Kinetics and kinematics after the Bridle procedure for treatment of traumatic foot drop

BackgroundThe Bridle procedure restores active ankle dorsiflexion through a tri-tendon anastomosis of the tibialis posterior, transferred to the dorsum of the foot, with the peroneus longus and tibialis anterior tendon. Inter-segmental foot motion after the Bridle procedure has not been measured. The purpose of this study is to report kinetic and kinematic variables during walking and heel rise in patients after the Bridle procedure.Methods18 Bridle and 10 control participants were studied. Walking and heel rise kinetic and kinematic variables were collected and compared using an ANOVA.FindingsDuring walking the Bridle group, compared with controls, had reduced ankle power at push-off [2.3 (SD 0.7) W/kg, 3.4 (SD 0.6) W/kg, respectively, P < .01], less hallux extension during swing [? 13 (SD 7)°, 15 (SD 6)°, respectively, P < .01] and slightly less ankle dorsiflexion during swing [6 (SD 4)°, 9 (SD 2)°, respectively, P = .03]. During heel rise the Bridle group had 4 (SD 6)° of forefoot on hindfoot dorsiflexion compared to 8 (SD 3)° of plantarflexion in the controls (P < .01).InterpretationThis study provides evidence that the Bridle procedure restores the majority of dorsiflexion motion during swing. However, plantarflexor function during push-off and hallux extension during swing were reduced during walking in the Bridle group. Abnormal mid-tarsal joint motion, forefoot on hindfoot dorsiflexion instead of plantarflexion, was identified in the Bridle group during the more challenging heel rise task. Intervention after the Bridle procedure must maximize ankle plantarflexor function and midfoot motion should be examined during challenging tasks.     

Evaluation of a novel colorimetric assay for free oxygen radicals as marker of oxidative stress

BackgroundFree oxygen radicals play an important role in the pathogenesis of many diseases including cardiovascular disease, diabetes, hypertension, cancer and aging. Several methods were developed for the direct or indirect measurement of oxygen free radical and its byproducts. The free oxygen radicals monitor (FORM) is a novel point-of-care system for the rapid measurement of free oxygen radicals (FORT) in blood. We have carefully evaluated the use of this assay for batch analysis of plasma samples in a research environment with respect to factors affecting its performance, including storage temperature and duration.MethodsWe determined the effect of storage, hemolysis, variability and reproducibility of the FORT in blood and plasma.ResultsPlasma FORT correlated significantly with hsCRP (P < 0.0001) and CHOL/HDL ratio (P < 0.02). While hsCRP results have shown agreater range of assay variability (27.82%–53.92%), FORT measurements in the same samples have less assay variability (5.63%–9.61%). Collected whole blood can be kept on ice for up to 7 h prior to plasma isolation without affecting FORT values. Storage of plasma has no effect on FORT when stored at 4 °C for up to 3 weeks (R² = 0.685). Comparable values can be obtained in samples stored for up to 3 months at ? 80 °C (R² = 0.5888) but not at ? 20 °C.ConclusionsThe day to day variability of FORT, as assessed by multiple measures in a group of controls over time, is minimal. FORT assay isstable when stored at ? 80 °C for a couple of months or at 4 °C for a few weeks. FORT correlation with hsCRP and other lipid markers provides an interesting insight and a novel link between oxidative stress, inflammation and lipid metabolism.     

Plasma HDL-cholesterol and triglyceride levels in familial hypercholesterolemia: data from the MedPed CZ database and the Czech population

