Ethanol vapour-fixation of rat lung for immunocytochemistry investigations

Ethanol-vapour fixation of rat lung has been successfully employed in the immunocytochemical detection of the gastrin mucin antigen termed mucin 5AC without the need of additional antigen retrieval steps. This procedure gives good morphological preservation and provides all the benefits associated with the microscopic examination of inflated lung tissue. This simple fixation technique provides another option for use in immunocytochemical investigations of rodent lung and could be adapted for other species.

The ACE gene and Alzheimer's disease susceptibility

A recent study suggested that the insertion (I) allele in intron 16 of the angiotensin converting enzyme gene (ACE) is associated with Alzheimer's disease (AD) risk. In our series of 239 necropsy confirmed late onset AD cases and 342 elderly non-demented controls aged >73 years, we found significantly different ACE genotype distributions in the case and control groups (p=0.007). Homozygotes for both the I and D alleles were associated with a higher risk compared to DI heterozygotes. While the APOE epsilon4 allele was strongly associated with AD risk in our series, we found no evidence for an interaction between the APOE and ACE loci. In addition, no interactions were observed between ACE and gender or age at death of the AD cases. A meta-analysis of all published reports (12 case-control series in total) suggested that both the II and ID ACE genotypes are associated with increased AD risk (odds ratio (OR) for II v DD 1.36, 95% confidence interval (CI)=1.13-1.63, OR for DI v DD 1.33, 95% CI=1.14-1.53, p=0.0002).

[Innovative teaching, a successful invention: the European Academy for Medicine of Ageing (EAMA). The viewpoint of teachers and students]

INTRODUCTION

The origins of the EAMA (European Academy for Medicine of Aging) course are described in this paper by the Scientific Committee of this new post-graduate teaching activity.

CURRENT KNOWLEDGE AND KEY POINTS

Innovations are constantly introduced to improve training methodology so as to enable the students to update their knowledge, help them improve their skills in data gathering and in the critical interpretation of information, and exchange geriatric experience and know-how. To reach such goals, an interactive teaching method is implemented by the professors, with world experts being called in to ensure scientific soundness and quality. Evaluations by students and teachers are regularly carried out with the aim of perfectly adjusting their training methodologies and increasing the scientific level of exchanges.

FUTURE PROSPECTS AND PROJECTS

If the students progress, so do the teachers....

Does the fly matter? the CRACKPOT study in evidence based trout fishing. The Collaborative Randomised and Controlled Kennet Piscatorial Options Trail (CRACKPOT) Investigators

OBJECTIVE

To investigate the importance of the type of dry fly (artificial floating fly) in catching trout (brown and rainbow) in an English chalkstream.

SETTING

River Kennet, Berkshire.

DESIGN

Five anglers on five separate occasions spent five hours using a randomly allocated fly from a sample of five types.

PARTICIPANTS

Five anglers of considerable but varying experience, determination, and opinion.

MAIN OUTCOME MEASURES

Number, weight, and species of trout caught.

RESULTS

One fly (Black Gnat) performed significantly worse than the others. The fly most successful in catching brown trout was the Cinnamon Sedge.

CONCLUSION

The possible prolongation of doctors' leisure time consequent on the use of unproductive trout flies has resource implications for the NHS. Urgent funding of a definitive, large multiriver trial is needed.

Removable partial dentures: the altered-cast technique

The altered-cast technique, also known as the corrected-cast technique, for distal extension removable partial dentures (RPD), is not routinely utilized by dentists. Although the technique requires an additional step for both the dentist and dental technician, it offers several advantages--maximum stability, minimal stress on abutment teeth, and more predictable occlusion. The following article describes the altered-cast technique, as well as some advantages and disadvantages of the technique. A quick and easy procedure for constructing an altered-cast is also presented.

Measurement of impact force, simulation of fall and hip fracture

It has been shown that the incidence of hip fracture in the elderly may be influenced by the type of floor covering commonly used in homes for the elderly. This study describes the development of a method for modelling a fall during a hip fracture event, to examine the influence of different floors on impact force. An impact transducer is dropped in free fall through a smooth plastic tube. The impactor nose of the transducer models the curvature of the greater trochanter, and a steel spring is used to simulate the compliance of the skeletal structure. A weight, which corresponds to one-sixteenth of average body mass, compresses the spring and applies force to the impactor nose on striking the floor. The temporal variation in the force of impact with the floor is measured by the transducer to within 0.41 percent (SD = 0.63%, n = 10). Five common floor coverings were tested over a concrete floor slab (vinyl, loop carpet and pile carpet--both with and without underpad). ANOVA analysis showed that the differences between mean forces for each floor covering were highly significant (p > 0.001), with the thicker coverings producing 7 percent lower forces. The transducer may be used to examine the correlation between impact force and fracture incidence for a variety of different floors in homes for the elderly.

Secular trends in proximal femoral fracture, Oxford record linkage study area and England 1968-86

OBJECTIVE

To study hospital admission rates for fractures of the proximal femur over a period when incidence is reported to have increased, compensating for known lack of precision in coding, excluding nonemergency admissions and transfers, and modelling for age, period, and cohort effects.

