A comparison between dual axis rotational coronary angiography and conventional coronary angiography

Background: Coronary angiography remains the gold standard for the investigation of coronary artery disease, and is carried out in multiple, predefined stationary views, at different angulations around the patient, for both left and right coronary arteries. Dual axis rotational coronary angiography (DARA) is an alternative technique wherein the c‐arm rotates around the patient in a preprogrammed single acquisition, exposing the entire coronary artery at different angulations. The DARA system has been recently installed in the Cardiac Catheterisation Suite at Mater Dei Hospital, Malta, where a monoplane and a biplane machine are available. This study was carried out in order to compare DARA with conventional single and biplane coronary imaging, with respect to radiation dose, contrast loads, and procedure time. Methods: This study was carried out over the period from September to December 2010. Four hundred sixty‐three patients were studied. Patients referred for the investigation of native coronary anatomy, for whatever indication, were consented and included, and randomly assigned to one of four groups depending on which machine and modality was used: monoplane conventional, monoplane DARA, biplane conventional, and biplane DARA. Results: DARA was statistically significantly superior in dose area product, fluoroscopy time, amount of contrast used, and procedure time. These reductions ranged between 12 (contrast used) and 71% (procedure time). Conclusions: The advantages of such systems are obvious to both patient and healthcare provider, and DARA may prove to be an important and useful tool in the refinement of diagnostic coronary angiography by reducing patient contrast and radiation doses and reducing procedure time. © 2012 Wiley Periodicals, Inc.     

Evaluation and Outcome of Antenatal Hydronephrosis: A Prospective Study

Antenatal hydronephrosis (AHN), defined as dilatation of renal pelvis and/or calyces, is the most frequently detected antenatal abnormality. However, postnatal management of AHN is controversial. The purpose of this study was to describe the clinical outcomes of infants with AHN and to contribute to the definition of the postnatal evaluation of these patients. One hundred and thirty-six infants with AHN were prospectively followed up to 18 months. Patients were divided into two groups according to the degree of sonographic hydronephrosis (HN) on days 5–7: group I (n = 87, 64%) included patients who had grades 1 and 2 (64%) and group II (n = 49, 36%) included patients who had grade 3 and above HN. The grade of HN was found to be correlated with the increased risk of urologic pathologies. Frequency of vesicoureteral reflux was found to be significantly lower in patients with mild HN (6%) as compared to patients with severe AHN (29%) (p = 0.005). In addition, the risk of urinary tract infection increases with increasing grades of HN (10% vs. 29%, p = 0.006). The frequency of spontaneous resolution in patients with mild AHN (64%) was also significantly higher than in patients with severe HN (29%) (p < 0.001). The degree of AHN can be used for making decision about further diagnostic imaging and treatment. Our results strongly suggest that low-grade HN is a relatively self-limited condition and needs minimal investigation. In contrast, the outcome of more severe degrees of AHN needs clarification.     

微创膝关节单髁置换中期临床疗效研究

目的前瞻性研究微创膝关节单髁置换术（UKR）治疗膝内侧室骨关节病的中期临床疗效。方法对自2006年1月～2008年6月采用OxfordphaseⅢ假体行微创（MIS）一UKR的56例患者（60膝）进行了中期临床疗效的分析,并从影像学、KSS评分、WOMAC评分以及VAS评分等方面进行疗效评价。结果平均随访时间（73．0±2．4）个月;所有患者无术后感染、血栓形成、活动半月板脱位等并发症;无一例翻修病例;无死亡病例;KSS临床和功能评分分别由术前平均（41．2±3．3）分和（52．1±4．6）分增至术后（94．8±4．1）分和（93．8±3．2）分;WOMAC评分由术前平均（46．7±3．6）分减少为术后（11．4±1．8）分;VAS评分由术前平均（7．39±1．25）分降为术后（1．72±0．36）分;各项指标手术前后比较均有统计学差异（P均〈0．05）。结论MIS—UKR中期临床疗效满意,是治疗膝关节内侧室骨关节病的一个良好的手术选择。     

Self‐regulatory skills: Are they helpful in the prevention of overuse injuries in talented tennis players?

Talented athletes use metacognitive skills to improve their performance. Also, it is known that these skills are important for managing one's health. The goal of this study was to identify the relationship between metacognitive skills and overuse injuries in talented tennis players. Metacognitive skills were measured in 73 talented tennis players (45 boys and 28 girls, age 11‐14) at the start of the season, using the Self‐Regulation of Learning Self‐Report Scale. Overuse injuries were monitored for one season using the Oslo Sports Trauma Research Centre Questionnaire on Health Problems. Ordinal regression indicated that moderate or low selfmonitoring skills (compared to high selfmonitoring) (OR 4.555, CI 1.096‐18.927, P = 0.037) and exposure time (OR 1.380, CI 1.106‐1.721, P = 0.004) were associated with more time loss overuse injuries. A second analysis showed that this was the case in girls (OR 10.757, CI 1.845‐62.714, P = 0.008), but not in boys. Linear regression revealed that higher reflection scores and exposure time predicted overuse severity (F(5,58) = 2.921, P = 0.020, R² = 0.201). Possibly, selfmonitoring can help players to prevent themselves from time loss overuse injuries. Coaches should be aware that players can differ in selfmonitoring ability and thus in the ability to prevent overuse injuries. The role of reflection needs more research.     

