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Is the stomach a main landmark on the abdominal circumference?

The fetal weight estimation depends largely on the accuracy of abdominal circumference. The quality criteria are standardized to minimize variability and include visualization of the stomach. The objective of this study is to investigate the presence or absence of the stomach on the abdominal circumference for 3 different operators. We conducted re-reading of 204 ultrasound images in the second and third trimester of pregnancy, performed by three operators, at the maternity Port Royal in Paris in 2013. On these images, the presence of the stomach was sought and other quality criteria were verified. Among the 204 images, 166 included the stomach (81%). When studying for each of the three operators, there were 79%, 72% and 98% of the stomach into the abdominal circumference, a significant difference between operators (P=0.0029). Regarding the secondary criteria, the quality criteria found most often were the calipers and well placed ellipse (89%).

According to the previous studies, the stomach seems to be a reference to search. Our study shows variability depending on the different operators. If a hierarchy of quality criteria is to be considered, the stomach does not seem to be the first criterion to search.

Is reducing drinking always the answer to reducing consequences in first-year college students?

Pre-college drinking has been shown to be a predictor of risky drinking and harmful outcomes in college. By contrast, less is known about how pre-college alcohol consequences influence subsequent consequences during the freshman year. The present study examined pre-college drinking and consequences in relationship to consequences experienced during the freshman year to better understand alcohol-related problems in this population. Incoming freshmen (N = 340, 58% female) were randomly selected and completed measures of drinking quantity, alcohol-related consequences, and drinking style behaviors at pre-college baseline and at 10-month follow-up. Pre-college consequences demonstrated a unique relationship with consequences at 10-month follow-up controlling for both pre-college and freshman-year alcohol consumption. Furthermore, precollege consequences moderated the relationship between pre-college drinking and consequences at 10-month follow-up. For individuals who reported above-average pre-college consequences, no differences in 10-month follow-up consequences were observed across different levels of drinking. Finally, drinking style significantly mediated the relationship between the interaction between pre-college drinking and consequences and consequences at follow-up.

The findings demonstrate the need to identify students who are at an increased risk of experiencing alcohol-related problems during their freshman year based on their history of consequences before college. Interventions aimed at these students may benefit from examining the usefulness of increasing protective behaviors as a method to reduce consequences in addition to reducing drinking quantity.

Intestinal anastomoses in small children: is there a higher risk?

Data were collected both retrospectively and by interviewing the parents. For the retrospective analysis, the underlying disease, biometric data, technical information about the anastomoses, associated illnesses, and complications were evaluated. In the parent interviews, the present quality of life and the state of health of the children were evaluated. From 1997 to 2007, intestinal anatomoses had been performed in 131 children for various reasons. There were no complications in 81.7% of the patients; 17 children received reoperation. In only 5 cases were anastomotic complications the reasons for the reoperation. Only 7.3% of the 77 interviewed families believe that their child has severe or relevant restrictions in daily life.

Among 131 children in whom an intestinal bowel anastomosis procedure was performed at age younger than 1 year, only 5 (3.2%) experienced complications associated with the anastomosis. The children are in good physical condition and have an excellent quality of life.

Are home interventions effective at decreasing indoor nitrogen dioxide concentrations?

Nitrogen dioxide (NO2 ), a by-product of combustion produced by indoor gas appliances such as cooking stoves, is associated with respiratory symptoms in those with obstructive airways disease. We conducted a three-armed randomized trial to evaluate the efficacy of interventions aimed at reducing indoor NO2 concentrations in homes with unvented gas stoves: (i) replacement of existing gas stove with electric stove; (ii) installation of ventilation hood over existing gas stove; and (iii) placement of air purifiers with high-efficiency particulate air (HEPA) and carbon filters. Home inspection and NO2 monitoring were conducted at 1 week pre-intervention and at 1 week and 3 months post-intervention. Stove replacement resulted in a 51% and 42% decrease in median NO2 concentration at 3 months of follow-up in the kitchen and bedroom, respectively (P = 0.01, P = 0.01); air purifier placement resulted in an immediate decrease in median NO2 concentration in the kitchen (27%, P < 0.01) and bedroom (22%, P = 0.02), but at 3 months, a significant reduction was seen only in the kitchen (20%, P = 0.05). NO2 concentrations in the kitchen and bedroom did not significantly change following ventilation hood installation. Replacing unvented gas stoves with electric stoves or placement of air purifiers with HEPA and carbon filters can decrease indoor NO2 concentrations in urban homes.