BackgroundThe aim of this study was to compare HDL-cholesterol and triglyceride levels in patients with familial hypercholesterolemia (FH) with a representative sample of the Czech population.MethodsFor the FH group: data of 1728 adult patients with FH (600 males and 1128 females) were taken from the MedPed CR database. The control group were 1995 individuals of the population sample of the Czech post-MONICA study (956 males and 1039 females).ResultsCompared with controls, FH males showed higher levels of HDL-cholesterol (1.35 ± 0.35 mmol/l vs. 1.31 ± 0.35 mmol/l; P < 0.05) and triglycerides (1.98 ± 1.00 vs. 1.81 ± 1.45 mmol/l; P < 0.01). After adjustment for age and BMI, the increase in triglycerides remained significant in the subgroup of non-FDB males only (2.22 ± 0.06 vs. 1.74 ± 0.04 mmol/l; P < 0.001). Compared with controls, HDL-cholesterol was lower (1.55 ± 0.40 mmol/l vs. 1.65 ± 0.37 mmol/l; P < 0.001), while triglycerides were higher (1.72 ± 0.82 mmol/l vs. 1.28 ± 0.75, P < 0.001) in FH females. After adjustment for age and BMI, HDL-cholesterol remained lower in the subgroup of FH females without FDB (1.52 ± 0.01 vs. 1.67 ± 0.01 mmol/l, P < 0.001) whereas triglycerides were higher in both female subgroups.ConclusionsA lower HDL-C in the group of FH patients compared with control subjects was demonstrated in FH females without FDB only. Elevated triglyceride levels were found in FH males and females, except for males with FDB.     

Gamma-glutamyl transferase level predicts the development of hypertension in Hong Kong Chinese

BackgroundPlasma activities of alkaline phosphatase, alanine aminotransferase (ALT), aspartate aminotransferase, and γ-glutamyl transferase (GGT) are often increased in cardiometabolic diseases. We investigated if hypertension is associated with increased activities of these plasma markers.MethodsWe included 235 hypertensive and 708 normotensive subjects (mean age 47.3 ± 9.6 and 58.0 ± 10.2 years respectively) from the Hong Kong Cardiovascular Risk Factor Prevalence Study-2 (CRISPS-2) in 2000–2004 who had drank < 1/week. In the follow-up study in 2005–2008 (CRISPS-3), 126 out of the 708 subjects had developed hypertension.ResultsRaised plasma ALT (OR = 1.22 per SD of log-transformed level, P = 0.045) and GGT (OR = 1.38 per SD of log-transformed level, P = 0.001) levels were associated with hypertension at baseline in CRISPS-2 after adjusting for covariates. Among subjects not on anti-hypertensive medications, plasma ALP, ALT and GGT were related to blood pressure (P < 0.01). In subjects normotensive at CRISPS-2, plasma GGT, but not ALP, ALT and AST, was an independent predictor of new-onset hypertension at CRISPS-3 (OR = 1.38 per SD of log-transformed level, P = 0.020 and OR = 2.68 for 3rd tertile vs. 1st tertile, P = 0.004) after adjusting for covariates.ConclusionsAmong the 4 plasma markers, increased GGT activity is the strongest predictor for existing and new-onset hypertension in Hong Kong Chinese.     

Quality of life and brace-treated idiopathic scoliosis: a cross-sectional study performed at the Centre des Massues on a population of 120 children and adolescents

ObjectivesTo determine the influence of orthopedic treatment on quality of life (QoL) in children and adolescents with idiopathic scoliosis and treated with either the carbon brace (CMCR, corset monocoque carbone respectant la respiration) or the Lyon brace. To compare these braces.Patients and methodsA cross-sectional study on a population of 120 patients with idiopathic scoliosis, visiting for routine evaluation following the onset of an orthopedic treatment at the Centre des Massues in Lyon. Eighty-two patients used the carbon brace and 38 patients used the Lyon brace. The patients completed the SRS-22 questionnaire (where a low score means a bad QoL), an evaluation scale of QoL specific to spinal deformities, and visual analogue scales (VAS) for pain, motivation and QoL ranging from 0 to 100 mm.ResultsThe QoL of Lyon brace-treated patients is significantly worse than that of patients treated with a carbon brace for the overall score (mean ± SD, 4.05 ± 0.37 vs 3.77 ± 0.46, P = 0.002) as well as for function (P = 0.01), pain (P = 0.001), and appearance (P = 0.004). These results are confirmed by the VAS for QoL (P = 0.001).ConclusionThe use of the carbon brace and of the Lyon brace induces a reduction in QoL whatever the evaluation tool, either SRS-22 or VAS. However, the use of the Lyon brace impairs QoL more than the use of the carbon brace.     

