Evaluation of Blood Pressure Measuring Devices

Validation of blood pressure measuring devices is a relatively new field of research. There are two national protocols for validating blood pressure measuring devices: the protocol of the American Association for the Advancement of Medical Instrumentation (AAMI) and the protocol of the British Hypertension Society (BHS), each of which has recently been revised, 19 blood pressure measuring devices have been validated according to one or both of these protocols. These protocols have been beneficial in drawing attention to the potential inaccuracy of blood pressure measuring systems, they permit comparison between devices and they have brought manufacturers of blood pressure measuring devices into closer contact with the profession. There are some inherent weaknesses in both protocols which include the fallibility of the ‘gold standard’, the lack of provision for validation in special circumstances and in special groups, such as the elderly and pregnant women, and failure to allow for deteriorating accuracy with higher pressure levels. The revised BHS protocol attempts to redress these deficiencies.     

World Trade Center "sarcoid-like" granulomatous pulmonary disease in New York City Fire Department rescue workers

BACKGROUND: Previous reports suggest that sarcoidosis occurs with abnormally high frequency in firefighters. We sought to determine whether exposure to World Trade Center (WTC) "dust" during the collapse and rescue/recovery effort increased the incidence of sarcoidosis or "sarcoid-like" granulomatous pulmonary disease (SLGPD). METHODS: During the 5 years after the WTC disaster, enrollees in the Fire Department of New York (FDNY) WTC monitoring and treatment programs who had chest radiograph findings suggestive of sarcoidosis underwent evaluation, including the following: chest CT imaging, pulmonary function, provocative challenge, and biopsy. Annual incidence rates were compared to the 15 years before the WTC disaster. RESULTS: After WTC dust exposure, pathologic evidence consistent with new-onset sarcoidosis was found in 26 patients: all 26 patients had intrathoracic adenopathy, and 6 patients (23%) had extrathoracic disease. Thirteen patients were identified during the first year after WTC dust exposure (incidence rate, 86/100,000), and 13 patients were identified during the next 4 years (average annual incidence rate, 22/100,000; as compared to 15/100,000 during the 15 years before the WTC disaster). Eighteen of 26 patients (69%) had findings consistent with asthma. Eight of 21 patients (38%) agreeing to challenge testing had airway hyperreactivity (AHR), findings not seen in FDNY sarcoidosis patients before the WTC disaster. CONCLUSION: After the WTC disaster, the incidence of sarcoidosis or SLGPD was increased among FDNY rescue workers. This new information about the early onset of WTC-SLGPD and its association with asthma/AHR has important public health consequences for disease prevention, early detection, and treatment following environmental/occupational exposures.     

Beck绝望量表中文版在青少年中使用的信度和效度

目的:研究Beck绝望量表中文版在青少年中使用的信度和效度。方法:采用Beck绝望量表和自杀意向量表,在大连医科大学和辽宁省大连市庄河县分别选取了192名大学生和292名高中生。间隔一周后对其中的86个大学生样本进行重测。主要采用相关分析和因子分析评价量表的信度和效度。结果:20个项目与总分之间的相关系数在0.19-0.70之间,平均相关系数为0.52。量表的Cronbachα系数为0.85,重测信度为0.62(P<0.001)。绝望量表总分与自杀意念量表总分成正相关(r=0.35,P<0.001),无自杀意念被试绝望量表的平均得分低于有轻度自杀意念和有自杀意图被试绝望量表的平均得分(P=0.007和P<0.001)。探索性因子分析提取了动力丧失、对未来的感觉和对未来的期望3个因子(累计解释的方差为43.44%)。除了项目3、4,其他条目的负荷范围在0.47-0.77之间。项目3、6、7、14、18的归属与Beck的假设不一致。结论:Beck绝望量表中文版在青少年中使用有较好的信度和构想效度,但是仍然需要扩大样本在将来的研究中更深入地验证并改进其结构效度。     

抑郁症患者儿童期受虐对5-羟色胺水平的影响

目的探讨抑郁症患者儿童期受虐对血清5-羟色胺水平的影响。方法对101例抑郁症患者采用儿童受虐问卷、汉密顿抑郁量表、自杀意念量表及Beck绝望量表评定儿童期受虐状况、抑郁严重程度、自杀意念强度和绝望严重程度;根据儿童受虐问卷评分将受试者分为受虐组（50例）,无受虐组（51例）。采用酶联免疫吸附法测定血清5-羟色胺水平。结果101例抑郁症患者中,49．5％在儿童期有过不同类型不同程度的受虐,其中情感虐待45．5％,情感忽视27．7％,躯体虐待24．8％,躯体忽视56．4％,性虐待18．8％。受虐组汉密顿抑郁量表总分显著高于无受虐组（P〈0．05）。受虐组的血清5羟色胺水平显著低于无受虐组（P〈0．05）,其中情感受虐组低于无受虐组（P〈0．05）。血清5羟色胺水平与汉密顿抑郁量表总分和情感虐待评分呈显著负相关（R=-0．25、-0．21,P〈0．05）。结论抑郁症患者儿童期受虐待对5-羟色胺水平有明显的影响,儿童期受虐可能是成年后罹患抑郁症的危险因素。     

Residual Disability,Mortality, and Nursing Home Placement After Hip Fracture Over 2 Decades

Objective

To examine trends in 12-month postfracture residual disability, nursing home placement, and mortality among patients with a hip fracture between 1990 and 2011.