Several combustion sources unique to the residential indoor environment, including gas stoves, produce nitrogen dioxide (NO2), and higher NO2 concentrations, are associated with worse respiratory morbidity in people with obstructive lung disease. A handful of studies have modified the indoor environment by replacing unvented gas heaters; this study, to our knowledge, is the first randomized study to target unvented gas stoves. The results of this study show that simple home interventions, including replacement of an unvented gas stove with an electric stove or placement of HEPA air purifiers with carbon filters, can significantly decrease indoor NO2 concentrations.

Do [ Bulky DNA adducts in human sperm correlate with semen parameters and sperm apoptosis ]?

To explore the correlation of sperm polycyclic aromatic hydrocarbons (PAH)-DNA adducts with semen quality and sperm apoptosis. We collected semen samples from 433 infertile Chinese men, detected sperm PAH-DNA adducts using immunofluorescence staining and flow cytometry, and determined the rate of sperm apoptosis by TUNEL. Multiple linear regression analysis showed that the level of sperm PAH-DNA adducts was correlated negatively with sperm concentration (beta = -0.632), total sperm count (beta = -0.830) and sperm motility (beta = -9.647), but positively with the rate of sperm apoptosis (beta = 0.130).

Sperm PAH-DNA adducts are evidently correlated with semen quality and sperm apoptosis, and play an important role in the evaluation of male productivity.

Does acute phase IL-10 plasma concentration associate with the high risk sources of cardiogenic stroke?

Etiological assessment of stroke is essential for accurate treatment decisions and for secondary prevention of recurrence. There is evidence that interleukin-10 (IL-10) associates with ischemic stroke. The aim of this prospective study was to assess the levels of IL-10 in ischemic stroke with unknown or suspected cardiogenic etiology, and evaluate the correlation between IL-10 plasma concentration and the number of diagnosed high risk sources for cardioembolism. A total of 141 patients (97 males; mean age 61±11 years) with acute ischemic stroke with unknown etiology or suspected cardiogenic etiology other than known atrial fibrillation (AF) underwent imaging investigations to assess high risk sources for cardioembolic stroke established by the European Association of Echocardiography (EAE). IL-10 was measured on admission to the hospital and on a three month follow-up visit. Acute phase IL-10 concentration was higher in patients with EAE high risk sources, and correlated with their number (p<0.01). In patients with no risk sources (n = 104), the mean IL-10 concentration was 2.7±3.1 ng/L (range 0.3-16.3 ng/L), with one risk source (n = 26) 3.7±5.5 ng/L (0.3-23.6 ng/L), with two risk sources (n = 10) 7.0±10.0 ng/L (1.29-34.8 ng/L) and with three risk sources (n = 1) 37.2 ng/L. IL-10 level was not significantly associated with cerebral infarct volume, presence of previous or recent myocardial infarction, carotid/vertebral artery atherosclerosis, paroxysmal AF registered on 24-hour ECG Holter monitoring or given intravenous thrombolytic treatment.

IL-10 plasma concentration correlates independently with the number of EAE cardioembolic risk sources in patients with acute stroke. IL-10 may have potential to improve differential diagnostics of stroke with unknown etiology.

General and specific self-efficacy reports of patients with chronic low back pain: are they related to performances in a functional capacity evaluation?

