Importance of familial predisposition to heart failure to the risk of anthracycline related cardiotoxicity: a nationwide study

Background/Introduction

Anthracycline-based chemotherapy has improved the prognosis in cancer and hematological malignancies but is associated with the development of heart failure (HF). Besides well-known cardiac risk factors and cumulative dose of anthracycline, recent research has suggested that genetic variations associated with cardiomyopathies may increase the risk of HF associated with anthracycline. However, the importance of familial predisposition for the risk of developing anthracycline associated cardiotoxicity is unknown.

Purpose

To evaluate the risk of anthracycline related HF in patients with vs. without a first-degree relative with HF.

Methods

In the nationwide Danish registries, patients treated with anthracycline from 2004–2016 were identified. Primary outcome was a subsequent diagnosis of HF. Follow-up was 10 years or December 31, 2017. Familial relations were identified in the Danish Family Registry, which hold all persons born since 1942. Exposure was a first-degree biological relative (parent or sibling) with a diagnosis of HF. Risk of HF was evaluated in a cumulative incidence function with death as competing event and in a Fine and Grey model adjusted for age, sex, prevalent ischemic heart disease, atrial fibrillation, hypertension and chronic obstructive pulmonary disease.

Results

A total of 11.651 patients (mean age 48.0 (SD±8.6), 12.2% male gender) were evaluated after exclusion of 46 with pre-anthracycline HF. Mean follow-up was 4.4 years (SD±2.9). In the group with a first-degree relative with HF (n=1.608) 35 patients (2.2%) was diagnosed with HF vs. 133 (1.3%) in the group without a first-degree relative with HF (n=10.043) corresponding to incidence rates per 1000 patient years of 5.2 (95% CI: 3.8–7.3) vs. 3.0 (95% CI: 2.5–3.5). The cumulative incidence of HF was higher in the first-degree relative HF group (Figure 1a), yielding an adjusted hazard ratio of 1.53 (95% CI: 1.05–2.24, p=0.03) for HF associated with anthracycline. All-cause mortality showed a trend towards higher risk in the later 5 years of follow-up in the first-degree relative HF group with a 10-year risk of 32.4% (95% CI: 28.4–36.5) vs. 26.1% (95% CI: 24.9–27.4) but no significant difference in the Kaplan-Meier estimate (p=0.08) (Figure 1b).

Conclusion

In this nationwide register-based study having a first-degree relative with HF was associated with a small but increased risk of anthracycline related HF, yielding attention towards the family predisposition, when estimating the risk of cancer therapy related cardiotoxicity.

Figure 1

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Odense University Hospital

Symptoms of depression at discharge after PCI are associated with an increased risk of 1-year mortality: findings from the national DenHeart study

Background

Although survival rates among patients with coronary artery disease have increased since the introduction of treatment with percutaneous coronary intervention, PCI, the effect of psychological factors such as symptoms of anxiety and depression on adverse outcomes are sparsely described.

Purpose

The objective of the current study was to investigate the association between symptoms of anxiety and depression and 1-year mortality after PCI.

Methods

A national cross-sectional survey at hospital discharge (responders, n=3,366) with register-based follow-up among patients having undergone elective or emergency PCI. Mental health was measured using the Hospital Anxiety and Depression Scale, HADS, and divided into symptoms of anxiety (HADS-A) and symptoms of depression (HADS-D). The association between mental health (HADS-A and HADS-D) and 1-year all-cause mortality were investigated with Cox Proportional Hazard models with time to death as the underlying time scale. The results are presented as hazard ratios (HR) with 95% confidence intervals (CI) and adjusted for sex, age and Tu-comorbidity score.

Results

At discharge, 32% of the population reported symptoms of anxiety (HADS-A ≥8) and 19% reported symptoms of depression (HADS-D ≥8). After one year, the mortality rate among patients being alive at discharge was 2.1%. All-cause mortality did not differ among patients reporting symptoms of anxiety compared to patients without symptoms of anxiety (2.3% vs 1.9%, p=0.454), whereas all-cause mortality was higher among patients reporting symptoms of depression compared to those, who did not (4.3% vs 1.6%, p≤0.001).

