7951.23) and nonoperative treatment (SGD 230.52). Conclusion Our study shows no difference in overall functional outcomes at 12 months for closed displaced intra-articular distal radius fractures treated with either ORIF with volar locking plates or plaster cast immobilisation, and this is independent of radiographic outcome. A longer follow-up, nevertheless, is needed to determine whether the development of post-traumatic arthritis will have an effect on function. The vast difference in treatment costs should be taken into consideration when deciding on the treatment option. Level of evidence Level 3.