The objective of this study was to analyze the relationship of general and specific self-efficacy (SE) beliefs with functional capacity evaluation (FCE) performances in patients with chronic non-specific low back pain (CLBP), while controlling for influence of gender, age, and self-reported pain intensity, self-esteem, disability, psychosocial distress and health status. Included were 92 patients with CLBP referred to an outpatient university based multidisciplinary pain rehabilitation program in The Netherlands. All patients underwent an FCE. General SE was measured with the ALCOS questionnaire prior to the FCE, specific SE was measured with a self-constructed standardized question during the FCE. Paired samples t-tests were used to tests differences between predicted and actual performances. Pearson and Spearman rank correlation coefficients were used to express the strength of the relationships between SE and performances. Multivariate analyses were used to test the influence of control variables on the relationships between SE (general or specific) and performances. Performances were consistently higher than patients' self-predictions. Differences between predictions and performances were significant in male lifting low, male carrying, and female carrying. With exception of the association between specific SE and lifting in males (r = 0.55, P<0.05), all other correlations between general and specific SE and FCE performances were non-significant. Multivariable regression analyses showed that the relative contribution of SE measures over gender was little or none.

The contribution of specific SE to the prediction of FCE performances is moderate in one instance, and insignificant in most instances (both specific and general SE). Because of the consistency of the differences between prediction (specific SE) and performances, and depending on the level of accuracy needed, future research may deliberate the use of predicted material handling capacities at group level and correct for a systematic underprediction.

Do iris-derived cells from adult rodents and primates adopt photoreceptor-specific phenotypes?

The purpose of this study was to investigate the effects of various genes related to photoreceptor development on rodent and primate iris cells and the potential of iris cells as donor cells for retinal transplantation. Adult rat and monkey iris tissue were cultured in serum-free medium containing basic fibroblast growth factor. Gene deliveries of Crx, Nrl, NeuroD and some combinations (Crx-Nrl, Crx-NeuroD) were performed with recombinant retrovirus. Immunocytochemistry, Western blot analysis, RT-PCR, and intracellular recording were used to examine the expression of photoreceptor-specific phenotypes in the iris-derived cells after gene transfer, . Coculture of the iris-derived cells with embryonic retinal explant was conducted, to investigate the potential integration of these cells in coculture conditions. Misexpression of Crx induced adult rat iris cells to express several photoreceptor-specific antigens and transcripts, such as rhodopsin, recoverin, cGMP-gated channel, arrestin, interphotoreceptor retinal-binding protein, rhodopsin kinase, and NeuroD. In primates, a combination of Crx and NeuroD was needed to induce monkey iris-derived cells to adopt photoreceptor-specific phenotypes. Furthermore, the photoreceptor-like cells derived from both rat- and primate-iris tissues showed rod photoreceptor-specific electrophysiological response to light stimuli after Crx and Crx-NeuroD gene transfer, respectively. The results further showed that iris-derived cells integrated in the developing host retina in coculture conditions.

Adult iris-derived cultured cells of both rodents and primates expressed photoreceptor-specific phenotypes by inductions of transcription factors. These iris-derived photoreceptor-like cells have electrophysiological characteristics of rod photoreceptors. Furthermore, they can integrate in the developing retina under coculture conditions.

Do effects of a Modified Hand Compression Bandage for Treatment of Post-Burn Hand Edemas?

To evaluate the effect of a modified hand compression bandage in patients with a post-burn hand edema. Patients were recruited from burn centers. We classified the patients into two groups: the modified hand compression bandage group comprising of 22 patients who had a modified hand compression bandage and received conventional physical therapy and the conventionally treated group, comprising of 20 patients who received only conventional physical therapy during the 4-week period post-burn. Hand circumference, hand skin thickness, and hand function were evaluated by grip strength, active range of motion (ROM), Jebsen hand function test, and visual analogue scale (VAS). These assessments were used to evaluate treatment effectiveness prior to the first treatment, 2 weeks after the first treatment, 4 weeks after the first treatment, and 4 months after the first treatment. As a result of repeated-measures analysis of variance on hand circumference, skin thickness, VAS, and each metacarpophalangeal joint ROM, we found significant differences that corresponded to time effect (p<0.05) and time×group (reciprocal action) effect (p<0.05). The results of grasp power, Jebsen hand function test, and each proximal interphalangeal joint ROM, show significant differences in accordance with the time effect (p<0.05), however, there was no reciprocal action effect (p>0.05).

