Chi Square Distribution

). Recent data, however, suggest that EVH may be associated with reduced graft patency rates. The objective of this study is to assess the effect of EVH on short-term and midterm outcomes after CABG. Methods. Data were prospectively collected on all first-time isolated CABG and combined valve/CABG with saphenous vein graft between 1998 and 2007 at a single center. Patients having traditional "open" vein harvest (OVH) were compared with patients having EVH. Multivariate models were used to examine the risk-adjusted impact of EVH on postoperative leg infection, composite in-hospital adverse events, and individual and composite midterm adverse events. Results. The study included 5,825 patients, of whom 2,004 (34.4%) had EVH. Patients having EVH were more likely to have ejection fraction less than 50% (32.0% versus 29.3%, p ‫؍‬ 0.04), recent myocardial infarction (24.2% versus 18.3%, p < 0.0001), and left main disease (26.0% versus 22.1%, p ‫؍‬ 0.0009). Median follow-up was 2.6 years. After risk adjustment, EVH was associated with reduced rates of leg infection (odds ratio 0.48, p ‫؍‬ 0.003) but had no association with either in-hospital (odds ratio 0.93, p ‫؍‬ 0.56) or midterm adverse outcomes (hazard ratio 0.93, p ‫؍‬ 0.22). Endoscopic saphenous vein harvest was associated with reduced readmission to hospital for unstable angina (odds ratio 0.74, p ‫؍‬ 0.01). Conclusions. Endoscopic saphenous vein harvest is associated with a lower rate of leg infection and is not an independent predictor of in-hospital or midterm adverse outcomes. Endoscopic saphenous vein harvest is a safe alternative to OVH for patients undergoing CABG with saphenous vein.

Despite the health benefits, vegetable intake in youth remains below recommended levels. The purpose of our study was to compare two methods for increasing vegetable consumption. It was hypothesized that participants randomized to both the exposure-only and the pairing condition would increase their vegetable consumption and increase the variety of vegetables consumed. A total of 78 Mexican-American middle school-aged children from a charter school in Houston, TX, were randomized to a pairing condition (nϭ40) or an exposure-only condition (nϭ38) during the Spring 2009 semester. Children in the pairing condition were provided a preferred taste (peanut butter) paired with vegetables weekly at school during a nutrition class for 4 months. Children in the exposureonly condition received vegetables weekly during a nutrition class that covered the same material as the pairing condition. After 4 months, the pairing condition participants demonstrated significant increases in vegetable consumption (Fϭ13.40, PϽ0.001) as well as variety of vegetables eaten (Fϭ13.69, PϽ0.001) when compared to those in the exposure-only condition. The findings of this study suggest that the pairing of vegetables with a preferred taste, such as peanut butter, may be an effective technique in increasing consumption, especially in children who report being resistant to eating vegetables.

In this work, the evolution of demographic and health patterns in a Basque rural population from Spain is analysed, as they relate to progress in demographic and epidemiological transition. For this purpose, parochial record data on 13,298 births and 9215 deaths, registered during the 19th and 20th centuries (1800–1990), were examined. The study area is a rural community called Lanciego, which is located at the southern end of the Rioja Alavesa area (Alava Province, Basque Country). In Lanciego, demographic transition began in the final decade of the 19th century, when a definite, irreversible trend began towards a reduction in mortality. The decrease in the birth rate came later than that in the death rate, and did not start until the 1930s. The post-transitional stage seemed to be reached in the 1970s, when the birth and death rates showed values below 20 per 1000. Other characteristics observed for the post-transitional stage in Lanciego are: (i) very low rates of infant mortalit...

Previous studies suggest a role for fibroblast growth factor receptor 1 (FGFR1) in the regulation of energy balance. Objective: Our objective was to investigate whether FGFR1 is an obesity gene by genetic association and functional studies. The study was designed to genotype common FGFR1 single-nucleotide polymorphisms (SNP) in large cohorts, confirm significant results in additional cohorts, and measure FGFR1 expression in human adipose tissue and in rodent hypothalamus. Setting: General community and referral centers for specialized care was the setting for the study. We genotyped FGFR1 SNP in 2438 obese and 2115 lean adults and 985 obese and 532 population-based children. Results were confirmed in 928 obese and 2738 population-based adults and 487 obese and 441 lean children. Abdominal sc adipose tissue was investigated in 202 subjects. We also investigated diet-induced, obese fasting, and fed rats. We analyzed the association between FGFR1 SNP and obesity. In secondary analyses, we related adipose FGFR1 expression to genotype, obesity, and degree of fat cell differentiation and related hypothalamic FGFR1 to energy balance. Results: FGFR1 rs7012413*T was nominally associated with obesity in all four cohorts; metaanalysis odds ratio ϭ 1.17 (95% confidence interval ϭ 1.10 -1.25), and P ϭ 1.8 ϫ 10 Ϫ6 , which was P ϭ 7.0 ϫ 10 Ϫ8 in the recessive model. rs7012413*T was associated with FGFR1 expression in adipose tissue (P Ͻ 0.0001). In this organ, but not in skeletal muscle, FGFR1 mRNA (P Ͻ 0.0001) and protein (P Ͻ 0.05) were increased in obesity. In rats, hypothalamic expression of FGFR1 declined after fasting (P Ͻ ]0.001) and increased after diet-induced obesity (P Ͻ 0.05). Conclusions: FGFR1 is a novel obesity gene that may promote obesity by influencing adipose tissue and the hypothalamic control of appetite.

OBJECTIVES: Surgical ventricular reconstruction (SVR) for patients with severe left ventricular (LV) remodelling due to ischaemic cardiomyopathy is still controversial, because the Surgical Treatment for Ischaemic Heart Failure (STICH) trial demonstrated that SVR not only has no beneficial effect on survival compared with coronary artery bypass grafting (CABG) alone, but also is worse for those with a larger LV. Therefore, we assessed the impact of LV remodelling on the outcomes after SVR for ischaemic cardiomyopathy in Japan, using Di Donato's LV shape classification. From 2000 to 2010, 627 patients underwent SVR for ischaemic heart failure in 11 Japanese hospitals. To assess the patients with an LV ejection fraction (LVEF) of ≤35% like the STICH trial, considering the severity of LV remodelling, the patients with a preoperative LVEF of >35%, no preoperative LV volume assessment and no preoperative LV shape classification were excluded. Finally, 323 patients were selected as the study subjects. The LV shape was divided into three types according to Di Donato's classification. Types 1 and 3 indicate the aneurysmal and globally akinetic LV, respectively. Type 2 is the intermediate shape. RESULTS: Type 1, 2 and 3 LV shapes were observed in 85 (26%), 104 (32%) and 134 (42%) of the patients, respectively. The preoperative LV volume and diameter increased if the LV became more akinetic (Type 3 > 2 > 1, P < 0.001). LVEF was lower in those with more akinetic LV (P = 0.002). The preoperative LV end-diastolic volume index and LVEF in Type 3 patients were 133 ± 47 ml/m 2 and 22 ± 7%, respectively. Mitral valve repair was more frequently performed for patients with the Type 3 LV shape (65%) than for the others (P < 0.001). The hospital mortality rates were 2.4, 2.9 and 7.4% for Type 1, 2 and 3 patients, respectively (P = 0.16). Kaplan-Meier analysis demonstrated no significant difference in mortality among the three groups (log-rank P = 0.37). The 5-year survival rates were 81, 70 and 73% for Type 1, 2 and 3 patients, respectively. The severity of LV remodelling did not affect survival after SVR plus CABG. The results of SVR were acceptable even for those with globally akinetic LV due to ischaemic cardiomyopathy.

