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PubMed2002

[Factors helping in the decision to change intubation for tracheotomy in critical patients].

We carry out a prospective study in order to determine the prognostic factors in the development of injuries of upper airways, and their influence in the decision to perform a tracheotomy. The time to tracheotomy was previously stated, according to the type of patient (neurological or non-neurological). This study includes the clinical data and the upper airways endoscopic exploration of 654 patients with oro-tracheal intubation and mechanical ventilation for more than 48 hours in a 6 year period. Three endoscopic explorations were carried out in the first month (early exploration), with two additional explorations at six and twelve months (late exploration). Using a multivariable statistical study we have analysed the prognostic factors and the risk groups for the development of later injuries of the upper airway of these patients. The later endoscopic exploration of the upper airways has shown injuries in 30 of 280 cases (11%). In this study, the main factor that determines the development of injuries of the upper airway was the time of intubation. The risk groups to develop later lesions of the upper airways include: patients with pathological background, patients with medical admissions, non-neurological patients and patients with serious lesions in the earlier endoscopic exploration. We conclude that it is necessary to state the time to perform a tracheotomy in patients with oro-tracheal intubation. It must be based on the own experience, the patient's clinical condition and the disease that caused hospital admission.

Clinical Protocols↗
PubMed2005

The role of state public health agencies in addressing less prevalent chronic conditions.

INTRODUCTION: State-based chronic disease programs typically focus on the most prevalent chronic conditions, such as cancer, diabetes, and cardiovascular disease, but interest in less prevalent chronic conditions (LPCCs), such as epilepsy, is growing. In our study, we examined the perceived roles of state health departments in addressing LPCCs and used this information to develop recommendations for state health departments that are considering developing LPCCs programs. We also compared the identified state health department roles for LPCCs with roles related to healthy aging, as well as to the essential elements of existing state-based chronic disease programs, to determine whether future LPCCs programs would have any unique requirements. METHODS: Participants used concept-mapping techniques to generate a set of 100 statements on steps that state health departments could take to address LPCCs. The participants sorted and rated each statement according to importance and feasibility. We used a sequence of multivariate statistical analyses to generate a series of maps, or clusters, and rating graphics. We reviewed the findings and produced recommendations for state health departments. We used a similar process to examine roles of state health departments in addressing healthy aging. RESULTS: The participants grouped the LPCCs statements into nine clusters, which they rated as moderately feasible and important. The healthy aging statements were grouped into eight clusters. Clusters for LPCCs and healthy aging were similar. We also compared LPCCs clusters and the essential elements of existing state-based chronic disease programs and found that they were similar. CONCLUSION: The similarities between LPCCs clusters and essential elements of existing state-based chronic disease programs highlight an important point. State health departments that are considering establishing LPCCs programs should use strategies that have already been used by other public health agencies to develop chronic disease prevention and control programs.

Chronic Disease↗
PubMed1993

Multivariate analysis of progression in superficial bladder cancer.

A total of 217 patients with superficial bladder cancer (SBC) category Ta-T1 were retrospectively analysed for tumour progression and prognostic factors; 46% of patients presented with recurrences, 13% with increasing grades of anaplasia and 12% with progression in tumour category. The mean annual index of recurrences was 0.7 +/- 0.1; 4% of patients died from tumour progression and the overall 5-year survival rate was 88% +/- 5.3. Factors that influenced progression significantly were peritumoural dysplasia, inflammatory infiltrate, residual tumour following transurethral resections, increasing grade of anaplasia and index of recurrences > 0.7. Multivariate statistical analysis revealed that only tumour category and increasing grade of anaplasia had significant prognostic value. Increasing grade of anaplasia predicts the likelihood of tumour progression with a 91% global predictive capacity. Thirty percent of patients with tumour progression did not have an increasing grade of anaplasia. Among these 87% were Ta, 50% were GI and the mean index of recurrences was 0.9. All were conservatively treated and 87% are alive. Among the patients with an increasing grade of anaplasia and tumour progression the mean index of recurrences was 1.7; 67% developed muscle infiltrating cancer and 7% metastatic spread without local progression; 64% of these patients died from cancer. An increasing grade of anaplasia affects prognosis. It defines patients with a high risk of tumour progression and tumour-related death, especially those with T1 bladder cancer.