Increased internal femoral torsion can be regarded as a risk factor for patellar instability — A biomechanical study

BackgroundIncreased internal femoral torsion is regarded as a risk factor for patellar instability. Biomechanical investigations confirming this hypothesis are missing.MethodsEight fresh-frozen cadaver knees were tested on a specially designed simulator. Patellar motion and patellofemoral pressure were evaluated for 0°, 10°, and 20° of increased internal and external femoral torsion with native and with transected medial patellofemoral ligaments used to simulate patellar instability. A regression analysis was used for statistical analysis.FindingsIn native medial patellofemoral ligaments, there were no significant changes in mean or peak pressures for any torsional states (P ≥ 0.07). At 20° increased internal femoral torsion, there was a significant center of force shift towards the lateral side (P = 0.01). Patellar shift was directed laterally at low knee flexion angles up to 30°. Lateral patellar tilt increased significantly at 10° and 20° of increased internal femoral torsion (P ≤ 0.004). In transected medial patellofemoral ligaments, mean pressure (P ≤ 0.005) and peak pressure (P ≤ 0.02) decreased significantly for all torsional states. There was a significantly greater lateral center of force shift with increased internal femoral torsion (P ≤ 0.04). Lateral patellar tilt increased significantly (P < 0.001). Patellar shift did not change significantly with increased internal femoral torsion (P ≥ 0.30).InterpretationIn a native medial patellofemoral ligament, 20° of increased internal femoral torsion can be regarded as a significant risk factor for patellar instability. With an insufficient medial patellofemoral ligament, 10° of increased internal femoral torsion already represents a significant risk factor.     

Association of beta 1-adrenergic receptor gene polymorphisms with left ventricular hypertrophy in human essential hypertension

ObjectivesExperimental evidence support a key role for beta (1)-adrenergic receptor (ADRB1) in the modulation of cardiac mass. This relationship has not yet been described in Chinese population. The goal of our study was to investigate the relationships between ADRB1 gene polymorphisms and left ventricular structure in human essential hypertension.Design and methodsA total of 2417 hypertensive patients were successfully investigated. The polymorphisms of ADRB1 gene (Arg389Gly and Gly49Ser) were genotyped by using PCR-RFLP and confirmed by sequencing.ResultsPatients carrying the Arg389Arg genotype had an increase in the left ventricular septal thickness (10.4 ± 1.5 mm vs. 9.6 ± 1.5 mm, P < 0.01 or 9.4 ± 1.4 mm, P < 0.01); left ventricular posterior wall thickness (10.4 ± 2.4 mm vs. 9.6 ± 2.4 mm or 9.7 ± 2.9 mm, P < 0.01); left ventricular mass index (51.6 ± 13.3 g/m^2.7 vs. 44.6 ± 12.9 g/m^2.7, P < 0.01 or 43.2 ± 14.4 g/m^2.7, P < 0.01) and relative wall thickness (45.0 ± 9.0% vs. 42.6 ± 8.1%, P < 0.01 or 43.2 ± 8.8%, P < 0.01) as compared with those carrying genotypes Arg389Gly and Gly389Gly. These associations were independent of anthropometric factors and major clinical features and were replicated in another independent hypertensive population (n = 327).ConclusionsOur findings show that the Arg389Gly polymorphism of the ADRB1 gene confers higher risk of left ventricular hypertrophy in human essential hypertension.     