OBJECTIVES: Surgical ventricular reconstruction (SVR) for patients with severe left ventricular (LV) remodelling due to ischaemic cardiomyopathy is still controversial, because the Surgical Treatment for Ischaemic Heart Failure (STICH) trial demonstrated that SVR not only has no beneficial effect on survival compared with coronary artery bypass grafting (CABG) alone, but also is worse for those with a larger LV. Therefore, we assessed the impact of LV remodelling on the outcomes after SVR for ischaemic cardiomyopathy in Japan, using Di Donato's LV shape classification. From 2000 to 2010, 627 patients underwent SVR for ischaemic heart failure in 11 Japanese hospitals. To assess the patients with an LV ejection fraction (LVEF) of ≤35% like the STICH trial, considering the severity of LV remodelling, the patients with a preoperative LVEF of >35%, no preoperative LV volume assessment and no preoperative LV shape classification were excluded. Finally, 323 patients were selected as the study subjects. The LV shape was divided into three types according to Di Donato's classification. Types 1 and 3 indicate the aneurysmal and globally akinetic LV, respectively. Type 2 is the intermediate shape. RESULTS: Type 1, 2 and 3 LV shapes were observed in 85 (26%), 104 (32%) and 134 (42%) of the patients, respectively. The preoperative LV volume and diameter increased if the LV became more akinetic (Type 3 > 2 > 1, P < 0.001). LVEF was lower in those with more akinetic LV (P = 0.002). The preoperative LV end-diastolic volume index and LVEF in Type 3 patients were 133 ± 47 ml/m 2 and 22 ± 7%, respectively. Mitral valve repair was more frequently performed for patients with the Type 3 LV shape (65%) than for the others (P < 0.001). The hospital mortality rates were 2.4, 2.9 and 7.4% for Type 1, 2 and 3 patients, respectively (P = 0.16). Kaplan-Meier analysis demonstrated no significant difference in mortality among the three groups (log-rank P = 0.37). The 5-year survival rates were 81, 70 and 73% for Type 1, 2 and 3 patients, respectively. The severity of LV remodelling did not affect survival after SVR plus CABG. The results of SVR were acceptable even for those with globally akinetic LV due to ischaemic cardiomyopathy.

The prognosis for patients with lymph node (LN)-positive bladder cancer (BCa) is likely affected by the extent of lymphadenectomy in radical cystectomy (RC) cases. Specifically, the prognostic significance of the LN density (ratio of positive LNs to the total number removed) has been demonstrated. Objective: To evaluate the prognostic signature of lymphadenectomy variables, including the LN density, for a large, multicentre cohort of RC patients with LNpositive BCa. Design, setting, and participants: The clinical and histopathologic data from 477 patients with LN-positive urothelial BCa (pN1-2) were analysed. The median follow-up period for all living patients was 28 mo. Measurements: Multivariable Cox regression analysis was used to test the effect of various pelvic lymph node dissection (PLND) variables on cancer-specific survival (CSS) based on colinearity in various models.

The three far-upstream element (FUSE) binding proteins (FBP1, FBP2, and FBP3) belong to an ancient family of single-stranded DNA binding proteins which are required for proper regulation of the c-myc proto-oncogene. Whereas it is known that c-myc alterations play a completely different role in various carcinomas of the urogenital tract, the relevance of FBPs is unclear. Methods: FBP1, FBP3 and c-myc expression was studied in 105 renal cell, 95 prostate and 112 urinary bladder carcinomas by immunohistochemistry using tissue microarrays. High rates of FBP1 and FBP3 expression were observed in all cancer types. There was a concomitant up-regulation of FBP1 and FBP3 in renal cell and prostate carcinomas (p < 0.001 both). C-myc expression was detectable in 21% of prostate, 30% of renal and 34% of urothelial carcinomas. Interestingly, strong FBP1 and FBP3 expression was associated with c-myc up-regulation in clear cell renal cell carcinomas (p < 0.001 and 0.09 resp.), but not in bladder or prostate cancer. The correlation between FBP1/FBP3, c-myc and high proliferation rate in renal cell carcinoma provides strong in vivo support for the suggested role of FBP1 and FBP3 as activators of c-myc. The frequent up-regulation of FBP1 and FBP3 in urothelial and prostate carcinoma suggests that FBPs also have an important function in gene regulation of these tumors.

Bacterial translocation (BT) occurs mainly in preseptic conditions such as intestinal obstruction, trauma, and burn, and the underlying mechanisms are still unclear. Pentoxifylline (PTX) is a derivative of methyl xanthine and has several beneficial effects in sepsis. We investigated the effects of PTX on a rat BT model. Simple intestinal obstruction (IO) was choosen to create high BT rates. Rats were divided in to five groups of 10 rats. Either 50 mg/kg PTX or placebo (3 mg/100 g saline) was administered subcutaneously following IO, either by single injection or twice with a 12-h interval. All rats were sacrificed 12 or 24 h after the procedure, and mesenteric lymph nodes (MLN), liver, and blood samples were obtained under aseptic conditions for bacterial cultures. The samples were obtained 12 h following IO in the first two groups, and the same samples were obtained 24 h after IO in last three groups. Groups IV and V were the PTX treatment groups. PTX was re-injected 12 h after IO only in group IV. As a result, BT rates in MLNs and liver were found to be significantly low, blood specimens remained sterile in PTX-pretreated and -treated rats, and BT rates were high in control groups and group V (once treatment late specimen group). We conclude that simple intestinal obstruction causes BT, and PTX reduces BT in rats with IO during the first 12-h period if PTX is given once immediately following IO. PTX reduces BT during the first 24-h after IO provided that is injected twice with a 12-h interval. More experimental studies are need to explain the exact mechanism of this beneficial effect.

The development of brain and behaviour is controlled by the interaction of genetic determinants and environmental factors. To study genetic determinants, model systems such as the Naples rat lines, i.e. Naples high (NHE) and low excitability (NLE), are useful. They have been selectively bred for divergent behaviour arousal to novelty. Aim of this study was to assess the extent of the genetic control of the selection trait. Thus adult albino rats of NHE and NLE lines have been used throughout. According to a classical Mendelian cross-breeding design, a first experiment was carried out with hybrids obtained from parental lines P1 (NHE) and P2 (NLE) as F1, F2 and related backcrosses B1 (F1 × P1) and B2 (F1 × P2). Young adults (60-80 days) offspring of both gender were exposed separately for two 10 min tests to a spatial novelty (Lát-maze). To verify a possible sex link of the trait, a second experiment was carried out adding to the Mendelian cross design parental gender. Behavioural variables were horizontal (corner-crossings: HA), vertical (rearings on hindlimbs: VA) or total activity (HVA: HA + VA) scores. The heritability of HVA trait was estimated across the 20 generations of selection and Mendelian cross hybrids. Quantitative-genetic analysis on this trait and its HA and VA components, was applied by the Lynch and Walsh joint-scaling test procedure to evaluate underlying genetic mechanism. The correlation between experimental data of hybrids and estimated values from different heritability models were also computed. Results indicated that (i) the activity scores by Mendelian hybrids were intermediate between the two parental lines and were also graded; (ii) there was no sex effect on the heritability of trait but only a general tendency of females to higher activity levels; (iii) the heritability of HVA trait was very high (h 2 index = 0.824); (iv) heritability model of HVA and HA trait was polygenic with a marked epistatic control where as VA trait was fitted by simpler model with less genes and lower epistatic effect. In conclusion the Naples lines reveal strong genetic determinants for behavioural traits associated with polygenic pattern. Moreover, HA and VA activity components with prevailing cognitive and non-cognitive meaning, respectively, show differential genetic control.

