Reliability and variability of heart rate monitoring in 3-, 4-, or 5-yr-old children.

We describe the daily heart rate patterns and the between day and within day reliabilities of several heart rate variables measured in 159 Anglo-, African-, and Mexican-American children aged 3-5 yr. Heart rates were measured over 12 waking hours with a Quantum XL Telemetry heart rate monitor. There were no significant ethnic, gender, day of week, or season of the year differences in either mean resting heart rate, mean daily heart rate, mean longest duration of the heart rate sustained above 120 bpm for the day, nor percent of minutes of daily heart rate above 120 bpm. The reliabilities for these variables for 2 d of observation separated by 3-6 months ranged from 0.65 to 0.66. At this level of reliability, just over 4 d of recording are necessary to achieve a reliability of 0.80. All within-day across-hour reliabilities were greater than 0.80. However, for mean hourly heart rate and the longest duration of heart rate sustained above 120 bpm each hour, a principal components analysis revealed three distinct time components during the day. This suggests that monitoring heart rate during limited portions of the day will provide a biased estimate of overall heart rate. For the morning component, there were significant ethnic and gender differences in the children's heart rates and younger children had longer durations of heart rate sustained above 120 bpm than older children. Although daily heart rate monitoring is not a perfect indicator of children's physical activity, these data suggest that it may be a reliable measure among younger children from different ethnic and gender groups.     

The effect of genital and lower urinary tract symptoms on steroid receptor expression in women with genital prolapse

Introduction and hypothesis  

This study evaluates the expression of estrogen receptor (ER) isoforms alpha (α) and beta (β) and progesterone receptor (PR) in vaginal and periurethral tissue in women with genital prolapse in relation to genital and lower urinary tract symptoms (LUTS).     

Changes in strain distribution of loaded proximal femora caused by different types of cementless femoral stems

BACKGROUND: A number of clinically used total hip femoral implants are claiming a more or less physiologic load transfer, mostly without providing experimental data. To compare three clinically cementless total hip stems of fundamentally different design, the strain distribution before and after insertion in human cadaver femora was measured in vitro. METHODS: A conventional straight stem based on a distal anchorage concept, a so-called "anatomic" stem designed to have a proximal force transmission and a "stemless" femoral neck prosthesis were evaluated under similar loading conditions. Strain distribution was measured with tri-axial strain-gauge rosettes before and after implantation of the stems. The same bending moment was used in all femora tested to compare magnitude and direction of the resulting strains. FINDINGS: The straight and the "anatomic" stem both led to a decrease of the longitudinal strains in the proximal femur, while the femoral neck implant mainly led to an increase of measured strains on the lateral side of the greater trochanter. The observed medial strains were closer to physiological values in the "stemless" prosthesis than those of the two full-stem prosthesis. INTERPRETATION: The decrease in strains seen in the proximal region of the femora with implanted conventional hip prosthesis corresponds well to the decrease of bone density in this region noted in clinical follow-up studies. The more physiological strain at the inferior base of the neck seen in "stemless implant" may induce a remodelling process that better retains bone stock in that area. However, the increase of strains noted after implantation of this prosthesis require further investigation to assess the risk they may pose to bone failure.     

Properties of wild-type and fluorescent protein-tagged mouse tetrodotoxin-resistant sodium channel (Na V 1.8) heterologously expressed in rat sympathetic neurons

The tetrodotoxin (TTX)-resistant Na(+) current arising from Na(V)1.8-containing channels participates in nociceptive pathways but is difficult to functionally express in traditional heterologous systems. Here, we show that injection of cDNA encoding mouse Na(V)1.8 into the nuclei of rat superior cervical ganglion (SCG) neurons results in TTX-resistant Na(+) currents with amplitudes equal to or exceeding the currents arising from natively expressing channels of mouse dorsal root ganglion (DRG) neurons. The activation and inactivation properties of the heterologously expressed Na(V)1.8 Na(+) channels were similar but not identical to native TTX-resistant channels. Most notably, the half-activation potential of the heterologously expressed Na(V)1.8 channels was shifted about 10 mV toward more depolarized potentials. Fusion of fluorescent proteins to the N- or C-termini of Na(V)1.8 did not substantially affect functional expression in SCG neurons. Unexpectedly, fluorescence was not concentrated at the plasma membrane but found throughout the interior of the neuron in a granular pattern. A similar expression pattern was observed in nodose ganglion neurons expressing the tagged channels. In contrast, expression of tagged Na(V)1.8 in HeLa cells revealed a fluorescence pattern consistent with sequestration in the endoplasmic reticulum, thus providing a basis for poor functional expression in clonal cell lines. Our results establish SCG neurons as a favorable surrogate for the expression and study of molecularly defined Na(V)1.8-containing channels. The data also indicate that unidentified factors may be required for the efficient functional expression of Na(V)1.8 with a biophysical phenotype identical to that found in sensory neurons.     

