IDF Diabetes Atlas: A review of studies utilising retinal photography on the global prevalence of diabetes related retinopathy between 2015 and 2018

AIMS

The purpose of this study is to assess the prevalence of diabetic retinopathy (DR) world-wide from articles published since 2015 where the assessment of the presence and severity of DR was based on retinal images.

METHODS

A total of 4 databases were searched for the MESH terms diabetic retinopathy and prevalence. Of 112 publications 32 studies were included and individual data pooled for analysis. The presence of any DR or diabetic macular edema (DME) was recorded and severity as mild, moderate or severe non-proliferative DR (NPDR), proliferative DR (PDR) and DME and/or clinically significant macular edema (CSME). The level of severity of DR reported refer to persons with diabetes and not individual eyes.

RESULTS

The global prevalence of DR and DME, for the period 2015 to 2019 were 27.0% for any DR comprising of 25.2%, NPDR, 1.4% PDR and 4.6% DME. The lowest prevalence was in Europe at 20.6% and South East Asia at 12.5% and highest in Africa at 33.8%, Middle East and North Africa 33.8%, and the Western Pacific region at 36.2%.

CONCLUSIONS

This study illustrated difficulties in deriving a meaningful global prevalence rate for DR and DME due to the lack of uniformity in defining the study populations, methodological differences, retinal image capture and grading criteria. Therefore, international consensus is required using a minimal data set for future studies.

Properties and Function of the Flexor Hallucis Capsularis Interphalangeus Tendon

INTRODUCTION

The fibrocartilagenous plantar plates of the forefoot are biomechanically important, forming the primary distal attachment for the plantar aponeurosis. They are integral to the function of the windlass mechanism in supporting the arches of the foot in gait. Dissection of the cadaveric hallux revealed an organised sagittal thickening of the dorsal side of the flexor hallucis longus (FHL) sheath, which attached the interphalangeal plantar plate to the metatarsophalangeal (MTP) plantar plate. A description of a similar structure was made in 1984 when it was termed the flexor hallucis capsularis interphalangeus (FHCI) - however, it has not been researched since, and we aim to study it further and identify its characteristics.

METHOD

Eight specimens were dissected from four cadavers. Two were stained and examined under magnification in both polarized and non polarized light. The remaining 6 were subjected to micrometer testing of their tensile properties.

RESULTS

Both the histological features and mechanical properties were consistent with tendon; with cross sectional area, ultimate tensile strength and stiffness varying between specimens.

CONCLUSIONS

Based on its location and properties, the FHCI tendon may be involved in limiting dorsiflexion of the first MTP joint and could have clinical relevance in pathological processes around both the first and second MTP joints. Clin. Anat., 33:689-695, 2020. © 2019 Wiley Periodicals, Inc.

Cancer survivors' concealment or disclosure of diagnosis: Implications for return to work

BACKGROUND

The ability to return to work (RTW) is a significant quality of life indicator for many working aged cancer survivors. In the void of available support, many are left to independently navigate the RTW process which includes such important considerations as disclosure or concealment of diagnosis with concomitant sequellae.

OBJECTIVE

This article reviews participants' variable approaches to concealment, disclosure, or even an open educative stance as well as the associated benefits and limitations.

METHODS

Photovoice methods combined with interviewing.

RESULTS

While most participants disclosed their diagnosis and many extolled the benefits of an open, educative stance, there were drawbacks experienced. Similarly, those who concealed their diagnosis also experienced benefits and challenges.

CONCLUSIONS

In the current void of appropriate cancer rehabilitation supports, cancer survivors must independently negotiate their RTW process. Although most participants openly disclosed their diagnosis and associated limitations, a few concealed or camouflaged. There are benefits and limitations to both approaches of which survivors should be made aware at the outset as such will shape their RTW experience. Multidisciplinary rehabilitation support services would best guide survivors' management of the myriad of factors that will impact their work reintegration.

Acute shoulder injuries: A clinical review of diagnosis and management in the deployed Naval environment

Musculoskeletal injuries of the shoulder are a common presentation in primary care. Injuries to this highly mobile region can have a profound impact on the range of movement, resulting in severe functional limitation. The shoulder can also be one of the more complicated regions to examine due to its high mobility, poor localisation of pain and numerous supporting structures. This article aims to review the anatomy of the shoulder, examination technique and the pathology underlying common acute injuries in order to provide guidance to medical personnel deployed with the Royal Navy and Royal Marines.

Liver metastases from esophageal carcinoma: is there a role for surgical resection?