Shiftwork is common in medical training and is necessary for 24-h hospital coverage. Shiftwork poses difficulties not only because of the loss of actual sleep hours but also because it can affect other factors related to lifestyle, such as food intake, physical activity level, and, therefore, metabolic patterns. However, few studies have investigated the nutritional and metabolic profiles of medical personnel receiving training who are participating in shiftwork. The aim of the present study was to identify the possible negative effects of food intake, anthropometric variables, and metabolic and sleep patterns of resident physicians and establish the differences between genders. The study included 72 resident physicians (52 women and 20 men) who underwent the following assessments: nutritional assessment (3-day dietary recall evaluated by the Adapted Healthy Eating Index), anthropometric variables (height, weight, body mass index, and waist circumference), fasting metabolism (lipids, cortisol, high-sensitivity C-reactive protein [hs-CRP], glucose, and insulin), physical activity level (Baecke questionnaire), sleep quality (Pittsburgh Sleep Quality Index; PSQI), and sleepiness (Epworth Sleepiness Scale; ESS). We observed a high frequency of residents who were overweight or obese (65% for men and 21% for women; p ¼ 0.004). Men displayed significantly greater body mass index (BMI) values (p ¼ 0.002) and self-reported weight gain after the beginning of residency (p ¼ 0.008) than women. Poor diet was observed for both genders, including the low intake of vegetables and fruits and the high intake of sweets, saturated fat, cholesterol, and caffeine. The PSQI global scores indicated significant differences between genders (5.9 vs. 7.5 for women and men, respectively; p ¼ 0.01). Women had significantly higher mean high-density lipoprotein cholesterol (HDL-C; p50.005), hs-CRP (p ¼ 0.04), and cortisol (p ¼ 0.009) values than men. The elevated prevalence of hypertriglyceridemia and abnormal values of low-density lipoprotein cholesterol (LDL-C; 4100 mg/dL) were observed in most individuals. Higher than recommended hs-CRP levels were observed in 66% of the examined resident physicians. Based on current recommendations, a high prevalence of low sleep quality and excessive daytime sleepiness was identified. These observations indicate the need to monitor health status and develop actions to reassess the workload of medical residency and the need for permission to perform extra night shifts for medical residents to avoid worsening health problems in these individuals.

Background. While dental anxiety is often correlated with prior negative dental experience, prevention of dental anxiety should in theory include early exposure to the dental setting. Objective. We set out to evaluate factors affecting dental fear in French children. Methods. Dental fear was evaluated using a visual analogue scale (DF-VAS) in a group of 1303 French children (681 boys and 622 girls) aged 5-11 years (mean: 8.12 years, SD: 1.42 years). Indicators of caries and oral hygiene were evaluated on dental examination. Indicators of wellbeing related to oral health, dental experience, and oral health education were collected via a structured interview. Results. Dental fear was scored low in 75.7% (DF-VAS 0-3), moderate in 16.7% (DF-VAS 4-6), and high in 7.6% (DF-VAS 7-10). DF-VAS decreased statistically with experience of a prior dental visit. Children who had at least one decayed tooth presented a higher level of dental fear than those with no decay, while children with fillings were significantly less anxious than those without previous dental care. Conclusions. This study shows that for children aged 5-12 years, prior experience of the dental setting can act as a positive component of dental fear.

Contact address: Alina Hohaci, MD, Discipline of Cardiology, “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases, Carol I Avenue, no. 50, Iasi, Romania. E-mail: [email protected] 1 Discipline of Cardiology, “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases, Iasi, Romania 2 “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania 3 Department of Interventional Cardiology, “Prof. Dr. George I. M. Georgescu” Institute of Cardiovascular Diseases, Iasi, Romania 4 Discipline of Cardiothoracic Surgery, “Prof. Dr. George I. M. Georgescu”, Institute of Cardiovascular Diseases, Iaşi, România Abstract: Introduction – Takotsubo cardiomyopathy (TCM) is a cardiac condition that mimics the clinical presentation of acute coronary syndrome, but without any evidence of obstructive atherosclerotic coronary artery disease. The prognosis is usually good, with improvement of the left ventricular (LV) dysfunction within a few weeks. There are some ...

Percutaneous coronary intervention with drug-eluting stents is an alternative for patients with high-risk unprotected left main coronary artery disease; those with diabetes mellitus are at even higher risk. Recent advances in percutaneous coronary intervention could lead to better results. The aim of this study was to evaluate medium-term results in a real-world sample of high-risk diabetic patients undergoing percutaneous coronary intervention with drug-eluting stents for unprotected left main coronary artery disease.From 3 tertiary hospitals, we retrospectively identified 334 high-risk patients, of whom 141 (42%) were diabetic and 193 (58%) were nondiabetic. The diabetes mellitus group showed a higher prevalence of peripheral vascular disease and left ventricular dysfunction. Angiographic and procedural characteristics did not differ significantly, with the exception of poor distal vessels in the diabetes mellitus group (44.5% vs 28.5%, P = 0.006). The use of intra-aortic balloon ...

Objectives. Measurement of cortical thickness and subjective assessment of cortical porosity on panoramic radiographs are methods previously reported for diagnosing osteoporosis. The aims of this study were to determine the relative efficacy of the mandibular cortical index and cortical width in detecting osteoporosis, both alone and in combination, and to determine the optimal cortical width threshold for referral for additional osteoporosis investigation. Study design. Six hundred seventy-one postmenopausal women 45 to 70 years of age were recruited for this study. They received dual energy x-ray absorptiometry (DXA) scans of the left hip and lumbar spine (L1 to L4), and dental panoramic radiographic examinations of the teeth and jaws. Three observers separately assessed the mandibular cortical width and porosity in the mental foramen region of the mandible. Cortical width was corrected for magnification errors. Chi-squared automatic interaction detection analysis (CHAID) software was used (SPSS AnswerTree, version 3.1, SPSS Inc., Chicago, IL). Results. Chi-squared automatic interaction detection analysis showed that the cortical porosity was a poorer predictor of osteoporosis than mandibular cortical width. For the 3 observers, a mandibular cortical width of Ͻ3 mm provided diagnostic odds ratios of 6.51, 6.09, and 8.04. The test is therefore only recommended in triage screening of individuals by using radiographs made for purposes other than osteoporosis. . When evaluating panoramic radiographs, only those patients with the thinnest mandibular cortices (i.e., Ͻ3 mm) should be referred for further osteoporosis investigation. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:821-8)

Aim: To determine the cross‐sectional association of the osteoporotic status of patients with the number of their teeth, with and without taking into account age and/or smoking.Material & Methods: At four centres, the study recruited 665 females aged 45–70 years and the number of teeth was counted for 651 subjects. Bone density was measured at the total hip, femoral neck and lumbar spine.Results: The mean number of teeth in the osteoporotic subjects was 3.3 fewer than normal subjects and 2.1 fewer if those with no teeth were excluded. The association between osteoporosis and having &lt;6 or having &lt;28 teeth remained significant after adjusting for age, smoking and centre with p‐values of 0.016 and 0.011, respectively. A single regression model for tooth count with normal errors would not fit all the data. By fitting mixture regression models to subjects with tooth count &gt;0, three clusters were identified corresponding to different degrees of tooth loss. The overall effect of o...

