Short but catching up: Statural growth among native Amazonian Bolivian children

The ubiquity and consequences of childhood growth stunting (Z score, HAZ) in rural areas of low‐income nations has galvanized research into the reversibility of stunting, but the shortage of panel data has hindered progress. Using panel data from a native Amazonian society of foragers‐farmers in Bolivia (Tsimane'), we estimate rates of catch‐up growth for stunted children. One hundred forty‐six girls and 158 boys 2 ≤ age ≤ 7 were measured annually during 2002–2006. Annual Δ height in cm and in HAZ were regressed separately against baseline stunting and control variables related to attributes of the child, mother, household, and village. Children stunted at baseline had catch‐up growth rates 0.11 SD/year higher than their nonstunted age and sex peers, with a higher rate among children farther from towns. The rate of catch up did not differ by the child's sex. A 10% rise in household income and an additional younger sibling lowered by 0.16 SD/year and 0.53 SD/year the rate of growth. Results were weaker when measuring Δ height in cm rather than in HAZ. Possible reasons for catch‐up growth include (a) omitted variable bias, (b) parental reallocation of resources to redress growth faltering, particularly if parents perceive the benefits of redressing growth faltering for child school achievement, and (c) developmental plasticity during this period when growth rates are most rapid and linear growth trajectories have not yet canalized. Am. J. Hum. Biol., 2010. © 2009 Wiley‐Liss, Inc.     

Potential biases in colorectal cancer screening using faecal occult blood test

Background Colorectal cancer (CRC) is one of the most common types of cancer in European countries and associated with a high mortality rate. A 16% relative risk reduction (RRR) of mortality was found in a meta‐analysis based on four randomized controlled trials (RCT) on CRC screening. The aim of this paper was to scrutinize these trials for potential biases and assess their influence on the screening trials. Methods The four RCTs were reviewed based on the principles of ‘Critical Appraisal of the Medical Literature’. Principal investigators of the four RCTs were contacted to clarify uncertainties in their study. Data were collected from The Danish Data Archives. Authors of the Cochrane review were contacted. Results Six biases were identified, of which five favour screening. Three of the biases identified were specific to CRC screening: type of diagnostic method, place of surgery and diagnostic delay. Conclusion The 16% RRR in CRC mortality found in the updated Cochrane review's meta‐analysis is overestimated.     

Treatment of progressive Hodgkin's disease with intensive chemoradiotherapy and autologous bone marrow transplantation

Twenty-six patients with progressive Hodgkin's disease after conventional chemotherapy received intensive chemoradiotherapy and autologous bone marrow transplantation (ABMT); 19 also received additional involved-field radiotherapy. Twenty-one patients [81%, 95% confidence intervals (CI) 61% to 94%] attained complete (n = 18) or partial responses. Ten patients (38%, 95% CI 20% to 59%) are disease- free a median of 4.5 years later (range 3.5 to 7.0 years), including seven patients with continuous complete responses. The likelihood of overall response was not significantly influenced by any clinical or treatment variable examined. However, there was a trend favoring patients with higher Karnofsky scores, and higher scores were associated with attainment of complete responses (P = .06 and P = .02, respectively, Mann-Whitney U test). Both higher Karnofsky scores and shorter durations of disease before transplantation were associated with improved survival in a stepwise Cox multivariate analysis. The chief cause of failure was progression at sites previously involved with Hodgkin's disease. No patient relapsed in the marrow, and two of three patients with a history of marrow involvement with Hodgkin's disease achieved durable complete responses after transplantation. These data suggest that inadequate pretransplant conditioning, and not the reinoculation of occult tumor cells in the autologous marrow, caused most relapses. Fatal treatment-related toxicity occurred in six patients. Three patients died of idiopathic interstitial pneumonitis; each had previously received local mediastinal irradiation before intensive chemoradiotherapy. Intensive chemoradiotherapy and ABMT produces durable responses in some patients with Hodgkin's disease incurable with conventional therapy. Use of such therapies at the first sign of failure with conventional chemotherapy and development of more effective conditioning regimens should further improve results.     