Patient and tumour biology predict survival beyond the Milan criteria in liver transplantation for hepatocellular carcinoma

Background

Patients with hepatocellular carcinoma (HCC) beyond the Milan criteria are not considered for liver transplantation (LT) in many centres; however, LT may be the only treatment able to achieve long-term survival in patients with unresectable HCC. The aim of this study was to assess the role of recipient age and tumour biology expressed by the DNA index in the selection of HCC patients for LT.

Patients

Clinicopathological data of 364 patients with HCC who underwent LT between 1989 and 2010 were evaluated. Overall survival (OS) was analysed by patient age, tumour burden based on Milan criteria and the DNA index.

Results

After a median follow-up time of 78 months, the median survival was 100 months. Factors associated with OS on univariate analysis included Milan criteria, patient age, hepatitis C infection, alpha-fetoprotein (AFP) level, the DNA index, number of HCC, diameter of HCC, bilobar HCC, microvascular tumour invasion and tumour grading. On multivariate analysis, HCC beyond Milan criteria and the DNA index >1.5 independently predicted a worse OS. When stratifying patients by both age and Milan criteria, patients ≤60 years with HCC beyond Milan criteria had an OS comparable to that of patients >60 years within Milan criteria (10-year OS: 33% versus 37%, P = 0.08). Patients ≤60 years with HCC beyond Milan criteria but a favourable DNA index ≤1.5 achieved excellent long-term outcomes, comparable with those of patients within Milan criteria.

Conclusions

Patients ≤60 years may undergo LT for HCC with favourable outcomes independently of their tumour burden. Additional assessment of tumour biology, e.g. using the DNA index, especially in this subgroup of patients can support the selection of LT candidates who may derive the most long-term survival benefit, even if Milan criteria are not fulfilled.     

Infant-feeding practices and childhood stature in three ethnic groups

Inconsistencies in the literature on the relationship of infant feeding practices to stature were explored in a tri-ethnic sample of 3- or 4-year-old children. Measures of child stature, maternal stature, child age, type of infant milk-feeding, time of introduction of high fat and high carbohydrate foods, and social characteristics were analyzed with multivariate statistical techniques. No statistically significant bivariate or more complex relationships were detected between the modes of infant-feeding and child stature. The best-fitting regression equation accounted for 61% of the variance, revealing strong relationships with child age and maternal height, and weak relationships with child adiposity, gender, and ethnicity. The present results indicate that there is little likelihood that metabolic effects induced by methods of infant-feeding affect stature, at least among 3- or 4-year-old children.     

Autotransfusion-bacterial contamination during hip arthroplasty and efficacy of cefuroxime prophylaxis: A randomized controlled study of 40 patients

40 patients undergoing primary hip arthroplasty, given autologous processed blood transfusion, were randomized to receive no antibiotic prophylaxis (group A, n 20) or cefuroxime (1.5 g single injection; group B, n 20). Bacterial contamination at various steps in the autotransfusion procedure was assessed in liquid and solid culture media. the operation field and the wound drainage blood were never contaminated in either of the groups but some of the suction tips were. Parts of the Vacufix® blood collection bags of group A contained bacteria, but none in group B. Processed red blood cell concentrates in both groups showed bacterial growth. Greater blood loss did not increase the contamination rate in general. Isolated bacteria included the species Staphylococcus epidermidis, coagulase-negative staphylococci and Propionibacteria in both groups, but with different cell counts. in addition, Corynebacterium bovis et minutissimum and Moraxella were identified in group A.

In conclusion, autologous blood transfusion was a safe procedure. If contamination occurred, the bacterial count was low, and the bacteria of low pathogenicity. Antibiotic prophylaxis with cefuroxime reduced this contamination of suction tips and collection bags and limited the transfer of autologous blood products.