In the regression analyses, symptoms of anxiety (HADS-A ≥8) was not associated with 1-year mortality (HR 1.16 95% CI 0.70–1.92); however, symptoms of depression was (HADS-D ≥8, HR 2.27 95% CI 1.38–3.73, adjusted analyses). Based on the continuous scores of HADS-D, a one-point increase in scores was associated with a 12% higher risk of 1-year mortality (HR 1.12 95% CI 1.05–1.18) (Figure 1).

Conclusion

After PCI, nearly one-third of patient report symptoms of anxiety and one-fifth symptoms of depression. Symptoms of anxiety was not associated with 1-year mortality, whereas symptoms of depression increased the risk of 1-year mortality.

Figure 1

Funding Acknowledgement

Type of funding source: None

Determination of Crude Protein in Animal Feed, Forage, Grain, and Oilseeds by Using Block Digestion with a Copper Catalyst and Steam Distillation into Boric Acid: Collaborative Study

A collaborative study was conducted to evaluate the repeatability and reproducibility of an extension of AOAC Official Method 991.20, Nitrogen (Crude) in Milk, to animal feed, forage (plant tissue), grain, and oilseed materials. Test portions are digested in an aluminum block at 420°C in sulfuric acid with potassium sulfate and a copper catalyst. Digests are cooled and diluted, and concentrated sodium hydroxide is added to neutralize the acid and make the digest basic; the liberated ammonia is distilled by using steam distillation. The liberated ammonia is trapped in a weak boric acid solution and titrated with a stronger standardized acid, hydrochloric acid; colorimetric endpoint detection is used. Fourteen blind samples were sent to 13 collaborators in the United States, Denmark, Sweden, Germany, and the United Kingdom. Recoveries of nitrogen from lysine, tryptophan, and acetanilide were 86.8, 98.8, and 100.1%, respectively. The within-laboratory relative standard deviation (RSDr, repeatability) ranged from 0.40 to 2.38% for crude protein. The among-laboratories (including within-) relative standard deviation (RSDR, reproducibility) ranged from 0.44 to 2.38%. It is recommended that the method be adopted First Action by AOAC INTERNATIONAL. A lower concentration (1% H3BO3) of trapping solution was compared with the concentration specified in the original protocol (4% H3BO3) and was found comparable for use in an automatic titration system in which titration begins automatically as soon as distillation starts. The Study Directors recommend that 1% H3BO3 as an optional alternative to 4% boric acid trapping solution be allowed for automatic titrators that titrate throughout the distillation.

Moderate alcohol consumption and depression - a longitudinal population-based study in Sweden

BACKGROUND AND AIMS

The interrelationship between alcohol consumption and depression is complex, and the direction of the association is unclear. We investigated whether alcohol consumption influences the risk of depression while accounting for this potential bidirectionality.

METHODS

A total of 10 441 individuals participated in the PART study in 1998-2000, 8622 in 2001-2003, and 5228 in 2010. Participants answered questions on their alcohol consumption, symptoms of depression, childhood adversity, and sociodemographic, socioeconomic, psychosocial, and lifestyle factors. A total of 5087 participants provided repeated information on alcohol consumption. We used marginal structural models to analyze the association between alcohol consumption and depression while controlling for previous alcohol consumption and depressive symptoms and other time-varying confounders.

RESULTS

Non-drinkers had a higher depression risk than light drinkers (≤7 drinks/week) (risk ratio: 1.7; 95% confidence interval 1.3-2.1). Consumers of seven-fourteen drinks/week had a depression risk similar to that of light drinkers. Hazardous drinking was associated with a higher risk of depression than non-hazardous alcohol consumption (risk ratio: 1.8, 95% confidence interval: 1.4-2.4).

CONCLUSION

Light and moderate alcohol consumption and non-hazardous drinking were associated with the lowest risk of subsequent depression after accounting for potential bidirectional effects. Hazardous drinking increased the risk of depression.

What is the Correct Period of Bandaging following Sclerotherapy?