The modified hand compression bandage will be clinically useful for the treatment of patients with post-burn hand edemas.

Is radiotherapy Alone Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma?

A moderate dose of radiation is the recommended treatment for solitary plasmacytoma (SP), but there is controversy over the role of surgery. Our study aimed at comparing different treatment modalities in the management of SP. Data from 38 consecutive patients with solitary plasmacytoma, including 16 with bone plasmacytoma and 22 with extramedullary plasmacytoma, were retrospectively reviewed. 15 patients received radiotherapy alone; 11 received surgery alone, and 12 received both. The median radiation dose was 50Gy. All operations were performed as radical resections. Local progression-free survival (LPFS), multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) were calculated and outcomes of different therapies were compared. The median follow-up time was 55 months. 5-year LPFS, MMFS, PFS and OS were 87.0%, 80.9%, 69.8% and 87.4%, respectively. Univariate analysis revealed, compared with surgery alone, radiotherapy alone was associated with significantly higher 5-year LPFS (100% vs 69.3%, p=0.016), MMFS (100% vs 51.4%, p=0.006), PFS (100% vs 33.7%, p=0.0004) and OS (100% vs 70%, p=0.041).

Radiotherapy alone can be considered as a more effective treatment for SP over surgery. Whether a combination of radiotherapy and surgery improves outcomes requires further study.

Is [ Goiter incidence in Germany greater than previously suspected ]?

The data regarding goitre prevalence in Germany is based on calculation arising out of dissimilar studies conducted among inhomogeneous study groups. The aim of our study was to collect data towards prevalence of goitre, thyroid size and structure through a prospective nationwide survey conducted using identical examination methods and study protocol. A total number of 6815 subjects belonging to various age groups and spread over 32 regions in Germany participated in our thyroid ultrasound study conducted with a 7.5 MHz transducer. Information regarding nutrition, use of iodised table salt and iodine containing medicine and/or substances were collected through a questionnaire. The volumetry and age related normal values were followed as per the guidelines set by Deutsche Gesellschaft für Endokrinologie. Enlarged thyroid was seen in 50% of 18 to 70 year age group, 52% of 11 to 17 year age group and in 21% of children up to 10 years. Focal lesions were detected in 2.5% of subjects below 18 years and in 30% of women and 21% of men over 18 years. A positive correlation between age, thyroid volume and number of thyroid nodules was seen. Up to 83% of the examined subjects admitted to using iodised table salt. Children consuming iodised salt were found to have smaller thyroid glands. No correlation was found between the consumption of iodised salt and thyroid size in the adolescent age group and young adults.

The prevalence of goitre in Germany is higher than it has been reported. The study underlines the insufficiency of the present goitre prophylaxis. Only an iodine prophylaxis (table salt, food products, fodder) backed by legislative measures can bring about a real breakthrough.

Risk-adjusted continuous outcome monitoring with an EWMA chart: could it have detected excess mortality among intensive care patients at Bundaberg Base Hospital?

To test whether applying a continuous riskadjusted charting method, using an exponentially weighted moving average (EWMA) chart, would have been useful for monitoring outcomes of patients admitted to the intensive care unit at Bundaberg Base Hospital, Queensland, between November 2000 and December 2005. An EWMA chart was constructed to show the change in observed compared with predicted mortality over time, using data submitted to the Australian and New Zealand Intensive Care Society Adult Patient Database. Limitations and practical implications of this monitoring technique were evaluated and compared with a routine monitoring technique using the annual standardised mortality ratio. In-hospital mortality. Data were submitted on three occasions (August 2002, November 2002 and February 2006). In each year before 2005, the EWMA chart showed periods when observed mortality appeared higher than predicted. These periods were not detectable by analysing the data with an annual standardised mortality ratio. Comparison of aggregated data from peer group hospitals suggested that the mortality prediction model (APACHE III-j) was an appropriate risk adjustment model for this analysis.