Adolescent↗
PubMed2000

Prospectively randomized comparison of different mechanical aortic valves.

BACKGROUND: The aim of this prospectively randomized study was to evaluate the hemodynamic and functional outcomes after aortic valve replacement with 3 different bileaflet mechanical valves. METHODS AND RESULTS: Three hundred consecutive patients were randomly assigned to receive ATS (n=100), Carbomedics (n=100), or St Jude Medical Hemodynamic Plus (n=100) mechanical aortic valve replacement. There were no significant differences regarding patient age (average 61+/-8 years), body surface area (1.9+/-0.2 m(2)), left ventricular function (ejection fraction 0.59+/-0.17), and presence of aortic stenosis (90%, 89%, and 91%), respectively. All patients had postoperative as well as 6-month and 1-year follow-ups that included transthoracic echocardiography. Multivariate statistical analysis was performed. Implanted valve sizes were comparable at 24+/-2 (ATS), 23.7+/-1.6 (CM), and 23.6+/-1.9 (SJMHP) mm (NS). At 1-year follow-up, the following incidence of events was noted: death 3/1/1, all non-valve related; stroke 0/1/1; trivial transvalvular incompetence 3/3/2; paravalvular leak 2/3/2; and reoperation 0/1/1, respectively (NS). Transvalvular flow velocities were 2.5/2.6/2.4 m/s postoperatively (P:=0.03) and 2.4/2.4/2.3 m/s at 6-month follow-up, respectively (NS). There was a significant decrease in left ventricular mass for all patients but no significant differences among the groups. CONCLUSIONS: There are no clinically relevant differences among the tested bileaflet aortic valves. Regardless of valve type, there was a low complication rate. On the basis of these findings, all 3 bileaflet prostheses are well suited for aortic valve replacement.

Aortic Valve↗
PubMed1996

Genetic structure in relation to the history of Hungarian ethnic groups.

The present analysis continues the study of 12 samples of 11 Hungarian ethnic groups and a collection of data from 8 foreign reference populations. The origin of these groups is entangled with the history of Hungary and specifically with the conquest of the Carpathian basin in the ninth century A.D. Given that each of the 11 groups has preserved its ethnic identity and assuming that genetic drift has played a major role, we expect that similarities and differences between the different Hungarian groups and between the Hungarian groups and the eight reference populations can be interpreted with respect to the controversial origin of the groups. The reference populations are those whose ancestors had high involvement in Hungarian history. We use multivariate statistical methods to analyze the gene frequencies of 22 loci. The results show that the Hungarian ethnic groups are genetically separate and that this separation is related to different migration waves. According to our results, Gypsies and Jews, who migrated relatively recently to Hungary, are distant from the other groups and, as predicted, appear to be genetically close to the North Indian and Ashkenazi reference populations, respectively. The Oriental population is least related to the Hungarian groups, but the distance diminishes when the P1 locus, which shows particularly high variability, is included. Some ethnic groups, especially Orség and Csángó, show genetic isolation and specific affinities with the reference populations that are related to their origin, namely, Slavs and Finns-Turks-Iranians, respectively. Other affinities were less striking than tradition would lead us to expect. Gene flow and admixture, as revealed by the significant correlation between genetic and geographic distances, may have played an important role in smoothing genetic differences between groups.

Emigration and Immigration↗
PubMed1997

Monte Carlo methods in clinical research: applications in multivariable analysis.

BACKGROUND: Monte Carlo methods use "simulated" analyses with random numbers for solving problems, particularly those that defy solutions using mathematical theory alone. Research using Monte Carlo simulations is very popular in many branches of science and is sometimes done in clinical investigation. The origins and basic strategy of the technique, however, may not be well known to clinical researchers. The purpose of this paper is to describe the history and general principles of Monte Carlo methods and to demonstrate how Monte Carlo simulations were recently applied to examine a phenomenon in multivariable statistical analysis called the number of outcome events per independent variable (EPV). For example, in a cohort of 200 people, with 50 deaths and 5 independent (predictor) variables, EPV = 50/5 = 10. METHODS: The "real-world" data came from a clinical trial of 673 patients in which 7 variables were cogent predictors of 252 deaths, so that EPV = 252/7 = 36. For the Monte Carlo simulations, special models were used while allowing simulations of proportional hazards and logistic regression to maintain the basic relationship of variables and the same size of the original population, at EPV values of 2, 5, 10, 15, 20, and 25. RESULTS: The Monte Carlo simulations confirmed a previously undocumented "rule of thumb" stating that when the EPV is less than 10-20, the algebraic models used in logistic regression and proportional hazards regression may be unreliable, leading to imprecise or spurious results. CONCLUSION: Monte Carlo techniques offer attractive methods for clinical investigators to use in solving problems that are not amenable to customary mathematical approaches.

