Time trends of chest pain symptoms and health related quality of life in coronary artery disease

Background  

There is at present a lack of knowledge of time trends in health related quality of life (HRQL) in common patients with coronary artery disease (CAD) treated in ordinary care. The objective of this study is to assess and compare time trends of health related quality of life (HRQL) and chest pain in patients with coronary artery disease.     

Long-term memory deficits in patients with malignant gliomas

Knowledge about the neuropsychological performance of adult patients with brain tumors, and especially with malignant gliomas, is limited. In this study 30 patients were consecutively included at time of diagnosis. Five months after completion of radiotherapy eleven of the patients showed no signs of focal neurology or tumor recurrence. These eleven patients, and their partners, were interviewed independently. Using each partner as control the patients were assessed neuropsychologically with special emphasis on memory abilities. The selective reminding technique was used with nouns of different visual imagery. A consistent pattern was found: there was no clear impairment in global intellectual abilities, but there was a pronounced deficit in long-term memory. However, the patients had a preserved capacity to use visual imagery to boost performance. It is important that medical staff acknowledge or confirm this problem. The sparing of imaginai coding makes it possible for the staff to assist with advice facilitating memory. Memory is a vital cognitive ability and the selective reminding technique was a sensitive method capable of detecting subtle impairments. The technique is recommended in future examinations of conditions and evaluations of treatments affecting the CNS.     

Ambulation versus oxytocin in protracted labour: a pilot study

We compared ambulation with oxytocin in the treatment of protracted labour with a randomized, controlled trial of 57 patients. Sixty percent of the women in the ambulant group delivered their babies without oxytocin. In the ambulant group, the mean length of the second stage of labour was shorter and the women themselves held relatively positive views on their experiences. In the oxytocin group, on the other hand, the women experienced stronger contractions before pushing and also suffered from more excessively strong contractions. Our trial included too few women to judge which treatment is better for the infant's health. Nevertheless, the women's opinions and the quality of their contractions demonstrate that more attention should be paid to ambulation as a treatment for protracted labour.     

Applications of economic models in healthcare: the introduction of pioglitazone in Sweden

Type 2 diabetes mellitus (T2DM) is a common disorder that is estimated to affect approximately 100 million people worldwide. Forecasts have suggested a substantial increase in incidence, mainly in Asia, Africa and North America. Thus, an increasing number of people with diabetes-related complications will have to be cared for in the future. This development will be a major health problem for the people affected, as well as a major health economic challenge for many countries. Thiazolidinediones represent a new class of drugs with a novel mechanism of action that addresses the root cause of T2DM. Their mode of action targets the core defect of T2DM, namely, insulin resistance. One of these drugs, pioglitazone, was recently approved by the Swedish authorities. To evaluate the cost effectiveness of this new drug, a published mathematical simulation model was used. This model was adapted to Swedish conditions, and local Swedish unit costs were put into the model. Modelling is necessary when performing economic evaluations in diabetes because of the complexity of the disease and its long time horizon. The cost-effectiveness analyses showed that the cost per life-year gained with pioglitazone combination therapy compared with current treatment ranged from 37,000 Swedish kronor (SEK) to SEK149,000. Although there is no threshold value for cost effectiveness in Sweden, the values presented would normally be regarded as cost effective in the Swedish healthcare system. Modelling studies are a good starting point, but long-term naturalistic studies are needed to establish the cost effectiveness of these new drugs.     

Evaluation of custom-made procera ceramic abutments for single-implant tooth replacement: a prospective 1-year follow-up study

PURPOSE: The aim of this study was to evaluate the clinical performance of customized ceramic single-implant abutments in combination with two different techniques for fabricating crowns. MATERIALS AND METHODS: Twenty consecutive patients were provided with 24 single-implant restorations with customized ceramic abutments. The restorations were either cemented to the abutment (n = 13) or fabricated with the veneering material fused directly onto the ceramic abutment (n = 11). The patients were evaluated at 6 and 12 months with radiographs and clinical parameters for complications and soft tissue response. RESULTS: All implants and restorations were still in function after 1 year. Few clinical problems were reported during the follow-up period. The interproximal soft tissue recovered to near normal size. The mean marginal bone loss was similar for both groups, reaching an average of 0.3 mm (SD 0.71) after 1 year in function. CONCLUSION: The short-term results indicate that customized ceramic abutments are successful and have comparable function, regardless of fabrication method.     