Continuous monitoring of outcomes using an EWMA chart may have advantages over other techniques. Had data been available, analysis with an EWMA chart might have prompted review of processes and outcomes among patients at Bundaberg Base Hospital ICU.

Does pPAR alpha activator fenofibrate inhibit myocardial inflammation and fibrosis in angiotensin II-infused rats?

Peroxisome proliferator-activated receptor (PPAR)alpha is highly expressed in the heart. PPAR alpha may play a role in cardiac hypertrophy, but effects on cardiac function, inflammation, and fibrosis are unknown. We tested the hypothesis that the PPAR alpha activator fenofibrate prevents myocardial inflammation and fibrosis in angiotensin (Ang) II-infused rats. Sprague Dawley rats received Ang II (120 ng/kg/min subcutaneously), fenofibrate (100 mg/kg/d p.o.), or Ang II + fenofibrate. After 7 d, systolic blood pressure (mmHg) was elevated (P < 0.01) in Ang II-infused rats (173 +/- 4) vs. controls (115 +/- 2) and reduced by fenofibrate (137 +/- 5). Electrophoretic mobility shift assay demonstrated that Ang II upregulated cardiac nuclear factor kappa B activity by 50%. Ang II significantly increased cardiac expression of vascular-cell adhesion molecule-1, platelet endothelial cell adhesion molecule, and intercellular adhesion molecule-1. Increases in expression of these inflammatory mediators were normalized by fenofibrate. Ang II-induced expression of transforming growth factor-beta 1, collagen deposition, and macrophage infiltration were partially prevented by fenofibrate.

The PPAR alpha activator fenofibrate prevented development of hypertension, and improved myocardial inflammation and collagen deposition in Ang II-infused rats. The hypolipidemic drug fenofibrate may be useful in prevention and treatment of myocardial disease associated with hypertension and hyperlipidemia.

Does the presence of autoantibodies without autoimmune diseases and hereditary thrombophilia have an effect on recurrent pregnancy loss?

To assess whether the presence of autoantibodies has any effect on recurrent pregnancy loss (RPL) and obstetric complications in women who do not have autoimmune diseases and hereditary thrombophilia. Retrospectively, 515 patients who underwent antibody investigation with anti-nuclear antibody, extractable nuclear antigen, anti-double stranded DNA, anti-parietal cell, anti-smooth muscle, anti-mitochondrial (AMA), anti-thyroid peroxidase, anti-thyroglobulin (anti-TG) and anti-phospholipid (aPL) at Hacettepe University were included. Of those patients, 212 had one or more autoantibodies whereas the remaining 303 were negative for all autoantibodies. RPL was the primary outcome and was defined as ≥2 pregnancy losses (n = 119). The frequency of RPL was significantly higher in the autoantibody positive group than controls (28.3% versus 14.5%, p<0.001). Anti-TG (21.2% versus 7.8%, p<0.001), aPL (18.3% versus 5.6%, p<0.001) and AMA (4.8% versus 0.5%, p = 0.001) antibodies were more common in patients with RPL. For the view of obstetric complications, oligohydramniosis (3.8% versus 0.7%, p = 0.03) and stillbirth (17.0% versus 10.6%, p = 0.002) were significantly higher in the autoantibody-positive group.

Even in women without autoimmune disease or hereditary thrombophilia, autoantibodies per se might directly increase the risk of RPL and obstetric complications. The screening anti-TG and aPL autoantibodies in the first step might be considered in patients with RPL.