Humans↗
PubMed2003

Treatment adherence associated with conventional and atypical antipsychotics in a large state Medicaid program.

OBJECTIVES: Rates of medication adherence over a one-year period were assessed among outpatients with schizophrenia who initiated therapy with conventional or atypical antipsychotic agents. METHODS: Data were drawn from paid medical and pharmacy claims for a random sample of 10 percent of all California Medicaid ("Medi-Cal") recipients. Outpatients with schizophrenia who were aged 18 years or older and who initiated monotherapy with a conventional or atypical antipsychotic medication in the last quarter of 1997 were identified. The percentages of patients who discontinued antipsychotic therapy or who had a switch in medications over a one-year period were determined. The use of selected concomitant medications was also assessed. Data were analyzed by means of chi square tests and multivariate statistics that adjusted for demographic and clinical differences between medication groups. RESULTS: A total of 298 patients who initiated therapy with a conventional (N=93) or atypical (N=205) antipsychotic medication were identified. The groups were similar in mean age (about 42 years) and gender distribution (about 54 percent were male). Compared with patients who received conventional antipsychotics, those receiving atypical antipsychotics were significantly less likely to have a switch in medication and to use concomitant anticholinergic and anxiolytic medications. In each group, antipsychotic medication was available for about 60 percent of days over one year of follow-up. CONCLUSIONS: Compared with the use of conventional antipsychotics, the use of atypical antipsychotic medications was associated with significantly less treatment switching and less use of concomitant medications. However, undertreatment, evidenced by a lack of prescription refills, occurred among patients taking both medication classes, which highlights the need for further research on nonadherence.

Adolescent↗
PubMed2002

Unequal impact of short-term testosterone repletion on the somatotropic axis of young and older men.

The present clinical study compares the impact of low- and high-dose parenteral testosterone (T) supplementation on daily GH secretory patterns and serum IGF-I, IGFBP-1, and IGFBP-3 concentrations in healthy older (60-82 yr) and young (20-40 yr) men. To this end, we administered three consecutive weekly injections of randomly ordered saline and either a low (100 mg) or a high (200 mg) dose of testosterone enanthate im; namely, saline (n = 17, young and n = 16, older), a low dose (n = 8 young, n = 8 older) and a high dose (n = 9 young, and n = 8 older) of androgen. To monitor somatotropic-axis responses, blood was sampled every 10 min for 24 h for later chemiluminescence-based assay of serum GH, RIA of serum IGF-I, and immunoradiometric assay of serum IGFBP-1 and IGFBP-3 concentrations. Data were analyzed via a nested analysis of covariance statistical design. At baseline (saline injection), older, compared with young, men maintained: 1) similar serum total T, IGFBP-1, and IGFBP-3 but reduced IGF-I concentrations, namely, mean (+/- SEM) IGF-I 160 plus or minus 15 vs. 280 plus or minus 18 microg/liter, (P < 0.001); 2) reduced GH secretory burst mass (0.68 +/- 0.09 vs. 1.2 +/- 0.20 microg/liter, P = 0.031); 3) more disorderly GH release patterns (approximate entropy 0.501 +/- 0.058 vs. 0.288 +/- 0.021, P < 0.001); and 4) blunted 24-h rhythmic GH output (nyctohemeral amplitude 0.25 +/- 0.05 vs. 0.47 +/- 0.08 microg/liter, P = 0.025). Serum T concentrations (ng/dl) did not differ in the two age groups supplemented with either a low dose [550 +/- 50 (young) and 544 +/- 128 (older)] and high [1320 +/- 92 (young) and 1570 +/- 140 (older)] dose of T. The 100-mg dose of androgen exerted no detectable effect on GH secretion in either age cohort but increased the serum IGF-I concentration in young men by 20% (P = 0.00098). The 200-mg dose of T failed to alter daily GH production in young volunteers but in older men stimulated: 1) a 2.03-fold rise in the mean (24-h) serum GH concentration (P = 0.0053, compared with the response to saline); 2) a 1.20-fold increase in basal (nonpulsatile) GH production (P = 0.039); 3) a 2.15-fold amplification of GH secretory burst mass (P = 0.0020); 4) a 2.17-fold elevation of the Mesor of nyctohemeral GH output (P = 0.025); 5) a 1.79-fold enhancement in GH approximate entropy (P = 0.0003); and 6) a 40% increase in the fasting serum IGF-I concentration (P = 0.000005). Multivariate statistical analysis indicated that following high-dose T administration, the E2 increment significantly predicted the IGF-I increment in both age groups combined (P = 0.003); T dose positively forecast the serum total IGF-I concentration (P = 0.0031); and age and T dose jointly determined serum LH concentrations (P = 0.031). In summary, neither a physiological nor a pharmacological dose of T administered parenterally for 3 wk augments daily GH secretion in eugonadal young men. In contrast, a high dose of aromatizable androgen significantly amplifies 24-h basal, pulsatile, entropic, and nyctohemerally rhythmic GH production and elevates the serum IGF-I concentration in older men. The mechanistic basis for the foregoing age-related distinction in GH/IGF-I axis responsivity to T is not known.