Objectives: In this study age and the trabecular pattern present on dental radiographs were used to predict the presence of osteoporosis. The objective was to evaluate the contribution of the trabecular pattern to the prediction. Methods: In this project, 671 women between 45 and 71 years of age were recruited. Medical history was obtained and dental radiographs were made. Bone mineral density (BMD) was measured at three sites to assess the presence of osteoporosis according to the World Health Organization criteria. The radiographs were subjected to image analysis methods yielding measurements of the trabecular pattern. Thereafter, discriminant analysis was used to predict the presence of osteoporosis by means of the trabecular pattern and age. Sensitivity and specificity of age and the trabecular pattern were compared. Also, it was checked whether the inclusion of the trabecular pattern improved the sensitivity and specificity that were obtained when only age was used as the predictor. Results: The sensitivity and specificity of the trabecular pattern present on dental radiographs were almost equal to those of age. However, combining age with the trabecular pattern increased the sensitivity from 0.71 to 0.75 and the specificity from 0.72 to 0.78; the latter increase was statistically significant. Conclusions: The trabecular pattern predicts the presence of osteoporosis just as well as age does. When combining the trabecular pattern with age, the sensitivity and specificity increased. Only the latter increase was statistically significant.

Diabetic retinopathy increases with duration of diabetes and may be associated with carotenoid status. Carotenoids alter the pro-oxidation/antioxidation balance, and circulating levels depend largely on dietary intake. Lower levels have been reported in diabetes and age-related macular degeneration; however, little is known of the relationship between carotenoids and diabetic complications. Consequently, the purpose of the present study was to evaluate the relationship between plasma carotenoids and diabetic retinopathy. We assessed the carotenoid–retinopathy relationship in 111 individuals with type 2 diabetes in a community-based, cross-sectional study. We photodocumented retinal status and used HPLC to measure plasma carotenoid concentrations. Data for clinical and demographic variables and risk factors for diabetic retinopathy were obtained from 24 h urine and fasting blood samples, and an interviewer-assisted lifestyle questionnaire. We found that the combined lycopene and lute...

We read with interest the article by Espana-Gomez et al. [1] published in the September 2009 issue. This is an interesting article, in which the authors have shared substantial experience of laparoscopic management of pancreatic insulinoma. As is true for all fields of surgery, the minimally invasive approach is making significant headway in the management of pancreatic insulinomas and we congratulate the authors for their contribution . However, we have a few comments and queries. The authors stated that the laparoscopic approach was initially selected for 21 patients. Were these cases randomly selected or did the authors have some selection and/ or exclusion criteria? Considering the fact that the pancreatic fistula rate was the highest in the conversion group (6/7), most of which was consisted of patients with tumor in pancreatic head (5/7), would the authors in the future recommend against attempting laparoscopic approach for patients with tumors in pancreatic head. According to the authors, calcium stimulation test (ASVS) was performed in nine patients and in four of them the stimulation test confirmed the suspected lesion, whereas in five the results indicated a regional hypersecretion of insulin. Did the authors mean that once a positive gradient was detected in the artery supplying a particular region, a lesion previously detected in the same region by

Aim: To assess vitamin D status and health correlates in a sample of apparently healthy Caucasian participants residing in an urban area, Athens, with latitude 370 58΄ 0΄΄ N and longitude 230 43΄ 0΄΄E, after taking into consideration a broad range of purported biological, behavioural and environmental factors. Method: Men and women 35+ years from a selected population (n=490) were studied. Participants completed a detailed questionnaire regarding socio-demographic, lifestyle, clinical and dietary characteristics. Biomarkers were measured after 12 h fasting. Linear and multinomial regression models were used to evaluate the association between 25(OH)D and determinants of vitamin D status. Results: Results revealed that one hour increase of sunlight exposure decreased the odds of having D deficiency (i.e., <20 ng/mL) by 70% (OR=0.30, 95% CI: 0.20-0.45), adjusted for age, sex, family status, physical activity, smoking habits, BMI, triglycerides, parathyroid hormone, uric acid, haptoglobin, folate acid and haemoglobin, as compared to sufficient levels (i.e., >30 ng/mL). Regarding biomarkers, parathyroid hormone and haptoglobin were found to be related with the odds of having vitamin D deficiency (OR=1.11, 95% CI: 1.05-1.16; OR=1.02, 95% CI: 1.00-1.03, respectively) as compared to the sufficient levels. Conclusions: Sufficient serum vitamin D levels were observed among participants with characteristics associated with reduced cardiovascular risk, such as normal BMI, increased physical activity, decreased parathyroid hormone and decreased inflammatory markers. Even a slight increase in sunlight exposure could have beneficial effects on serum vitamin D concentrations and eventually on haemoglobin and inflammatory markers levels, thus providing a simple and inexpensive lifestyle intervention that promotes public health.

Background: Chronic bronchitis and previous exacerbations are both well-known risk factors for new exacerbations, impaired health-related quality of life, and increased mortality in COPD. The aim of the study was to characterize the phenotype of concurrent chronic bronchitis and frequent exacerbation in severe COPD. Methods: Information on patient characteristics, comorbidity, and exacerbations from the previous year (total number and number requiring hospitalization) was collected from 373 patients with stage III and IV COPD attending 27 secondary care respiratory units in Sweden. Logistic regression used chronic bronchitis and frequent exacerbations (2 exacerbations or 1 hospitalized exacerbations in the previous year) as response variables. Stratification and interaction analyses examined effect modification by sex. Results: Chronic bronchitis was associated with current smoking (adjusted odds ratio [OR] [95% CI], 2.75 [1.54-4.91]; P=0.001), frequent exacerbations (OR [95% CI], 1.93 [1.24-3.01]; P=0.004), and musculoskeletal symptoms (OR [95% CI], 1.74 [1.05-2.86]; P=0.031), while frequent exacerbations were associated with lung function (forced expiratory volume in 1 second as a percentage of predicted value [FEV 1 % pred]) (OR [95% CI] 0.96 [0.94-0.98]; P=0.001) and chronic bronchitis (OR [95% CI] 1. 73 [1.11-2.68]; P=0.015). The phenotype with both chronic bronchitis and frequent exacerbations was associated with FEV 1 % pred (OR [95% CI] 0.95 [0.92-0.98]; P=0.002) and musculoskeletal symptoms (OR [95% CI] 2. 55 [1.31-4.99]; P=0.006). The association of smoking with the phenotype of chronic bronchitis and exacerbations was stronger in women than in men (interaction, P=0.040). Conclusion: Musculoskeletal symptoms and low lung function are associated with the phenotype of combined chronic bronchitis and frequent exacerbations in severe COPD. In women, current smoking is of specific importance for this phenotype. This should be considered in clinical COPD care.

Background: A flanged humeral stem design can be advantageous in achieving an interlock between the prosthetic and bone interface leading to a long-term stable loading pattern. The purpose of this study is to report a short case series involving revision of a flanged humeral prosthesis. Our hypothesis was that a greater percentage of the flanged prostheses undergoing revision would require some form of bone expansion to achieve stem removal compared to the nonflanged. Methods and Results: In the period from October 2004 to July 2008, 43 patients underwent revision of a humeral prosthetic stem by a single surgeon. Of these, 6 prostheses were of a triflanged design. Of these six, five (83%) could not be removed with longitudinal force and required some expansion of the bone in order to achieve stem extraction. Of the nonflanged humeral stems, 3/37 (8%) required bone expansion to achieve extraction. Analysis of the 2 groups showed a statistical difference in the need for humeral expansion (P < .000001). Conclusions: Surgeons preparing to revise a flanged humeral stem should include expansion of the humeral shaft, by episiotomy or windowing, as part of their preoperative planning and informed consent of the patient.

