External skeletal fixation: special techniques: dynamic control of anterior ankle subluxation

This article discusses dynamic control of anterior ankle subluxation.     

A model for karyotypic evolution in testicular germ cell tumors

Testicular germ cell tumor karyotypes are characterized by near-triploidy, with chromosome numbers ranging from 50 to 70, and by the frequent appearance of i(12p). The high chromosome number has been attributed to the formation of tetraploid carcinoma in situ cells followed by chromosomal losses that ultimately lead to tumor forms that are more advanced. In the present investigation, we show by analysis of the accumulated cytogenetic data on testicular germ cell tumors and computer simulations that two distinct processes are operating in the karyotypic evolution of these tumors. The results suggest that whole-chromosome changes originate from a multipolar cell division of a tetraploid cell, whereas imbalances caused by structural changes accumulate in a stepwise manner.     

Noise reduction and convergence of Bayesian algorithms with blobs based on the Huber function and median root prior

Iterative image reconstruction algorithms have the potential to produce low noise images. Early stopping of the iteration process is problematic because some features of the image may converge slowly. On the other hand, there may be noise build-up with increased number of iterations. Therefore, we examined the stabilizing effect of using two different prior functions as well as image representation by blobs so that the number of iterations could be increased without noise build-up. Reconstruction was performed of simulated phantoms and of real data acquired by positron emission tomography. Image quality measures were calculated for images reconstructed with or without priors. Both priors stabilized the iteration process. The first prior based on the Huber function reduced the noise without significant loss of contrast recovery of small spots, but the drawback of the method was the difficulty in finding optimal values of two free parameters. The second method based on a median root prior has only one Bayesian parameter which was easy to set, but it should be taken into account that the image resolution while using that prior has to be chosen sufficiently high not to cause the complete removal of small spots. In conclusion, the Huber penalty function gives accurate and low noise images, but it may be difficult to determine the parameters. The median root prior method is not quite as accurate but may be used if image resolution is increased.     

Myospherulosis of the middle ear -- a rare differential diagnosis of cholesteatoma

BACKGROUND: Myospherulosis is a chronic-inflammatory lesion that is most commonly iatrogenic of origin and occurs in tissues exposed to petrolatum-based products. The disease does not exhibit characteristic symptoms and is therefore not diagnosed in some instances. In previous otorhinolaryngological studies, myospherulosis was mainly found in paranasal sinuses, while only four otitic cases have been reported. METHODS: A 48-year-old female Egyptian patient suffered from bilateral chronic otitis media that had been treated in Egypt by tympanoplasty. The patient presented few months later at the university ENT department (Mainz) with deteriorated otorrhea and otalgia. Clinical, otoscopical, and radiological examination led to the diagnosis of cholesteatoma. During revision surgery of the right side, ointment-like material was found, which was embedded in granulation tissue. Middle ear biopsies were taken from both sides and routinely processed for standard histological examination and transmission electron microscopy. RESULTS: Histological examination of the right middle ear biopsy showed cystic tissue spaces lined by histiocytes and foreign-body giant cells in a fibrous stroma. In the tissue spaces, scattered debris and sac-like structures containing round spherules of aggregated erythrocytes were found. In addition, erosion of adjacent bone matrix was seen. Diagnosis of myospherulosis was made. By contrast, histological evaluation of the left middle ear biopsy revealed cholesterol granuloma. CONCLUSION: Myospherulosis of the middle ear has been hitherto diagnosed in a very few otitic cases, but might be overlooked as it mimicks other chronic proliferative and inflammatory lesions such as cholesteatoma in the present case. Thus myospherulosis should be considered in otitic cases with a suspicious history (exposure to petrolatum-based products). Furthermore, patients with myospherulosis have a significantly higher likelihood of developing postoperative complications. Since the lesion exhibits distinct histological findings, microscopy plays a central role for the diagnosis of this important disease.     