Aged↗
PubMed2003

Dermatoglyphs of digito-palmar complex in autistic disorder: family analysis.

AIM: To examine the role of the genetic component in the quantitative dermatoglyphic traits of autistic patients and their families, and the transmission of the autism. METHODS: Finger and palm prints were taken from 120 autistic patients (92 males and 28 females), their parents (92 mothers and 70 fathers), 32 healthy brothers and 28 sisters, as well as 400 healthy controls (200 males and 200 females). An analysis of quantitative traits of dermatoglyphs on the fingers (FRC - finger ridge count) and palms (a-b, b-c, and c-d ridge count, and atd angle) was performed. Descriptive statistics, multivariate analysis of variance (MANOVA) with Tukey HSD post hoc test, and discriminant analysis were used to determine the differences among the groups. In addition, correlations among family members were analyzed. RESULTS: Multivariate analysis showed significant differences among examined groups of autistic patients and their family members and healthy volunteers regarding both group membership and sex. Autistic male patients differed significantly from the healthy controls in the ridge count (RC) on the fourth and fifth finger, and in a-b RC and atd angle of both hands. Healthy fathers of autistic patients differed in atd angle, and brothers of autistic patients differed in all palmar variables from the healthy control group. Mothers of autistic patients differed significantly from the healthy female controls in the RC of the first, fourth, and fifth finger, in a-b and c-d RC on the palms, and atd angle of both hands. The first two discriminant functions explained 85.4% of variance and separated groups clearly in two ways: the first function separated healthy controls from family members of autistic patients, and the second one males from females. Interfamilial analysis showed significant interclass correlations between autistic sons and their mothers or fathers in practically all variables. However, the correlation between parents and their autistic daughters was lower. Both mothers and fathers of autistic patients correlated with their healthy children only in palmar variables. CONCLUSIONS: We found significant differences in ridge counts on the fingers and palms between the affected patients and their healthy controls, but these differences also existed between family members of autistic patients and healthy controls. Particularly pronounced were the differences between healthy female controls and female family members, including not only autistic female patients, but also their healthy mothers and sisters. Since the mothers and their autistic sons showed higher statistically significant correlation in most of the examined variables, unlike the mothers and their autistic or healthy daughters, it is possible that there is a connection between a recessive X-chromosome linkage, as a genetic component in the etiology of autistic disorders, and the influence of the inactivation of the affected X-chromosome in the females.

Adolescent↗
PubMed2006

Validation of a brief, reliable scale to measure knowledge about the health risks associated with obesity.

