Cholesterol-based personal risk assessment in coronary heart disease

Using data from the National Health and Nutrition Examination Survey (NHANES II) 1976-1980, we demonstrate how cross-sectional total serum cholesterol surveillance data can be used by an individual to assess current and future personal cholesterol risk status. We propose statistical models, based on a person's current measured cholesterol level and the relationship between cross-sectional age and cholesterol percentile estimates, that will allow prediction of future cholesterol levels or the age at which specified cholesterol risk levels will be reached if no cholesterol-altering intervention is taken. These models incorporate the observed variation in the NHANES II data and expected intraperson biological variation and intralaboratory analytical variation. We illustrate the adequacy of the models using data from the longitudinal Framingham Study.     

“A SPECIAL KIND OF MAGIC”: CHANGES IN FAMILY DYNAMICS ARISING FROM PARENT PARTICIPATION IN A CONDUCTIVE EDUCATION PROGRAM FOR CHILDREN WITH CEREBRAL PALSY

This paper reports on five families whose parents described the stress arising from their child's disability and the additional stress and reward of participation in a Conductive Education program. The reports support the Conductive Education thesis, that children with physical disabilities respond well to integrated management which weaves medical insights and therapeutic practice into the fabric of daily life through a program which has an educational rather than a therapeutic bias. Parents also appreciate personal support from a non-intimidating, professionally comprehensive resource. An attempt was made to identify the elements which produced parental self-confidence and family cohesion.     

Troponin T levels in baboons with pig heterotopic heart transplants.

Troponin T levels have been monitored in baboons (n = 8) undergoing pig heterotopic heart transplantation, and correlated with a decrease in graft contractions and graft survival. Pig heart graft survival was from 12 to 139 days (mean 45, median 33), and graft failure was associated with predominant thrombotic microangiopathy and ischemia, with focal hemorrhage, and edema. An increase in troponin T levels 5 to 6 days before graft failure correlated closely with diminished graft contractions. An increase in troponin T was a reliable indicator that graft dysfunction was occurring.     

Complications associated with the use of the GlideScope® videolaryngoscope

PURPOSE: Two cases are presented wherein the GlideScope videolaryngoscope (GVL) facilitated laryngeal exposure and successful endotracheal intubation, but resulted in pharyngeal injury. CLINICAL FEATURES: GlideScope videolaryngoscopy was performed in two female patients, whose airways were anticipated to present difficulties for direct laryngoscopy. In the first case, following induction of anesthesia, moderate difficulty was encountered in directing the endotracheal tube (ETT) into the patient's larynx. In the second case, minimal difficulty with the GVL was experienced, and no problems were identified with airway instrumentation until the drapes covering the patient's face were removed. In both instances, the ETT had passed through the right palatopharyngeal arch, requiring suturing in the first patient, and electrocautery in the second patient. CONCLUSION: There have been no previously published reports of injuries related to GlideScope laryngoscopy, but perforation of the palatopharyngeal arch occurring in two patients demonstrates a rare but potentially important complication of the GVL. Strategies to minimize this complication are considered.     

Evaluating the effectiveness of interventions: exploration of two statistical methods.

Repeated measures designs are often used to evaluate the effectiveness of interventions. In these designs, the outcomes are measured on several occasions before and after implementation of the intervention. Two statistical methods, the repeated measures analysis of variance (RM-ANOVA) and hierarchical linear models (HLM), can be used to analyze the data. The authors provide an overview of the statistical models underlying RM-ANOVA and HLM and discuss the strengths and limitations of each. They propose that the 2 methods are complementary in determining the effectiveness of interventions.     