Serum brain-derived neurotrophic factor in patients with type 2 diabetes mellitus: Relationship to glucose metabolism and biomarkers of insulin resistance

ObjectivesThe aims of this study were to measure serum levels of brain-derived neurotrophic factor (BDNF) in patients with type 2 diabetes mellitus (T2DM) and to investigate the association of these BDNF levels with biomarkers of glucose metabolism and insulin resistance.Design and methodsWe studied 112 patients with T2DM and 80 age- and gender-matched control subjects.ResultsSerum BDNF levels were significantly lower in patients with T2DM compared to control subjects (15.5 ± 5.2 ng/mL vs. 20.0 ± 7.3 ng/mL, P < 0.01). In patients with T2DM, BDNF levels were significantly higher in females than in males (P < 0.01). In the female patients, BDNF was positively related to immunoreactive insulin (IRI) (ρ = 0.458, P < 0.05) and HOMA-R (ρ = 0.444, P < 0.05). Stepwise multiple regression analysis showed a significant relationship between BDNF and IRI (F = 5.294, P < 0.05) in female patients with diabetes.ConclusionsThese findings suggest that BDNF may contribute to glucose metabolism.     

A genetic variant in the gene encoding adrenomedullin predicts the development of dysglycemia over 6.4 years in Chinese

BackgroundAdrenomedullin, a vasodilatory peptide, facilitates the differentiation of pre-adipocytes, and affects lipolysis and glucose uptake. We investigated the association of common single nucleotide polymorphisms (SNPs) in the gene encoding adrenomedullin (ADM) with dysglycemia in the Hong Kong Chinese population.MethodsFour SNPs were genotyped in 1391 subjects without dysglycemia at baseline from the Hong Kong Cardiovascular Risk Factor Prevalence Study-2, which had a median follow-up time of 6.4 years. Dysglycemia included impaired fasting glucose, impaired glucose tolerance, and diabetes according to the WHO 1998 criteria. At follow-up, 382 subjects had developed dysglycemia.ResultsIn stepwise logistic regression, the SNP rs11042725 was a significant independent predictor of the development of dysglycemia (OR = 1.31, P = 0.012), together with baseline age (P < 0.001), plasma triglycerides (P < 0.001), body mass index (P = 0.004), 2-h glucose after oral glucose tolerance test (P < 0.001), homeostasis model assessment of insulin resistance index (P = 0.045), and follow-up duration (P = 0.009). The association was more significant in women (P = 0.002) and in subjects without regular exercise (P = 0.001).ConclusionsOur study suggests a potential role of genetic variants in the ADM gene in the development of dysglycemia in our local Chinese population.     

Analysis of amplitude spectral area and slope to predict defibrillation in out of hospital cardiac arrest due to ventricular fibrillation (VF) according to VF type: Recurrent versus shock-resistant

BackgroundIn out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF), VF may recur during resuscitation (recurrent VF) or fail to defibrillate (shock-resistant VF). While retrospective studies have suggested that amplitude spectral area (AMSA) and slope predict defibrillation, it is unknown whether the predictive power is influenced by VF type. We hypothesized that in witnessed OHCA with initial rhythm of VF that the utility for AMSA and slope to predict defibrillation would differ between shock-resistant and recurrent VF.MethodsAMSA and slope were measured immediately prior to each shock. For second or later shocks, VF was classified as recurrent or shock-resistant. Cardiac arrest was classified according to whether the majority of shocks were for recurrent VF or shock-resistant VF.Results44 patients received 98 shocks for recurrent VF and 96 shocks for shock-resistant VF; 24 patients achieved ROSC in the field. AMSA and slope were higher in recurrent VF compared to shock-resistant VF (AMSA: 28.8 ± 13.1 vs 15.2 ± 8.6 mV Hz, P < 0.001, and slope: 2.9 ± 1.4 vs 1.4 ± 1.0 mV s^?1, P = 0.001). Recurrent VF was more likely to defibrillate than shock-resistant VF (P < 0.001). AMSA and slope predicted defibrillation in shock-resistant VF (P < 0.001 for both AMSA and slope) but not in recurrent VF. Recurrent VF predominated in 79% of patients that achieved ROSC compared to 55% that did not (P = 0.10).ConclusionsIn witnessed OHCA with VF as initial rhythm, recurrent VF is associated with higher values of AMSA and slope and is likely to re-defibrillate. However, when VF is shock-resistant, AMSA and slope are highly predictive of defibrillation.     

