Premedication with sublingual triazolam compared with oral diazepam

The clinical effects of a new administration form of triazolam, 0.2 mg sublingual (sl) tablet, were compared with those of a 10 mg tablet of diazepam in a double-blind study, in 100 ASA I-II patients scheduled for opthalmic surgery under local anaesthesia. The sedative and anxiolytic effects of the study drugs were followed at 15 min intervals by plotting the patient’s assessments on a visual analogue scale and by a trained observer. The onset of sedative and anxiolytic effect was similar. At 75 min after premedication and after the operation triazolam 0.2 mg caused deeper sedation than diazepam 10 mg according to the observer (P < 0.001, P < 0.01) and according to the patient (P < 0.01, P < 0.05). Ten patients (20%) in the triazolam group and one in the diazepam group were assessed to be too sedated during the operation. All these patients were 61–70 yr old. The study drugs resulted in equal reduction of anxiety during the preoperative period. Both premedicants provided good patient comfort but caused total amnesia only to one patient in each group. Neither caused any severe cardiorespiratory or other side effects. It is concluded that 0.2 mg triazolam si produces deeper sedation than 10 mg oral diazepam. For elderly patients this dose is excessive for intraocular surgery.     

Comparison of knowledge, attitudes and behaviour regarding smoking among Estonian and Finnish physicians

Summary. Objectives: To compare smoking behaviour, attitudes and opinions towards smoking and smoking cessation among Estonian and Finnish physicians. Methods: A cross-sectional postal survey using a self-administered questionnaire was carried out among 2 480 Estonian and 2 075 Finnish physicians. Results: Daily smoking prevalence was higher among Estonian physicians than among their Finnish counterparts in both male (18.6% and 6.7%) and female (6.6% and 3.6%). Compared to Estonia, physicians in Finland more often agreed that smoking is very harmful to their health, that trying to convince people to stop smoking is their responsibility and that smoking prevention should be part of the normal and special training of health professionals. In both countries, non-smoking physicians held more unfavourable attitudes towards smoking than those who were smoking. Conclusions: Physicians’ own smoking patterns and quitting behaviour are important because physicians serve as models for their patients and play a key role in the reinforcement of smoke-free health facilities. These results remain a challenge to medical educators, especially in Estonia. Estonia needs to improve medical education in terms of motivating physicians to ask about the smoking patterns of their patients and of training medical students and resident physicians to counsel their patients to stop smoking.

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Zusammenfassung. Vergleich der Kenntnisse, Einstellungen und des eigenen Verhaltens bezüglich des Rauchens zwischen der estnischen und der finnischen ?rzteschaft Fragestellung: Es werden die Unterschiede in den Rauchgewohnheiten, in der Einstellung und den Ansichten über das Rauchen und die Raucherentw?hnung zwischen estnischen und finnischen ?rzten untersucht. Methoden: Eine Querschnittsstudie mit selbstauszufüllendem Fragebogen wurde bei 2 480 estnischen und 2 075 finnischen ?rzten durchgeführt. Resultate: Die t?gliche Rauchpr?valenz war sowohl bei den ?rzten (18,6%) als auch bei den ?rztinnen (6,6%) in Estland h?her als bei ihren finnischen Kollegen (6,7%) und Kolleginnen (3,6%). Verglichen mit Estland, waren ?rzte in Finnland ?fters der Meinung, dass Rauchen sehr sch?dlich für ihre Gesundheit ist, dass sie dafür verantwortlich sind, ihre Patienten davon zu überzeugen, dass es wichtig ist, aufzuh?ren zu rauchen, und dass Tabakpr?vention ein Teil der normalen und speziellen Ausbildung von Gesundheitsfachleuten sein sollte. In beiden L?ndern hatten nichtrauchende ?rzte gegenüber dem Rauchen eine st?rker ausgepr?gte negative Haltung als die rauchenden. Schlussfolgerung: Dem Rauchverhalten der ?rzteschaft selbst kommt wegen deren Vorbildfunktion gegenüber den Patienten eine Schlüsselrolle bei der Erreichung von rauchfreien Gesundheitseinrichtungen zu. Diese Resultate zeigen, dass die medizinische Ausbildung vor allem in Estland betreffend Rauchen noch ein Verbesserungspotential hat. Estland muss die medizinische Ausbildung so verbessern, dass ?rzte mehr motiviert sind, mit ihren Patienten über das Rauchen zu sprechen. Zudem sollten Studierende der medizinischen F?cher aber auch bereits praktizierende ?rzte dahingehend geschult werden, dass sie ihre Patienten st?rker zur Raucherentw?hnung motivieren k?nnen.

