The association between connective tissue laxity and the risk of an abdominal aortic aneurysm.

AIMS: to investigate whether connective tissue laxity is associated with abdominal aortic aneurysms (AAA). METHODS: a nested case control study in a population-based screening programme. The presence of pes planus, scoliosis, pectus deformities, flexible auricular cartilages and Gorling's sign were combined with the Beighton joint mobility score to form a connective tissue laxity score. The association between connective tissue laxity and the risk of AAA was investigated through a logistic regression model. Type III collagen turnover was assessed using a serum radio-immunoassay for type III procollagen (PIIINP). RESULTS: data from 231 controls (aortic diameter <2.5 cm) and 190 cases (AAA >2.9 cm) were analysed. Odds ratios (OR), adjusted for known confounders were 3.1 (95% CI: 1. 1-8.6) for the highest group of connective tissue scores and 2.4 (95% CI: 1.0-5.4) for the middle group, compared with those with no signs of abnormal connective tissue function. There was no difference in mean collagen turnover between cases and controls, nor between those with a stable AAA >4 cm and those with an expanding AAA. CONCLUSION: connective tissue laxity is associated with a higher risk of having an AAA. The collagen turnover is similar in subjects with an AAA and controls. Aneurysms may be associated with abnormal connective tissue rather than an increased breakdown of normal collagen.     

The theory of preventive stress management: a 33‐year review and evaluation

The theory of preventive stress management (TPSM) has contributed to theoretical understanding, empirical exploration and organizational practices since its introduction in 1979. This paper describes the theoretical concepts contained in the theory, reviews the empirical findings based on the theory and outlines the organizational practices associated with the application of the theory. Special attention is given to the contribution of the three principal authors associated with the theory as well as the work of their key collaborators. The impact of the theory is evaluated and discussed. Opportunities for future research based on the TPSM are offered. Copyright © 2011 John Wiley & Sons, Ltd.     

Opposition Splint for Partial Thumb Amputation: A Case Study Measuring Disability before and after Splint Use

Study DesignCase report.IntroductionA combined burn and a partial amputation can be extremely debilitating as the thumb constitutes 40% of the entire hand when evaluating functional impairment.Purpose of the StudyMeasure disability with and without opposition splint use after partial thumb amputation due to a burn.MethodsImpairment and disability measures were completed at discharge from the hospital and subsequently during outpatient follow-up visits while wearing and not wearing a thumb opposition splint at 3, 6, 8, and 15 months. Comparisons between disability and impairment scores were assessed over time.ResultsThe difference between DASH scores with and without using the splint were 25 at 3 months, 16 at 6 months, 10 at 8 months, and 12 at 15 months.ConclusionsSplint use in this case demonstrated clinically significant changes over time with minimal changes in impairment indicating enhanced function and improved patient perception of disability.Level of Evidence4     

不同补锌方法对儿童免疫功能的影响

研究不同补锌方法（补锌，补充微量营养素，补充锌加微量营养素）改善缺锌儿童免疫功能的作用，结果显示：实验１０ｗｋ后，三个实验组缺锌儿童血清锌浓度明显升高，同时淋巴细胞刺激指数明显高于对照组，流式细胞仪检测细胞周期显示对照组Ｇ０／Ｇ１期细胞增多，而实验组Ｓ＋Ｇ０／Ｇ１期细胞增多，细胞处于增殖活化状态。三组中又以锌＋微量营养素作用效果最好。表明：锌和微量营养素单独使用均增强缺锌儿童的免疫功能，但锌和微量     

Geometrical optimization of a phased array coil for high-resolution MR imaging of the carotid arteries.

