Coronary Risk Assessment by Point-Based vs. Equation-Based Framingham Models: Significant Implications for Clinical Care

BACKGROUND  

US cholesterol guidelines use original and simplified versions of the Framingham model to estimate future coronary risk and thereby classify patients into risk groups with different treatment strategies. We sought to compare risk estimates and risk group classification generated by the original, complex Framingham model and the simplified, point-based version.     

Coordination of grasping and walking in Parkinson’s disease

Studies on grasp control underlying manual dexterity in people with Parkinson disease (PD) suggest that anticipatory grasp control is mainly unaffected during discrete tasks using simple two-digit grasp. Nevertheless, impaired hand function during daily activities is one of the most disabling symptoms of PD. As many daily grasping activities occur during functional movements involving the whole body, impairments in anticipatory grasp control might emerge during a continuous dynamic task such as object transport during walking. In this case, grasp control must be coordinated along with multiple body segments. The present study investigated the effect of PD on anticipatory grasp control and intersegmental coordination during walking with a hand-held object. Nine individuals with idiopathic PD (tested OFF and ON medication) and nine healthy age-matched controls carried a grip instrument between their right thumb and index finger during self-paced and fast walking. Although the amplitude of grip forces was higher in standing and walking for subjects with PD, both subjects with PD and control subjects coupled grip and inertial force changes in an anticipatory fashion while walking. However, gait-induced motions of the object relative to that of the trunk (i.e., dampening) was reduced in subjects with PD. Medication increased the dampening in all subjects with PD. We suggest that these differences are associated with impairments in intersegmental coordination.     

Paediatric stroke: The need for interdisciplinary models of care

Abstract:   Stroke is an important cause of mortality and long-term morbidity in children. The aetiology of stroke in childhood differs from that of adults, with vasculopathies and congenital heart disease being the most commonly identified risk factors. Recognition and diagnosis are often delayed, limiting access to acute medical interventions such as thrombolysis. Optimal management of stroke in children is still not known and existing guidelines are at the level of expert consensus. Interdisciplinary childhood stroke programmes are required to meet the needs of this population and to contribute to the development of evidence-based therapies.     

Pathology of oesophageal tumours

Both epithelial and non-epithelial tumours are seen commonly within the oesophagus. Benign epithelial tumours usually take the form of polypoid squamous lesions; benign non-epithelial tumours tend to be submucosal and smooth muscle in origin. Malignant tumours of the oesophagus are mostly epithelial and divided into squamous cell carcinoma (SCC) and adenocarcinoma. Both tend to develop following epithelial dysplastic changes. Adenocarcinoma mostly arises in the metaplastic columnar lined mucosa seen in Barrett’s oesophagus. Risk factors for SCC include excess alcohol, poor diet and smoking whereas those for adenocarcinoma tend to relate to gastro-oesophageal reflux disease (GORD). Prognosis and management options in both tumours depend primarily on tumour stage.     

Pubertal Growth,IGF-1, and Windows of Susceptibility: Puberty and Future Breast Cancer Risk

PurposeRisk markers for breast cancer include earlier onset of menarche (age at menarche [AAM]) and peak height velocity (PHV). Insulin-like growth factor-1 (IGF-1) is associated with pubertal milestones, as well as cancer risk. This study examined the relationships between pubertal milestones associated with breast cancer risk and hormone changes in puberty.MethodsThis is a longitudinal study of pubertal maturation in 183 girls, recruited at ages 6–7, followed up between 2004 and 2018. Measures included age at onset of puberty, and adult height attained; PHV; AAM; adult height, and serum IGF-1, and estrone-to-androstenedione (E:A) ratio.ResultsPHV was greatest in early, and least in late maturing girls; length of the pubertal growth spurt was longest in early, and shortest in late maturing girls. Earlier AAM was related to greater PHV. IGF-1 concentrations tracked significantly during puberty; higher IGF-1 was related to earlier age of PHV, earlier AAM, greater PHV, and taller adult height. Greater E:A ratio was associated with earlier AAM.ConclusionsFactors driving the association of earlier menarche and pubertal growth with breast cancer risk may be explained through a unifying concept relating higher IGF-1 concentrations, greater lifelong estrogen exposure, and longer pubertal growth period, with an expanded pubertal window of susceptibility.