DESIGN

Validation of coding of a sample of hospital admissions followed by study of two sets of routinely collected statistical abstracts of hospital records; graphical analysis and statistical modelling were used to search for period and cohort effects.

SETTING

Oxfordshire and west Berkshire in 1968-86, covered by the Oxford record linkage study (ORLS), and ENGLAND in 1968-85, covered by the hospital inpatient enquiry (HIPE). The ORLS and HIPE datasets are almost independent (ORLS contributed about 1.8% of the HIPE data).

SUBJECTS

Records of patients aged 65 and over.

OUTCOME MEASURES

Admission rates for fractured neck of femur and fracture of other and unspecified parts of femur (N820 and N821), and evidence of period and cohort effects.

RESULTS

The validation study indicated that it was important to combine the codes 820 and 821 in this age group. Admission rates increased over the period studied in both HIPE and ORLS datasets. In HIPE the pattern was of two plateaux separated by a period of rapid rise in the late 1970s. In the ORLS data there was a more steady rise. Statistical analysis showed significant period and cohort effects but much of this was attributable to the component of the model common to both period and cohort effects (termed "drift").

CONCLUSIONS

The finding that admission rates increased in both datasets, combining relevant codings and restricting analysis to emergency admissions, strongly suggests that the rise was real. At least part of the period effect in the HIPE data, however, might be attributable to a sampling artefact. The cohort effect in incidence rates of femoral fracture has not been previously shown and would be compatible with a number of aetiological hypotheses.

The incidence of diabetes mellitus in an English community: a 20-year follow-up of the Whickham Survey

The original Whickham Survey documented the prevalence of diabetes and lipid disorders in a sample of 2779 adults aged 18 years and over, which matched the British population structure. The aim of the 20-year follow-up study was to determine the incidence and natural history of diabetes. Outcomes in terms of morbidity and mortality at follow-up were determined in over 97% of the original population. Ninety-four subjects had been identified and treated for diabetes since the first survey, including 17 subjects identified as having a fasting plasma glucose > or = 7.8 mmol l-1 at follow-up. The incidence of diabetes for the total population was 2.2 1000-1 year-1 (95% confidence interval 1.8, 2.6). The risk factors identified at first survey were corrected for age, cut-off at the 95 centile and entered into a log linear model. Those which strongly predicted development of diabetes in the total population were fasting blood glucose (odds ratio (OR) (with 95% confidence intervals) = 2.3 (1.5, 3.5)) and body mass index (OR = 2.2 (1.5, 3.3)) in men, and fasting blood glucose (OR = 2.6 (1.7, 4.1)) and fasting serum triglyceride (OR = 2.8 (1.8, 4.4)) in women. A logit model has enabled the calculation of the probability of developing diabetes 20 years later. It was the characteristics of becoming older such as obesity, hypertriglyceridaemia, and raised fasting blood glucose, rather than age itself, which were associated with the development of diabetes.

General medicine and geriatrics, where is the difference? The example of infective disease

Geriatric medicine differs from internal medicine not in quality, but rather in the probability structures of diagnosis and outcome, presentation of illness and the need for explicit determination of aim of intervention. Older people need more investigation than the young if comparable levels of diagnostic accuracy are to be obtained. In view of the progressive loss of adaptability with its loss of sufficient functional and social reserves, the old more often need a formal program of rehabilitation than younger patients. Infectious diseases exemplify this difference. Age associated impairment of immunity, such as lower T-cell activity and IL-2 production, are associated with an increasing lethality of infections, and permit the reactivation of latent infections. The loss of adaptability has its impacts on mental functioning by increasing the risk of delirium as a consequence of infectious diseases or drug side effects. The cryptic presentation of illness makes even severe infections such as endocarditis, peritonitis or tuberculosis difficult to diagnose. The traditional exclusion of older people from research studies contributed to the still prevailing underestimation of the complexity and need of adequate therapy in geriatric patients.

Mobility after proximal femoral fracture: the relevance of leg extensor power, postural sway and other factors

We studied 40 previously healthy women (median age 83 years 90% central range 77-90) 1 week after surgical fixation of their proximal femoral fracture to establish the significance of leg extensor power, postural sway, age, pre-injury mobility and fracture type in recovery of walking and stair-climbing ability. Subjects demonstrated a range of walking and stair-climbing abilities. Those not mobile all had sway greater than 40.9 cm/1 min and were more likely to have suffered a trochanteric fracture (p < 0.05). These subjects were not the oldest or those with the worst pre-injury mobility, but did report much greater pain (p < 0.05). Multiple linear regression revealed leg extensor power in the fractured leg (LEPf) to be the most important determinant of walking speed (R2 0.40, p < 0.001) and stair climbing time (R2 0.33, p < 0.002). LEPf was less than in the uninjured leg (p < 0.001), and accounted for only 30% of the total power output. LEPf was determined by pain, and not pre-injury mobility or fracture pattern. These findings have implications for the development of rehabilitation programmes.