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PubMed2005

Ultraviolet radiation exposure and risk of malignant lymphomas.

BACKGROUND: The incidence of malignant lymphomas has been increasing rapidly, but the causes of these malignancies remain poorly understood. One hypothesis holds that exposure to ultraviolet (UV) radiation increases lymphoma risk. We tested this hypothesis in a population-based case-control study in Denmark and Sweden. METHODS: A total of 3740 patients diagnosed between October 1, 1999, and August 30, 2002, with incident malignant lymphomas, including non-Hodgkin lymphoma, chronic lymphocytic leukemia, and Hodgkin lymphoma, and 3187 population controls provided detailed information on history of UV exposure and skin cancer and information on other possible risk factors for lymphomas. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by logistic regression. Statistical tests were two-sided. RESULTS: Multivariable-adjusted analyses revealed consistent, statistically significant negative associations between various measures of UV light exposure and risk of non-Hodgkin lymphoma. A high frequency of sun bathing and sunburns at age 20 years and 5-10 years before the interview and sun vacations abroad were associated with 30%-40% reduced risks of non-Hodgkin lymphoma (e.g., for sunbathing four times a week or more at age 20 versus never sunbathing, OR = 0.7, 95% CI = 0.6 to 0.9; for two or more sunburns a year at age 20 versus no sunburns, OR = 0.6, 95% CI = 0.5 to 0.8). These inverse associations increased in strength with increasing levels of exposure (all P(trend)< or =.01). Similar, albeit weaker, associations were observed for Hodgkin lymphoma. There were no clear differences among non-Hodgkin lymphoma subtypes, although associations were stronger for B-cell than for T-cell lymphomas. A history of skin cancer was associated with a doubling in risks of both non-Hodgkin and Hodgkin lymphoma. CONCLUSIONS: A history of high UV exposure was associated with reduced risk of non-Hodgkin lymphoma. The positive association between skin cancer and malignant lymphomas is, therefore, unlikely to be mediated by UV exposure.

Adult↗
PubMed2006

Commonly studied single-nucleotide polymorphisms and breast cancer: results from the Breast Cancer Association Consortium.

BACKGROUND: The Breast Cancer Association Consortium (BCAC) is an international collaboration that was established to provide large sample sizes for examining genetic associations. We conducted combined analyses on all single-nucleotide polymorphisms (SNPs) whose associations with breast cancer have been investigated by at least three participating groups. METHODS: Data from up to 12 studies were pooled for each SNP (ADH1C I350V, AURKA F31I, BRCA2 N372H, CASP8 D302H, ERCC2 D312N, IGFBP3 -202 c>a, LIG4 D501D, PGR V660L, SOD2 V16A, TGFB1 L10P, TP53 R72P, XRCC1 R399Q, XRCC2 R188H, XRCC3 T241M, XRCC3 5' UTR, and XRCC3 IVS7-14). Genotype frequencies in case and control subjects were compared, and genotype-specific odds ratios for the risk of breast cancer in heterozygotes and homozygotes for the rare allele compared with homozygotes for the common allele were estimated with logistic regression. Statistical tests were two-sided. RESULTS: The total number of subjects for analysis of each SNP ranged from 12,013 to 31,595. For five SNPs--CASP8 D302H, IGFBP3 -202 c>a, PGR V660L, SOD2 V16A, and TGFB1 L10P--the associations with breast cancer were of borderline statistical significance (P = .016, .060, .047, .056, and .0088 respectively). The remaining 11 SNPs were not associated with breast cancer risk; genotype-specific odds ratios were close to unity. There was some evidence for between-study heterogeneity (P<.05) for four of the 11 SNPs (ADH1C I350V, ERCC2 D312N, XRCC1 R399Q, and XRCC3 IVS5-14). CONCLUSION: Pooling data within a large consortium has helped to clarify associations of SNPs with breast cancer. In the future, consortia such as the BCAC will be important in the analysis of rare polymorphisms and gene x gene or gene x environment interactions, for which individual studies have low power to identify associations, and in the validation of associations identified from genome-wide association studies.

