Modulators of length of gestation: A study in Greece

In order to ascertain correlates of gestational age and predictorsof prematurity, all the mothers delivered in 1993 at the maternityclinic of the First University Department of Obstetrics andGynaecology and at one division of a private maternity hospitalin Athens, Greece, were interviewed. From a total of 3,770 deliveries,those involving multiple pregnancies or Caesarean deliverieswere excluded, as were pregnancies with an apparent durationof less than 150 or more than 300 days. The analysis was eventuallybased on 2,538 singleton deliveries. The duration of gestationwas modelled as an outcome variable through multiple regression.The following factors were found to be significantly (p<0.05)related to the duration of gestation: maternal education, +0.8day per 3 schooling years; family integrity, single comparedto currently married mother, –3.7 days; parity, muttiparous(4+ births) compared to primiparae, +2.8 days; age at menarche,+1.8 days per 2 years; maternal age, +3.9 days for younger than20 years and –1.7 days for older than 30 years in comparisonto women 20–29 years old; maternal weight before pregnancy,+0.4 day per 5 kg; coffee drinking, +0.7 day per cup per day;tobacco smoking, –1.8 days per 0.5 pack per day. Bleedingduring any trimester of pregnancy and maternal diabetes weresignificantly associated with shorter duration of gestationby 6.7 and 8.2 days respectively. The constellation of riskfactors for a pre-term delivery in Greece appears similar tothat in other populations. However, a positive association betweencoffee drinking and duration of pregnancy has not always beendemonstrated in other studies and the longer duration of pregnancyamong very young women represents an unusual finding. At therange of variation under investigation the individual factorsare not powerful predictors but their combination could identifywomen at high risk for prematurity.     

A new cleavage site for elastase within the complement component 3

Claesson R, Kanasi E, Johansson A, Kalfas S. A new cleavage site for elastase within the complement component 3. APMIS 2010; 118: 765–68. The lysosomal enzyme elastase was earlier shown to cleave the complement molecule C3. During some preliminary experiments on the interactions of certain pathogenic bacteria with the innate defence mechanisms, we observed C3 cleavage, in the presence of elastase, to fragments not previously described. To elucidate this proteolytic reaction, the present study was conducted. Degradation of C3 in mixtures with elastase or cathepsin G was detected by an immunoblot procedure using anti‐C3c and anti‐C3d antibodies after separating the proteins by SDS‐PAGE. Certain C3 fragments were analysed for amino acid sequence. The results revealed the existence of a cleavage site for elastase at the position alanine1350/lysine1351 of the C3 molecule, which has not been previously described. The fragment resulted from this cleavage has a size of about 39 kDa and it contains a part or the whole of C3d. This cleavage was distinct from the one previously described at position 987/988, which gives a 34 kDa C3d‐containing fragment.     

Investigating demographic,work-related and job satisfaction variables as predictors of motivation in Greek nurses

Aim To investigate whether demographic variables and work-related factors predict work motivation in Greek nurses. Background Nurses’ motivation is crucial for an effective health-care system. Herzberg’s and Maslow’s motivation theories constitute the framework of this study. Method The sample consisted of 200 nurses from every sector and registration level in a University Hospital in Greece. The response rate was 76%. Instruments A previously developed and validated questionnaire addressing four work-related motivators (job attributes, remuneration, co-workers and achievements) on a five-point Likert scale. Results Most participants were women, married, between 36 years and 45 years old and higher education graduates. The highest mean score was recorded for ‘achievements’ (mean 4.07, SD 0.72), which emerged as the most important motivator. Job satisfaction, work sector and age were statistically significantly related to motivational factors. Conclusions Nurses placed emphasis on motivators not strictly relating to economic rewards, but which can be seen as intrinsic and could lead to self-actualization. Implications for nursing management The constantly changing health sector requires that human resources and job context be a priority for health administrators. By promoting nurses’ satisfaction and efficacy, an improvement in service quality is expected.     

Has Gallo proven the role of HIV in AIDS?

The evidence that Robert Gallo and his colleagues presented on 4th May 1984 regarding HTLV-III (HIV) isolation and the role of HIV in the pathogenesis of AIDS is critically analysed. It is concluded that the evidence does not constitute proof of the isolation of a retrovirus, that the virus is exogenous, or that the virus is causally related to AIDS.     