Esophageal cancer recurrence rates after esophagectomy are high, and locally recurrent or distant metastatic disease has poor prognosis. Management is limited to palliative chemotherapy and symptomatic interventions. We report our experience of four patients who have undergone successful liver resection for metastases from esophageal cancer. All underwent esophagectomy and were referred to our unit with metastatic recurrent liver disease, two with solitary metastases and two with multi-focal disease. The patients underwent multidisciplinary assessment and proceeded to a course of neoadjuvant chemotherapy followed by open or laparoscopic liver resection. Three patients were male, and the mean age was 57.5 (range 44-71) years. Response to chemotherapy ranged from partial to complete response. Following liver resection, two patients developed recurrent disease at 5 and 15 months, and both had disease-specific mortality at 10 and 21 months, respectively. The other two patients remain disease free at 22 and 92 months. Recurrent metastatic esophageal cancer continues to have a poor prognosis, and the majority of patients with liver involvement will not be candidates for hepatic resection. However, this series suggests that in selected patients, liver resection of metastases from esophageal cancer combined with neoadjuvant and adjuvant chemotherapy is feasible, but further research is required to determine whether this can offer a survival advantage.

Everolimus method comparison between Waters MassTrak™ Immunosuppressants XE (IUO) kit and an in-house laboratory developed LC-MS/MS method in renal transplant patients

Everolimus is an immunosuppressant drug that was approved for prophylactic use in the United States to prevent organ rejection in adult kidney and liver transplant recipients. Therapeutic drug management (TDM) is required to optimize the dose for efficacy and to minimize toxicity. Prior to the development of immunoassay reagents for everolimus, laboratory developed chromatographic methods were routinely used to support TDM for everolimus testing. However, the use of high performance liquid chromatography coupled to tandem mass spectrometry (HPLC-MS/MS)for everolimus TDM is not widely utilized in hospitals or transplant centers due to either a lack of mass spectrometry instrumentation or resources for assay development. An everolimus reagent kit and method was developed by Waters Corporation for use on the Waters ACQUITY TQD mass spectrometer system.

PURPOSE

The purpose for this study was to evaluate the investigational use only (IUO) Waters MassTrak Immunosuppressants XE (IUO) kit on a Waters ACQUITY(®) ultra performance liquid chromatography (UPLC) coupled to an ACQUITY(®) TQD mass spectrometer and to compare this test system to a laboratory developed mass spectrometry assay for everolimus.

METHOD

We evaluated precision and performed a patient comparison study on 56 renal transplant patients that received everolimus against a validated in house HPLC-MS/MS method.

RESULTS

5-day precision was performed on two patient pooled samples and analyzed in triplicate. Total imprecision for the low patient pool (3.77 ng/mL) and high patient pool (10.87 ng/mL) was <15 %CV. Deming regression analysis was performed for the patient comparison and the linear regression equation was y=0.973x+0.03, Sy/x 0.55, and the correlation coefficient was 0.9815.

CONCLUSION

The Waters MassTrak Immunosuppressants XE (IUO) kit and method had good correlation between the concentration range of 3-15 ng/mL to the established in-house HPLC-MS/MS method.

Diabetic retinopathy screening: perspectives of people with diabetes, screening intervals and costs of attending screening

AIMS

To obtain the views of people with diabetes about the provision of diabetic retinopathy screening services; and the interval of screening.

METHODS

Between October 2009 and January 2010, people with diabetes attending diabetic retinopathy screening clinics across Wales were asked to complete a questionnaire comprising of two parts: the first asking about their health, diabetes history, demographic characteristics and views about the diabetic retinopathy screening service, and the second asking about the costs of attending the screening.

RESULTS

The response rate was 40% (n = 621) from 1550 questionnaires distributed at diabetic retinopathy clinics, with 600 complete responses analysed. Respondents had a mean known duration of diabetes of 8.5 years (sd 7.8) and had attended for screening on average 3.2 times (sd 1.6) in the last 5 years. Sixty-eight per cent (n = 408) of respondents reported having their eyes screened approximately once a year. Eighty-five per cent (n = 507) felt that they should have their eyes screened every year. However, 65% (n = 390) of respondents would accept screening at 2- or 3-year intervals if medical evidence showed that it was safe. The reported personal costs incurred by respondents attending diabetic retinopathy screening were low.

CONCLUSION

Our study suggests that people with diabetes undergoing diabetic retinopathy screening would accept a greater screening interval, provided that adequate clinical evidence and medical reassurance were given.

Preferences of people with diabetes for diabetic retinopathy screening: a discrete choice experiment

AIMS

The ever-increasing prevalence of diabetes places pressure on the provision of diabetic retinopathy screening services. As the first study of its kind, we aimed to determine preferences for diabetic retinopathy screening in people with diabetes and to examine the trade-offs between frequency of screening and other service attributes.

METHODS

A questionnaire including a discrete choice experiment was administered to people (n = 198) attending diabetic retinopathy screening at eight clinics across Wales, United Kingdom. The discrete choice experiment contained eight pairwise choices in which screening provision was described by five attributes: frequency of screening; travel time; results time; ability of screening to detect other changes; and explanation of results. Data were analysed using logistic regression techniques.

