Achilles tendon: MR imaging at 1.5 T

Thirty magnetic resonance (MR) examinations of the Achilles tendon were performed: 20 from patients without suspected tendon abnormalities; ten from patients with suspected tendon abnormalities. The appearance of the normal Achilles tendon is hypointense and flattened. Partial tears appeared as high-signal intratendinous collections, complete acute ruptures appeared as tendinous discontinuity, and uncomplicated surgical repairs appeared as areas of tendinous continuity with inhomogeneous signal in the operative site. Chronic tendinitis appeared as a diffuse thickening of the tendon. MR imaging of the Achilles tendon at 1.5 T enabled the determination of the degree of tendinous continuity, which may help with diagnosis, treatment, and the pacing of rehabilitation.     

Local clinical guidelines: description and evaluation of a participative method for their development and implementation

BACKGROUND: National guidelines are rarely followed by immediate changein clinical behaviour. We present our experience of an activeeducational method for local development and implementationof a guideline. OBJECTIVE: To evaluate the effectiveness of a participative method fordeveloping local clinical guidelines. METHODS: A trial in a district of the effect of guideline developmentincorporating active participation of intended recipients onsubsequent relevant prescribing. It was carried out in WirralFamily Health Services Authority district (the Wirral peninsula)comprising 69 general practices covering a population of 345763. An exemplar guideline on ‘hypertension in the elderly’was developed by the method described. The principal recommendeddrug was bendrofluazide 2.5 mg once daily. The differences inprescribed daily doses (PDD) of bendrofluazide 2.5 mg tabletsper quarter per 1000 prescribing units (age-weighted population)between the intervention district and England as a whole wasmeasured. RESULTS: Comparison of the intervention district with England data demonstratesa median difference of 122.49 PDD before and 206.34 PDD afterguideline production, this change is statistically highly significant(Mann-Whitney two-tailed P < 0.0001; 95% CL = 36.51–104.77).Grouped regression analysis shows no significant difference(0.89) in slope gradients before guideline production (P = 0.35,95% CL = –3.97–5.76), but the difference in slopegradients after (12.95) is statistically highly significant(P < 0.0001; 95% CL = 8.17–17.73). The data suggeststhat the change in clinical behaviour persisted for at leasttwo years. CONCLUSION: Participation of intended recipient general practitioners andlocal specialists in the development of a guideline by an activeeducational method as described was followed by a favourablechange in clinical behaviour which persisted for at least twoyears. Keywords. Clinical guidelines, development, evaluation, implementation, participation.     

Autism severity is associated with child and maternal MAOA genotypes

Cohen IL, Liu X, Lewis MES, Chudley A, Forster‐Gibson C, Gonzalez M, Jenkins EC, Brown WT, Holden JJA. Autism severity is associated with child and maternal MAOA genotypes. We replicated and extended a previously reported association between autism severity and a functional polymorphism in the monoamine oxidase A (MAOA) promoter region, MAOA‐uVNTR, in a sample of 119 males, aged 2–13 years, with autism spectrum disorder from simplex families. We demonstrated that (i) boys with the low activity 3‐repeat MAOA allele had more severe sensory behaviors, arousal regulation problems, and aggression, and worse social communication skills than males with the high activity allele; and (ii) problems with aggression, as well as with fears and rituals, were modified by the mothers' genotype. Boys with the 4‐repeat high activity allele who had homozygous 4‐repeat mothers showed increased severity of these behaviors relative to those born to heterozygous mothers. These findings indicate the importance of considering maternal genotype in examining associations of MAOA and other genes with behavior in male offspring.     

Yoga lifestyle intervention reduces blood pressure in HIV‐infected adults with cardiovascular disease risk factors*

Objective

People living with HIV infection are at increased risk for developing cardiovascular disease (CVD). Safe and effective interventions for lowering CVD risk in HIV infection are high priorities. We conducted a prospective, randomized, controlled study to evaluate whether a yoga lifestyle intervention improves CVD risk factors, virological or immunological status, or quality of life (QOL) in HIV‐infected adults relative to standard of care treatment in a matched control group.

Methods

Sixty HIV‐infected adults with mild–moderate CVD risk were assigned to 20 weeks of supervised yoga practice or standard of care treatment. Baseline and week 20 measures were: 2‐h oral glucose tolerance test with insulin monitoring, body composition, fasting serum lipid/lipoprotein profile, resting blood pressures, CD4 T‐cell count and plasma HIV RNA, and the Medical Outcomes Study Short Form (SF)‐36 health‐related QOL inventory.

Results

Resting systolic and diastolic blood pressures improved more (P=0.04) in the yoga group (−5 ± 2 and −3 ± 1 mmHg, respectively) than in the standard of care group (+1 ± 2 and+2 ± 2 mmHg, respectively). However, there was no greater reduction in body weight, fat mass or proatherogenic lipids, or improvements in glucose tolerance or overall QOL after yoga. Immune and virological status was not adversely affected.

