Manual compression device for fluoroscopy

A device for manual compression and palpation during supine fluoroscopy has been designed. It enables effective use of the physiologic grasping and lever force potentials of the hand and wrist. The device permits optimal fluoroscopic palpation and compression techniques and prevents direct exposure to the lead-gloved hand.     

Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study

Isolated headache as the presenting clinical manifestation of intracranial tumors: a prospective study. Cephalalgia 1994;1'4:270-1. Oslo. ISSN 0333-1024We prospectively studied over two years the incidence of headache as the initial and isolated clinical manifestation of adult patients suffering from intracranial tumors ( n = 183). Fifteen patients (8%) exhibited headache as their first and isolated clinical manifestation. Age, sex, neoplasm localization, or pathological diagnosis did not correlate with the presence of headache. Posterior fossa location and hydrocephalus, though not reaching statistical significance, were more frequent in patients who presented with headache as the first symptom. At the moment of diagnosis, 59 (31%) of the patients admitted to headache, though only I out of the 15 patients starting as headache still had this symptom as the only manifestation. From our experience in adults, isolated headache for longer than 10 weeks will only exceptionally be secondary to an intracranial neoplasm.     

Relationship between physical activity and inflammation among apparently healthy middle-aged and older US adults

BACKGROUND: Physical activity has been associated with a reduced risk of coronary heart disease, but the mechanism underlying this association is unclear. Because coronary heart disease is increasingly seen as an inflammatory process, it might be reasonable to hypothesize that physical activity reduces risk of coronary heart disease by reducing or preventing inflammation. METHODS: The study examined the relationship between physical activity and elevated inflammation as indicated by a high C-reactive protein level, white blood cell count, or fibrinogen level. Study subjects were 3638 apparently healthy US men and women 40 years and older who participated in the Third National Health and Nutrition Examination Survey. RESULTS: More frequent physical activity was independently associated with a lower odds of having an elevated C-reactive protein level. Compared with those engaging in physical activity 0 to 3 times per month, the odds of having an elevated C-reactive protein level was reduced among those engaging in physical activity 4 to 21 times per month (odds ratio, 0.77; 95% confidence interval, 0.58-1.02) and 22 or more times per month (odds ratio, 0.63; 95% confidence interval, 0.43-0.93) (P for trend,.02). Similar associations were seen for white blood cell count and fibrinogen levels. CONCLUSIONS: More frequent physical activity is independently associated with a lower odds of having elevated inflammation levels among apparently healthy US adults 40 years and older, independent of several confounding factors. The results suggest that the association between physical activity and reduced coronary heart disease risk may be mediated by anti-inflammatory effects of regular physical activity.     

个性化颅骨成形术中植入材料类型与颅骨缺损面积的关系

目的：分析个性化颅骨成形术中,植入材料类型与颅骨缺损面积的关系。 方法：选择解放军总医院第二附属医院神经外科2002-03/2005-01和河北省三河市医院神经外科2003-09/2005-04收治的资料齐全的计算机辅助设计颅骨成形术患者75例,分为嵌入性材料（骨水泥、硅橡胶）组40例,根据颅骨缺损面积又分为大面积（≥36cm2）组17例和小面积（〈36cm2）组23例;覆盖性材料（钛网）组35例,大面积组14例和小面积组21例。采用头颅CT超薄扫描（层厚1.5mm）,三维重建,模拟缺损颅骨补片,应用激光快速成形技术,制作缺损颅骨及颅骨补片模型,患者认可后,根据患者的病情应用硅橡胶、骨水泥、钛网作为植入材料,进行手术植入。术后1周观察并发症：头痛、积液、松动。 结果：75例患者的补片与颅骨完整适配,塑形满意,术中无需修整,平均手术时间45min,83%（63/75）患者感到基本或完全恢复了原有容貌。手术并发症：嵌入性材料组头痛4例,积液10例,松动2例,共16例,其中大面积组13例,小面积组3例;覆盖性材料组头痛1例,积液2例,松动0例,共3例次,其中大面积组2例,小面积组1例。应用精确概率分析,两材料组之间手术并发症差异显著,两材料组颅骨缺损面积之间手术并发症差异显著,嵌入性材料大面积组与覆盖性材料大面积组之间手术并发症差异显著,嵌入性材料小面积组与覆盖性材料小面积组之间手术并发症无显著性差异。 结论：个性化设计的颅骨修补材料,能够最大限度的恢复患者外形,缩短手术时间,大面积的颅骨缺损应用钛网修补,小面积的应用钛网和嵌入性材料修补。根据患者颅骨缺损面积,选择不同植入材料,可以提高手术疗效,减少术后并发症。     