RESULTS

We gained a response rate of 86.4% from the 198 questionnaires administered at clinics; 160 complete responses were analysed. Respondents valued four out of the five attributes [ability of screening to detect other changes (P = 0.000), explanation of results (P = 0.024), frequency of screening (P = 0.000) and travel time (P = 0.007)]. Results time was insignificant (P = 0.122). Respondents were willing to wait an additional 12, 2 and 1 month between screening tests to have a test that was able to detect additional changes, to have their results explained in person rather than by letter and to have a 15-min reduction in travel time, respectively.

CONCLUSIONS

Respondents were willing to accept a longer screening interval, as long as preferences for other attributes of service provision (ability of screening to detect other changes, explanation of results and travel time) were made available.

Incidence of diabetic retinopathy in people with type 2 diabetes mellitus attending the Diabetic Retinopathy Screening Service for Wales: retrospective analysis

OBJECTIVES

To determine the incidence of any and referable diabetic retinopathy in people with type 2 diabetes mellitus attending an annual screening service for retinopathy and whose first screening episode indicated no evidence of retinopathy.

DESIGN

Retrospective four year analysis.

SETTING

Screenings at the community based Diabetic Retinopathy Screening Service for Wales, United Kingdom.

PARTICIPANTS

57,199 people with type 2 diabetes mellitus, who were diagnosed at age 30 years or older and who had no evidence of diabetic retinopathy at their first screening event between 2005 and 2009. 49,763 (87%) had at least one further screening event within the study period and were included in the analysis.

MAIN OUTCOME MEASURES

Annual incidence and cumulative incidence after four years of any and referable diabetic retinopathy. Relations between available putative risk factors and the onset and progression of retinopathy.

RESULTS

Cumulative incidence of any and referable retinopathy at four years was 360.27 and 11.64 per 1000 people, respectively. From the first to fourth year, the annual incidence of any retinopathy fell from 124.94 to 66.59 per 1000 people, compared with referable retinopathy, which increased slightly from 2.02 to 3.54 per 1000 people. Incidence of referable retinopathy was independently associated with known duration of diabetes, age at diagnosis, and use of insulin treatment. For participants needing insulin treatment with a duration of diabetes of 10 years or more, cumulative incidence of referable retinopathy at one and four years was 9.61 and 30.99 per 1000 people, respectively.

CONCLUSIONS

Our analysis supports the extension of the screening interval for people with type 2 diabetes mellitus beyond the currently recommended 12 months, with the possible exception of those with diabetes duration of 10 years or more and on insulin treatment.

Liver resection for colorectal cancer metastases involving the caudate lobe

BACKGROUND

Up to 5 per cent of liver resections for colorectal cancer metastases involve the caudate lobe, with cancer-involved resection margins of over 50 per cent being reported following caudate lobe resection.

METHODS

Outcomes of consecutive liver resections for colorectal metastases involving the caudate lobe between 1996 and 2009 were reviewed retrospectively, and compared with those after liver surgery without caudate resection.

RESULTS

Twenty-five patients underwent caudate and 432 non-caudate liver resection. Caudate resection was commonly performed as part of extended resection. There were no differences in operative complications (24 versus 21·1 per cent; P = 0·727) or blood loss (median 300 versus 250 ml; P = 0·234). The operating time was longer for caudate resection (median 283 versus 227 min; P = 0·024). Tumour size was larger in the caudate group (median 40 versus 27 mm; P = 0·018). Resection margins were smaller when the caudate lobe was involved by tumour, than in resections including tumour-free caudate or non-caudate resection; however, there was no difference in the proportion of completely excised tumours between caudate and non-caudate resections (96 versus 96·1 per cent; P = 0·990). One-year overall survival rates were 90 and 89·3 per cent respectively (P = 0·960), with 1-year recurrence-free survival rates of 62 and 71·2 per cent (P = 0·340).

CONCLUSION

Caudate lobe surgery for colorectal cancer liver metastases does not increase the incidence of resection margin involvement, although when the caudate lobe contains metastases the margins are significantly closer than in other resections.

Comparison of SHO surgical logbooks a generation apart

There is current concern regarding operative experience obtained by senior house officers (SHOs) during basic surgical training prior to beginning registrar level. Anecdotally, working hours are greatly reduced compared to 20 years ago. The reduction in experience is attributed to the New Deal, which was introduced by the Department of Health in 1991 to improve working conditions for doctors, primarily through reduction of working hours to 76 per week maximum by 1996. In addition, Calmanisation, ie the introduction of the specialist trainee registrar grade of training, and the recent introduction of the European Working Time Directive (EWTD) have both had an effect on juniors' working hours.

