It has recently been reported that the transverse acetabular ligament (TAL) is helpful in determining the position of the acetabular component in total hip replacement (THR). In this study we used a computer-assisted navigation system to determine whether the TAL is useful as a landmark in THR. The study was carried out in 121 consecutive patients undergoing primary THR (134 hips), including 67 dysplastic hips (50%). There were 26 men (29 hips) and 95 women (105 hips) with a mean age of 60.2 years (17 to 82) at the time of operation. After identification of the TAL, its anteversion was measured intra-operatively by aligning the inferomedial rim of the trial acetabular component with the TAL using computer-assisted navigation. The TAL was identified in 112 hips (83.6%). Intra-observer reproducibility in the measurement of anteversion of the TAL was high, but inter-observer reproducibility was moderate. Each surgeon was able to align the trial component according to the target value of the angle of anteversion of the TAL, but it was clear that methods may differ among surgeons. Of the measurements of the angle of anteversion of the TAL, 5.4% (6 of 112 hips) were outliers from the safe zone. In summary, we found that the TAL is useful as a landmark when implanting the acetabular component within the safe zone in almost all hips, and to prevent it being implanted in retroversion in all hips, including dysplastic hips. However, as anteversion of the TAL may be excessive in a few hips, it is advisable to pay attention to individual variations, particularly in those with severe posterior pelvic tilt.

Multivariate analyses have identified factors that have enabled the development of sophisticated equations and scoring models with the ability to predict outcomes following out-of-hospital cardiac arrest (OHCA). However, implementation of such outcome prediction models in research and clinical practice has been slow. The more crucial aspect of these predictions is the lack of prehospital risk stratification for OHCA patients. Prehospital risk stratification for patients after OHCA may help clinicians guide in-hospital strategies, particularly in the emergency department. The purpose of this study was to develop a simple and generally applicable prehospital risk-stratification scheme for patients after OHCA.

Epinephrine has been a cornerstone of cardiac resuscitation and advanced cardiac life support since the 1960s. However, there is little evidence from clinical trials that epinephrine administration after out-of-hospital cardiac arrest (OHCA) improves long-term survival. There would be subsets of patients for whom epinephrine administration is in fact beneficial. Our objective was to determine whether prehospital epinephrine administration would improve survival at 1 month in OHCA patients with unshockable initial rhythm.

Identification of prehospital prognostic factors in out-of-hospital cardiac arrests (OHCAs) with prehospital return of spontaneous circulation (ROSC) and establishment of a prediction model for survival with favorable neurological outcome may minimize the costs and save the medical resources. In this study, we developed a best model for predicting 1-month survival with favorable neurological outcome (defined as Glasgow-Pittsburgh cerebral performance category (CPC) scale = 1 or 2), using a logistic regression analysis.

Two international termination-of-resuscitation (TOR) rules for the emergency medical services (EMS) personnel have been proposed to identify nonsurvivors after out-of-hospital cardiac arrest (OHCA). The first is for use by responders providing basic life support (BLS) which includes three criteria: not witnessed by EMS personnel, no shocks are administered and no return of spontaneous circulation (ROSC). The other is for use by responders providing advanced life support (ALS) which adds two criteria: unwitnessed by a bystander and no bystander cardiopulmonary resuscitation. Simpler criteria as a universal TOR rule may be desirable for any level of EMS personnel. We performed this study to validate two TOR rules and a modified BLS TOR rule which includes three criteria: unwitnessed arrest, no shocks administered and no ROSC achieved before arrival at hospital for predicting refractory OHCAs.