Two consecutive randomized trials following injection sclerotherapy for varicose veins compared 3 and 6 weeks bandaging in 148 patients and 1 to 3 weeks bandaging in 130 patients. Objective assessment and patient's symptoms, using a scoring system, correlated well and showed that there was no difference whatsoever between 3 and 6 weeks' bandaging after a 6 year follow-up. In the second trial, the patients who were bandaged for 3 weeks were significantly better (P < 0.001) than after only one week of bandaging at a maximum follow up of 4 years. Long term follow up of injection sclerotherapy for primary varicose veins suggests that 3 weeks is superior to 1 week bandaging, but that there is no additional advantage in continuing bandaging for six weeks.

Polymorphisms in the Renin-Angiotensin system and outcome of very-low-birthweight infants

BACKGROUND

The insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE-ins/del) and the angiotensin II type 1 receptor 1166A/C polymorphism (ATR1166A/C) were reported to be associated with several unfavorable outcome parameters in preterm infants like bronchopulmonary dysplasia, persistent ductus arteriosus and impaired insulin sensitivity.

OBJECTIVE

To confirm the above-mentioned associations in a large cohort of very-low-birthweight (VLBW) infants.

METHOD

Clinical data of VLBW infants were prospectively recorded. The ACE-ins/del polymorphism and the ATR1166A/C polymorphism were determined by polymerase chain reaction in 1,209 and 1,168 infants, respectively.

RESULTS

There was no significant association between ACE-ins/del or ATR1166A/C genotype and outcome parameters (death, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, ventilation, supplemental oxygen at discharge, postnatal treatment with insulin, surgery for intestinal perforation/necrotizing enterocolitis/retinopathy of prematurity/persistent ductus arteriosus.

CONCLUSION

Both known functional polymorphisms of the renin-angiotensin system do not seem to be associated with the outcome of VLBW infants.

Increasing the magnetic helicity content of a plasma by pulsing a magnetized source

By operating a magnetized coaxial gun in a pulsed mode it is possible to produce large voltage pulses of duration approximately 500 mus while reaching a few kV, giving a discrete input of helicity into a spheromak. In the sustained spheromak physics experiment (SSPX), it is observed that pulsing serves to nearly double the stored magnetic energy and double the temperature. We discuss these results by comparison with 3D MHD simulations of the same phenomenon.

New mode of operating a magnetized coaxial plasma gun for injecting magnetic helicity into a spheromak

By operating a magnetized coaxial plasma gun continuously with just sufficient current to enable plasma ejection, large gun-voltage spikes (approximately 1 kV) are produced, giving the highest sustained voltage approximately 500 V and highest sustained helicity injection rate observed in the Sustained Spheromak Physics Experiment. The spheromak magnetic field increases monotonically with time, exhibiting the lowest fluctuation levels observed during formation of any spheromak (B/B>/=2%). The results suggest an important mechanism for field generation by helicity injection, namely, the merging of helicity-carrying filaments.

Gliadin is a good substrate of several transglutaminases: possible implication in the pathogenesis of coeliac disease

BACKGROUND

Deamidation of distinct glutamines in HLA-DQ2 restricted gliadin epitopes, considered critical in the pathogenesis of coeliac disease (CD), can be mediated by tissue transglutaminase (tTG). To elucidate the possible role of other transglutaminases in CD we investigated whether different mammalian, microbial and vegetable transglutaminases can use gliadin as substrate.

METHODS

Studies in which small amounts of transglutaminase have been measured have led to our modifying a microtitre plate assay. We used proteolytically digested gliadin as solid phase substrate and Europium-labelled streptavidine to quantify the biotinylated product covalently linked by the enzyme to the plate.

RESULTS

The modified assay is ultrasensitive and quantitative, measuring guinea pig liver transglutaminase concentrations between 0.5 and 50 ng/well. The specific activities of the enzymes (counts/min/mg) against gliadin and N,N-dimethylcasein, respectively, are: tTG 9800/4900, Factor XIII 97330/55620, epidermal transglutaminase 47650/50770, streptoverticillium transglutaminase 4290/2200, phytophora cactorum transglutaminase 6910/4110. For the first time, we have detected transglutaminase activity in bean sprouts, spinach leaves and green peas, which are commonly used Vegetables.