Development of the Qualeffo–31, an osteoporosis-specific quality-of-life questionnaire

Introduction Vertebral deformities are a common consequence of osteoporosis and are known to decrease quality of life. The Qualeffo–41 is a quality-of-life questionnaire especially developed for measuring quality of life in patients with vertebral deformities. It consists of 41 questions arranged in five domains: pain, physical function, social function, general health perception, and mental function. The objectives of this study were: (1) to develop a shorter version of the Qualeffo–41 by removing redundant questions; and (2) to investigate the scale characteristics, reliability, and validity of this shorter version. Methods The study was performed using data from the Qualeffo validation study and the Multiple Outcomes of Raloxifene Evaluation (MORE) study. The analyses were performed in patients with vertebral deformities (n=579). Factor analysis on polychoric correlations and an item response theory (IRT) model, i.e., the generalized partial credit model (GPCM), were used to create a shorter version of Qualeffo–41. Using GPCM, scoring weights were computed for all items. Results Three items were removed from the data set because of too many missing values. Factor analysis identified three instead of five domains: (1) pain, (2) physical function, and (3) mental function. Five items had factor loadings <0.4 and were not included in the GPCM. After excluding several items, the domains pain (four items), physical function (18 items), and mental function (nine items) showed a good, reasonable, and excellent fit, respectively. This indicates that the mental function domain and the pain domain are more unidimensional than the physical function domain. All three domains showed a very high correlation (r ≥0.95) with the corresponding domains of the Qualeffo–41. Conclusions Qualeffo–31 was developed, consisting of three domains with a reasonable to excellent fit to the GPCM. Although the fit to the GPCM supports the construct validity of the Qualeffo–31, validation in a new study should be performed before using it in practice.     

创伤后迟发性脑肿胀的临床特点与治疗

目的 探讨创伤后迟发性脑肿胀的临床特点、发病机制与治疗。方法 回顾性分析1998年1月～2005年6月年收治的17例迟发性脑肿胀患者的临床特点和救治情况。结果 所有颅脑损伤患者采用保守治疗后均有好转，但于伤后5-10d出现恶化，CT复查有脑肿胀，经加强综合脱水等治疗后16例治愈，1例死亡。结论 迟发性脑肿胀好发于对冲性额、颞叶挫裂伤伴明显蛛网膜下腔出血、硬膜下薄层血肿及早期CT有脑肿胀者。其发病机制可能与创伤后的迟发性脑血管痉挛、微循环障碍、静脉回流障碍及甘露醇作用下降等因素有关。此类患者病情隐蔽性强，应加强观察、积极行CT复查，如能早期明确诊断，保守治疗多数效果良好。     

The contribution of selected anthropometric and physiological variables to 10K performance of wheelchair racers: a preliminary study.

The purpose of this study was to determine the relationship between selected anthropometric and physiological variables and 10K time. Eleven male wheelchair athletes with spinal cord injuries in training for national competition performed continuous progressive exercise tests on a wheelchair ergometer to determine maximal metabolic and cardiorespiratory values. Anthropometric data were also collected. The laboratory data were analyzed for correlation with the best 10K time of each subject during the test period. The subjects averaged 27 min 30 sec for their 10K races, 2.49 L.min-1 for VO2max and 35 percent for maximal gross mechanical efficiency during submaximal exercise. Speed at peak oxygen consumption (r = -0.66), gross mechanical efficiency (r = -0.56), and body density (r = -0.57) was found to be significantly (p less than 0.10) correlated with 10K time. The results show very little correlation between VO2max and 10K time (r = 0.02). Further study is indicated for the relationship between gross mechanical efficiency, speed at maximal oxygen consumption, body density, and 10K time; these variables may be useful in evaluating training programs for improving race performance.     

Use of a new videolaryngoscope (GlideScope®) in the management of a difficult airway

PURPOSE: To describe the clinical use of a new videolaryngoscope in a patient who had repeatedly been difficult or impossible to intubate by conventional direct laryngoscopy. This device provided excellent glottic visualization and permitted easy endotracheal intubation. CLINICAL FEATURES: A 74-yr-old male presenting for repeat elective surgery had a history of failed intubations by direct laryngoscopy and pulmonary aspiration with a laryngeal mask airway. He refused awake flexible fibreoptic intubation. After the induction of general anesthesia, laryngoscopy was performed using a GlideScope. This provided complete glottic exposure and easy endotracheal intubation. CONCLUSION: This new videolaryngoscope provided excellent laryngeal exposure in a patient whom multiple experienced anesthesiologists had repeatedly found to be difficult or impossible to intubate using direct laryngoscopy. The clinical role of this device awaits confirmation in a large series of difficult airways.