Wolframin gene H611R polymorphism: No direct association with suicidal behavior but possible link to mood disorders

Wolframin gene polymorphisms, including the H611R polymorphism, are reportedly associated with mood disorders and psychiatric hospitalization, but there is disagreement about the association of this specific variant with suicidality and impulsive traits. This study tested the association of the H611R polymorphism with mood disorders, suicidal behavior, and aggressive–impulsive traits. Two hundred and one subjects with mood disorders and 113 healthy volunteers were genotyped for the H611R polymorphism and underwent structured interviews for diagnosis and clinical ratings. All were Caucasians. The H611R polymorphism was associated with mood disorders but not suicidal behavior, aggressive/impulsive traits or suicidality in first-degree relatives. The HR heterozygote genotype was more frequent in mood disorder (χ² = 7.505; df = 2; p = .023). If this finding will be replicated, the H611R polymorphism may be a possible marker for mood disorders in a psychiatric population, and not just in relatives of Wolfram syndrome probands.     

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry for the identification of beta-hemolytic streptococci

Objective

Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) has emerged as promising technology for species identification. The purpose of this investigation was to compare the performance of MS and the traditional method for identification of beta-hemolytic streptococci (BHS).

Methods

Clinical BHS isolates were identified by the BD Phoenix SMIC/ID Streptococcal panels, and two MALDI-TOF MS platforms: the VITEK MS and the Bruker MALDI Biotyper systems respectively. In case of discordant results, 16sRNA sequencing was performed to provide the reference ID.

Results

A total of 96 isolates of BHS were analyzed. Thirty-six isolates (20.8%) were re-tested by BD Phoenix for identification failure; and four isolates (4.2%) were rerun on the Bruker system for low identification score. No isolate need a second run for identification by Vitek MS system. Overall, BD Phoenix, BioTyper and Vitek MS automated system accurately identified 76 strains (79.2%), 91 (94.7%) strains and 92 (95.8%) strains, respectively.

Conclusions

Our study suggests that MALDI-TOF MS is a superior method to conventional phenotypic methods for BHS identification.     

Serum vitamin E concentrations among highly functioning hip fracture patients are higher than in nonfracture controls

Malnutrition after hip fracture is common and associated with poor outcomes and protracted recovery. Low concentrations of vitamin E have been associated with incident decline in physical function among older adults and may, therefore, be particularly important to functionally compromised patients hip fracture patients. Serum concentrations of α-tocopherol and γ-tocopherol, the 2 major forms of vitamin E, were assessed in 148 female hip fracture patients 65 years or older from the Baltimore Hip Studies cohort 4 around the time of fracture (baseline) and at 2, 6, and 12 month postfracture follow-up visits (recovery). It was hypothesized that mean concentrations of both forms of vitamin E among these hip fracture patients would be lowest at the baseline visit and increase at each study visit during the year after fracture. Linear regression and generalized estimating equations were used to assess changes in vitamin E concentrations after adjustment for covariates and to determine predictors of vitamin E concentrations at baseline and throughout recovery. It was also hypothesized that vitamin E concentrations shortly after hip fracture would be lower than those in nonfracture controls after adjustment for covariates. To evaluate this hypothesis, linear regression was used to perform adjusted comparisons of baseline vitamin E concentrations among Baltimore Hip Studies cohort 4 participants to 1076 older women without history of hip fracture from the Women's Health and Aging Study I, Invecchiare in Chianti Study, and the National Health and Nutrition Examination Surveys. Mean α-tocopherol was lowest at baseline, and time from fracture to blood draw was positively associated with baseline α-tocopherol (P = .005). Mean γ-tocopherol did not change appreciably throughout the year after fracture, although it fluctuated widely within individuals. Serum concentrations of α-tocopherol and γ-tocopherol were highest among the hip fracture population after adjustment (P < .0001). In general, highly cognitively and physically functioning hip fracture patients demonstrated higher vitamin E concentrations. Thus, the relatively high degree of function among this cohort of hip fracture patients may explain their higher-than-expected vitamin E concentrations.     

Validation of automated oscillometric sphygmomanometer (HDBPM) for arterial pressure measurement during haemodialysis

An HDBPM oscillometric sphygmomanometer used for the automatic measurement of arterial blood pressure is evaluated according to the ANSI/AAMI SP10-1992 standard. The accuracy of the HDBPM is ascertained by comparing it against the standard Riva-Rocci ascultatory method. Following the ascultatory method, two independent observers use the HDBPM devise to simultaneously measure the arterial blood pressure in 92 subjects of varying ages and having different blood pressures and arm sizes. High agreement is found when comparing the observers' pressure determinations (within 10 mmHg for 100% of observations). Correlation between the average of two ascultatory determinations and the HDBPM is high both for the systolic (r=0.98) and diastolic (r=0.94) pressures. The mean of the differences between the pressures measured by the observers and the HDBPM device are 0.2 mmHg (systolic) and −0.4 mmHg (diastolic). The percentages of readings within 10 mmHg between those taken by the observers and those taken by the HDBPM are 88% (systolic) and 97% (diastolic). These results largely satisfy current requirements.