CONCLUSION

Gliadin is a good substrate for endogenous, microbial and plant transglutaminases. An interesting altemative is that gliadins are deamidated by microbial or food transglutaminases in the intestinal lumen. The assay described provides an ultrasensitive method for measuring small amounts of transglutaminase and is considered a helpful tool in further studies of the possible role of transglutaminases in the pathogenesis of CD.

Suppression of MHD fluctuations leading to improved confinement in a gun-driven spheromak

Magnetic fluctuations have been reduced to approximately 1% during discharges on the Sustained Spheromak Physics Experiment by shaping the spatial distribution of the bias magnetic flux in the device. In the resulting quiescent regime, the safety factor profile is nearly flat in the plasma and the dominant ideal and resistive MHD modes are greatly reduced. During this period, the temperature profile is peaked at the magnetic axis and maps onto magnetic flux contours. Energy confinement time is improved over previous reports in a driven spheromak.

Within-person variation of plasma homocysteine and effects of posture and tourniquet application

BACKGROUND

Frequently, the result of only a single determination of total homocysteine in plasma (P-Hcy) is used to distinguish between the probability of the presence or absence of risk for vascular disease. A prerequisite for the interpretation of a single P-Hcy test is knowledge of the magnitude of within-person variation and the possible effects of preanalytical variables. However, data on within-person variation are still sparse and inconsistent, and data for the effect on P-Hcy of posture and tourniquet application during venipuncture are not available.

METHODS

The within-person variation of P-Hcy and the effects of posture and tourniquet application during venipuncture were studied in 24 healthy subjects. The analytical imprecision of our stable-isotope dilution assay was 3.1%.

RESULTS

The within-person variation (CV) was 8.1%. Daily supplementation with 0.4 mg of folic acid for 2 weeks produced a small but significant decrease in P-Hcy, but there were no significant changes in within-person variation before and after supplementation. After 30 min in the horizontal posture, P-Hcy declined by 6.3%. A 3-min tourniquet application caused a 2.8% increase of P-Hcy.

CONCLUSIONS

Our value for within-person variation is consistent with results from studies reported recently in the literature. A 3-min tourniquet application does not add appreciable variation to the measurement of P-Hcy, but the posture of the subject during venipuncture contributes considerably to the within-person variation. We recommend that blood collection when the patient is in a supine position be avoided.

Towards safer drug use in general practice

A voluntary, anonymous incident-monitoring study was set up to identify and characterize events or circumstances which could have or did harm a patient in general practice. The study included 673 practitioners who made 2582 reports, of which half (n = 1294) involved medication problems. Amongst these reports, 1556 adverse drug events (ADE) were identified. More common in general practice than in hospitals were problems with therapeutic use (26% vs. 8%), and prescribing of contraindicated medications (15% vs. 5%). In the latter group, 64 reports (4%) involved the prescription of a medication to which the patient was known to be allergic, 66 (4%) involved medication for which there was a recognized potential for a drug interaction, and 68 (4%) involved contraindicated medications due to pathophysiological factors. It was estimated that computer-based prescribing with decision support could eliminate at least a third of these problems in general practice. Further studies are needed to develop this and other preventive strategies.

At risk in two worlds: injury mortality among indigenous people in the US and Australia, 1990-92

This paper outlines the commonalties and unique differences in injury experience among the indigenous people in the United States and Australia. Injury mortality rates among Indigenous people in the United States and Australia are approximately 2-3 times greater than rates for the non-Indigenous population in each country. Motor vehicle-related injuries accounted for one-third of the injury deaths for Native Americans and Australian Aboriginals. Suicide accounted for more deaths in Native Americans (15.5 per 100,000) than it did for Australian Aboriginals (11.1 per 100,000), whereas the injury death rate in Australian Aboriginals due to poisoning was almost twice that of Native Americans. Culturally appropriate interventions tailored to specific local settings and problems will be necessary to reduce injury mortality among Indigenous people.

Fetal intracerebral hemorrhage in the second trimester: diagnosis by sonography and magnetic resonance imaging

Germinal matrix intraventricular hemorrhage has rarely been observed in the fetus. In most cases the etiology is clear. We report one case of prenatal diagnosis of a periventricular hemorrhage of uncertain etiology in a fetus of 22 weeks' gestation. For confirmation of the ultrasound diagnosis, antenatal magnetic imaging was performed. A male child was delivered in good condition at 37 weeks by Cesarean section. Postnatal ultrasound examination showed a cystic lesion in the right frontal lobe (10 x 10 mm) connecting with the right lateral ventricle. The development of the child at 18 months of age has been normal without any neurological impairment.