BACKGROUND: Obesity represents a serious threat to health through its association with conditions such as type 2 diabetes mellitus, coronary heart disease and certain types of cancer. Knowledge regarding risk to health is an important determinant of behaviour and is the focus of many health education strategies. To the authors' knowledge, there is no valid and reliable measure of knowledge regarding the health risks associated with obesity. AIM: To validate a short, reliable psychometric scale measuring knowledge regarding the effects of obesity on health, the Obesity Risk Knowledge (ORK-10) scale. METHODS: The ORK-10 scale was administered to a sample of individuals with no specific obesity-related expertise (n=230) and a sample of experts (n=200). Univariate and multivariate statistical analyses were used to investigate the scale's criterion validity. RESULTS: The ORK-10 scale has good internal consistency (Cronbach's alpha coefficient>0.7) and is acceptable for use in a UK adult population with an estimated reading age of 12-13 years. The scale demonstrated strong criterion validity, as those with educational or vocational expertise in the field of obesity achieved significantly higher scores than nonexperts (median 9.0 vs 4.0, Z=-17.364; P<0.001). This relationship was maintained after controlling for the potentially confounding factors of age and level of education. Nonexperts demonstrated low levels of knowledge regarding the health risks associated with obesity. CONCLUSIONS: The ORK-10 scale meets standard psychometric criteria for reliability and validity. This scale could be used to assess the effectiveness of health education interventions, to target the provision of health information and to investigate the interaction between knowledge and obesity-related behaviour.

Adolescent↗
PubMed1998

Genetic history of the population of Sicily.

We investigated the genetic heterogeneity of 2354 individuals from the 9 provinces of Sicily. The genetic markers we used were HP, GC, TF, PI, and AK1 plus other previously tested polymorphisms, for a total of 24 independent markers. Distinct multivariate statistics were applied to verify the claimed genetic distinctiveness between extant eastern and western Sicilian populations. Our hypothesis stated that any diversity found between the two subpopulations would represent the signature of early colonization of the island by Greek and Phoenician peoples. Correspondence analysis showed that there was no clear geographic clustering within Sicily. The genetic distance matrix used for identifying the main genetic barriers revealed no east-west differences within the island's population, at least at the provincial level. FST estimates proved that the population subdivision did not affect the pattern of gene frequency variation; this implies that Sicily is effectively one panmictic unit. The bulk of our results confirm the absence of genetic differentiation between eastern and western Sicilians, and thus we reject the hypothesis of the subdivision of an ancient population in two areas.

Acute-Phase Proteins↗
PubMed2000

Kinematic analysis of total knee prosthesis designed for Asian population.

In designing a total knee replacement (TKR) prosthesis catering for the Asian population, 62 sets of femur were harvested and analyzed. The morphometrical data obtained were found to be in good agreement with dimensions typical of the Asian knee and has reaffirmed the fact that Caucasian knees are generally larger than Asian knees. Subsequently, these data when treated using a multivariate statistical technique resulted in the establishment of major design parameters for six different sizes of femoral implants. An extra-small implant size with established dimensions and geometrical shape has surfaced from the study. The differences between the Asian knees and the Caucasian knees are discussed. Employing the established femoral dimensions and motion path of the knee joint, the articulating tibia profile was generated. All the sizes of implants were modeled using a computer-aided software package. Thereupon, these models that accurately fits the local Asian knee were transported into a dynamic and kinematic analysis software package. The tibiofemoral joint was modeled successfully as a slide curve joint to study intuitively the motion of the femur when articulating on the tibia surface. An optimal tibia profile could be synthesized to mimic the natural knee path motion. Details of the analysis are presented and discussed.

Aged↗
PubMed2000

Obstructive sleep apnea (OSA): a cephalometric analysis of severe and non-severe OSA patients. Part II: A predictive discriminant function analysis.

One hundred male obstructive sleep apnea (OSA) patients were classified into 2 groups on the basis of apnea-hypopnea index (AHI) as severe (AHI > or = 50) and non-severe (AHI < 50). A comprehensive cephalometric analysis of cervicocraniofacial skeletal and upper airway soft tissue morphology was performed in 51 non-severe and 49 severe OSA patients. In addition, a multivariate statistical method (principal component, analysis and predictive discriminant analysis) was performed to identify the components that could correctly differentiate the severe from the non-severe OSA patients. Eight principal components (PCs) of cervicocraniofacial skeletal morphology, 4 PCs of hyoid bone position and head posture, and 7 PCs of upper airway soft tissue morphology, together with the selected demographic variables, were deduced to formulate a linear canonical discriminant function. The equation of a 9-variable model was generated as follows: PDF score = 4.127 - 0.144 (Body Mass Index) - 0.376 (PC1.1) + 0.311 (PC1.4) + 0.214 (PC1.5) + 0.075 (PC 2.1) - 1.309 (PC2.3) + 0.708 (PC3.2) - 0.059 (PC3.3) + 0.609 (PC3.6). The cutoff score was -0.03899. The overall rate of correct classification was 83%. The results showed that Body Mass Index and 8 other PCs contributed significantly to the OSA severity. These analyses are proven to be a useful adjunctive diagnostic tool to select optimal treatment regimens for OSA patients with varying degrees of severity.