Adult↗
PubMed1999

Effects of a low-intensity worksite-based nutrition intervention.

Male employees from four local worksites were recruited to participate in a short-term and low-intensity nutrition intervention which focused on promoting low-fat dietary habits. The sites were randomized to control conditions or to the intervention programme that consisted of an individualized health risk appraisal, group sessions, mass media activities and environmental changes. Participants were seen before and three months after intervention to measure blood lipids, nutrition knowledge and dietary changes. Eighty-three per cent of all eligible subjects were screened (n = 770) and follow-up measures were obtained for 82%. The score for nutrition knowledge improved significantly in the intervention group. There was also a net reduction in the intake of total calories and in the percentage of energy from total fat. Reported intake of carbohydrates and proteins increased. For all employees assessed, there were no changes in mean total cholesterol level or fatty acid composition. Only among participants with hypercholesterolemia was a significant reduction in blood cholesterol observed. This low-intensity intervention programme achieved some self-reported dietary changes and was successful (at least in part because statistical regression needs to be considered) in obtaining a more short-term beneficial cholesterol level in employees at higher cardiovascular risk.

Adult↗
PubMed1987

Contrasting diet and body mass among users and nonusers of oral contraceptives and exogenous estrogens: the Lipid Research Clinics Program Prevalence Study.

Mean dietary constituent levels using the 24-hour recall method and body mass measures were examined among oral contraceptive and exogenous estrogen users and nonusers in the Lipid Research Clinics Program Prevalence Study. Among women aged 20-44 years, oral contraceptive users had a significantly lower mean Quetelet index of body mass and triceps skinfold thickness and a significantly higher total caloric intake. Among women aged 45-69 years, those taking exogenous estrogens had a significantly lower mean Quetelet index. No significant differences between hormone users and nonusers were seen for per cent of calories from fat (saturated or unsaturated), protein, carbohydrates, starch, sucrose, or alcohol. The higher total caloric intake in oral contraceptive users in contrast to nonusers and the lower body mass in both groups of gonadal hormone users may in part be indicative of other differences in life-style and behavior between the study groups. Further documentation of specific eating patterns, nutrient intake, and energy metabolism in women consuming gonadal hormones and in suitable control subjects seems to be indicated.

Adult↗
PubMed2000

Caesarean section for placenta praevia: a retrospective study of anaesthetic management.

A retrospective survey of anaesthesia for Caesarean section (CS) for placenta praevia was performed, covering the period between January 1, 1984 and December 31, 1998. Three hundred and fifty consecutive cases of placenta praevia were identified. Overall a regional technique was used 60% of the time. Five women had a placenta accreta which required Caesarean hysterectomy: one had general anaesthesia (GA) throughout and four initially received a single-shot spinal injection. Of these latter four cases, two were converted to GA during the hysterectomy and two continued with spinal anaesthesia throughout. Two other women (both GA), suffered postoperative thrombotic episodes (one pulmonary embolus and one cerebral thrombosis) but made full recoveries. Control of blood pressure when using regional anaesthesia (RA), even in the presence of considerable haemorrhage, was not a problem. Statistical regression models indicated that RA was associated with a significantly reduced estimated blood loss and reduced need for blood transfusion. This retrospective survey finds no data to support the much quoted aphorism that RA is contraindicated for CS in the presence of placenta praevia.

Anesthesia, Epidural↗
PubMed1994

Light, immunofluorescence and electron microscopy renal biopsy findings as predictors of mortality in eighty-five Spanish patients with systemic lupus erythematosus.