Objectives: Determine which social, demographic and sexual function variables that most influence libido or desire and orgasm domains in the premenopausal and postmenopausal women. Methods: A cross-sectional analysis of 231 Colombian-born women, aged 40-62 years. The sexual function was measured by self-questionnaire. The analysis was performed by using the χ 2 -test and multivariate regression analysis. The sexual function was divided in five domains: desire, arousal, lubrication, orgasm, pain; additionally satisfaction was included. Results: The women with a higher level of education and with a good perception of their satisfaction with their partners, reported better performance in the desire. Age and the non existence of sexual partner influenced in a negative way on the desire. In sexual active women the orgasm was negatively influenced by low satisfaction scores, lack of emotional closeness with their partners and low educational level. High scores in lubrication and desire were associated with a good performance in the orgasm. The hormone therapy (HT) was associated with better scores in orgasm. Conclusions: Age, level of education, the presence or lack of sexual partner, degree of satisfaction with emotional closeness with the partner and adequate lubrication, influence the desire and orgasm domains in a significant way. By identifying these associations we can then perform some inexpensive interventions. Improving lubrication for menopausal women. Including men in educational activities to sensitize them toward women's feelings. Organizing educational campaigns for middle-aged women to demystify that sexuality is only for young people.

Introduction: Socioeconomic differences in health-related behaviours have been widely studied in the Western populations, but are seldom considered in Asian populations. We examined the effect of education attainment on health-related behaviours (physical activity, cigarette smoking and alcohol consumption) among non-institutionalised Singaporeans aged 18-69 years. Methods: We used data from the Singapore National Health Survey 2004. Information on physical activity, cigarette smoking, alcohol consumption and sociodemographic characteristics was collected from 4,084 adults. Age-adjusted prevalence of the three health-related behaviours by educational attainment was calculated by the direct method. Logistic regression models, adjusted for age, gender, ethnic group and employment status, were used to estimate the odds ratio and 95% confidence interval, in order to study the prevalence of health-related behaviours according to educational attainment. Results: The prevalence of physical inactivity, daily smoking and regular alcohol consumption was found to be consistently highest among men and women with the least education. Prevalence of physical inactivity and smoking was inversely related to educational attainment for both genders. However, no clear gradient was found between education and alcohol consumption for men and women. Conclusion: Less-educated Singaporeans were more likely to smoke daily, drink alcohol regularly or not to exercise regularly. Health promotion policies or programmes aimed at encouraging healthy lifestyles in the Singapore population should take into account the educational inequalities in these health-related behaviours.

Background-There is inconclusive data on whether critically ill individuals with severe secondary peritonitis requiring multiple staged laparotomies may became eligible candidates for deferred primary anastomoses (DPA). We sought to compare a protocol for DPA against a protocol for diversion in severely ill critical patients with intra-abdominal sepsis. Methods-A retrospective cohort study was performed examining 112 patients admitted through an ICU between 2002 and 2006, with diagnosis of secondary peritonitis and managed with staged laparotomies whom required small-or large-bowel segment resections. Patients were categorized and compared according to the surgical treatment necessitated to resolve the secondary peritonitis (DPA versus diversion). Outcome measures were days on mechanical ventilation, days required in ICU, days required in hospital, incidence of fistulas/leakages, acute respiratory distress syndrome (ARDS), and mortality. Results-There were 34 patients subjected to DPA and 78 to diversion. Fistulas/leakages developed in three patients (8.8%) with DPA and four patients (5.1%) with diversion (p = 0.359). ARDS was present in 6 patients (17.6%) with DPA and 24 patients (30.8%) with diversion (p = 0.149). There were 30 patients (88.2%) with DPA and 65 patients (83.3%) with diversion discharged alive (p = 0.51). There were not statistical significant differences between groups among survivors regarding hospital length of stay, ICU length of stay, and days on mechanical ventilation. Conclusions-We did not find significant differences in morbidity or mortality when we compared DPA versus diversion surgical treatment. It is feasible to perform a primary anastomosis in critically ill patients with severe secondary peritonitis managed with staged laparotomies.

Background: The purpose of this experience was to define patient characteristics, aneurysm anatomy and presentation, types of utilized repair options, and temporal changes over 2 decades in the management of femoral artery aneurysms (FAAs). Methods: Between January 1988 and December 2009, 27 patients with a total of 35 true FAAs were analyzed. Histologic examination was obtained for all the operated FAAs. Postoperative follow-up included clinical and radiologic examinations every 6 months in the first year and once per year thereafter. Results: There were 25 men; mean age was 65 ؎ 19 years. Aneurysms involved the common femoral artery in 20 cases (57%), the superficial femoral artery in 9 cases (26%), and the profunda femoris artery in 6 cases (17%). Seven patients (26%) had bilateral aneurysms, and 13 patients (48%) had additional aneurysms. Overall, 10 FAAs (29%) were symptomatic. Mean aneurysm diameter was 46 ؎ 19 mm. Three patients with four aneurysms were not operated on, and 31 aneurysms were finally operated on. Intensive care unit admission was never needed and hospital mortality was not registered. Major complications occurred in 3 cases (3 of 31; 8.5%) only. Amputations were never performed. Mean follow-up was 56 ؎ 49 months. No graft thrombosed and only a late (6 months) anastomotic pseudoaneurysm was detected and treated with an endograft. Patients' survival was 93% ؎ 0.5% at 6 months, 88.6% ؎ 0.6% at 1 year, and 77.6% ؎ 1.2% at 5 years. Conclusion: FAAs have been uncommon and rarely isolated lesions. Surgical repair offered good results either in elective or urgent settings. (

The objective of this study was to report the 10-year outcomes of the multicenter Italian Excluder Registry for elective endovascular aneurysm repair (EVAR). A retrospective analysis of all patients who underwent elective EVAR using the Gore Excluder (W. L. Gore & Associates, Flagstaff, Ariz) endograft (EG) at four Italian centers between 1998 and 2006 was carried out. Follow-up consisted of duplex ultrasound scan and computed tomography performed at 1 month, 6 months, and 12 months and yearly thereafter. Long-term outcomes were evaluated according to a life-table analysis. The Excluder EG was used in 461 patients (425 men; mean age, 72.9 ± 9.2 years) with abdominal aortic aneurysm (mean diameter, 52.2 ± 11.9 mm) who underwent elective EVAR. The 10-year cumulative survival was 62.5% ± 3.5% (95% confidence interval [CI], 55.5%-69.1%). During the follow-up, 14 (3.03%) patients were lost to follow-up. Estimated freedom from EG-related complication was 90.5% ± 1.5% (95% CI, 87.4%-92.9%)...