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Résumé. Connaissances, attitudes et comportements des médecins estoniens et finlandais envers le tabagisme Objectifs: Comparer les habitudes de consommation de tabac, les attitudes et les opinions concernant le tabagisme et la cessation tabagique parmi les médecins estoniens et finlandais. Méthodes: Enquête par questionnaire auto administré, auprès de 2 480 médecins estoniens et de 2 075 médecins finlandais. Résultats: La prévalence du tabagisme était plus élevée parmi les médecins estoniens que parmi leurs collègues finlandais, tant pour les hommes (18,6% et 6,7%) que pour les femmes (6,6% et 3,6%). Les médecins en Finlande ont accepté plus souvent qu’en Estonie l’idée que le tabagisme est très nuisible pour leur santé, qu’il est de leur responsabilité de convaincre les gens de cesser de fumer et que la prévention du tabagisme devrait être un sujet normalement abordé dans la formation des professionnels de la santé. Dans les deux pays, les médecins non-fumeurs avaient une attitude plus défavorable envers le tabagisme que les médecins fumeurs. Conclusion: L’attitude des médecins concernant le tabagisme et la cessation tabagique est importante car ils servent de modèles pour leurs patients et ils jouent un r?le-clé pour assurer que le système de santé offre un environnement sans tabac. L’Estonie surtout a besoin d’améliorer la formation des médecins pour inciter ces derniers à interroger leurs patients sur leurs habitudes tabagiques et pour enseigner aux étudiants et aux internes comment informer leurs patients sur les programmes de cessation tabagique.

     

Motion detection and correction for dynamic 15O-water myocardial perfusion PET studies

Purpose Patient motion during dynamic PET studies is a well-documented source of errors. The purpose of this study was to investigate the incidence of frame-to-frame motion in dynamic ¹⁵O-water myocardial perfusion PET studies, to test the efficacy of motion correction methods and to study whether implementation of motion correction would have an impact on the perfusion results.Methods We developed a motion detection procedure using external radioactive skin markers and frame-to-frame alignment. To evaluate motion, marker coordinates inside the field of view were determined in each frame for each study. The highest number of frames with identical spatial coordinates during the study were defined as non-moved. Movement was considered present if even one marker changed position, by one pixel/frame compared with reference, in one axis, and such frames were defined as moved. We tested manual, in-house-developed motion correction software and an automatic motion correction using a rigid body point model implemented in MIPAV (Medical Image Processing, Analysis and Visualisation) software. After motion correction, remaining motion was re-analysed. Myocardial blood flow (MBF) values were calculated for both non-corrected and motion-corrected datasets.Results At rest, patient motion was found in 18% of the frames, but during pharmacological stress the fraction increased to 45% and during physical exercise it rose to 80%. Both motion correction algorithms significantly decreased (p<0.006) the number of moved frames and the amplitude of motion (p<0.04). Motion correction significantly increased MBF results during bicycle exercise (p<0.02). At rest or during adenosine infusion, the motion correction had no significant effects on MBF values.Conclusion Significant motion is a common phenomenon in dynamic cardiac studies during adenosine infusion but especially during exercise. Applying motion correction for the data acquired during exercise clearly changed the MBF results, indicating that motion correction is required for these studies.     