Body fluids, circadian blood pressure and plasma renin during growth hormone administration: a placebo-controlled study with two growth hormone doses in healthy adults

Side effects that can be related to fluid retention are common during the initial phases of growth hormone (GH) administration. The aim of this study was to examine the changes in body fluid compartments, diurnal blood pressure and plasma renin concentration during GH administration with two different dosages in healthy adults. Eight healthy male subjects aged 24-32 years were examined during three 2-week study periods in a double-blind placebo controlled study. They received, in random order, GH (3 or 6 IU m-2 daily) or placebo during 2 weeks. Bio-impedance was measured every 2nd day, and extracellular volume (ECV) and plasma volume (PV) were isotopically determined at day 6. Blood samples were obtained regularly. Diurnal blood pressure was recorded and 24-h urinary samples were collected at days 0, 6 and 14. ECV (l) was increased by GH (placebo, 19.58 +/- 0.82; 3 IU m-2, 20.77 +/- 1.22; 6 IU m-2, 20.65 +/- 0.94; p<0.01), whereas PV (l) was unaffected (placebo, 3.91+/- 0.20; 3 IU m-2, 4.04 +/- 0.22; 6 IU m-2, 3.90 +/- 0.27). Total body water (l) increased significantly during GH administration (placebo, 50.8 +/- 2.6; 3 IU m-2, 52.6 +/- 2.3; 6 IU m-2, 53.9 +/- 1.8, p<0.05). After 6 days of treatment a significant increase in renin (p = 0.03) was observed. Mean diurnal blood pressure levels remained unchanged, whereas mean diurnal heart rate (min-1) increased significantly (placebo, 75 +/- 3.6; 3 IU m-2, 79 +/- 3.2; 6 IU m-2, 79 +/- 3.7; p<0.01). In conclusion, GH administration induces an elevation in total body water which may involve a stimulation of plasma renin and an increased ECV without any changes in PV or diurnal blood pressure.

Normal basal and insulin-stimulated fuel metabolism in lean women with the polycystic ovary syndrome

Many reports have suggested that hyperandrogenaemic patients with the polycystic ovary syndrome (PCOS) may be insulin resistant. However, there have also been suggestions that their insulin resistance may relate to obesity and android fat distribution. To assess whether PCOS induces metabolic disturbances independently of obesity, we studied seven lean patients with PCOS (age, 27.1 +/- 2.0 yr; body mass index, 22.2 +/- 0.78 kg/m2; waist/hip ratio, 0.79 +/- 0.02; fat-free mass, 46.38 +/- 1.13 kg) and seven normal women (age, 25.7 +/- 1.4 yr; body mass index, 21.3 +/- 0.69 kg/m2; waist/hip ratio, 0.74 +/- 0.02; fat-free mass, 50.1 +/- 1.51 kg) for 3 h in the basal period and 2 h during a hyperinsulinemic (0.4 mU/kg.min) euglycemic clamp. In the basal state, comparable metabolic indices were recorded: serum insulin, 35.9 +/- 7.7 (PCOS) vs. 37.3 +/- 2.87 pmol/L (controls); plasma C-peptide, 364.1 +/- 66.2 vs. 397.2 +/- 66.2 pmol/L; plasma glucose, 4.95 +/- 0.09 vs. 4.77 +/- 0.09 mmol/L; forearm arterio-venous difference in glucose, 0.17 +/- 0.04 vs. 0.15 +/- 0.07 mmol/L; isotopically determined endogenous glucose production, 1.9 +/- 0.1 vs. 2.0 +/- 0.1 mg/kg.min; and serum nonesterified fatty acids, 545 +/- 40 vs. 617 +/- 54 mumol/L (all P > 0.05). During the clamp, all recordings were again similar: serum insulin, 282.7 +/- 21.5 vs. 270.5 +/- 13.6 pmol/L; plasma C-peptide, 331.0 +/- 33.1 vs. 364.1 +/- 66.2 pmol/L; plasma glucose, 4.99 +/- 0.07 vs. 4.99 +/- 0.05 mmol/L; glucose arterio-venous difference, 1.01 +/- 0.18 vs. 0.85 +/- 0.12 mmol/L; endogenous glucose production, -0.9 +/- 0.1 vs. -0.5 +/- 0.2 mg/kg.min; amount of exogenous glucose necessary to maintain euglycemia, 4.0 +/- 0.4 vs. 3.8 +/- 0.5 mg/kg.min; and nonesterified fatty acids, 205 +/- 7 vs. 246 +/- 18 mumol/L (all P > 0.05). By showing normal basal and insulin-stimulated substrate metabolism in lean hyperandrogenemic PCOS patients, these data suggest that insulin resistance may be an epiphenomenon, rather than a primary feature of PCOS.