Fewer accidents and better maintenance with active wheelchair check-ups: a randomized controlled clinical trial

OBJECTIVE: To investigate whether active intervention using a compiled checklist for wheelchair check-ups increases user satisfaction and/or decreases accidents, near accidents and pressure sores. DESIGN: A randomized controlled trial comparing active intervention versus standard intervention for prescribed, manually propelled wheelchairs. SETTING: Patients within primary health care of Bor?s and Bollebygd municipalities, a mixed urban and rural population. SUBJECTS: Users of manually propelled wheelchairs over 16 years of age. INTERVENTIONS: The accident rate, extent of pressure sores, number and extent of repairs, reconditioning, adjustments as well as user satisfaction were measured initially and at one year. In the standard intervention, the user and carer were encouraged to initiate contact when necessary. In the active intervention, an occupational therapist performed a scheduled, thorough check-up of the wheelchair, following a compiled checklist for safety, comfort and positioning, manoeuvrability and transportation. RESULTS: Of 253 registered wheelchair users, 216 were suitable and randomized. In the active intervention group, 99% (95% confidence interval 96-100%) of the inspected wheelchairs required maintenance. The incidence of accidents was unchanged in the standard intervention group, but decreased to 'no accidents' in the active intervention group (p = 0.03). User satisfaction was not affected by the active intervention. CONCLUSION: Most wheelchair users are unable to determine on their own when adjustments are needed. An active check-up on manually propelled wheelchairs seems to reduce accidents. More information is available at http://www.wheelchair.se     

Effect of free plant sterols in low-fat milk on serum lipid profile in hypercholesterolemic subjects

OBJECTIVE: To determine the effect of nonesterified, nonhydrogenated plant sterols solubilized in a partly vegetable oil-filled low-fat milk on serum low-density lipoprotein cholesterol (LDL) in mildly hypercholesterolemic patients. DESIGN: Double-blind, randomized, placebo-controlled three-arm crossover study. SETTING: Outpatient clinical trial. SUBJECTS: A total of 138 patients were screened, providing 81 patients for randomization; 71 patients completed the study. INTERVENTIONS: The study product was a 500 ml milk blend with or without nonesterified, nonhydrogenated sterols. The daily consumption of sterols in the three groups was 0 g/day, control group (C); 1.2 g/day, (Lo); or 1.6 g/day, (Hi), respectively. The patients were randomly assigned to one of three different treatment sequences. Each intervention period was 4 weeks. The total study duration was 12 weeks. RESULTS: The milk product was well tolerated. The placebo-adjusted mean reduction in LDL was 7.13+/-12.31 and 9.59+/-12.44% (mean+/-s.d.) for Lo and Hi groups, respectively (P<0.0001); there was no statistically significant difference in LDL lowering for the Lo and Hi groups. There were no significant changes in serum vitamin E or carotenoid concentrations after standardization with LDL cholesterol during the study period. CONCLUSION: The present study shows for the first time a substantial reduction in LDL cholesterol with a new, partly vegetable oil-filled 1.2% low-fat milk product, containing nonesterified plant sterols from soybean oil, in a randomized, placebo-controlled trial. This result encourages further development of novel low-fat dairy products containing free plant sterols for future use in cholesterol-lowering initiatives.     

Sexual Health

HEALTH ISSUE: Much attention is devoted to women's reproductive health, but the formative and mature stages of women's sexual lives are often overlooked. We have analyzed cross-sectional data from the Sexual Behaviour module of the 2000/2001 Canadian Community Health Survey (CCHS), and reviewed the literature and available indicators of the sexual health of Canadian women. KEY FINDINGS: Contemporary Canadian adolescents are becoming sexually active at younger ages than in previous generations. The gender gap between young males and females in age at first intercourse has virtually disappeared. The mean age at first intercourse for CCHS respondents aged 15-24 years was between 16 and 17. Canadian-born respondents are significantly younger at first intercourse than those who were born outside of Canada. Few adolescents recognize important risks to their sexual health. Older Canadians are sexually active, and continue to find emotional and physical satisfaction in their sexual relationships. DATA GAPS AND RECOMMENDATIONS: Both health surveys and targeted research must employ a broader understanding of sexuality to measure changes in and determinants of the sexual health of Canadians. There is reluctance to direct questions about sexual issues to younger Canadians, even though increased knowledge of sexual health topics is associated with delayed onset of sexual intercourse. Among adults, sex-positive resources are needed to address aspects of aging, rather than medicalizing age-related sexual dysfunction. Age and gender-appropriate sexual health care, education, and knowledge are important not only for women of reproductive age, but for Canadians at all stages of life.     