Torsion of undescended testis in a man with Down''s syndrome

Undescended testis is one of the most common disorders in Down's syndrome. We present an extremely rare case of torsion of an inguinal undescended testis in a 35-year-old patient with Down's syndrome. Surgical exploration revealed a rotated gangrenous testis, radical orchiectomy was performed, and pathological examination confirmed the diagnosis of testicular torsion.     

Clinical and polysomnographic determinants of snoring

Snoring is considered one of the hallmarks of sleep‐disordered breathing, but its determinants remain obscure in both obstructive sleep apnoea (apnoeic) and non‐apnoeic snorers. We aimed to document positional dependency of snoring along with its association with clinical and polysomnographic variables. Seventy‐seven apnoeic and 27 non‐apnoeic snorers who complained for every‐night loud snoring and slept in supine and lateral positions in all sleep stages during overnight polysomnography were included. Snoring (i.e. sound intensity > 40 dB) was quantified by measuring the mean and maximum sound intensity, and snoring frequency. In apnoeic and non‐apnoeic snorers, mean snoring intensity and snoring frequency were higher in supine than in lateral positions irrespective of sleep stage, and were also usually higher in N3 in comparison to rapid eye movement and/or N2 sleep stage in any given position. Positional change in snoring intensity as expressed by the ratio of mean intensity in the supine to lateral positions was independently and positively correlated with body mass index, tonsils size and age in the total of patients. Snoring is more prominent in the supine position and in N3 sleep stage in apnoeic and non‐apnoeic snorers. Snoring positional dependence is determined by body mass index, tonsils size and age.     

A New Nonfluoroscopic Navigation System to Guide Pulmonary Vein Isolation

Different techniques have been proposed to treat atrial fibrillation (AF) by catheter ablation. This study compares a new three-dimensional (3D) nonfluoroscopic navigation system with conventional fluoroscopy to guide pulmonary vein (PV) isolation. A total of 60 consecutive patients with paroxysmal or persistent AF were randomly assigned to 3D-guided ablation (group 1, n = 30), versus conventional fluoroscopy guidance ablation (group 2, n = 30). Complete PV isolation was achieved in both groups. The mean duration of fluoroscopy exposure (22 ± 8 vs 56 ± 10 minutes), and radiofrequency delivery (5 ± 1 vs 10 ± 3 minutes) were significantly shorter in group 1 than in group 2, P < 0.05 for both comparisons). The mean procedural time in group 1 was longer (225 ± 15 minutes) than in group 2 (156 ± 10 minutes, P < 0.05) due to the learning curve and time spent to generate the 3D maps. Over a mean follow-up of 7 ± 2 months, 6 patients (20%) in group 2 had AF recurrences compared to 3 patients (10%) in group 1 (ns). The new nonfluoroscopic 3D system allows a high-resolution reconstruction of the left atrium and PVs. It significantly reduces the mean radiofrequency delivery and fluoroscopy times as opposed to ablation performed under fluoroscopy guidance.     

RELATIVE AND POPULATION ATTRIBUTABLE RISK OF TRAFFIC INJURIES IN RELATION TO BLOOD-ALCOHOL LEVELS IN A MEDITERRANEAN COUNTRY

Blood samples were taken from, and interviews were conductedwith, 76 persons injured in motor vehicle crashes, and from126 controls with a home and leisure injury. The analysis wasundertaken by modelling the data through conditional logisticregression, controlling for gender- and age-matched variablesand other potentially confounding variables, including educationand visual acuity. Detectable alcohol levels were associatedwith a 4.9 relative risk (95% confidence intervals 1.4 to 16.8).The population attributable fraction was about 10% with wideconfidence intervals. There was no evidence for a safe thresholdin these data. The increased injury risk associated with detectableblood-alcohol levels was disproportionally, albeit non-significantly,elevated among occasional drinkers in comparison to regulardrinkers. We conclude that alcohol intake is an important causeof road traffic injuries even in the context of the Mediterraneancountries where alcohol is taken in moderation and mainly inthe form of wine during meals.