Automated surgical screwdriver: Automated screw placement

The use of power screwdrivers and drills for tapping and screw insertion in surgery is becoming more common. It has been established from clinical observations that the use of a small air drill for inserting self-tapping screws provides improved coaxial alignment and precision, and that the drill should be stopped before the screw head is completely seated on the plate, presumably to reduce the risk of over-tightening. The risk of overrun and over-tightening during tapping and screw insertion is increased with the use of power tools. Prevention of over-tightening is dependent upon when the surgeon detects the onset of tightening, both visually and from the feel of the rapid increase in torque. If detection is too late, then over-tightening or stripping can occur. This study is concerned with using a mechatronic screwdriver to control the tapping depth and to prevent the over-tightening of screws. The effects of various parameters upon the torque profile during tapping and screw insertion have been investigated in synthetic bone and sheep tibia. An automated system is proposed for preventing over-tightening of pre-tapped and self-tapping screws when attaching a surgical plate to a sheep tibia in vitro. The system was used to attach a plate to a sheep tibia using self-tapping screws. The mean torque of the screws inserted using the automated system was 35 per cent of the stripping torque.

Recent Deformation in the Bottom Sediments of Western and Southeastern Lake Ontario and its Association with Major Structures and Seismicity

Geophysical surveys, undertaken in the Toronto-Burlington corridor of western Lake Ontario and in the Rochester Basin of southeastern Lake Ontario, revealed the presence of features affecting the young lake-bottom sediments. In the western part of the lake, they include inferred pop-ups in bedrock, and plumose structures, dark linear patterns, and linear belts of circular to elliptical signatures in the modern mud. In southeastern Lake Ontario the glacial and post-glacial sediments display vertical separations of on the order of 10-15 m. Pop-ups are tectonically-induced structures. The features in the modern mud commonly parallel the orientation of P-stresses measured in Paleozoic rocks nearby and, along with the pop-ups, are spatially related to an aeromagnetic lineament. Furthermore, all of these features occur within a seismically active belt. The vertical displacements of the layered glacial and post-glacial sediments, within the Rochester Basin, are located along the southern margin of the postulated WSW extension of the seismically active St. Lawrence rift system and are interpreted to be due to faulting. The geologically young age of the sediments affected by the various deformational features, along with the characteristics of the features themselves, suggest that the lake-bottom sediments surveyed in this study may have recorded the effects of neotectonic processes.

Altered cytokine expression in tissues of mice subjected to simulated microgravity

Space flight is known to induce microgravity-associated immune dysfunction in humans, non-human primates and rodents. To understand the mechanism underlying these defects, several studies in rodents have been conducted in a ground-based antiorthostatic suspension (AOS) model that would mimic the effects of microgravity. In all these in vivo studies that showed the effects on cytokine profiles actually investigated the ex vivo production from culturing the cells isolated from whole organism that was exposed to space flight and/or microgravity. So, the purpose of the study was to examine the in vivo expression of cytokines in mice in immunologically important tissue environments of mice that were subjected to AOS. Cytokines such as Interleukin-1beta, (IL-1beta), IL-2, IL-3, IL-6, Interferon-gamma (IFN-gamma) and Tumor Necrosis Factor-alpha (TNF-alpha) were measured by Enzyme Linked Immunosorbent Assay (ELISA) in the homogenates of spleen tissue, lymph nodes and also in serum of AOS mice and compared with that of control mice. AOS induced no change in the IL-3 levels, but IL-1beta was increased significantly whereas IL-2 levels decreased in spleen, lymph nodes and serum. IL-6 levels did not differ in spleen but were significantly increased in lymph nodes and serum of AOS mice. IFN-gamma levels in spleen did not change but showed nonsignificant reduction in lymph nodes and significant reduction in serum in response to AOS. TNF-alpha levels in spleen and serum were unchanged and increased in lymph nodes. This in vivo cytokine study confirms the earlier findings that microgravity-simulated conditions induce tissue-specific immune response.

Pressure recovery in pediatric aortic valve stenosis

This study was designed to evaluate the phenomenon of pressure recovery in pediatric patients with aortic stenosis and also to evaluate how observed differences between catheter and Doppler gradients can be predicted by Doppler echocardiography. Doppler measurements of aortic valve stenosis gradients are known to overestimate observed gradients in the catheterization laboratory. Pressure recovery has been shown to be a contributing factor to this discrepancy. However, the clinical relevance of correcting Doppler gradients using the pressure recovery equation has not been evaluated in the pediatric population. Simultaneously obtained catheter and Doppler gradients were studied in 14 patients (range, 0.03-18 years; mean, 4.1 years) with aortic valve stenosis. A total of 23 data points were measured because 9 patients underwent balloon valvuloplasty and had both a pre- and a post-balloon valvuloplasty data point in the study. The catheter gradients were then compared to peak, mean, and pressure recovery corrected Doppler gradients. Pressure recovery was calculated using a previously validated equation. As expected, measured echocardiographic continuous-wave peak Doppler gradients overestimated the observed catheter gradients (range, 16-93 mmHg; mean, 43 mmHg). The continuous-wave peak Doppler gradients, mean, and pressure recovery adjusted gradients were equally as good in correlating the observed catheter gradients to those obtained by Doppler echocardiography (r = 0.92). However, pressure recovery corrected Doppler gradients were in better agreement with catheter gradients than echocardiographic mean or peak Doppler gradients (95% limit of agreement: -9 to 19 mmHg for pressure recovery corrected gradients, -30 to 11 mmHg for mean Doppler gradients, and 2-83 mmHg for peak Doppler gradients). Measured continuous-wave peak Doppler gradients consistently overestimated catheter gradients. The noted differences may be predicted using the pressure recovery equation. Pressure recovery is a significant factor in children with aortic valve stenosis.