A study of donor alloreactivity, which may predict acute graft-versus-host disease in HLA identical bone marrow transplantations for early leukaemia

Recent studies performed in Seattle, USA have suggested that pretransplant assignment of high or low donor alloreactivity may predict acute graft-versus-host disease (aGvHD) after allogeneic HLA identical marrow transplantation for acute leukaemia. The effect of such pretransplant assignment was studied in a Scandinavian population of 114 consecutive transplantations for acute and chronic leukaemias in 1st remission (n = 74) or chronic phase (n = 40) performed between 1975 and 1989. The selected cut-off value for discriminating between donors of high and low responding capacity (DRC) was based on distribution plots of results from the pretransplant mixed lymphocyte culture (MLC) and chosen as the median value (80% normalized response). Then 57 donors were assigned with high DRC and 57 donors assigned with low DRC. Kaplan-Meier estimates of the probability of patients to develop Grade II or higher aGvHD in receipt of high or low responder donor transplants were compared by univariant analysis. The patients in first remission or chronic phase transplanted with bone marrow from donors assigned as high or low responders had a 36.1% and 10.6% risk for aGvHD, respectively, a difference found to be significant by log rank test (chi-squared = 10.1, d.f. = 1, P = 0.0015). Subsequent studies of the cellular and humoral requirements for this predictive response of donor cells, by blocking with cytokine specific antibodies, addition of excess of recombinant human cytokines and scanning of lymphocyte subsets during the response, showed that the response against pool cells mostly depended upon IL-2 responding cells with the phenotype CD3+, CD4+, CD8-, CD25+, CD16-. It is concluded that prospective studies of alloreactivity as a risk factor should be performed to confirm the above findings.

Stimulation of AIDS lymphocytes with calcium ionophore (A23187) and phorbol ester (PMA): studies of cytoplasmic free Ca, IL-2 receptor expression, IL-2 production, and proliferation

We have studied whether the decreased lymphocyte proliferative responses of AIDS lymphocytes to stimulation by mitogens and antigens may be overcome when challenged with a combination of calcium ionophore A23187 and phorbol ester PMA. Comparison of the proliferative response of lymphocytes from nine patients with AIDS with the response of lymphocytes from nine control subjects showed that the response of AIDS lymphocytes was severely decreased when stimulated with PHA and no further response could be achieved by stimulation with A23187/PMA. On the other hand, no significant difference between the PHA-induced rise of cytoplasmic free calcium concentration ([Ca2+]1) in normal and AIDS lymphocytes was observed. The percentage of cells expressing IL-2 receptors (CD25) was also normal both after addition of PHA and after addition of A23187/PMA and the expression was normal on both CD4 and CD8 cells. The production of IL-2 in normal lymphocytes stimulated with A23187/PMA was 33 times higher than that after stimulation with PHA. In AIDS lymphocytes the production of IL-2 induced by all activators was severely decreased compared to control subjects, although the production of IL-2 after stimulation with A23187/PMA was higher than that in control lymphocytes after stimulation with PHA. The present study shows that a direct activation of protein kinase C combined with mobilization of cytoplasmic calcium does not overcome the lymphocyte proliferative deficiency of AIDS lymphocytes.