Identification of dihydropteridine reductase in human platelets

Normal human platelets were shown to contain the enzyme dihydropteridine reductase. The enzyme was not found in a variety of other cells of hematogenous origin. Partial purification and kinetic and physical data indicated that the platelet enzyme is similar to that previously characterized from liver. Dihydropteridine reductase is important for the regeneration of tetrahydrobiopterin, a required cofactor in hydroxylation reactions involved in biogenic amine formation. The presence of the enzyme may indicate that some synthesis de novo of serotonin and/or catecholamines occurs in platelets, as opposed to a purely storage and transport function. In addition, screening for hyperphenylalaninemia due to dihydropteridine reductase deficiency may become feasible by assaying platelets for enzyme activity.     

Response of cerebral blood flow to changes in carbon dioxide tension during hypothermic cardiopulmonary bypass

Changes in cerebral blood flow (CBF) in response to changes in PaCO2 were measured by intraaortic injection of 133Xe in 12 patients during hypothermic (23-30 degrees C) cardiopulmonary bypass. In each patient, CBF was determined at two randomly ordered levels of PaCO2 obtained by varying the rate of gas inflow into the pump oxygenator (Group I, n = 6) or by varying the percentage of CO2 added to the gas inflow (Group II, n = 6). Nasopharyngeal temperature, mean arterial pressure, pump-oxygenator flow, and hematocrit were maintained within a narrow range. In group I, a PaCO2 (uncorrected for body temperature) of 36 +/- 4 mmHg (mean +/- SD) was associated with a CBF of 13 +/- 5 ml X 100 g-1 X min-1, while a PaCO2 of 42 +/- 4 mmHg was associated with a CBF of 19 +/- 10 ml X 100 g-1 X min-1. In group II, a PaCO2 of 47 +/- 3 mmHg was associated with a CBF of 20 +/- 8 ml X 100 g-1 X min-1, and a PaCO2 of 53 +/- 3 mmHg was associated with a CBF of 26 +/- 9 ml X 100 g-1 X min-1. Within group I, the difference in CBF was significant (P less than 0.05); within group II, the difference in CBF was significant at the P less than 0.002 level. All CBF measurements were lower than those reported for normothermic, unanesthetized subjects of similar age.(ABSTRACT TRUNCATED AT 250 WORDS)     

Pharmacists need to participate and pay closer attention to the Medicare for All discussion

It has been a decade since the Patient Protection and Affordable Care Act (ACA) was signed into law. The ACA’s reception remains mixed, despite its moderate success in increasing insurance coverage, and discussions of health care reform have not abated. Among ongoing efforts to reform or repeal the ACA, “Medicare for All” appears in several prominent policy proposals. Public opinion polls from across the United States have demonstrated the growing popularity of reform proposals, which has encouraged legislators to be stronger advocates for such changes. Between 2017 and 2020, the 115th and 116th U.S. Congress introduced more than a dozen legislative proposals aimed at health care reform. Unfortunately, the variety and nuance of these legislative proposals have resulted in considerable confusion and division across the nation among health care providers and patients regarding definitions and implications of Medicare for All. This commentary aims to improve pharmacists’ understanding of Medicare for All, discuss the possible impact of Medicare for All on pharmacy practice, and serve as a call for U.S. pharmacists to participate in advocacy and reform of the health care system in which they practice. We argue that only through proactive participation in legislative advocacy will the pharmacists’ role in patient care continue to evolve. This brief commentary is divided into 5 major sections: (1) support for Medicare for All, (2) definitions of existing Medicare for All policy proposals, (3) estimation of the impact of Medicare for All proposals on the health care system, (4) the pharmacist perspective on the impact of Medicare for All, and (5) recommendations for pharmacy practice and advocacy.     