Antimicrobial activity of native chitosan, degraded chitosan, and O-carboxymethylated chitosan

The antimicrobial activity of native chitosan was compared to that of lipase-degraded chitosan. The effects of O-carboxymethylated (O-CM) substitution on native (molecular weight, 120; degree of deacetylation, 84.71%) and lipase-degraded chitosans were also investigated. The antimicrobial activity of native chitosan was more extensive than that of lipase-degraded chitosan; however, lipase-degraded chitosan was still highly effective and more water-soluble. O-CM chitosan derived from degraded chitosan was more effective than O-CM chitosan derived from native chitosan. O-CM substitution enhanced lipase-degraded chitosan's antimicrobial activity without reducing its solubility.

The nido-osmaboranes [2,2,2-(CO)(PPh(3))(2)-nido-2-OsB(5)H(9)] and [6,6,6-(CO)(PPh(3))(2)-nido-6-OsB(9)H(13)]

The structural characterization of the osmahexaborane 2-carbonyl-2,2-bis(triphenylphosphine)-nido-2-osmahexaborane(9), [Os(B(5)H(9))(C(18)H(15)P)(2)(CO)], (I), a metallaborane analogue of B(6)H(10), confirms the structure proposed from NMR spectroscopy. The structure of the osmadecaborane 6-carbonyl-6,6-bis(triphenylphosphine)-nido-6-osmadecaborane(13), [Os(B(9)H(13))(C(18)H(15)P)(2)(CO)], (IV), is similarly confirmed. The short basal B-B distance of 1.652 (8) A in (I), not bridged by an H atom, mirrors that in the parent hexaborane(10) [1.626 (4) A].

Three quantitative approaches to the diagnosis of abdominal pain in children: practical applications of decision theory

BACKGROUND/PURPOSE

The authors compared 3 quantitative methods for assisting clinicians in the differential diagnosis of abdominal pain in children, where the most common important endpoint is whether the patient has appendicitis. Pretest probability in different age and sex groups were determined to perform Bayesian analysis, binary logistic regression was used to determine which variables were statistically significantly likely to contribute to a diagnosis, and recursive partitioning was used to build decision trees with quantitative endpoints.

METHODS

The records of all children (1,208) seen at a large urban emergency department (ED) with a chief complaint of abdominal pain were immediately reviewed retrospectively (24 to 72 hours after the encounter). Attempts were made to contact all the patients' families to determine an accurate final diagnosis. A total of 1,008 (83%) families were contacted. Data were analyzed by calculation of the posttest probability, recursive partitioning, and binary logistic regression.

RESULTS

In all groups the most common diagnosis was abdominal pain (ICD-9 Code 789). After this, however, the order of the most common final diagnoses for abdominal pain varied significantly. The entire group had a pretest probability of appendicitis of 0.06. This varied with age and sex from 0.02 in boys 2 to 5 years old to 0.16 in boys older than 12 years. In boys age 5 to 12, recursive partitioning and binary logistic regression agreed on guarding and anorexia as important variables. Guarding and tenderness were important in girls age 5 to 12. In boys age greater than 12, both agreed on guarding and anorexia. Using sensitivities and specificities from the literature, computed tomography improved the posttest probability for the group from.06 to.33; ultrasound improved it from.06 to.48; and barium enema improved it from.06 to.58.

CONCLUSIONS

Knowing the pretest probabilities in a specific population allows the physician to evaluate the likely diagnoses first. Other quantitative methods can help judge how much importance a certain criterion should have in the decision making and how much a particular test is likely to influence the probability of a correct diagnosis. It now should be possible to make these sophisticated quantitative methods readily available to clinicians via the computer.