The geometry of an RF phased-array receiving coil for high-resolution MRI of the carotid artery, particularly the bifurcation, was optimized with respect to signal-to-noise ratio (SNR). A simulation tool was developed to determine homogeneity, sensitivity, and SNR for a given imaging situation. The algorithm takes into account the coil geometry, the parameters of the measured object, and the imaging parameters of the pulse sequence. The coil with the optimum geometry was implemented as a receive-only coil for 1.5 T and comparative SNR measurements with different coils were performed. The experimental SNR measurements verified the simulations. The optimized carotid artery phased array offered the best SNR over the desired field of view. In vivo high-resolution MRI of the carotid arteries of healthy volunteers and patients with known stenosis was conducted with the optimized phased array coil. The capability of the phased array coil for resolving components within the carotid artery walls is demonstrated. Magn Reson Med 50:439-443, 2003.     

Sertoli-Leydig cell tumour in an infertile patient after stimulated ovulation

A 36 year-old infertile female developed a stage IV (FIGO) ovarian carcinoma consisting of a poorly differentiated Sertoli-Leydig cell tumour after receiving one course of ovulation induction with follicle stimulating hormone (FSH), human menopausal gonadotrophin (HMG) and human chorionic gonadotrophin (HCG) followed by gonadotrophin-releasing hormone analogue (GnRHa). The patient died of liver metastasis and hepatic failure 4 1/2 months after first diagnosis, despite aggressive treatment consisting of debulking surgery and aggressive adjuvant chemotherapy.      

A comparison between the short term and long term benefits of screening for abdominal aortic aneurysms from the Huntingdon Aneurysm screening programme.

BACKGROUND: The UK Multicentre Aneurysm Screening Study (MASS) showed a 44% reduction in AAA-related mortality after 4 years and predicted an increased number of deaths prevented in the longer term. We aim to compare the 5 and 13 years benefit from aneurysm screening in the Huntingdon Aneurysm screening programme. METHODS: Incidence and mortality of ruptured AAA (RAAA) after 5 and 13 years of screening in a population based aneurysm screening program. RESULTS: Five years of screening resulted in a reduction in the incidence of RAAA of 49% (95% CI: 3-74%). Nine out of 11 ruptures in the invited group did not survive (mortality 82%; 95% CI: 48-98%) compared to 38 non-survivors from 51 ruptures in the control group (mortality 75%; 95% CI: 60-86%). Five years of screening resulted in an RAAA-related mortality reduction of 45% (95% CI: -15 to 74%). After 13 years of screening the incidence of RAAA was reduced by 73% (95% CI: 58-82%). Twenty-one out of 29 ruptures in the invited group did not survive (mortality 72%; 95% CI: 53-87%) compared to 64 non-survivors from 82 ruptures in the control group (mortality 78%; 95% CI: 68-86%). Thirteen years screening resulted in a reduction of mortality from RAAA of 75% (95% CI: 58-84%). The number needed to screen to prevent one death reduced from 1380 after 5 years to 505 after 13 years. The number of elective AAA operations needed to prevent one death reduced from 6 after 5 years to 4 after 13 years. CONCLUSION: AAA screening becomes increasingly beneficial as screening continues over the longer term. Benefits continue to increase after screening has ceased.     

Cost and financial sustainability of a household-based water treatment and storage intervention in Zambia

Providing safe water to >1 billion people in need is a major challenge. To address this need, the Safe Water System (SWS) - household water treatment with dilute bleach, safe water storage, and behavior change - has been implemented in >20 countries. To assess the potential sustainability of the SWS, we analyzed costs in Zambia of "Clorin" brand product sold in bottles sufficient for a month of water treatment at a price of $0.09. We analyzed production, marketing, distribution, and overhead costs of Clorin before and after sales reached nationwide scale, and analyzed Clorin sales revenue. The average cost per bottle of Clorin production, marketing and distribution at start-up in 1999 was $1.88 but decreased by 82% to $0.33 in 2003, when >1.7 million bottles were sold. The financial loss per bottle decreased from $1.72 in 1999 to $0.24 in 2003. Net program costs in 2003 were $428,984, or only $0.04 per person-month of protection. A sensitivity analysis showed that if the bottle price increased to $0.18, the project would be self-sustaining at maximum capacity. This analysis demonstrated that efficiencies in the SWS supply chain can be achieved through social marketing. Even with a subsidy, overall program costs per beneficiary are low.