Poor co-ordination in 5 year olds: a screening test for use in schools

A simple standardized screening test (South Australian Motor Co-ordination Screening Test, SAM Test) was developed to screen for poor co-ordination in 5 year olds. This SAM Test, which can be used by teachers, nurses and doctors, has explicit pass/fail criteria and has classified correctly 90% of children. The McCarthy Motor Scales, which are time consuming and limited to use by psychologists, were used to categorize 60 poorly co-ordinated and 60 normal children. The 120 children thus selected were tested on 19 items covering gross and fine motor skills. Statistical analysis to determine which items best discriminated between the two groups found the following five gross motor items to be most effective: one leg balancing, hopping, heel-toe walking on line, jumping over ribbon and dropping ball and catching.

The case for scoliosis screening in Australian adolescents

A survey of 3660 Year 10 students, with an average age of 15 years, was carried out in a random sample of Adelaide secondary schools to determine the prevalence of structural scoliosis and the need for implementing a programme of scoliosis screening. By means of the Forward Bending Test and a specially devised scoring system 144 (3.9%) children were found to have signs that were suggestive of scoliosis; all but 12 were assessed subsequently by standardized clinical and radiological examinations. One hundred and three children were found to have structural scoliosis of 5 degrees or more; this represented a prevalence of 3.1%. The prevalence in girls (4.3%) was significantly higher than in boys (1.9%), and girls tended to have more severe curves and require treatment more frequently. Only one third (34) of the cases of structural scoliosis had been detected before this survey; most (28) of these had been detected through an earlier, subsequently discontinued, school screening programme. This study concludes that screening for scoliosis by means of a scored Forward Bending Test should be carried out in South Australian schools for all students in Year 8 and for girls in Year 10. The policy of screening boys in Year 8 should be the subject of further research. An educational programme for health professionals, parents, students and physical education teachers should support the programme.

Bed rest in twin pregnancy

A total of 146 twin pregnancies were studied to evaluate the importance of bed rest. A significantly reduced frequency of preterm delivery was found after bed rest in hospital as compared to bed rest at home or no bed rest at all. An increase in gestational age and in birth weight was seen after bed rest. No effect was found on the intrauterine increase of fetal weight per time. Early routine ultrasound is recommended, so that effective bed rest may be instituted in due time.

Human placental lactogen and dU-estrogen levels in normal twin pregnancies

Reference intervals for human placental lactogen (hPL) and dU-estrogens (dU-E) in uncomplicated twin pregnancies are found to be higher than singleton pregnancies and considerably wider. Significantly more monozygotic than dizygotic pregnancies, and significantly more monoplacental than diplacental pregnancies showed hPL values below the median on the normal range curve. The same was not found for dU-E. Significantly more growth-retarded fetuses were found in monoplacental than diplacental pregnancies. The benefit of measuring the two parameters in order to identify the intrauterine growth retarded fetuses were evaluated in terms of sensitivity and specificity. Both parameters were found less suitable for the purpose.

The technique of the Fontan procedure with posterior right atrium-pulmonary artery connection

A detailed technique is described for use of a modified Fontan procedure applicable to transposed as well as nontransposed anatomy. In the modified procedure, the use of circumferential grafting is eliminated, as are the complications arising from an anterior conduit in front of the aorta. Clinical results are reported for 9 young adults undergoing this operation.

Determination of mass spectrometric sensitivity of different metalloporphyrin esters relative to porphyrin ester

Quantitative determination of metalloporphyrin contamination in preparations of biologically important porphyrins was achieved mass spectrometrically by application of the integrated ion current technique. For this purpose, the relative molecular ion sensitivities of the contaminating metal complexes were determined from the ratios of the integrated molecular ion currents of a series of calibration samples containing a porphyrin ester and one of its metal complexes in known molar ratio. Complexes formed with divalent ions of Cu, Zn, Fe, Co and Ni of copro- as well as uro-porphyrin permethylester were all found to have the same molecular ion sensitivities as their metal-free porphyrin ester. The relative metalloporphyrin ester content in a sample of porphyrin ester was thus obtained directly as the integrated ion current ratios of the normalized molecular ions. The preparation of calibration samples, including complex formation and the mass spectrometric methodology, is described and discussed.