Aged↗
PubMed1998

[The effect of the mean platelet volume on the short-term prognosis of acute myocardial infarct].

INTRODUCTION AND OBJECTIVES: The increase of mean platelet volume in the late phase of myocardial infarction is an independent predictor for recurrent myocardial infarction and death, but the association between this finding and the short-term prognosis after acute myocardial infarction is unknown. The goals of this study were to assess the influence of mean platelet volume on the risk of death, recurrent ischemic events or cardiac heart failure during the in-hospital phase of myocardial infarction and to analyse the relationship between mean platelet volume and several demographic and clinical variables registered on admission. MATERIAL AND METHODS: A population of 1,082 patients with acute myocardial infarction were distributed in two groups according to the platelet volume measured on admission: group 1, mean platelet volume > 9 fl (n = 443) and group 2, mean platelet volume < or = 9 fl (n = 639). The difference between both groups on the end-point of this study were assessed by univariate and multivariate statistical methods. An univariate analysis was also applied to assess the relationship between platelet volume and the baseline variables. RESULTS: A mean platelet volume > 9 fl was associated with a significant increase of risk for the combined end-point considered (OR = 1.37; p = 0.026). By univariate analysis, an increased platelet volume was related to a higher risk of cardiac failure (OR = 1.46; p = 0.01) and a non-significant increase in the incidence of recurrent ischemic events (OR = 1.35; p = 0.07). In addition, a large platelet volume was also associated with a higher prevalence of prior myocardial infarction, arterial hypertension and diabetes mellitus. CONCLUSIONS: The results of this study suggest that the increase of mean platelet volume on admission is an independent risk factor for cardiac heart failure and is associated with a non significant higher rates of ischemic events during the recovery phase of acute myocardial infarction.

Aged↗
PubMed2002

Experiences of stigmatization play a role in mediating the impact of disease severity on quality of life in psoriasis patients.

BACKGROUND: Psoriasis may have a severe impact on patients' quality of life (QOL) in several ways, an impact mediated by the mental or physical difficulties they have to deal with during the course of the disease and the various treatment regimens. In addition, psoriatic patients often suffer from experiences of stigmatization (EOS) related to the disease. OBJECTIVES: This study was designed to test the hypotheses that psoriasis patients report higher levels of stigmatization than a comparison group, and that their EOS play a role in mediating the impact of the severity of psoriasis on their QOL. METHODS: One hundred patients with psoriasis (study group) and 100 patients with mixed skin problems (comparison group) were matched according to age, sex and education. All subjects answered questionnaires on EOS and QOL. A dermatologist diagnosed the diseases and measured severity scores. The Psoriasis Area and Severity Index score was used for psoriasis and a linear severity score for the comparison patients. The mediating effect of EOS was analysed using structural equation modelling (SEM). SEM is a multivariate statistical method used to examine the consistency of a theory relating one group of variables (termed a 'latent construct') to another: in the present study, the relationship between EOS and QOL. RESULTS: Psoriatic patients were found to report significantly higher levels of EOS related to the disease, compared with the comparison group. No significant differences were found regarding QOL or severity of disease. Clinical severity of psoriasis was found to correlate negatively with QOL in psoriasis patients. EOS were found to have a complete mediating effect for the severity of disease on the QOL in patients with psoriasis. This result was not found among the comparison group patients. CONCLUSIONS: The results of this study indicate that psoriasis patients experience higher levels of stigmatization than do other dermatological patients, and that these EOS mediate the association between disease severity and patients' reported low levels of QOL. Treatment of psoriatic patients should consider these results and should include tools for psychosocial intervention.