This study aimed to define prognostic indicators of death in renal biopsies from Spanish patients with SLE. Renal biopsies of eighty-five lupus patients with and without clinical nephritis, taken between 1974 and 1987, were reviewed. Samples previously processed for light (LM), immunofluorescence (IM) and electron (EM) microscopy were analysed blind. Kaplan-Maier curves, log-rank test, and multivariate Cox's regression statistical methods were used for comparison of biopsy data in relation to patient survival. Univariate analysis showed that vascular hyalinosis, glomerular sclerosis, fibrous crescent and chronicity index higher than 3 by LM, and intramembranous dense-deposits by EM are predictors of poor survival. A multivariate approach confirmed the independent influence of vascular hyalinosis, chronicity index higher than 3 and intramembranous deposits. A predictive model can be constructed with three LM (hyalinosis, tubular atrophy and glomerular sclerosis) and three EM variables (subepithelial, mesangial and intramembranous deposits). Selected renal biopsy changes detected by LM and EM are therefore predictors of death in patients with lupus. Chronicity markers, more than those of activity or severity, are the best prognostic indicators.

Adolescent↗
PubMed2003

Explanation of vegetation succession in subtropical southern China based on ecophysiological characteristics of plant species.

A stomatal conductance model and a photosynthesis model were applied to field measurements of transpiration and photosynthesis of seven tree species growing in subtropical southern China. Parameter values of drought resistance and tolerance and biochemical assimilation capacity were obtained by means of nonlinear statistical regression, and were used to quantify species succession. The analysis indicated that the models adequately described the ecophysiological behavior of the trees under various environmental conditions. We found a general pattern of decreased drought resistance and tolerance, but increased biochemical assimilation capacity from pines to heliophilus broadleaf trees to mesophilus broadleaf trees. Succession was explained on the basis of these physiological characteristics together with positive feedbacks caused by changes in soil physical properties. The ecophysiological explanation of succession implies that: (1) fitness of a species for a particular succession stage at a particular location can be measured by stomatal behavior and biochemical assimilation capacity under local climate and soil conditions; (2) selection of species for a particular location at a particular succession stage can be guided by the parameter values provided in this study; and (3) succession may be accelerated by selecting trees with large root systems and large soil-root conductances that facilitate soil hydraulic redistribution of water.

China↗
PubMed1998

Prognostic significance of plasma markers of immune activation, HIV viral load and CD4 T-cell measurements.

OBJECTIVE: To evaluate the prognostic significance for AIDS occurrence of plasma levels of immune activation markers in comparison with and in conjunction with HIV viral load and CD4 T-cell measurements. DESIGN: A retrospective analysis was conducted of three plasma activation markers, the soluble tumor necrosis factor (TNF) receptor II (TNF-RII), neopterin and soluble interleukin-2 receptor levels, and of CD4 T-cell levels and plasma HIV viral load. SUBJECTS: The participants were 659 men taking part in the University of California Los Angeles Multicenter AIDS Cohort Study who were HIV-seropositive but AIDS-free in 1985. MAIN OUTCOME MEASURE: Clinically defined AIDS within 3 years. Failure time statistical regression models for the time to development of AIDS were used to assess prognostic capacity of the parameters alone and in combination. RESULTS: All the markers had prognostic capability. The levels of the three plasma activation markers correlated well with each other (median r = 0.61). They related less well with HIV RNA plasma levels (median r = 0.50) and least well with CD4 cell levels (median r = 0.36). Furthermore, plasma marker levels were shown to be able to stratify patients for prognosis within all the major categories of CD4 T-cell and HIV RNA levels. CONCLUSIONS: Plasma levels of soluble TNF-RII and other soluble markers of immune activation have prognostic capabilities which are different from HIV and CD4 T-cell levels. Combination of a single plasma activation marker measurement (such as soluble TNF-RII) with CD4 T-cell levels improved the prognostic capability of each. A new graphic technique for presenting prognostic capability indicated that plasma soluble TNF-RII and CD4 cell levels are better prognostic factors than HIV plasma level with CD4 cells < 200 x 10(6)/l. Inexpensive tests for one of the plasma activation markers, such as soluble TNF-RII or neopterin, can be useful for evaluations of HIV disease course, especially when expensive equipment, technical expertise and funding required for flow cytometry and for HIV load measurements are not readily available.

Antigens, CD↗
PubMed2001

Angular malalignment after intramedullary nailing of femoral shaft fractures.