Contraception

HEALTH ISSUE: Contraception choices affect the long-term sexual health and fertility of women and men. Data from the 1998 Canadian Contraception Study and the 2000/2001 Canadian Community Health Survey were assessed for measures of contraceptive use and familiarity with various methods among Canadian women. KEY FINDINGS: The oral contraceptive (OC) pill is the dominant method of contraception for Canadian women. Canadian women demonstrate high awareness of the benefits of condom use, but 75% are unaware of the female condom. Among youth, condom use drops as OC use increases. Contraception use in sexually active females aged 15-17 is fairly high, but use is inconsistent. Sexually active adolescent females report high awareness of emergency contraception but poor knowledge of the time frame within which it is most effective. Women aged 35-44 are more familiar with and likely to choose sterilization than younger women. There has also been a shift away from tubal ligation in favour of vasectomies. DATA GAPS AND RECOMMENDATIONS: National data to guide policy and program development are limited. More data are needed on contraception use among males, and factors affecting accessibility, adherence and negotiation of choice. The importance of dual protection, and correct and consistent use of the chosen contraceptive method must be communicated to younger Canadians, as well as health care providers and educators. All women of reproductive age should be made aware of emergency contraception methods and increased efforts on sexual health promotion and education are required. Further research is essential to develop expanded contraceptive choices.     

Lead sources in human diet in Greenland

Although blood lead levels have declined in Greenland, they are still elevated despite the fact that lead levels in the Greenland environment are very low. Fragments of lead shot in game birds have been suggested as an important source of dietary exposure, and meals of sea birds, particularly eider, contain high concentrations of lead. In a cross-sectional population survey in Greenland in 1993-1994, blood lead adjusted for age and sex was found to be associated with the reported consumption of sea birds. Participants reporting less than weekly intake of sea birds had blood lead concentrations of approximately 75 microg/L, whereas those who reported eating sea birds several times a week had concentrations of approximately 110 microg/L, and those who reported daily intake had concentrations of 170 microg/L (p = 0.01). Blood lead was not associated with dietary exposure to other local or imported food items.     

Ambient particulate air pollution, heart rate variability, and blood markers of inflammation in a panel of elderly subjects

Epidemiologic studies report associations between particulate air pollution and cardiopulmonary morbidity and mortality. Although the underlying pathophysiologic mechanisms remain unclear, it has been hypothesized that altered autonomic function and pulmonary/systemic inflammation may play a role. In this study we explored the effects of air pollution on autonomic function measured by changes in heart rate variability (HRV) and blood markers of inflammation in a panel of 88 elderly subjects from three communities along the Wasatch Front in Utah. Subjects participated in multiple sessions of 24-hr ambulatory electrocardiographic monitoring and blood tests. Regression analysis was used to evaluate associations between fine particulate matter [aerodynamic diameter less than or equal to 2.5 microm (PM2.5)] and HRV, C-reactive protein (CRP), blood cell counts, and whole blood viscosity. A 100- microg/m3 increase in PM2.5 was associated with approximately a 35 (SE = 8)-msec decline in standard deviation of all normal R-R intervals (SDNN, a measure of overall HRV); a 42 (SE = 11)-msec decline in square root of the mean of the squared differences between adjacent normal R-R intervals (r-MSSD, an estimate of short-term components of HRV); and a 0.81 (SE = 0.17)-mg/dL increase in CRP. The PM2.5-HRV associations were reasonably consistent and statistically robust, but the CRP association dropped to 0.19 (SE = 0.10) after excluding the most influential subject. PM2.5 was not significantly associated with white or red blood cell counts, platelets, or whole-blood viscosity. Most short-term variability in temporal deviations of HRV and CRP was not explained by PM2.5; however, the small statistically significant associations that were observed suggest that exposure to PM2.5 may be one of multiple factors that influence HRV and CRP.