An efficient method for the cryopreservation of fetal human liver hematopoeitic progenitor cells

The use of human hematopoietic progenitor cells (HPC) for transplantation requires efficient recovery methods and cryopreservation procedures. The purpose of this study was to determine cryopreservation techniques for fetal human liver (FHL) CD34(+) cells. We assessed FHL HPC recovery efficiency after freezing and thawing by viability testing, fluorescence-activated cell sorting analysis, and colony-forming ability under different conditions. We also determined optimal cell freezing concentrations and the effect of rate-controlled freezing on cell recovery. Lastly, cell recovery after varying freezing time periods was examined. Our results indicated that optimal cell recovery occurs when: A) cryopreservation medium consists of either 5% dimethylsulphoxide (DMSO) or 10% DMSO in combination with either 20% fetal bovine serum (FBS) or 70% FBS and when Iscove's modified Dulbecco's medium consists of not more than 10% DMSO; B) a rate-controlled freezing device container is used; C) CD34(+) cells are frozen at a concentration of 1 x 10(6)/ml, and D) a thawing temperature of 37 degrees C is used. These observations indicate that cryopreservation of FHL HPC is possible for up to 18 months in optimal conditions without losing hematopoietic activity.

Left ventricular dysfunction after long-term right ventricular apical pacing in the young

OBJECTIVES

The goal of this study was to assess long-term global left ventricular (LV) function in patients paced from the right ventricular (RV) apex at a young age.

BACKGROUND

Ventricular contraction asynchrony with short-term RV apical pacing has been associated with reduced LV pump function and relaxation. The long-term effect of RV apical pacing on global LV function in the young remains unknown.

METHODS

Twenty-four patients with normal segmental anatomy paced from the RV apex (follow-up 1 to 19 years) underwent noninvasive assessment of global LV function with automated border detection echocardiography-derived fractional area of change (FAC), coupled with the Doppler index of myocardial performance (MPI). Data were analyzed from 24 RV-paced patients (mean follow-up 9.5 years, age 19 years, body surface area [BSA] 1.6 m2, QRS duration 140 ms) and compared with 33 age- and BSA-matched control subjects (age 16.4 years, BSA 1.6 m2). Multiple linear regression analysis was performed to identify patient variables that can affect these indexes of LV function.

RESULTS

Assessment of LV function (median follow-up 10 years) in 24 paced patients demonstrated impaired area- and Doppler flow-derived indexes of LV systolic and diastolic function, compared with those indexes of control subjects (FAC: 52% vs. 60%, p < 0.01; MPI: 0.46 vs. 0.34, p < 0.01). Paced QRS interval and age were found to significantly influence global LV contraction in these patients (R2 = 0.4, p < 0.05).

CONCLUSIONS

In the presence of impaired LV function with long-term RV apical pacing, alternative sites of ventricular pacing that simulate normal biventricular electrical activation should be explored to preserve function in pediatric patients in need of long-term pacing.

Low Levels of Interleukin‐8 and Interferon‐Inducible Protein–10 in Serum Are Associated with Fatal Infections in Acute Lassa Fever

To investigate the role of inflammatory mediators in the pathogenesis of Lassa fever, the levels of a number of pro- and anti-inflammatory cytokines and chemokines in serum samples collected from hospitalized patients with fatal and nonfatal acute Lassa fever were compared with those from 2 control groups: patients with other febrile illnesses and uninfected individuals. Serum interleukin (IL)-8 and interferon (IFN)-inducible protein (IP)-10 levels were significantly higher in patients with acute nonfatal Lassa fever than in control subjects. In striking contrast, levels of these chemokines were low or undetectable in patients with fatal Lassa fever. IFN-gamma, IL-12, IL-6, and RANTES levels were elevated in all the febrile study groups. Tumor necrosis factor-alpha levels were not elevated in patients with fatal or nonfatal Lassa fever. These data indicate that acute nonfatal Lassa fever is associated with high levels of circulating IL-8 and IP-10 and that low levels or absence of these mediators correlates with a poor outcome.

Preliminary results comparing two methods of lateral column lengthening

Forty-five patients (49 feet) underwent lateral column lengthening as treatment for painful pes planus. Twenty-five patients (27 feet) were available for both radiographic and clinical evaluation at least one year postoperatively. Of these 25 patients, 10 feet underwent Evans opening wedge osteotomy with tricortical iliac crest bone graft; 17 feet underwent calcaneocuboid distraction arthrodesis utilizing iliac crest bone graft. In addition, both groups underwent debridement of the posterior tibial tendon combined with transfer of the flexor digitorum longus into the navicular for reinforcement. Radiographic results documented marked improvement in all parameters. There was more improvement in the calcaneocuboid fusion group than the osteotomy group, but the difference was not statistically significant. Postoperative AOFAS rating scores averaged 87.9 for the osteotomy group and 80.9 for the distraction arthrodesis group. The difference was not statistically significant. Twenty of 25 patients (83.5%) in both groups were very satisfied. Twenty-four of 25 patients (96%) stated that knowing the final result they would have the same surgery again. Complications were reported for 32 patients (34 feet). Both the Evans opening wedge calcaneal osteotomy and calcaneocuboid distraction arthrodesis offer significant improvement in the radiographic parameters and AOFAS clinical scores for patients with painful, flexible flatfoot deformity. However, the complication rate remains high with both methods, and the rate of nonunion and delayed union with the calcaneocuboid distraction arthrodesis method remains a significant problem with this technique.