OBJECTIVES: To determine factors associated with angular malalignment of femoral shaft fractures treated with intramedullary nails and to determine differences in the incidence of angular malalignment based on fracture location, fracture comminution, and method of treatment (i.e., antegrade or retrograde). DESIGN: Retrospective. SETTING: Level I trauma center. PATIENTS: Three hundred sixty patients with 374 femoral shaft fractures were identified from a prospectively obtained orthopaedic trauma database. Complete sets of immediate postoperative anteroposterior and lateral radiographs were available for 355 (95 percent) of the 374 fractures. INTERVENTION: Patients were treated with antegrade (183 cases) or retrograde (174 cases) intramedullary femoral nailing. MAIN OUTCOME MEASURE: Goniometric measurements were made on all immediate postoperative radiographs to determine the coronal plane and sagittal plane angular alignments. A multiple linear regression statistical analysis was used to determine factors associated with increasing angular malalignment. The incidence of malalignment was determined using more than 5 degrees of deformity in any plane as the definition of malalignment. RESULTS: Proximal fracture location, distal fracture location, and unstable fracture pattern were associated with increasing fracture angulation (p < 0.001). Fracture location in the middle third, stable fracture pattern, method of treatment (i.e., antegrade or retrograde), and nail diameter were not associated with increasing fracture angulation (p > 0.05). The incidence of malalignment was 9 percent for the entire group of patients, 30 percent when the fracture was of the proximal third of the femoral shaft, 2 percent when the fracture was of the middle third, and 10 percent when the fracture was of the distal third. The incidence of malreduction was 7 percent for patients with stable fracture patterns and 12 percent for those with unstable fracture patterns. CONCLUSIONS: Patients with fractures of the proximal third of the femoral shaft treated with intramedullary nails are at highest risk for malalignment. Proximal fracture location, distal fracture location, and unstable fracture pattern are associated with increasing fracture angulation.

Adolescent↗
PubMed1995

The correlation of multichannel urodynamic pressure-flow studies and American Urological Association symptom index in the evaluation of benign prostatic hyperplasia.

PURPOSE: We correlated multichannel pressure-flow urodynamics and the American Urological Association (AUA) symptom index in the evaluation of benign prostatic hyperplasia. MATERIALS AND METHODS: We evaluated 121 consecutive, symptomatic patients older than 55 years with the AUA symptom score and multichannel pressure-flow urodynamic studies. Testing was performed during a single session and the data obtained from 103 patients were plotted on the Schäfer nomogram for assessment of outflow obstruction. Linear regression statistical analysis was used to determine correlations. RESULTS: There was no significant correlation between uroflowmetry and Schäfer curves (r = 0.173 to 0.326), uroflowmetry and AUA symptom scores (r = 0.134 to 0.153) and, most importantly, AUA symptom scores and Schäfer curves (r = 0.025 to 0.137). CONCLUSIONS: We conclude that these modalities measure independent variables, and should not be linked in the evaluation and treatment decision of the patient with prostatism.

Aged↗
PubMed1998

Embryonic middle ear mesenchyme disappears by redistribution.

OBJECTIVE: The fate of embryonic middle ear mesenchyme from a postgestational infant ear has been speculative. Recently a volume analysis of human neonatal temporal bones demonstrated that embryonic mesenchyme disappeared by redistribution and thinning to surface a growing middle ear space. If this model is accurate, interaction with amniotic fluid and the gestational environment should not influence mesenchymal behavior. Therefore an opossum marsupial model was compared with human data. METHODS: The temporal bones of opossum pups (20 to 36 days of age) were sectioned for histologic analysis. Computations were made for the volume of the middle ear air cavity (VAC), volume of the bone cavity (VBC), volume of mesenchyme (VM), and percentage of the middle ear occupied by mesenchyme (%M), which were plotted against height using regression statistics. These data were compared with human neonatal (0 to 30 days of age) temporal bones. RESULTS: In both the opossum and the human the VAC and the VBC increased in parallel with growth of the body. In the opossum the VAC and VBC both grew at 0.148 mm3/mm of body length. In humans, both the VAC and VBC grew 6.1 mm3/cm of body length. The VM in the opossum remained constant at 0.98 mm3, regardless of body length. In humans the VM remained constant at 71.7 mm3, regardless of body length. Therefore the %M proportionately decreased inversely with increasing ear size in both the opossum and the human neonate. CONCLUSION: This study supports a simple and credible explanation for the illusion of mesenchymal disappearance in the neonatal middle ear. The mesenchymal connective tissue redistributes to cover a larger surface area in a persistently enlarging cavity. These findings occur in different species, whether gestation is completed in an intrauterine or an extrauterine environment.