Outcomes of thrombolytic therapy for acute myocardial infarction in women

Coronary artery disease is the leading cause of mortality in women older than 50 years of age. Thrombolytic therapy substantially reduces mortality in both women and men with ST-elevation acute myocardial infarction. However, the mortality risk reduction is somewhat lower in women, in spite of similar rates of successful coronary reperfusion after thrombolytic therapy in women and men. Hemorrhagic complications including stroke and other major bleeding appear to be more common in women, particularly elderly women. The risk of reinfarction after thrombolytic therapy also is greater in women compared with men. Because of the higher complication rates, women should be monitored closely after thrombolytic therapy. However, this lifesaving treatment should not be withheld or delayed in women when indicated.     

Modeling premature brain injury and recovery

Premature birth is a growing and significant public health problem because of the large number of infants that survive with neurodevelopmental sequelae from brain injury. Recent advances in neuroimaging have shown that although some neuroanatomical structures are altered, others improve over time. This review outlines recent insights into brain structure and function in these preterm infants at school age and relevant animal models. These animal models have provided scientists with an opportunity to explore in depth the molecular and cellular mechanisms of injury as well as the potential of the brain for recovery. The endogenous potential that the brain has for neurogenesis and gliogenesis, and how environment contributes to recovery, are also outlined. These preclinical models will provide important insights into the genetic and epigenetic mechanisms responsible for variable degrees of injury and recovery, permitting the exploration of targeted therapies to facilitate recovery in the developing preterm brain.     

Use of confirmatory factor analysis for the identification of new components of the metabolic syndrome: the role of plasminogen activator inhibitor-1 and Haemoglobin A1c

BACKGROUND AND AIM: This study was aimed to identify additional components of metabolic syndrome from a set of cardiovascular risk markers. METHODS AND RESULTS: The homeostasis model assessment of insulin resistance (HOMA-IR), C-reactive protein, fibrinogen, plasminogen activator inhibitor-1 (PAI-1), von Willebrand factor, homocysteine, Haemoglobin A1c (HbA1c), and lipoprotein(a) were assessed in a population-based sample of 902 nondiabetic adult subjects. Those biomarkers that were associated with metabolic syndrome were evaluated by multiple regression analysis, along with other traditional cardiovascular risk factors. Confirmatory factor analysis (CFA) was used to test the hypothesis that both the established components of metabolic syndrome and the novel variables identified by the regression analysis were associated with a single underlying factor. HOMA-IR, PAI-1 and HbA1c were the only biomarkers independently related to metabolic syndrome. CFA validated a one-factor model that included these variables. Moreover, the indices of goodness of fit were better for this expanded model than those obtained for a previously validated one-factor model that was restricted to the conventional elements of the syndrome. CONCLUSIONS: These findings show that PAI-1 and HbA1c are singularly linked to metabolic syndrome. Their elevation is presumably another manifestation of the same pathophysiological mechanism that underlies the recognized traits of the syndrome.     

Investigation of gender heterogeneity in the associations of serum phosphorus with incident coronary artery disease and all-cause mortality

Serum phosphorus levels in the general population have beenreported to be associated with cardiovascular morbidity andmortality and increased carotid intima-media thickness. Theauthors examined gender heterogeneity in the association ofphosphorus with all-cause mortality and incident coronary arterydisease using data from the Atherosclerosis Risk in CommunitiesStudy (1987–2001). Baseline phosphorus levels were higherin women and were associated differently among men and womenwith traditional atherosclerosis risk factors such as age, lowdensity lipoprotein cholesterol, diabetes mellitus, and hypertension.In a multivariable-adjusted model, men in the highest quintileof serum phosphorus level (>3.8 mg/dL) had an increased mortalityrate (hazard ratio = 1.45, 95% confidence interval: 1.12, 1.88),while women did not (hazard ratio = 1.18, 95% confidence interval:0.89, 1.57). The multivariable likelihood ratio test of effectmodification by gender was significant at = 0.1 (P = 0.085)for all-cause mortality. Although the associations of phosphoruswith coronary artery disease also appeared to differ substantiallyby gender, the multivariable test for effect modification suggestedthat the difference was consistent with random variation (P= 0.195). These results suggest the need for further investigationinto gender differences in the contribution of mineral metabolismto cardiovascular disease in the general population. cardiovascular diseases; coronary artery disease; mortality; phosphorus; risk; sex factors