Ueber multiple Hirnsklerose

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Ueber familiale Irrenpflege in Schottland

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Die Heredität der Psychosen

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Methicillin resistance in staphylococci: an evaluation of conditions for detection

Ninety-four strains of coagulase positive staphylococci and 73 strains of coagulase negative staphylococci were tested for their susceptibility to methicillin, using agar dilution and disc diffusion techniques with Diagnostic Sensitivity Test agar (DST) and DST supplemented with salt, incubated at 30 degrees C and 37 degrees C. Disc diffusion on salt-incorporated DST at 30 degrees C was most reliable for detecting methicillin resistance in both types of staphylococci. The agar dilution methods were particularly poor for detecting resistance with coagulase negative staphylococci. The simultaneous testing of coagulase positive and negative staphylococci by this method indicated the need for both DST and salt-incorporated DST agar plates, incubated at 30 degrees C. However, sensitive strains should still be tested by disc diffusion for confirmation.     

Active stability of the glenohumeral joint decreases in the apprehension position

BACKGROUND: Muscle forces that compress the glenohumeral joint during mid-ranges of motion may lead to increased translational forces in end-range positions, such as the apprehension position, where symptoms of anterior instability occur. OBJECTIVE: The objective of this study was to quantify active stability provided by eight shoulder muscles in mid-range and end-range positions through muscle force vector analysis. METHODS: Lines of action were derived from a geometric model and muscle force magnitudes were estimated with electromyography-based techniques. Resultant muscle force vectors were calculated by summing individual muscle force vectors. RESULTS: Compared to mid-range positions, lines of action of resultant force vectors were more anteriorly directed in end-range positions compared to 15 degrees of abduction, up to 26 degrees. Consequently, anterior stability was lowest in the apprehension position. The magnitudes of the resultant force vectors were comparable to other studies. Based on a sensitivity analysis, lines of action of resultant force vectors vary up to 6 degrees within the population. CONCLUSIONS: Data obtained from this model will improve conservative management, post-surgical rehabilitation, and strength training protocols.     

Serum vitamin D levels correlate to coronary artery disease severity: a retrospective chart analysis

Background: The pro-atherosclerotic nature of vitamin D deficiency has been shown to increase cardiovascular events. We further emphasized and evaluated the severity of coronary artery disease (CAD) with varying levels of vitamin D in relation to age, gender, ethnicity and baseline confounders.

Methods: A retrospective, single-center study of 9,399 patients admitted between 2005 and 2014 for chest pain who underwent coronary angiography. Patients without a vitamin D level, measured as 25-dihydroxyvitamin D (25[OH]D) were excluded from our study. 25(OH)D deficiency and insufficiency were defined by having serum concentration levels of less than 20 ng/ml and 20 to 29.9 ng/ml, respectively, while normal levels were defined as greater than or equal to 30 ng/ml. We assessed levels of 25(OH)D and extent of coronary disease with coronary angiography as obstructive CAD (left main stenosis of ≥50% or any stenosis of ≥70%), non-obstructive CAD (≥1 stenosis ≥20% but no stenosis ≥70%) and normal coronaries (no stenosis >20%).

Results: Among 9,399 patients, 1,311 qualified, of which 308 patients (23%) had normal 25(OH)D levels, 552 patients (42%) had 25(OH)D deficiency and 451 patients (35%) had 25(OH)D insufficiency. In an analysis of the extent of coronary disease, we identified 20% of patients having normal coronaries, 55% having obstructive CAD and 25% having non-obstructive CAD. Baseline clinical risk factors and co-morbidities did not differ between the groups.

Patients with normal 25(OH)D levels were found to have normal coronaries compared to patients with 25(OH)D deficiency or insufficiency (OR: 7, 95% CI: 5.2 – 9.5, p < 0.0001). Comparing patients with normal 25(OH)D levels, patients with 25(OH)D deficiency or insufficiency (<29 ng/ml), 62% were found to have obstructive CAD (n = 624, OR: 2.9, 95% CI: 2.3-3.7, p < 0.0001) and 25% had non-obstructive CAD (n = 249, OR: 1.5, 95% CI: 1.1-2, p = 0.02).

Conclusion: Normal coronaries and CAD were shown to correlate with normal and low levels of 25(OH)D, respectively. There is an inverse relationship between the percentage of coronary artery occlusion and serum 25(OH)D concentrations. Vitamin D may provide benefits in risk stratification of patients with CAD and serve as a possible risk factor.     

Percutaneous suture closure for brachial artery puncture

Percutaneous suture closure for femoral artery hemostasis has gained broad use over the last few years since its introduction. The appeal of suture closure is the immediate and definitive hemostasis that it achieves, even in anticoagulated patients. Described is the use of the Perclose Techstar XL 6Fr suture closure device for the management of brachial artery puncture after diagnostic and therapeutic catheterization. A 6Fr Perclose Techstar device was used for hemostasis during ten procedures in eight patients. In addition, 6Fr and 7Fr sheaths were used. Hemostasis was achieved in all but one patient, in whom hemostasis was not achieved and surgical repair was necessary. The Perclose Techstar device is useful for selected patients for achieving brachial arterial puncture site hemostasis. The large excursion of the foot of the new closer device may not be as applicable in arteries as small as the brachial artery. Patients who are obese may be best suited for this approach.     

Association between birth outcomes and aflatoxin B1 biomarker blood levels in pregnant women in Kumasi,Ghana

Objective To investigate the association between birth outcomes and blood levels of aflatoxin B₁ (AFB1)‐lysine adduct in pregnant women in Kumasi, Ghana. Method A cross‐sectional study of 785 pregnant women attending antenatal clinic was conducted. Aflatoxin B₁ (AFB₁)‐lysine adduct levels were determined by high performance liquid chromatography (HPLC) on blood taken after delivery. The birth outcomes considered were small for gestation age, low birthweight, preterm delivery and stillbirth. Participants were divided into quartiles based on the distribution of aflatoxin B₁‐lysine adducts in pg/mg albumin (‘low’: ≤2.67, ‘moderate’: >2.67 to ≤4.97, ‘high’: >4.97 to ≤11.34, ‘very high’: >11.34). Statistical analysis involved models that included socio‐demographic variables and other potential confounders. Results The average AFB₁‐lysine adduct level in maternal serum was 10.9 ± 19.00 pg/mg albumin (range = 0.44–268.73 pg/mg). After adjusting for socio‐demographic variables and potential confounding factors, participants in the highest AFB₁‐lysine quartile with ‘very high’ AFB₁‐lysine level (>11.34 pg/mg) were more likely to have low birthweight babies (OR, 2.09; 95% CI, 1.19–3.68), and showed a trend of increasing risk for low birthweight (P_trend = 0.007) compared to participants in the lowest quartile. Conclusion This study adds to the growing body of evidence that aflatoxins may increase the risk of adverse birth outcomes. The findings have implications for targeted nutritional education of pregnant women in areas with high levels of aflatoxin contamination of foods.     

Transhepatic closure of patent foramen ovale

Transhepatic right heart catheterization is an uncommon procedure for adult interventional cardiologists. We report its successful use for closure of a patent foramen ovale in an elderly patient without femoral vein access. Also described is a novel method of using a vascular plug to achieve hemostasis of the hepatic venous access site. © 2009 Wiley‐Liss, Inc.     

Cardiac Procedures among American Indians and Alaska Natives compared to Non-Hispanic Whites Hospitalized with Ischemic Heart Disease in California

Background  

American Indians/Alaska Natives (AIAN) experience a high burden of cardiovascular disease with rates for fatal and nonfatal heart disease approximately twofold higher than the U.S. population.