Effects of ergonomic intervention in work with video display units

OBJECTIVES: This study evaluated the effect of an intensive ergonomic approach and education on workstation changes and musculoskeletal disorders among workers who used a video display unit (VDU). METHODS: A randomized controlled design was used. The subjects (N=124) were allocated into three groups (intensive ergonomics, ergonomic education, reference) using stratified random sampling. The evaluation involved questionnaires, a diary of discomfort, measurements of workload, and an ergonomic rating of the workstations. The assessments were made 2 weeks before the intervention and after 2 and 10 months of follow-up. RESULTS: The intensive and training groups showed less musculoskeletal discomfort than the reference group after 2 months of follow-up. Positive effects on discomfort were seen primarily for the shoulder, neck, and upper back areas. No significant differences were found for the strain levels or prevalence of pain. After the intervention the ergonomic level was distinctly higher in the intensive ergonomic group than in the education or reference group. CONCLUSIONS: Both the intensive ergonomics approach and education in ergonomics help reduce discomfort in VDU work. In attempts to improve the physical ergonomics of VDU workstations, the best result will be achieved with cooperative planning in which both workers and practitioners are actively involved.     

Spatial Expression of VEGF-A in Human Glioma

Astrocytoma, especially of high grade, is dependent on neovascularization for its growth and progression. The expression of vascular endothelial growth factor (VEGF-A), an important angiogenesis factor, has been demonstrated in perinecrotic cells in glioblastoma. In order to achieve more knowledge regarding the process of astrocytoma angiogenesis and growth we have investigated the expression of VEGF-A immunohistochemically in different areas of tumors.In 21 patients with astrocytomas of varying grade serial stereotactic biopsies were performed. Biopsies were taken from brain adjacent to tumor (BAT), tumor periphery, and tumor center. In the BAT region of high-grade astrocytomas, we found a frequent expression of VEGF-A in tumor cells and less frequent in blood vessels. In the periphery, there was an expression mainly in tumor cells while in the center of grade IV tumors VEGF-A was also frequently expressed in cells adjacent to necrosis. VEGF-A in astrocytoma grade II was demonstrated in viable tumor cells preferentially in the periphery but also in peripheral vessels and in centrally located tumor cells.The findings indicate that, in addition to hypoxia in necrotic areas there may be other factors that stimulate the expression of VEGF-A. It is suggested that VEGF-A may be a prerequisite for the aggressive and infiltrative growth of astrocytomas. Therefore, when operating high-grade astrocytomas it may be of importance to resect this aggressive peripheral part of the tumor and also to take this finding into account when planning radiotherapy.     

p53 and vascular-endothelial-growth-factor (VEGF) expression predicts outcome in 833 patients with primary breast carcinoma

The angiogenic factor vascular endothelial growth factor (VEGF) predicts outcome in primary breast carcinoma. Alteration of the p53 gene causes down-regulation of the expression of thrombospondin-1, a natural inhibitor of angiogenesis. This study was conducted to investigate the association between mutant p53 protein and VEGF expression, and the prognostic value of these factors. VEGF165 and p53 protein were measured in tumour cytosols by enzyme immunoassays. Recurrence-free survival (RFS) and overall survival (OS) were estimated in 833 consecutive patients, 485 node-negative (NNBC) and 348 node-positive (NPBC) with primary invasive breast cancer. A significant association was found between mutant p53 protein and VEGF expression. Univariate analysis showed both p53 and VEGF to be significant predictors of survival. Similar correlation was seen when p53 was combined with VEGF. Univariate analysis of NNBC showed significant prognostic value of p53 for OS, also when combined with VEGF expression; for NPBC, significant reductions in RFS and OS were seen for p53-positive patients, and these findings were enhanced when combined with VEGF, also in the sub-group receiving adjuvant endocrine treatment. Multivariate analysis showed both p53 and VEGF as independent predictors of OS in all groups. When the 2 factors were combined, an increased relative risk of 2.7 was seen for OS in the group with both p53 positivity and high VEGF content, as compared with 1.7 in the group with one risk factor. The results suggest an association between loss of wt-p53 and increased VEGF expression, indicating that angiogenic activity may depend, at least partly, on altered p53-protein function. Combination of these 2 biological markers appears to give additional predictive information of survival. A high-risk group of patients was associated with p53 positivity and higher VEGF content.