Risk and protective factors for antepartum and postpartum depression: a prospective study

Introduction: Antepartum risk and protective factors for postpartum depression (PPD; the most common mental disorder after childbirth besides postpartum anxiety), have been frequently investigated in cross-sectional studies, but less often longitudinally. This study examined linear and moderator effects of risk and protective factors for peripartum depression. First, we investigated the predictive power of risk factors (physical problems during pregnancy, pregnancy-related anxiety, stressful life events, dysfunctional self-consciousness (DSC)) and protective factors (resilience, social support) for antepartum depression (APD) and PPD. Second, as DSC plays an important role in major depression, we examined whether the protective factors moderate the association between the risk factors DSC and APD as well as PPD.

Methods: We conducted a prospective study with three measurement time points: six weeks antepartum (N?=?297), as well as six weeks (N?=?278) and twelve weeks (N?=?266) postpartum. Direct and moderator effects on APD were analyzed using hierarchical regression analysis. Moderated mediation effects were investigated to explore whether the indirect, long-term effect of DSC on PPD six weeks after birth (PPD-6) and PPD twelve weeks after birth (PPD-12) is moderated by resilience.

Results: Predictors for APD were high DSC, high concerns about one’s appearance, low resilience and low social support. Resilience buffered (weakened) the impact of DSC on APD and affected PPD-6 and PPD-12 indirectly through APD.

Discussion: The results suggest that PPD-12 is influenced directly and indirectly through PPD-6 by APD, but that this effect depends upon risk and protective factors, especially on the combined effects of resilience and DSC. The key finding of our study is the moderating (i.e. weakening) effect of resilience on the relationship between DSC and depression. Resilience and DSC may be an important issue for depression prevention and treatment programs in the peripartum period.     

Anxiety and depression in patients with advanced ovarian cancer: a prospective study

Introduction: Survival of ovarian cancer patients is still unsatisfactory despite the introduction of new diagnostic and therapeutic methods. Women with advanced ovarian cancer with long-term survival are at persistent risk of anxiety and reactive depression due to poor prognosis and risk of burdensome symptoms. The aim of the study was to assess changes in anxiety and depression during multimodality ovarian cancer treatment and to identify correlates of anxiety and depression.

Method: The study included 106 consecutive patients with advanced ovarian cancer. Mean age of the study group was 53.9 years (SD = 10.8, range: 23–79). The participants completed Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory four times: prior to and one week after surgery, and before the second and the fourth course of adjuvant chemotherapy. Multivariate analysis was performed to identify the independent determinants of distress at various stages of treatment.

Results: The level of anxiety and the prevalence of pathological anxiety (74%) were the highest prior to surgery and gradually decreased thereafter. Irrespective of the treatment stage, the level of anxiety was higher than the corresponding level of depression. History of abortion, presence of intestinal stoma, poor general status, residual disease and time from the initial diagnosis were the main determinants of distress in ovarian cancer patients.

Conclusions: Significant changes in the level of anxiety and slight fluctuations in the depression level experienced during ovarian cancer treatment are mostly determined by clinical variables. Identification of individuals with psychological comorbidities is a vital component of patient-oriented multidisciplinary care.     

全膝关节置换术后康复影响因素的前瞻性队列研究

目的  探讨影响全膝关节置换术（TKA）患者术后康复的相关因素,为预测患者术后康复情况及制定预防控制措施提供科学依据。方法  采用前瞻性队列研究方法,选取2010年1月-2014年6月在该院住院治疗并行TKA的患者310例,组成队列资料。应用Spearman相关性分析及多元Logistic回归的方法,分析人口学因素、临床及手术因素对患者术后功能恢复的影响。结果  310例患者中,12例因故取消或推迟手术,19例于随访期内脱失,最终纳入综合分析患者共279例。Spearman相关性分析结果显示,性别、年龄、体重指数（BMI）、吸烟史、糖尿病史、低白蛋白血症、应用静脉血栓形成危险度（RAPT）评分、基于性能的功能测试（PBT）评分、手术时间、术中出血量、术后疼痛与患者术后康复相关（P <0.05）。多元Logistic回归结果表明,较大的年龄及BMI、糖尿病史、RAPT及PBT评分较差为延长患者住院时间的危险因素;较大的年龄、糖尿病史、低白蛋白血症为罹患术后并发症的危险因素;较大的年龄、糖尿病史为影响术后肢体功能恢复的危险因素,RAPT及PBT评分为术后肢体功能恢复的预测因子。结论  TKA患者术后康复与多种因素相关。临床应重点关注具有上述危险因素的患者,于术前及术中采取有效预防措施,促进患者康复。