BACKGROUND & AIMS: Drug-induced liver injury (DILI), especially from antimicrobial agents, is an important cause of serious liver disease. Amoxicillin-clavulanate (AC) is a leading cause of idiosyncratic DILI, but little is understood about genetic susceptibility to this adverse reaction. METHODS: We performed a genome-wide association study using 822,927 single nucleotide polymorphism (SNP) markers from 201 White European and US cases of DILI following AC administration (AC-DILI) and 532 population controls, matched for genetic background. RESULTS: AC-DILI was associated with many loci in the major histocompatibility complex. The strongest effect was with an HLA class II SNP (rs9274407, P ϭ 4.8 ϫ 10 Ϫ14 ), which correlated with rs3135388, a tag SNP of HLA-DRB1*1501-DQB1*0602 that was previously associated with AC-DILI. Conditioned on rs3135388, rs9274407 is still significant (P ϭ 1.1 ϫ 10 Ϫ4 ). An independent association was observed in the class I region (rs2523822, P ϭ 1.8 ϫ 10 Ϫ10 ), related to HLA-A*0201. The most significant class I and II SNPs showed statistical interaction (P ϭ .0015). High-resolution HLA genotyping (177 cases and 219 controls) confirmed associations of HLA-A*0201 (P ϭ 2 ϫ 10 Ϫ6 ) and HLA-DQB1*0602 (P ϭ 5 ϫ 10 Ϫ10 ) and their interaction (P ϭ .005). Additional, population-dependent effects were observed in HLA alleles with nominal significance. In an analysis of autoimmune-related genes, rs2476601 in the gene PTPN22 was associated (P ϭ 1.3 ϫ 10 Ϫ4 ). CONCLUSIONS: Class I and II HLA genotypes affect susceptibility to AC-DILI, indicating the importance of the adaptive immune response in pathogenesis. The HLA genotypes identified will be useful in studies of the pathogenesis of AC-DILI but have limited utility as predictive or diagnostic biomarkers because of the low positive predictive values.

The purpose of this study was to evaluate, over an 18-month period, the clinical performances of a resinmodified glass ionomer cement for bonding orthodontic brackets and to analyze various factors that influenced their survival and failure rates. Two orthodontists using the edgewise technique participated in this study; 6113 brackets, including 20 molar tubes, were bonded with Fuji Ortho LC (GC, Europe, N.V. Leuven, Belgium) in 135 patients. Ceramic, metal, and resin brackets were tested, and both operators used the same bonding method for the brackets. The survival rate and the failure rate of the brackets were evaluated. The rates were determined by operator, bracket type, tooth position in the dental arch, and age and sex of the patients. Bracket survival rates were estimated using the Kaplan-Meier test. The Cox-Mantel statistical test with a level of significance set at 0.05 was used to compare survival curves. The chi-square test was used at a level of P < .05 to compare failure rates. The overall failure rate for the sample was 7%, and the overall survival rate was equal to 0.918. Age had no significant influence on the failure rate (P = .07); however, it had a significant influence on the survival rate (P < .01). The best survival rates were obtained in the groups aged 16 to 20 years (S[t] = 0.943) and older than 20 years (S[t] = 0.929). The difference between males and females was not statistically significant in terms of failure rate (P = .17). However, the Cox-Mantel test showed a higher bracket survival rate for the males (S[t] = 0.924) than for the females (S[t] = 0.839) (P < .00001). The influence of the operator was not statistically significant on the failure rate (P = .08); however, it was significant on the survival rate (P < .0002). Location in the arch had a significant influence on the failure and survival rates. The worst results were obtained in the upper incisors and the canines, and the best results in the lower premolars. Fifteen percent of the molar tubes failed; their survival rate was equal to 0.833. The failure rate was significantly greater for resin brackets than for metal or ceramic brackets (P = .007). The highest survival rate was obtained with ceramic brackets (P = .0001). This in vivo study showed that bonding brackets and molar tubes with Fuji Ortho LC is compatible with clinical orthodontic practice. (

Background: Low cardiac output syndrome is defined as the need for a postoperative intra-aortic balloon pump or inotropic support for longer than 30 minutes in the intensive care unit. Mitral valve surgery is increasingly being performed in high-risk patients who might require mechanical circulatory support for low cardiac output syndrome. Therefore the aim of this study was to identify the preoperative predictors of low cardiac output syndrome after mitral valve surgery. Methods: We conducted a retrospective review of data prospectively entered into an institutional database. Between 1990 and February 2008, 3039 patients underwent isolated mitral valve surgery with or without coronary bypass surgery. The independent predictors of low cardiac output syndrome and operative mortality were determined by means of stepwise logistic regression analysis. Results: The overall prevalence of low cardiac output syndrome was 7%. The independent predictors of low cardiac output syndrome were urgency of the operation (odds ratio, 2.9), earlier year of operation (odds ratio, 2.4), left ventricular ejection fraction of less than 40% (odds ratio, 2.1), New York Heart Association class IV (odds ratio, 2), body surface area of 1.7 m 2 or less (odds ratio, 1.6), ischemic mitral valve pathology (odds ratio, 1.6), and cardiopulmonary bypass time (odds ratio, 1.02). The operative mortality was higher in patients with low cardiac output syndrome (30% vs 1.3%, P < .001). Overall operative mortality was 3.4%. The independent predictors of mortality were urgency of the operation (odds ratio, 7.1), renal failure (odds ratio, 4.3), nonuse of polytetrafluoroethylene sutures (Gore-Tex; W. L. Gore & Associates, Inc, Austin, Tex; odds ratio, 2.1), any reoperative surgical intervention (odds ratio, 1.8), increasing age (odds ratio, 1.03), and cardiopulmonary bypass time (odds ratio, 1.02). Conclusions: Low cardiac output syndrome is associated with significantly increased morbidity and mortality. Novel strategies to preserve renal function, optimization of pre-existing heart failure symptoms, and use of artificial polytetrafluoroethylene sutures might reduce the incidence of low cardiac output syndrome and lead to improved results after mitral valve surgery. (

Background: Chagas disease (ChD) patients might present chronotropic incompetence during exercise, although its physiopathology remains uncertain. We evaluated the heart rate (HR) response to exercise testing in ChD patients in order to determine the role of autonomic modulation and left ventricular dysfunction in the physiopathology of chronotropic incompetence. Methods: ChD ambulatory patients (n = 170) and healthy controls (n = 24) underwent a standardized protocol including Doppler echocardiography, Holter monitoring, HR variability analysis, brain natriuretic peptide (BNP) measurement, and maximal exercise testing. The chronotropic response was calculated as the percentage of predicted HR achieved and the HR increment ( HR) during exercise. ChD patients were divided according to the absence or presence of cardiopathy and chronotropic incompetence (<85% predicted HR). Results: Chronotropic incompetence was present in 34 (20%) of all ChD patients. The group with cardiopathy displayed reduced HR (91 ± 19 bpm) during exercise in comparison with ChD patients without cardiopathy (100 ± 19 bpm). Both the values observed in ChD groups were significantly different from those of controls (112 ± 13 bpm). Exercise duration, maximal oxygen consumption, and systolic blood pressure increment were significantly reduced in patients with abnormal chronotropic response. HR during the exercise was significantly correlated with markers of autonomic control of sinus node, such as rest HR (r = -0.498, P ≤ 0.001), peak HR during exercise (r = 0.775, P ≤ 0.001), minimal HR during Holter recording (r = -0.231, P = 0.003), and high-and low-frequency components of short-term HR variability (r = 0.188, P = 0.042 and r = 0.203, P = 0.027). Neither left ventricular function nor BNP levels were independently related to the presence of chronotropic incompetence. Conclusions: Chronotropic incompetence may be considered an early sign of autonomic dysfunction in ChD patients. A.N.E. 2006;11(1):3-11 Chagas disease; exercise test; chronotropic incompetence; autonomic nervous system; heart rate variability Chagas disease (ChD) is caused by the protozoan Trypanosoma cruzi and represents one of the main causes of mortality in Latin America, where nearly 15 million individuals are infected. The disease has