Vital and functional outcomes of the first-ever hemispheric stroke, epidemiological comparative study between Kunming (China) and Limoges (France)

BackgroundClinical outcomes and socioeconomic consequences after a stroke may differ between regions.MethodsOne cohort was established prospectively in Kunming (China) to compare with a cohort of 156 stroke patients included in Limoges (France). During 1 year, patients hospitalized within 48 hours for a first-ever hemispheric stroke were included. Demographic data and neurocardiovascular risk factors were registered. Hemiplegia was evaluated. Functional outcome was assessed using the Barthel Index (BI) after 3 months.ResultsOne hundred and eighteen patients were included in Kunming. Patients of Kunming were younger (61.4 ± 13.4 vs 72.3 ± 14.6 years in Limoges, P < 0.0001), more involved in professional activity (36.4% vs 12.8%, P < 0.0001). Survival analysis indicated that mortality did not differ between cohorts, but independently predicted by coma at the 2nd day (HR = 9.33, 95% CI [4.39, 19.78]) and age > 70 years (HR = 6.29, 95% CI [2.36, 16.59]). Despite a better baseline BI for patients of Kunming (50.0 ± 34.9 vs 37.4 ± 34.2, P = 0.0031), after adjustment for confusing, patients in Limoges had a 2.11 OR 95% CI [1.03, 4.31]) to reach a BI > 80 at 3 months.ConclusionsFunctional recovery for patients of Kunming was not as good as expected. The socioeconomic consequences of stroke in Kunming are significant as they involved younger subjects who were still in work.     

Determination of protein-incorporated methylated arginine reference values in healthy subjects whole blood and evaluation of factors affecting protein methylation

ObjectivesProtein arginine methylation is a post-translational modification involved in the regulation of signal transduction, RNA export, and cell proliferation. Reference values of arginine methylation of whole blood proteome remain to be determined.Design and methodsAsymmetric dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) and monomethylarginine (MMA) incorporated in whole blood protein and methionine, cysteine and homocysteine plasma levels from 134 healthy subjects were measured by capillary electrophoresis.ResultsThe mean protein-incorporated concentration of the selected population was 4.11 ± 0.77 nmol/mg protein for ADMA; 1.66 ± 0.42 nmol/mg protein for SDMA and 4.31 ± 1.17 nmol/mg protein for MMA. Multiple correlation analysis showed that plasma Hcy was positively related to incorporated protein ADMA (P = 0.002) and MMA (P = 0.049).ConclusionsThe study was able to define a reference value for protein-incorporated ADMA, SDMA and MMA levels and found a positive association between protein-incorporated ADMA and plasma homocysteine.     

Impact of CYP3A4*1G polymorphism on metabolism of fentanyl in Chinese patients undergoing lower abdominal surgery

PurposeThis study aimed to investigate the impact of CYP3A4*1G genetic polymorphism on metabolism of fentanyl in Chinese patients undergoing lower abdominal surgery.Methods176 patients receiving elective lower abdominal surgery under general anesthesia were recruited into this study. Genotyping of CYP3A4*1G was carried out by direct sequencing. The plasma fentanyl concentration was detected 30 min after anesthesia induction by high performance liquid chromatography–ultraviolet ray (HPLC–UV). The visual analog scale (VAS) was used for pain evaluation at rest during patient-controlled analgesia (PCA) treatment 0 h, 12 h and 24 h after operation. PCA fentanyl consumption and adverse effects were recorded during the first 24 h after surgery.ResultsThe frequency of CYP3A4*1G variant allele was 0.227 (80/352, 95% CI 0.165, 0.289) in these patients. After grouping according to the genotype of CYP3A4*1G, plasma fentanyl concentration in the *1/*1 variant (wild-type) group (12.8 ± 6.5 ng/ml) was significantly lower than that in the *1/*1G group (16.8 ± 9.0 ng/ml, P < 0.01) and the *1G/*1G group (28.1 ± 9.5 ng/ml, P < 0.01). Patients in the *1G/*1G group (247.1 ± 73.2 μg) consumed significantly less fentanyl than that in either the wild-type group (395.0 ± 138.5 μg) or the *1/*1G group (359.8 ± 120.2 μg) (P < 0.01). There was a significant correlation between plasma fentanyl concentration and PCA fentanyl consumption (r = ?0.552, P < 0.001).ConclusionsCYP3A4*1G polymorphism is related to the pharmacokinetics of fentanyl, and patients with CYP3A4*1G variant A allele have a lower metabolic rate of fentanyl. The specific CYP3A4*1G polymorphism may predict the individual requirement of fentanyl.     