Conclusion

Among traditional lifestyle modifications, yoga is a low‐cost, simple to administer, nonpharmacological, popular behavioural intervention that can lower blood pressure in pre‐hypertensive HIV‐infected adults with mild–moderate CVD risk factors.

     

A cross‐sectional study of psychological morbidity in patients with acne,psoriasis and atopic dermatitis in specialist dermatology and general practices

Background There is considerable evidence for an association of skin diseases with psychological morbidity. This relationship is best established for acne, psoriasis and atopic eczema. Previous studies have mostly been performed in specialist dermatological practice, and there is a lack of studies that include patients from general practice and a lack of controlled studies employing multivariate analysis. Aims/objectives This study aims to examine the relationship of acne, psoriasis and atopic eczema with psychological morbidities in patients recruited from general practice as well as specialist dermatology practice. Methods and subjects In this cross‐sectional study, 108 patients from general and specialist dermatology practices with the three diseases had disease severity assessed and completed measures of minor psychological disturbance (General Health Questionnaire‐12), anxiety and depression (Hospital Anxiety and Depression Scale), public self‐consciousness and social anxiety (Fenigstein Self‐Consciousness Scale), and neuroticism and extraversion/introversion (Eysenck Personality Inventory). Demographic data were also collected, along with self‐ratings of disease severity. Control subjects were 96 patients without skin disease recruited from the same general practices as the subjects. Results On univariate analyses, patients with skin disease had higher levels of minor psychological disturbance, public self‐consciousness and neuroticism than did controls. There were no differences in psychological measures between specialist and general practice patients or between patients with different skin diseases. On multivariate analyses, the significant differences did not persist. Conclusions This study demonstrates confounding in the relationship of skin diseases with psychological morbidity. The complex relationship of skin disease and psychological morbidity should be re‐examined.     

环氧乙烷对雄性大鼠精子形成影响的研究

用光镜和电镜观察环氧乙烷（ＥｔＯ）对精子形成的影响。Ｗｉｓｔａｒ雄性大鼠，静式吸入染毒，浓度为０、９０、３６０和８００ｍｇ／ｍ３，２ｈ／日，６日／周，连续染毒１３周或９周。结果表明，ＥｔＯ引起睾丸重量减轻，附睾尾精子数及活精率降低。低浓度（９０ｍｇ／ｍ３）组，电镜下可见少数异常形态结构的精子细胞和畸形精子尾丝。３６０ｍｇ／ｍ３组，染毒１３周，光镜下可见睾丸边缘部分曲细精管出现空泡，生精细胞减少，偶见多核巨细胞。电镜下观察，部分精细胞和支持细胞中线粒体受损及许多各种不同变态发育阶段的畸形精细胞，附睾尾精子畸形率明显升高。高浓度（８００ｍｇ／ｍ３）ＥｔＯ染毒９周，停止染毒４周后，生精细胞严重变性、坏死，曲细精管明显萎缩，生精细胞大部分消失。电镜下观察，所有精细胞崩解，附睾尾少精、死精或无精。结果提示，亚慢性吸入８００ｍｇ／ｍ３ＥｔＯ时，引起睾丸萎缩，出现死精或无精，损伤是不可恢复的。长期吸入低浓度ＥｔＯ对大鼠精子形成有影响，其中最敏感的是精细胞变态发育成精子的发育阶段。     

How to standardize vasomotor tone in serial studies based on quantitation of coronary dimensions?

In patients with coronary artery disease including those after coronary bypass graft operation and heart transplantation intervention studies based on serial quantitative coronary angiography, in part combined with intravascular ultrasound, are of increasing relevance. Since vasomotor tone of epicardial coronary arteries is influenced by a variety of factors, angiographic follow-up studies require standardization of coronary tone by induction of maximal dilation. We reviewed the effects of the most potent coronary vasodilatory drug groups, calcium antagonists and nitrocompounds, on coronary diameters. Intravenous or intracoronary injections of verapamil, diltiazem, nifedipine, nicardipine, and nisoldipine can cause profound coronary dilation which has been shown to be maximal with verapamil and nisoldipine. Shortcomings of calcium antagonists include short or unknown duration of action after bolus administration, severe drop in blood pressure, and lack of commercial availability of solutions for injection of many substances. Isosorbide dinitrate induces profound coronary dilation; however, after sublingual administration marked blood pressure decrease can occur, and the duration of action and ideal dose of intracoronary isosorbide dinitrate has not been investigated yet. Injections of molsidomine and its active metabolite, SIN-1, cause longlasting, reproducible, maximal coronary dilation, although only after a waiting period of at least 10 minutes; unfortunately, SIN-1 is only commercially available in France. Nitroglycerin induces reproducible maximal coronary dilation and is easy to administer sublingually or as intracoronary bolus injection with rapid onset of action and no major side effects. The short duration of action may require repeated administrations. To date, repeated intracoronary bolus injections of 0.1 mg nitroglycerin every 10 minutes seem to be the optimal known regimen for standardization of coronary vasomotor tone in serial angiographic studies. Further investigations in this field with old and new vasodilatory drugs are recommendable.