Tensile and shear stresses in the orthodontic attachment adhesive layer with 3D finite element analysis

The tests commonly used for the evaluation of orthodontic adhesives measure tensile and shear bond strength. The two methods were compared with finite element analysis using a three-dimensional model and the effect of misalignment of the tensile and shear forces was calculated. Applying a shear load produces significant compressive and tensile stresses in the adhesive layer. Under ideal conditions of shear loading, the induced tensile stress is over 5 times the induced shear stress. The model shows that a tensile load induces predominantly tensile stresses in the adhesive layer. The calculations indicate that the tensile test method is a robust testing method with low sensitivity to misalignment of the applied load.

Mass spectrometric identification of increased C16 ceramide levels during apoptosis

A variety of molecular changes occur during the process of apoptosis. Much of the recent work has focused on changes in critical cellular proteins, proteins necessary for the initiation and continuation of the apoptotic process. Given the fact that numerous membrane changes occur throughout the apoptotic process, we initiated an investigation aimed at determining the major lipid changes that occurred during programmed cell death. When ionizing radiation was used to initiate the apoptotic process in Jurkat cells, one of the major changes that occurred within 24 h was an increase in a species with a m/z of 572 as determined by negative ion electrospray mass spectrometry. This particular mass ion displayed high performance liquid chromatography characteristics of a neutral lipid species. Further analysis by collision-induced-dissociation tandem mass spectrometry indicated only one daughter species indicative of a Cl adduct and therefore a parental mass of 537. Comparison to a commercial C16 ceramide yielded identical spectra by mass spectrometry (MS) and MS/MS analysis in the negative ion mode. Increases in C16 ceramide levels occurred 2 h after initiation of apoptosis by ionizing radiation, and its accumulation paralleled apoptosis as determined by cellular morphology. Interestingly, radiation-sensitive Jurkat cells displayed increased levels of long term C16 ceramide accumulation, whereas radiation-resistant K562 cells did not. These findings were supported by increases in caspase-3 activity in Jurkat cells, whereas caspase-3 activity in K562 cells remained unchanged. C16 ceramide accumulation and sensitivity to ionizing radiation was investigated further in a melanoma cell line. Only those cells that were radiation sensitive (approximately 70-75%) displayed increases in long term ceramide accumulation. Taken together, these results indicated a correlation between increases in C16 ceramide accumulation and radiation sensitivity. Increases in long term C16 ceramide accumulation were also seen in Fas-induced apoptosis, which occurred at time points greater than 2 h. Analysis of mitochondrial modifications using the mitochondrial probe nonyl acridine orange (NAO) indicated that initial increases in C16 ceramide levels closely paralleled the decrease in mitochondrial mass during Fas or radiation-induced apoptosis. Taken together, these results support a role for C16 ceramide in the effector (mitochondrial) phase of apoptosis.

The structure of a PKD domain from polycystin-1: implications for polycystic kidney disease

Most cases of autosomal dominant polycystic kidney disease (ADPKD) are the result of mutations in the PKD1 gene. The PKD1 gene codes for a large cell-surface glycoprotein, polycystin-1, of unknown function, which, based on its predicted domain structure, may be involved in protein-protein and protein-carbohydrate interactions. Approximately 30% of polycystin-1 consists of 16 copies of a novel protein module called the PKD domain. Here we show that this domain has a beta-sandwich fold. Although this fold is common to a number of cell-surface modules, the PKD domain represents a distinct protein family. The tenth PKD domain of human and Fugu polycystin-1 show extensive conservation of surface residues suggesting that this region could be a ligand-binding site. This structure will allow the likely effects of missense mutations in a large part of the PKD1 gene to be determined.

A comparison of group and individual remembering: does collaboration disrupt retrieval strategies?

M. S. Weldon and K. D. Bellinger (1997) showed that people who collaborate on a recall test (collaborative group) perform much more poorly than the same number of people tested individually (nominal group). Four experiments tested the hypothesis that retrieval-strategy disruption underlies this collaborative inhibition when categorized lists are studied. Collaborative groups performed worse than nominal groups when categories were large (Experiment 1) and when category names were provided at recall (Experiment 2). However, collaborative- and nominal-group recall were equivalent when participants retrieved nonoverlapping parts of the list (Experiment 3) and when participants were forced to organize their recall by category (Experiment 4). Clearly, disorganized retrieval can account for collaborative inhibition with the materials and procedures used here.

A comparison of group and individual remembering: does collaboration disrupt retrieval strategies?

M. S. Weldon and K. D. Bellinger (1997) showed that people who collaborate on a recall test (collaborative group) perform much more poorly than the same number of people tested individually (nominal group). Four experiments tested the hypothesis that retrieval-strategy disruption underlies this collaborative inhibition when categorized lists are studied. Collaborative groups performed worse than nominal groups when categories were large (Experiment 1) and when category names were provided at recall (Experiment 2). However, collaborative- and nominal-group recall were equivalent when participants retrieved nonoverlapping parts of the list (Experiment 3) and when participants were forced to organize their recall by category (Experiment 4). Clearly, disorganized retrieval can account for collaborative inhibition with the materials and procedures used here.