The Effect of Body Position on Pulmonary Function,Chest Wall Motion,and Discomfort in Young Healthy Participants

ObjectiveThe purpose of this study was to investigate the effect of different recumbent positions on pulmonary function, chest wall motion, and feelings of discomfort in young nonobese healthy volunteers.MethodsTwenty healthy volunteers (age, 28.0 ± 1.4 years; height, 167.5 ± 10.1 cm; weight, 62.3 ± 10.2 kg) were studied in the sitting position and in the following 6 recumbent positions: supine, left retroversion at a 45° tilt, left anteversion at a 45° tilt, right retroversion at a 45° tilt, right anteversion at a 45° tilt, and prone. After 5 minutes of a selected position, pulmonary functions, including vital capacity (VC), forced expiratory volume in 1 second, maximal inspiratory and expiratory mouth pressures (MIP and MEP, respectively), and breathing pattern components at the chest wall were assessed. Discomfort was assessed using a modified Borg scale.ResultsWhen participants changed position from sitting to each of the 6 recumbent positions, forced expiratory volume in 1 second values decreased significantly (P < .05). None of the participants showed changes in the MIP or MEP in any of the 6 recumbent positions. Rib cage motion was restricted in all recumbent positions except supine, left anteversion at a 45° tilt, and prone. In all 6 recumbent positions, discomfort was experienced during the pulmonary tests. However, in the left retroversion at a 45° tilt position, no discomfort was experienced during the MIP and MEP assessments.ConclusionIn young, nonobese, healthy volunteers, recumbent positions caused diminished pulmonary functions and induced feelings of discomfort.     

Effects of temperature and light on the stability of bilirubin in plasma samples

BackgroundAlthough it is known that bilirubin is photo-sensitive, detailed effects of both temperature and artificial light exposure on bilirubin stability in plasma have not been well investigated. We determined the impact of temperature and artificial light on bilirubin stability in plasma.MethodsPlasma total and direct bilirubin were analyzed using a diazo method. The aliquots of 38 samples were stored at 3 °C and 22 °C with light protection for 2, 4, 8, and 24 h respectively before analysis. The aliquots of 20 samples with normal bilirubin and additional 20 with elevated bilirubin were exposed to artificial light for 2, 4, 8, 24, and 48 h at 22 °C, and total and direct bilirubin were measured. The differences between the baselines and subsequent measurements were analyzed with analysis of variance.ResultsThe baseline total bilirubin was 9.6 ± 8.1 mg/dl (mean ± SD) and the concentrations were 9.6 ± 8.2, 9.0 ± 7.4, 9.0 ± 7.5, and 8.8 ± 7.5 mg/dl at 3 °C and 9.5 ± 8.1, 9.0 ± 7.4, 9.6 ± 8.1, and 9.5 ± 8.0 mg/dl at 22 °C after 2, 4, 8, and 24 h (p > 0.05, n = 38). The baseline direct bilirubin was 1.3 ± 1.2 mg/dl and the concentrations after 2, 4, 8, and 24 h were 1.4 ± 1.2, 1.4 ± 1.2, 1.5 ± 1.2, and 1.3 ± 1.1 mg/dl at 3 °C and 1.4 ± 1.1, 1.3 ± 1.1, 1.3 ± 1.1, and 1.3 ± 1.0 mg/dl at 22 °C (p > 0.05, n = 19). In samples with elevated bilirubin exposed to light at 22 °C, the baseline total and direct bilirubin concentrations were 10.2 ± 1.7 mg/dl and 5.0 ± 1.9 mg/dl, respectively. After 2, 4, 8, 24, and 48 h, total bilirubin concentrations were 10.1 ± 1.8, 10.0 ± 1.8, 10.0 ± 1.8, 9.3 ± 2.0 (p > 0.05, n = 20), and 8.4 ± 2.3 (p < 0.01, n = 20) mg/dl and direct bilirubin concentrations were 4.9 ± 1.8, 4.9 ± 1.9, 4.8 ± 1.8, 4.2 ± 1.6 (p > 0.05, n = 20), and 3.5 ± 1.5 (p < 0.01, n = 20) mg/dl. For samples with normal bilirubin levels under the same conditions, the average baseline total and direct bilirubin concentrations were 0.7 ± 0.1 mg/dl and below the lower limit of quantification (LLOQ), respectively. After 2, 4, 8, 24, and 48 h, the average total bilirubin concentrations were 0.7 ± 0.1, 0.6 ± 0.1, 0.6 ± 0.1 (p > 0.05, n = 20), 0.5 ± 0.1, and 0.4 ± 0.1 mg/dl (p < 0.01, n = 20) and direct bilirubin concentrations were still below LLOQ.ConclusionsBilirubin in plasma is stable in refrigerator or at room temperature without light exposure for at least 24 h. In normal laboratory environment, a delay of up to 8 h in the measurement of bilirubin left unprotected from light at room temperature does not significantly affect the results. Under these conditions, the changes in bilirubin concentration are not clinically significant until 24 h (direct bilirubin) and after 48 h (total bilirubin).     

