Intra-articular botulinum toxin A injection (IA BoNT/A) is a promising new approach to arthritis joint pain (Mahowald et al., 2006. J. Neurotoxicity Res. 9, 179). 42 patients with refractory arthritis knee pain were randomized to receive 100 U IA-BoNT/A (B) (Allergan, Inc.) or IA-saline (P). 2 P patients dropped out before 1 mo evaluation, 21/40 patients requested 2nd injection at 1 mo and entered open-label phase. At 1–3 mo fu, 4 P and 3 B patients were re-injected. There was a significant decrease in the Short Form McGill Multidimensional Pain Questionnaire (SF-MPQ) pain score 3 mo after IA-BoNT/A (20.1 to 15.9, p=.022) and a non-significant decrease in the IA-P grp. 10x TST improved significantly in IA-BoNT/A grp (37.3 to 33-s, p=.04) at 3 mo and a non-significant decrease in the IA-P grp. In subgroup analysis based on baseline pain severity we found a greater analgesic effect of IA-BoNT/A in those with severe baseline pain (⩾7 on NRS)—SF-MPQ total pain decreased from 23.8 (8.8) to 15.8 (9.1) at 3 mo (p=.002). 3 mo 10X TST decreased from 37 (10.5) to 31.5 (12.6) s, p=.05. WOMAC Physical Function score improved from 39.8 (8.8) to 32.7 (10.1), p=.013, WOMAC Total score improved from 56.8 (11.4) to 47.6 (13.3), p=.029. There were no significant adverse effects. Results of open-label phase will be discussed. Conclusion: IA-BoNT/A produced clinically and statistically significant decreases in severe OA and RA knee pain, and improvements in function.

This paper addresses the diversity status and distribution of higher plants in the Spiti cold desert of the trans-Himalaya in India. Ecological surveys to measure species richness were conducted using random sampling. The vegetation is quite sparse, with patchy distribution. A total of 166 species in 101 genera and 37 families were recorded at sites from 3100–5200 m above mean sea level. The highest species richness was from 3400 to 3700 m. Nine species of threatened medicinal plants were observed, particularly from 3700 to 4000 m. A number of rare and endemic plants were found in several habitats, particularly from 3400 to 4300 m, mostly in localized pockets or with a very narrow distribution. Given the sparse vegetation and status of rare, endemic and threatened plants, effective strategies are required for sustainable management and conservation of plant species in the Spiti cold desert.

ObjectiveA parastomal hernia is an incisional hernia at the site of an intestinal stoma. The incidence varies, as do techniques for repair and their associated rates of success. The aim of this study was to evaluate the methods of parastomal hernia repair and their outcome.Patients and methodsBetween 1988 and 1998, 33 patients who underwent elective parastomal hernia repair were identified by the use of a computerized database. Information was collected on the indication and type of reparative procedure, as well as any morbidity or recurrence, post‐operative complications and recurrence. The operative procedures performed included reanastomosis and ipsilateral and contralateral relocation with hernia repair. Additional data were collected on whether a laparotomy was required or mesh was placed.ResultsThe commonest operation was relocation without laparotomy or mesh (36%), followed by laparotomy still without mesh (21%); the overall recurrence rate was 9% (3/33) at a mean follow up of 55.2 months (range 10–108 months).ConclusionParastomal hernia repair without laparotomy or mesh is a safe and effective method of repair.

The purpose of this study was to distinguish the route of colonization/infection of the lower airways, in a group of mechanically ventilated children requiring tracheotomy; i.e. endogenous (via oropharynx) or exogenous (via tracheotomy). Nineteen children requiring tracheotomy were prospectively studied. Longitudinal serial samples of both oropharynx and the lower airways were taken to distinguish pathogenesis. The lower airways were colonized in 66% of the children pre-tracheotomy; post-tracheotomy this was 95% ( P   =  0.03). Post-tracheotomy, infective episodes reduced from 36% to 21% (not significant). Infection following colonization with the same micro-organism was less common, post-tracheotomy (7/12 pre-tracheotomy versus 4/18 post-tracheotomy, P   <  0.05). Colonization preceded all the 12 cases of infection. Pseudomonas aeruginosa , Staphylococcus aureus , Acinetobacter and Haemophilus influenzae were the infective pathogens. Out of 28 colonization/infection episodes following the tracheotomy, 15 (54%) were of primary endogenous development, i.e. carriage in the oropharynx at the time of the tracheotomy. We showed a rate of 46% ‘true’ nosocomial episodes; 36% of exogenous and 10% of secondary endogenous development ( P   <  0.003). We conclude (1) exogenous colonization is difficult to prevent; (2) flora differs from that found in adults; and (3) immune status of host/micro-organism determines infection.

Journal of the American Ceramic SocietyVolume 79, Issue 4 p. 1133-1135 Comment on “Fracture Criteria for Piezoelectric Cerqamics” Kumar, Kumar Department of Materials Science and Engineering, University of Cincinnati, Cincinnati, Ohio 45221-0012Search for more papers by this author Singh, Singh Department of Materials Science and Engineering, University of Cincinnati, Cincinnati, Ohio 45221-0012Search for more papers by this author Kumar, Kumar Department of Materials Science and Engineering, University of Cincinnati, Cincinnati, Ohio 45221-0012Search for more papers by this author Singh, Singh Department of Materials Science and Engineering, University of Cincinnati, Cincinnati, Ohio 45221-0012Search for more papers by this author First published: April 1996 https://doi.org/10.1111/j.1151-2916.1996.tb08563.xCitations: 6 D. B. Marshall—contributing editor Supported by the National Science Foundation through Grant No. DMR-9202111 AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume79, Issue4April 1996Pages 1133-1135 RelatedInformation

1. The vagus nerves of the frog’s heart were stimulated in 26 experiments. In 11 experiments, there was no detectable release of acetylcholine; in 15 there was release in variable amounts.