Animals↗
PubMed2000

A functional model system of an hypoxic nerve injury and its evaluation.

OBJECTIVES/HYPOTHESIS: Develop an hypoxic peripheral nerve injury model with a controlled injury type and two types of clinically relevant physiological measurements of function during and after recovery. The model, controlling for injury and measurement variables, would have predictable outcomes in function. The functional model could test potential therapeutic interventions with greater sensitivity. STUDY DESIGN: Twenty-one rats were used in preliminary studies evaluating peroneal nerve injury types and functional model evaluation. Forty-eight rats were used in a controlled and blinded evaluation of the injury model followed by treatment with hyperbaric oxygen (HBO) as a potential therapeutic intervention and evaluated with functional models. METHODS: Preliminary studies compared nerve injuries: epineurectomy, epineurectomy with crush and transection with autograft for rate of return of function and final extent of return of function. The gait analysis model was also evaluated and modified to decrease variability. The final study evaluated peroneal epineurectomy and nerve crush injury with serial gait analysis during recovery, final elicited maximum force measurements, and histological analysis. Half of the animals were treated with HBO during recovery (ANOVA or regression statistical analysis were used to determine group differences.). RESULTS: Preliminary studies suggested that the peroneal nerve injury model of an epineurectomy with crush of specified length and a modification of the gait analysis model would yield a useful and predictable injury outcome. The final study resulted in predicted and consistent injury outcomes. In the HBO treatment group, a 12% improvement in function 5 days after HBO treatment was demonstrated (P < .03), but no long-term or histological benefit was seen. CONCLUSION: A reliable hypoxic nerve injury model has been developed and tested utilizing two functional methods as the primary outcome variables.

Animals↗
PubMed2000

Nursing home costs and risk-adjusted outcome measures of quality.

BACKGROUND: The inadequacy of quality of care in nursing homes has been and continues to be a focus of public concerns. Understanding the relationship between quality and costs can offer guidance to policies designed to encourage high quality. OBJECTIVES: To investigate the relationship between costs and quality of care in nursing homes, and to test the hypothesis that higher quality may be associated with lower costs. RESEARCH DESIGN: Statistical regression techniques were used to estimate nursing home variable-cost functions that included three risk-adjusted outcome measures of quality. Quality measures were based on decline in functional status, worsening pressure ulcers, and mortality. The study hypothesis was tested by an F test for the exclusion of nonlinear quality variables in the cost functions. SUBJECTS: The study included 525 free-standing private and public nursing homes in New York State, or 84% of all nursing homes in the state during 1991. RESULTS: F tests rejected the hypotheses that the three quality measures could be excluded from the cost function and that the association between costs and quality was linear. An inverted U-shaped relationship between quality and costs suggests that there are quality regimens in which higher quality is associated with lower costs. CONCLUSIONS: Policies that encourage research to identify care protocols and management strategies leading to better outcomes and lower costs, as well as policies that encourage dissemination of such practices, may prevent decline in quality despite the continued financial constraints faced by nursing homes.

Activities of Daily Living↗
PubMed2000

Determinants of patient satisfaction in postmastectomy breast reconstruction.