Myositis ossificans: an unusual presentation in the foot

Myositis ossificans is a non-neoplastic lesion characterized by heterotopic ossification of soft tissue. At varying stages of maturity, it shares similar histologic characteristics with sarcomatous lesions or maturing bone. Misdiagnosis can result in unnecessary radical treatment. This lesion has only rarely been reported in the foot. We present the case of a patient with plantar forefoot myositis ossificans.

Minor psychiatric morbidity, its prevalence and outcome in a cohort of civil servants--a seven-year follow-up study

During the years 1979-1986, a cohort of direct entrant executive officers in the Civil Service were followed up to examine the prevalence and outcome of minor psychiatric morbidity in an occupational setting. All studies using epidemiological standardized research methods agree that prevalence rates are high in occupational settings. As in primary care settings, half of the illness episodes followed a chronic course, which emphasizes the need for early detection and prompt management of these conditions, and for evaluative studies of intervention strategies.

Radiographic changes in the first metatarsal head after distal chevron osteotomy combined with lateral release through a plantar approach

The purpose of this study was to evaluate the development of clinically significant avascular necrosis of the head of the first metatarsal after: (1) distal metatarsal osteotomy of the chevron configuration beginning apically at the center of the metatarsal head and extending into the head metatarsal neck junction and (2) release of the adductor hallucis muscle, the lateral capsulosesamoid ligament, and the lateral head of the flexor hallucis brevis via fibular sesamoidectomy in the majority of procedures (71/77). Although there were initial radiographic findings suspicious of avascular necrosis, subchondral lucencies (28 feet), mottling (40 feet), and focal lucencies (29 feet) in 76% of the feet, at final follow-up (12-43 months, average 25 months) this figure had fallen to 25%. The range of motion of the first metatarsophalangeal joint and articular symptoms were important in this study because of the assumption that these two parameters of evaluation would correspond to the severity of radiographic evidence of avascular necrosis. Only those patients (8 feet) with persistent mottling at final follow-up had a statistically significant decrease in the average range of motion (P = .013), with 51 degrees total arc of motion compared with 64 degrees total arc of motion for the remainder. There were no patients with persistent radiographic changes suggesting avascular necrosis who complained of pain.(ABSTRACT TRUNCATED AT 250 WORDS)

Open laparoscopy for an adnexal mass in pregnancy. A case report

Adnexal masses requiring surgical intervention in pregnancy occur at a frequency cited as 1 in 81-2,500. We present an alternative to exploratory celiotomy applicable in special cases. Open laparoscopy can provide definitive information on adnexal masses without the operative time, incision size or morbidity associated with exploratory celiotomy.

A one-year experience in the antenatal evaluation of suspected abdominal wall and bowel defects at a military tertiary referral center

A variety of fetal abdominal wall defects and bowel anomalies are detected or suspected antenatally at institutions providing primary, secondary, and tertiary level care. Presented is a summary of a 1-year experience at a tertiary care center demonstrating a working referral network and its advantages. Of the 10 cases presented, 8 were referred and 2 originated from within our institution. The initial diagnosis was uncertain or differed from the final diagnosis in half of referred cases. Within the military, a reliable route for referral enhances prenatal evaluation and provides intensive neonatal support at delivery if needed and more immediately available surgery if indicated.

Prenatal diagnosis of giant cystic hygroma: prognosis, counselling, and management; case presentation and review of the recent literature

Cystic hygromas have historically been associated with a grim prognosis when discovered during prenatal sonographic study of the fetus. This same grim prognosis is not observed by the paediatric surgeon who evaluates the neonate or paediatric patient. We present a fetal patient with a massive anterior cystic hygroma discovered in the third trimester prior to 30 weeks. This case and a review of the literature suggest tailoring the prognosis by category when counselling patients: (1) first trimester, normal karyotype--good; (2) first trimester, abnormal karyotype--poor; (3) second trimester and early third--poor to guarded; and (4) mid to late third trimester--good.

Pregnancy complicated by Goodpasture syndrome

Goodpasture syndrome is characterized by pulmonary hemorrhage, glomerulonephritis, and an autoantibody to glomerular basement membrane antigens. Current management of this potentially lethal disease consists of glucocorticoids to control pulmonary hemorrhage, cytotoxic drugs to inhibit further renal damage, and plasma exchange to clear circulating anti-basement membrane antibodies. These treatment modalities pose difficult management issues during pregnancy. We describe a successful pregnancy outcome in a parturient with Goodpasture syndrome. Antepartum care included serial pulmonary and renal evaluations. In patients without disease progression, a favorable outcome may be possible.