Validation of the Taiwanese version of the Athens Insomnia Scale and assessment of insomnia in Taiwanese cancer patients

ContextIt is well known that insomnia is highly prevalent in cancer patients. Although various studies have used the Athens Insomnia Scale (AIS) for insomnia assessment, it has never been applied to cancer patients with insomnia.ObjectivesThe purpose of this study was to establish the reliability and validity of the Taiwanese AIS version (AIS-T) and evaluate the severity of insomnia among cancer patients in Taiwan.MethodsUsing a cross-sectional research design, 195 cancer patients (n = 195) were recruited from outpatient oncology clinics.ResultsCronbach’s alpha for internal consistency was 0.83, and the test-retest reliability was 0.94 over an interval of three days, based on a sample of 30 patients. Moreover, concurrent validity could be evaluated by significant correlations of the AIS-T with the Pittsburgh Sleep Quality Index-Taiwan form (PSQI-T) (r = 0.82, P < 0.001) and sleep efficiency measured by Actiwatch parameters (r = ?0.54, P < 0.001). Construct validity could be established by the Brief Fatigue Inventory-Taiwan form (r = 0.56, P < 0.001) and Medical Outcomes Study Short Form-36-Taiwanese version (physical component summary: r = ?0.52, P < 0.001; mental component summary: r = ?0.53, P < 0.001). The AIS-T could detect significant known-group validity from sleep quality (PSQI-T ≥5 or <5, respectively). The Actiwatch parameters are consistent with the results of the AIS-T, and both data sets indicate that patients experienced sleep disturbances. The prevalence of insomnia, as defined by the criteria of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4th ed., was 22.56%; 49.2% subjects had significant insomnia at the score ≥6 at AIS-T.ConclusionThis study concludes that the AIS-T is a reliable and valid instrument for assessing insomnia among cancer patients in Taiwan.     