Tendons are frequently used for reconstructive surgery. This includes palmaris longus, plantaris, the long extensors of the toes and fingers as well as the flexors of the fingers. The surgeon must base his or her selection of the donor tendon for grafting on what is needed, for example tendon size, length, and width. The most desirable tendons in reconstructive surgery are the palmaris longus and plantaris tendons. These two muscles are also considered to be the easiest tendons to harvest, and therefore they remain the ideal choices for flaps or tendon grafts. Apart from what is mentioned in the literature, questions remain such as: which characteristics do the palmaris longus and plantaris muscles possess that make them suitable for use as flaps or grafts in reconstructive surgery and; how can knowledge of the characteristics of these muscles improve reconstructive surgery in South Africa? The palmaris longus and plantaris muscles are indeed subject to variation, whether in the general anatomy, form, attachment, actions and/or prevalence. A statistical significant difference was found between the male and female sample when considering the length of the palmaris longus muscle. When comparing the palmaris longus muscle to the plantaris muscles, it was found that there is a statistical significant difference between them as well. Therefore, although these muscles may look alike, when it comes to the surgical aspect it is suggested that the palmaris longus is used when a wider tendon is preferred and the plantaris muscle when a longer tendon is needed. The prevalence of the palmaris longus and v plantaris muscles compared well with studies done on other population groups. No correlation was found between the sex of the cadaver and the prevalence of the palmaris longus and plantaris muscles. In addition it was established that there is no relationship between the prevalence of the palmaris longus and plantaris muscles in the same individual. A possible phylogenetic degenerative trend for the palmaris longus muscle was also examined. After studying various age groups, it was determined that such a trend could not be established for this sample. In conclusion, based on the morphology and prevalence of the palmaris longus and plantaris muscles in a South African population, they are ideal for the use of flaps and/or tendon graft in reconstructive surgery. But it is of utmost importance that the reconstructive surgeon, working on South African patients, remember that both these muscles are subject to variation and not only will it be beneficial to employ proper detection methods to determine the viability of either muscle before considering its suitability in reconstructive surgery but also a sound knowledge of the anatomy of these muscles must be known. Tendons word dikwels gebruik vir rekonstruktiewe chirurgie. Dit sluit die M. palmaris longus en M. plantaris, die lang ekstensors van die tone en vingers, sowel as die fleksors van die vingers in. Die chirurg moet sy of haar keuse van die skenkertendon baseer op dit wat benodig word, byvoorbeeld tendongrootte, ~lengte en ~breedte. Die mees gesogte tendons in rekonstruktiewe chirurgie is dié van M. palmaris longus en M. plantaris. Hierdie twee spiere word ook geag as die maklikste spiere om te oes / bekom, en daarom bly hulle die ideale keuse vir weefselsnitte of tendon-oorplantings. Afgesien van wat in die literatuur beskryf word, bly die volgende vrae onbeantwoord: Watter eienskappe maak M. palmaris longus en M. plantaris geskik vir die gebruik as weefselsnitte of tendon-oorplantings in rekonstruktiewe chirurgie en, hoe kan kennis van hierdie eienskappe van dié spiere, rekonstruktiewe chirurgie in Suid-Afrika verbeter? M. palmaris longus en M. plantaris is inderdaad onderworpe aan variasie van die algemene anatomie, vorm, aanhegtings, aksies en / of aanwesigheid en/of afwesigheid. 'n Statistiese beduidende verskil is gevind tussen die manlike en vroulike steekproef ten opsigte van die lengte van M. palmaris longus. M. palmaris longus is met M. plantaris ook vergelyk en daar was gevind dat vi daar 'n statisties beduidende verskil tussen hierdie spiere is. Alhoewel hierdie spiere dieselfde lyk, is dit belangrik om in ag te neem dat as dit by die chirurgiese aspekte kom, word daar voorgestel dat M. palmaris longus eerder gebruik moet word wanneer 'n wyer tendon verkies word en M. plantaris gekies moet word wanneer 'n langer tendon benodig word. Daar is goeie ooreenkoms tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris wanneer hul met studies, wat op die ander bevolkingsgroepe gedoen was, vergelyk word. Geen ooreenkomste was tussen die geslag van die kadawer en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris gevind nie. Daarbenewens was dit vasgestel dat daar geen verhouding tussen die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris in dieselfde individu is nie. 'n Moontlike filogenetiese degeneratiewe tendens vir M. palmaris longus is ook ondersoek. Na die bestudering van verskillende ouderdomsgroepe, is daar bepaal dat so 'n tendens nie bevestig kon word vir hierdie steekproef nie. Ter afsluiting, die morfologie en die aanwesigheid en/of afwesigheid van M. palmaris longus en M. plantaris, in 'n Suid-Afrikaanse bevolking, is ideaal vir die gebruik van weefselsnitte of tendonoorplantings in rekonstruktiewe chirurgie. Maar dit is van uiterste belang dat die rekonstruktiewe chirurg, wie met Suid-Afrikaanse pasiënte werk, onthou dat beide hierdie spiere onderworpe is aan variasie. Dit sal dus voordelig wees om behoorlike opsporingsmetodes te gebruik om die vatbaarheid van hierdie spiere in rekonstruktiewe chirurgie vas te stel, maar hy of sy het ook kennis van die anatomie van hierdie spiere, nodig.

The literature reports that the palmaris longus muscle (PL) is only found in mammals in which the forelimbs are weight-bearing extremities. It is suggested that the function of this muscle has been taken over by the other flexors in the forearm. Terms used in the literature to describe the diminishing of this muscle include retrogressive or phylogenetic degenerative trends. The aims of this study were to determine the prevalence of PL in a South African population and whether a 2 phylogenetic degenerative trend for the PL exists. To determine the prevalence of the PL, five groups, representing different age intervals (Years 0-20, 21-40, 41-60, 61-80 and 81-99) were used. A sample of 706 participants of various ages was randomly selected. Statistical analysis included comparisons of the prevalence of the muscle between males and females and left and right sides, using a student ttest. A Chi-squared test was used to determine a possible phylogenetic degenerative trend of PL within the five groups. The sample yielded a bilateral absence of the PL in 11.9% of the cases. The muscle was unilaterally absent on the left side in 7.65% and 6.94% on the right side. The Chi-squared tests revealed a pvalue of 0.27 for the left arm and 0.39 for the right arm. No obvious trend could be established for the phylogenetic degeneration of the PL in this study. It would appear that the PL muscle should not be considered as a phylogenetically degenerating muscle in a South African population.

hypertension (89.9% vs 90.4%, P ¼ .61). OPs were associated with higher mortality rates (1.9% vs 0.6%, P ¼ .0004), postoperative worsening of renal function (1.4% vs 0.4%, P ¼ .002), cardiac events (3.5% vs 1.4%, P < .0001), respiratory complications (3.2% vs 1.1%, P < .0001), and combined outcomes (6.8% vs 2.3%, P < .0001). The Table reports results for stratified analyses. Significantly worse outcomes with OP vs EP techniques persisted in multivariate logistic regression models adjusted for group differences. Conclusions: In patients with moderate or severe kidney disease, endovascular revascularization is associated with lower mortality and reduced postoperative complications compared with open revascularization.

It is challenging to distinguish benign from malignant thyroid nodules on high resolution ultrasound. Many ultrasound features have been studied individually as predictors for thyroid malignancy, none with a high degree of accuracy, and there is no consistent vocabulary used to describe the features. Our hypothesis is that a standard vocabulary will advance accuracy. We performed a systemic literature review and identified all the sonographic features that have been well studied in thyroid cancers. We built a controlled vocabulary for describing sonographic features and to enable us to unify data in the literature on the predictive power of each feature. We used this terminology to build a Bayesian network to predict thyroid malignancy. Our Bayesian network performed similar to or slightly better than experienced radiologists. Controlled terminology for describing thyroid radiology findings could be useful to characterize thyroid nodules and could enable decision support applications.