Operative treatment and arthroscopic findings in chronic patellar tendinitis

Patellar tendinitis is a well-described clinical entity that usually responds well to conservative treatment. However, a subset of patients continue with symptoms despite exhaustive nonoperative means. The objective of the study was to review the treatment course and operative results of seven patients (eight knees) with chronic patellar tendinitis treated surgically. Five (70%) of these patients were either professional or collegiate athletes. The average age was 30 years (range, 20 to 45 years). Duration of symptoms averaged 1.4 years (range, 3 months to 4 years) before surgical correction. Operative treatment included knee arthroscopy and open repair consisting of excision of degenerated tissue and stimulation of a healing response of the patellar tendon pathology. Operative findings and pathology reports consistently showed marked fibrotendinous degeneration. Follow-up averaged 3.6 years (range, 4 months to 8.5 years). Outcomes were measured subjectively with SF36 results and objectively with Biodex testing (Biodex, Shirley, NY) and return to previous level of competition. Overall, 86% of patients achieved an excellent result and 14% had a fair result. We recommend operative intervention in a patient with chronic patellar tendinitis who does not improve with well-supervised, comprehensive conservative treatment. (Arthroscopy 1998 Nov-Dec;14(8):836-9.)     

Low-artifact intravascular devices: MR imaging evaluation

Flow-phantom magnetic resonance (MR) imaging, with use of both spin-echo (SE) and gradient-echo (GRE) techniques at 1.5 T, was performed on the percutaneous Greenfield (beta-III titanium alloy [TMA wire]), Amplatz (MP32-N alloy), and Simon nitinol filters and TMA wire facsimiles of the bird's nest, Gunther, new retrievable, and Amplatz vena caval filters. SE imaging allowed detection of thrombi as small as 5 X 5 mm trapped within the percutaneous Greenfield, Simon nitinol, and TMA-wire facsimile filters; with the MP32-N Amplatz filter, a larger volume of thrombus (10 X 20-mm clots) was necessary for clot detection. GRE imaging allowed detection of intraluminal tilting of the percutaneous Greenfield and facsimile Amplatz (TMA-wire) filters. GRE imaging was useful for demonstrating postfilter turbulence due to clots, which was greatest for the Amplatz filter. Imaging of facsimile vascular devices made of tantalum or TMA wire did not cause the severe "black-hole" MR artifacts typical of the stainless-steel devices. SE and GRE imaging were very useful for determining caval patency in two patients with previously placed Mobin-Uddin filters. Noninvasive MR evaluation of blood vessels in the presence of a variety of low-artifact intravascular devices appears feasible.     

老年人血浆溶血磷脂酸和磷脂酸水平综合干预后的效果比较

目的:通过对老年人进行血浆溶血磷脂酸和磷脂酸的筛检,从而认识血浆溶血磷脂酸和磷脂酸在血栓预防中的作用。方法:对2004-04/07期间的1657名和2005-04/07期间的1748名离休干部进行血浆溶血磷脂酸和磷脂酸含量测定,并对溶血磷脂酸>3.0μmol/L和磷脂酸>5.0μmol/L的阳性人员进行药物干预。同时,选择2004年溶血磷脂酸和/或磷脂酸阳性人员119人,随机分为两组:①干预组(n=72):男63人,女9人,平均年龄78岁。口服阿司匹林100mg/d,持续1个月。②对照组(n=47):男42人,女5人,平均年龄76岁。干预后,测定两组血浆中溶血磷脂酸和磷脂酸的含量。结果:纳入对象全部进入结果分析。2005年磷脂酸及血浆溶血磷脂酸 磷脂酸阳性率均明显低于2004年(P<0.01),尤其是磷脂酸的阳性率降低的更为明显。2005年血浆溶血磷脂酸和磷脂酸的平均值均明显低于2004年(P<0.01)。干预组干预后血浆溶血磷脂酸和磷脂酸明显低于干预前及对照组(P<0.01)。结论:①血浆溶血磷脂酸和磷脂酸的测定可作为血栓预警和了解抗血栓药物疗效的一种手段。②阿司匹林干预后,血浆溶血磷脂酸和磷脂酸的含量均降低,可作为一种降低缺血性疾病发生率的有效途径。