In today's increasingly competitive health care marketplace, consumer satisfaction has become an important measure of quality. Furthermore, measures of satisfaction with treatment inteerventions are influential factors in determining patients' and payers' choices of health care. This study sought to evaluate satisfaction with postmastectomy breast reconstruction and to assess the effects of procedure type and timing on patient satisfaction. As part of the Michigan Breast Reconstruction Outcome Study, patients undergoing first-time mastectomy reconstruction were prospectively evaluated, including cohorts of women choosing expander/implant, pedicle TRFAM flap, and free TRAM flap procedures. Preoperatively and 1 year postoperatively, participants completed a questionnaire that collected a variety of health status information. The postoperative questionnaire had an additional seven items assessing both general satisfaction with reconstruction (five items) and aesthetic satisfaction (two items) as separate subscales. Patients were asked to respond to each item using a five-point Likert scale. Item responses ranged from 1, indicating high satisfaction, to 5, reflecting low satisfaction. In the data analysis, only patients responding with a 1 or 2 for all of the items within a subscale were classified as "satisfied" for the subscale. To assess the effects of procedure type (implant, pedicle TRAM flap, and free TRAM flap) and timing (immediate versus delayed) on satisfaction and to control for possible confounding effects from other independent variables, multiple logistic regression was employed. In our analysis, odds ratios and associated 95 percent confidence intervals were calculated for each independent variable in the regression. Statistical significance was designated at the p < or = 0.05 level. A total of 212 patients were followed during the period of 1994 to 1997, including 141 immediate and 71 delayed reconstructions. The study population consisted of 49 expander/implant, 102 pedicle TRAM flap, and 61 free TRAM flap reconstruction patients. The analysis showed a significant association between procedure type and patient satisfaction. TRAM flap patients (both free and pedicle) appeared to have significantly greater general and aesthetic satisfaction compared with expander/implant patients (p = 0.03 and 0.001, respectively). Furthermore, pedicle TRAM flap patients were more aesthetically satisfied than those with free TRAM flaps (p = 0.072). The other independent variables of age and procedure timing did not appear to significantly affect either general or aesthetic satisfaction. However, preoperative physical activity was positively correlated with general satisfaction at the p = 0.034 level. The choice of procedure seems to have a significant effect on both aesthetic and general patient satisfaction with breast reconstruction. In this study, autogenous tissue reconstructions produced higher levels of patient aesthetic and general satisfaction compared with implant techniques. Pedicle and free TRAM flap patients do not seem to differ significantly in general satisfaction. However, women receiving pedicle TRAM flaps reported greater aesthetic satisfaction compared with patients undergoing free TRAM flaps. Furthermore, patient age and procedure timing may not have an effect on patient satisfaction with breast reconstruction.

Adult↗
PubMed2000

Appropriateness of endotracheal tube size and insertion depth in children undergoing air medical transport.