A redução dos níveis de atividade física e o aumento da obesidade já na infância são preocupantes. Esses dois fatores estão associados a diversos problemas de saúde. A escola e as aulas de educação física são meios importantes de promover hábitos saudáveis de atividade física. O objetivo do estudo foi comparar os níveis de atividade física (NAF) durante aulas de Educação Física em relação ao estado nutricional e verificar se existem diferenças em relação ao sexo e a idade (7 a 9 anos). Os NAF de 92 meninos e 95 meninas foram mensurados com pedômetros. O índice de massa corporal foi classificado conforme as curvas do Center of Disease Control. Os resultados evidenciam que 1) crianças obesas apresentaram menores NAF do que crianças saudáveis; 2) meninos apresentaram maiores NAF do que meninas; 3) crianças saudáveis de 8 anos foram mais ativas do que as obesas; aos 9 anos as crianças saudáveis e com excesso de peso apresentaram maiores NAF do que as obesas. A regressão linear mostrou que o sexo e o estado nutricional são preditores significativos dos NAF, explicando 47% e 22% a variância dos NAF, respectivamente. Os resultados encontraram ressaltam a necessidade de estratégias que incluam o aumento dos níveis de atividade física de todas as crianças nas aulas de educação física, principalmente meninas e crianças com excesso de peso.

The medicalization of female genital cutting (FGC) has been increasing. This cross-sectional study estimated the determinants of the practice of FGC among Egyptian physicians. Responses from 193 physicians showed that while 88% of them knew at least one adverse physical or sexual consequence, 18% approved of it, mostly as a religious observation (82%). Almost one-fifth (19%) of physicians practised FGC, mostly due to conviction (51%) or for profit (30%). A negative correlation was found between knowledge of the adverse consequences of FGC and both approval and practice. Cultural influences were the highest determinant (81%) followed by lack of knowledge (35%).

The purpose of this study is to present the clinical and radiological features of 27 cases of central giant cell granuloma (CGCG) of the jaws. This study was carried out on 27 cases diagnosed as CGCG, ranging in age from 8 to 70 years. The patient's age, sex, location of the lesion, expansion caused by the lesion, and greatest diameter were evaluated. Radiographs and radiological descriptions were studied for the features of border definition, radiopacity, locularity, root resorption, tooth displacement, and tooth association. Data were analyzed with Chi square test, Fisher's exact test, Mann Whitney U-test, and the Student t-test. Results: It was determined 89% of CGCG occurred prior to the age of 40. Seventy-eight percent of the cases were females. In addition, it was observed that these lesions occurred primarily in the mandible mostly anterior to the molar region. It was determined most of the lesions were multilocular. Unilocular lesions averaged 23.75 mm and multilocular lesions were 53.00 mm. In 24 (89%) cases regular borders were seen, and in three cases diffuse borders were observed. There was bone expansion in 44% of the cases. The cases with bone expansion were 60.00 mm in average size, and the cases without bone expansion were 24.00 mm in average size. Seventy-eight percent of lesions were associated with teeth, and there was tooth displacement in 43% of these lesions. The lesions with tooth displacement were 18.33 mm in average size, and the lesions without tooth displacement were 44.00 mm in average size. It was determined there is a significant correlation between the locularity, tooth displacement, and bone expansion with the size of the CGCG.

Background: Elevation of the deep inferior epigastric perforator (DIEP) flap interrupts its superficial venous system, and if drainage through the deep venous system is inadequate the flap may develop congestion. The purpose of this retrospective study was to determine the fate of the congested DIEP flap and to optimize the strategy for its salvage. Methods: Thirty-two of 162 patients who underwent unilateral breast reconstruction with a DIEP flap developed venous congestion. For the purpose of outcome analysis, cases were retrospectively allocated to "observationonly" (group A, n ϭ 11), postoperative salvage (group B, n ϭ 7), and intraoperative salvage (group C, n ϭ 14), and complications among the various groups were compared to determine the necessity and optimal timing of salvage intervention. Results: Two flaps (1 in group A, another in group B) failed completely, giving a success rate 98.8%. The complication rate and hospital stay were significantly lower in group C than in group B (P ϭ 0.03, P ϭ 0.02). The rate of venous congestion requiring salvage procedures was 13%, with a salvage rate of 95%. Salvage procedures included venous augmentation with an additional recipient vein in 7 procedures, adding superficial inferior epigastric vein (SIEV) to DIEV in 11 procedures, and substituting with SIEV in 7 procedures. There was no statistical difference in flap salvage rate using the SIEV between "augmentation" and "substitution." Conclusions: The salvage procedures for venous compromised DIEP flap are better performed intraoperatively rather than postoperatively to prevent further complications. The engorged SIEV could be incorporated by anastomosing to an additional recipient vein or adding to the DIEV-internal mammary vein axis or substituting for DIEV.

This study investigated alterations in platelet counts pre- and post-treatment with artemisinin derivatives in uncomplicated and severe falciparum malaria. Serial platelet counts were taken over 4 weeks for 110 uncomplicated and 110 severe falciparum malaria patients admitted to the Hospital for Tropical Diseases during 2005-2008. On admission, prior to treatment, thrombocytopenia was found in 73.6% of uncomplicated falciparum malaria patients and 90.9% of severe falciparum malaria cases. Platelet levels significantly lower in severe malaria cases. Although initial platelet counts were lower than normal in both study groups, they slowly increased significantly over time, and approached normal levels by several weeks post-treatment. No bleeding was evident during treatment, and none of the patients required a platelet transfusion. Platelet transfusions are not required for malaria patients with thrombocytopenia who have no bleeding.

Multiple sclerosis (MS) typically affects young adults; however, the first symptoms can occur after age 50 and is classified as late-onset MS (LOMS).  In this retrospective study, we extracted the records of 3522 MS patients (2716 females and 806 males) registered in the Isfahan MS Society (IMSS) from 2003 to 2010. Next, we searched for LOMS cases. We aimed to compare these cases with 1698 non-LOMS subjects also extracted from the IMSS database. We found 48 LOMS patients (28 females and 20 males), which gave a crude frequency of 1.36%. The frequency by sex of LOMS in males (2.4%) was significantly greater than in females (1.0%, P = 0.002). The mean age at onset was 55.1 ± 4.3 years. The female to male ratio of 1.4:1 in these patients was significantly lower than in non-LOMS subjects (3.37:1, P = 0.003). The leading pattern of MS was relapsing-remitting (RR) in 62.5%, followed by primary progressive (PP) in 27.1%, and secondary progressive (SP) in 10.4%. Predominant presenting sympto...

Postpneumonic empyema complicates 5% of all pneumonia cases. The loculated fibrinopurulent stage cannot be resolved by drainage tube insertion alone; it requires a de ´briding limited thoracotomy. Recent reports of series seem to indicate that video-assisted thoracic surgery (VATS) can replace thoracotomy advantageously. Eighty-six cases of postpneumonic empyema were operated on in our institution during the last 12 years: 33 cases (group I) using limited thoracotomy (1985-1991) and 53 by VATS (1992)(1993)(1994)(1995)(1996). Data were collected prospectively for group II and retrospectively for the first group. The two populations were comparable in age, gender, stage of disease, and co-morbid status. There were no significant differences between the groups. VATS de ´bridement for loculated fibrinopurulent postpneumonic empyema offers better results than thoracotomy in terms of resolution of the disease and length of stay in hospital. It also seems to be more advantageous, resulting in fewer surgical sequelae, lower cost, less labor impediment, and better cosmesis.