Nephrin strands contribute to a porous slit diaphragm scaffold as revealed by electron tomography

Nephrin is a key functional component of the slit diaphragm, the structurally unresolved molecular filter in renal glomerular capillaries. Abnormal nephrin or its absence results in severe proteinuria and loss of the slit diaphragm. The diaphragm is a thin extracellular membrane spanning the approximately 40-nm-wide filtration slit between podocyte foot processes covering the capillary surface. Using electron tomography, we show that the slit diaphragm comprises a network of winding molecular strands with pores the same size as or smaller than albumin molecules, as demonstrated in humans, rats, and mice. In the network, which is occasionally stratified, immunogold-nephrin antibodies labeled individually detectable globular cross strands, about 35 nm in length, lining the lateral elongated pores. The cross strands, emanating from both sides of the slit, contacted at the slit center but had free distal endings. Shorter strands associated with the cross strands were observed at their base. Immunolabeling of recombinant nephrin molecules on transfected cells and in vitrified solution corroborated the findings in kidney. Nephrin-deficient proteinuric patients with Finnish-type congenital nephrosis and nephrin-knockout mice had only narrow filtration slits that lacked the slit diaphragm network and the 35-nm-long strands but contained shorter molecular structures. The results suggest the direct involvement of nephrin molecules in constituting the macromolecule-retaining slit diaphragm and its pores.     

Vitamin D receptor gene polymorphism as an important modifier of positive family history related breast cancer risk

The association between vitamin D receptor (VDR) gene polymorphisms and diseases such as breast cancer, prostate cancer and osteoporosis has been extensively investigated during recent years. To date, several polymorphisms have been found in the VDR gene. In this Finnish case-control study, comprising 483 breast cancer patients and 482 healthy population controls, we investigated the association between altered breast cancer risk and two polymorphisms in the 3' end of the gene detectable with ApaI and TaqI restriction enzymes. A statistically significant difference was observed in the ApaI genotype distribution between cases and controls. Women with the VDR variant a allele containing genotypes showed a decreased risk for breast cancer [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.54-0.98] compared to women with the AA genotype. This association was especially strong among women with a positive family history of breast cancer (OR 0.14, 95% CI 0.03-0.76). Moreover, there was a trend (P for trend = 0.0007) for decreased risk with increasing number of variant alleles. The lowest risk of breast cancer was seen for the women with the aa genotype (OR 0.03, 95% CI 0.003-0.31) compared to women with the AA genotype. A tendency of decreased risk of breast cancer was also observed for the TaqI T allele containing genotypes (Tt and TT) (OR 0.68, 95% CI 0.41-1.12), but because the distribution of Taql alleles in the controls missed the Hardy-Weinberg equilibrium (P = 0.01), we were unable to properly assess the potential impact of the TaqI polymorphism in breast cancer susceptibility. In conclusion, our results suggest that the VDR ApaI genotype may be an important modifier of individual breast cancer risk among Finnish women, especially if they have a positive family history of breast cancer.     

Effect of extent of motion and type of load on the wear of polyethylene in a biaxial hip simulator

The most commonly used wear test device for prosthetic hip joints is the so-called biaxial rocking motion (BRM) design. The design has been criticized for its excessive sliding distance per cycle. The design was modified so that the extent of motion was reduced from 46 to 23 degrees, and comparative tests were run with the use of 1-kN static load. The present authors have earlier used 1-kN static load with good results. To further confirm this finding, additional, comparative tests were run with double-peak dynamic load and 46 degrees extent of motion. All three tests (46 degrees /static, 23 degrees /static and 46 degrees /dynamic), were done with conventional ultra-high-molecular-weight polyethylene acetabular cups against polished CoCr femoral heads in diluted calf serum lubricant. In all tests, the principal cup wear mechanism was adhesive, manifested as burnishing. With respect to wear particles, those produced in the 46 degrees /dynamic test showed the lowest resemblance to particles isolated from periprosthetic tissues. The 46 degrees /dynamic test produced a mean wear rate 43% higher than 46 degrees /static, whereas the 46 degrees /static and 23 degrees /static tests produced almost identical values. The results indicated that the 46 degrees extent of motion and dynamic load may not always be the optimal combination in BRM tests.