OBJECTIVES: Guidelines for pediatric endotracheal tube (ETT) size and insertion depth are important in the helicopter EMS (HEMS) setting, where intubated patients are frequently transported by a non-physician flight crew providing protocol-based care in an environment noted for limitations in clinical airway assessment. The objectives of this study were to characterize, in a HEMS pediatric population, the frequency of compliance with guideline-recommended ETT size and insertion depth, and to test for association between guideline noncompliance and subsequent receiving hospital adjustment of ETT size or insertion depth. DESIGN: This retrospective review analyzed 216 consecutive pediatric (age <14) scene and interfacility HEMS transports, of patients intubated before or during HEMS transport, by an urban two-helicopter HEMS service providing protocol-based care with a nurse/paramedic crew configuration. Patients were transported to one of three receiving academic pediatric referral centers. Pediatric Advanced Life Support (PALS) criteria for ETT size and insertion depth were used to assess guideline-appropriateness of pediatric ETTs. Receiving hospital records were reviewed to determine if post-transport ETT size or lipline adjustment were associated with guideline-appropriateness of size and lipline during HEMS transport. Univariate (chi-square and Fisher's exact) and multivariate (logistic regression) statistics were used to assess and control for the following covariates: intubator group (physician, flight crew, ground EMS), transport year, sex, age, transport type (scene versus interfacility), and receiving hospital. For all analyses, statistical significance was set at the 0.05 level. RESULTS: The initial ETT size was within 0.5 mm of guideline-recommended sizes in 178 (83.6%) of the 213 patients for whom this data were available. Inappropriate sized ETTs were nearly always (32 of 35, 91.4%) too small. Compared to initial ETTs placed by ground EMS personnel, initial ETTs placed by flight crew or physicians were more likely to be appropriate as defined by guidelines (P = .008 and .032, respectively). Receiving hospitals changed the ETT size in 18 (8.3% of 216) cases. Receiving hospital ETT size change was more likely with later transport year (P = .018) and less likely in patients over 2 years of age (P = .03); there was no significant association between receiving hospital ETT size change and intubator group (P > .22) or guideline-appropriateness of ETT size (P = 0.94). The initial ETT insertion depth was within 1 cm of the guideline-recommended lipline in 86 (43.2%) of the 199 patients for whom this data were available. Inappropriate liplines were almost always (109 of 113, 96.5%) too deep. Compared to initial ETT liplines determined by ground EMS personnel, initial liplines determined by flight crew (P = .007), but not physician (P = .47) were more likely to be appropriate as defined by guidelines. Receiving hospitals changed the ETT insertion depth in 72 (33.3% of 216) cases. Receiving hospital lipline change was more likely (P = .03) in patients older than 2 years of age, but was not associated with intubator group (P = .75) or lipline guideline-appropriateness (P = .35). CONCLUSIONS: As judged by frequently used guidelines, pediatric ETTs are often too small and commonly inserted too deep. However, this retrospective study, limited by lack of clinical correlation for ETT size and insertion depth, failed to find an association between lack of ETT size or lipline guideline compliance and subsequent ETT adjustment at receiving pediatric centers. This study's findings, which should be confirmed with prospective investigation, cast doubt upon the utility of pediatric ETT size/lipline guidelines as strict clinical or quality assurance tools for use in pediatric airway management.

Age Factors↗
PubMed1994

The diagnosis of visual field progression in glaucoma.

The detection of true visual field deterioration in glaucoma is of fundamental importance but is limited by inherent variability of the measurements. New techniques have been developed that use powerful statistical regression analysis methods to objectively quantify progression of visual field defects. These have been combined with new methods of graphical presentation to reveal the spatial distribution in the visual field of deterioration. New measurement techniques utilizing blue-on-yellow, flicker, and motion stimuli provide further advantages and may be combined with regression analysis to improve the early detection of real progression of visual field loss.

Glaucoma↗
PubMed2002

Seven-day (24-h) ambulatory blood pressure monitoring, self-reported depression and quality of life scores.

OBJECTIVE: Effects of environmental conditions on blood pressure (BP) and heart rate (HR) variations as putative factors underlying the onset of vascular events. METHODS: BP and HR were monitored around the clock for 7 days on 54 residents from Urausu, Hokkaido, Japan. Daytime, night-time, and 24-h means served to identify dippers and non-dippers. Questionnaire-assessed depression and subjective quality of life were related to BP and HR by analyses of variance and linear regression. Statistical significance was at 5%. RESULTS: A circaseptan (about 7-day) component characterizes the 24-h mean and standard deviation (SD) of HR, and the daytime and day-night ratio of systolic BP. The SD of HR is higher on weekends and lower on Mondays and Thursdays. When awake, systolic BP is lowest on Sundays and the day-night ratio is optimal on weekends (Saturdays: 15.7 +/- 9.4%; Sundays: 14.0 +/- 13.2%). Depression was detected in 15 subjects, who had higher mean systolic and diastolic BP values (systolic BP: P = 0.028 Fridays, P = 0.021 Tuesdays; diastolic BP: P = 0.022 Mondays, P = 0.006 daytime Mondays) and a lower day-night ratio of diastolic BP (P = 0.012 Tuesdays, P = 0.005 Wednesdays, and P = 0.038 Thursdays). A depressive mood correlated positively with 24-h averages of systolic (P = 0.037) and diastolic (P = 0.030) BP. CONCLUSIONS: Depression (and subjective quality of life) can affect BP and HR variability. The results indicate the role that psychological factors may play in the pathogenesis of cardiovascular disease. Therapeutic implications are suggested for primary and secondary prevention.

Adult↗