Fear of falling as seen in the Multidisciplinary falls consultation

Fear of falling may be as debilitating as the fall itself, leading to a restriction in activities and even a loss of autonomy.ObjectivesThe main objective was to evaluate the prevalence of the fear of falling among elderly fallers. The secondary objectives were to determine the factors associated with the fear of falling and evaluate the impact of this fear on the activity “getting out of the house”.Patients and methodProspective study conducted between 1995 and 2006 in which fallers and patients at high risk for falling were seen at baseline by the multidisciplinary falls consultation team (including a geriatrician, a neurologist and a physical medicine and rehabilitation physician) and then, again 6 month later, by the same geriatrician. The fear of falling was evaluated with a yes/no question: “are you afraid of falling?”.ResultsOut of 635 patients with a mean age of 80.6 years, 502 patients (78%) expressed a fear of falling. Patients with fear of falling were not older than those who did not report this fear, but the former were mostly women (P < 0,001), who experienced more falls in the 6 months preceding the consultation (P = 0.01), reported more frequently a long period of time spent on the floor after a fall (P < 0.001), had more balance disorders (P = 0.002) and finally, were using more frequently a walking technical aid (P = 0.02). Patients with fear of falling were not going out alone as much as the fearless group (31% vs 53%, P < 0.0001). Eighty-two percent of patients in the fearful group admitted to avoiding going out because they were afraid of falling.ConclusionThe strong prevalence of the fear of falling observed in this population and its consequences in terms of restricted activities justifies systematically screening for it in fallers or patients at risk for falling.     

Relationship of age-related concentrations of serum FSH and LH with bone mineral density, prevalence of osteoporosis in native Chinese women

BackgroundFollicle-stimulating hormone (FSH) and luteinizing hormone (LH) may play an important role in bone mass regulation in postmenopausal women.MethodsA cross-sectional study of 699 healthy Chinese women, aged 20 to 82 y, was conducted. Serum FSH and LH and BMD were measured at the posteroanterior (PA) spine, lateral spine, total hip, and distal forearm.ResultsThe geometric mean values (± SD) of serum FSH and LH in premenopausal women were 3.94 ± 2.08 and 7.51 ± 2.58 IU/l, respectively, and in postmenopausal women were 28.8 ± 1.88 and 25.6 ± 1.95 IU/l, respectively. The correlation of FSH to BMD at different skeletal regions (r = ? 0.597 – ? 0.492, P = 0.000) was higher than that of LH to BMD (r = ? 0.452 – ? 0.332, P = 0.000). The prevalences of osteoporosis for the quartiles of FSH at various skeletal sites were 0.57%, 0.43%, 27.1%, and 30.9%, respectively; and of LH were 2.14%, 4.43%, 19.5%, and 26.0%, respectively. The prevalence of osteoporosis in 3rd and 4th quartile was more significantly increased than the 1st and 2nd quartile.ConclusionsThese data suggest that FSH and LH levels in circulation are associated with BMD changes and osteoporosis occurrence in Chinese women.     

Association between serum retinol-binding protein 4 and small dense low-density lipoprotein cholesterol levels in young adult women

BackgroundSerum retinol-binding protein 4 (RBP4) and small dense low-density lipoprotein (sdLDL) have been suggested to be associated with insulin resistance, but no information is available on the relationship between RBP4 and sdLDL.MethodsWe determined serum RBP4, sdLDL-cholesterol, and other metabolic variables on 38 young women, aged 19–29 years. The homeostatic model assessment of insulin resistance (HOMA-IR) was used for the estimation of insulin resistance.ResultsIn simple regression analyses, RBP4 levels had significant correlations with total cholesterol (r = 0.354, P = 0.029), LDL-cholesterol (r = 0.396, P = 0.014), and sdLDL-cholesterol (r = 0.510, P = 0.001) levels. The sdLDL-cholesterol levels also correlated significantly with total cholesterol (r = 0.402, P = 0.012), LDL-cholesterol (r = 0.627, P < 0.001) and triglycerides (r = 0.449, P = 0.005). Stepwise multiple regression analyses showed only sdLDL-cholesterol (β coefficient (ß) = 0.510, P = 0.001) level was a significant independent predictor of RBP4 levels (adjusted R² = 0.240), whereas RBP4 (ß = 0.289, P = 0.026) level was one of major factors affecting sdLDL-cholesterol levels (adjusted R² = 0.519). There was no significant association of HOMA-IR with RBP4 or sdLDL levels.ConclusionsWe showed an independent linkage between serum RBP4 and sdLDL-cholesterol levels in young adult women. These findings may contribute to understanding of lipoprotein metabolisms involved in diabetes and cardiovascular disease.