Adult↗
PubMed2000

Random amplified polymorphic DNA (RAPD) and quantitative trait analyses across a major phylogeographical break in the Mediterranean ragwort Senecio gallicus Vill. (Asteraceae).

Random amplified polymorphic DNA (RAPD) and quantitative trait variation of the widespread and ephemeral Senecio gallicus were surveyed in 11 populations sampled from the Iberian Peninsula and southern France. The aim of the study was to compare population relationships and levels of geographical differentiation with chloroplast (cp) DNA and allozyme variation assessed previously in the same populations. Employing multivariate statistics, a moderate level of intraspecific differentiation was observed among populations from Iberian coastal and inland regions for both RAPDs and quantitative traits. However, RAPDs provided greater resolution in identifying additional population structure within the hypothesized, Pleistocene refugial source area of the species in coastal Iberia. A major part of the geographical subdivision in RAPD and quantitative traits was concordant with the coastal vs. inland divergence as previously inferred from cpDNA haplotype frequencies, but strongly contrasted with the geographical uniformity of the species for allozymes. This concordance across various nuclear and cytoplasmic markers (RAPDs/quantitative traits, cpDNA) suggests that geographical uniformity for allozymes is more attributable to low rates of evolution and/or small genome sampling rather than high rates of pollen dispersal, slow rates of nuclear lineage sorting, or indirect balancing selection. The present study underscores the value of using additional classes of nuclear markers for narrowing the numbers of competing causal hypotheses about intraspecific cpDNA-allozyme discrepancies and their underlying evolutionary processes.

Alleles↗
PubMed2000

Risk factors for multiple intracranial aneurysms.

BACKGROUND AND PURPOSE: The presence of multiple intracranial aneurysms may be a sign of significant risk factors for aneurysm formation that differ from those factors that increase risk for aneurysm rupture. Only 2 studies concern independent risk factors for multiple aneurysms, and the results are in part controversial. This study was designed to identify independent risk factors for multiple intracranial aneurysms in patients with subarachnoid hemorrhage. METHODS: Of 266 patients with aneurysmal subarachnoid hemorrhage (139 men and 127 women, aged 15 to 60 years), 80 (30%) had multiple intracranial aneurysms. The prevalence of several health-related habits, previous diseases, and medications of these patients were compared by multiple logistic regression between those with single and those with multiple aneurysms. RESULTS: On the basis of multivariate statistics, only regular cigarette smoking at any time was a significant risk factor for the presence of multiple aneurysms. The odds ratio (OR) of smoking for multiple aneurysms was 2.10 (95% CI, 1.06 to 4.13) after adjustment for age and sex. After additional adjustment for hypertension, the risk was 2.06 (95% CI, 1. 04 to 4.07). Of other variables, only age (OR, 1.02 per year; 95% CI, 1.00 to 1.05; P=0.09) and female sex (OR, 1.60; 95% CI, 0.90 to 2. 85; P=0.11) showed a tendency to increase the risk for multiple aneurysms after adjustment for smoking. On the other hand, patients with hypertension had significantly (P=0.029) more aneurysms (1. 61+/-1.04) than did those without (1.37+/-0.68), although they did not more frequently have multiple aneurysms. CONCLUSIONS: Cigarette smoking and possibly also age and female sex seem to be risk factors for multiple intracranial aneurysms in patients of working age who have suffered a subarachnoid hemorrhage. Patients with hypertension seem to have more aneurysms than those without.

Adult↗
PubMed1997

New and classical risk factors--the Münster heart study (PROCAM).

A total of 4,849 male participants of the prospective cardiovascular Münster Study (PROCAM), aged 40 - 65 years underwent extensive screening for cardiovascular risk factors before 1986 and were subsequently followed up for at least 8 years. During this time 189 non-fatal and 49 fatal myocardial infarctions occurred, 28 men suffered a sudden cardiac death and 169 persons died of other causes. Using multivariate statistical methods we confirmed that age, increased LDL cholesterol levels, decreased HDL cholesterol levels, high blood pressure, cigarette smoking, diabetes mellitus, angina pectoris and a positive family history are important risk factors for a myocardial infarction or cardiac death. The results of the PROCAM Study demonstrate that elevated triglycerides are an independent risk factor for an early myocardial infarction or cardiac death. Using a multiple logistic function analysis an algorithm for the assessment of the global risk was derived from the data. The observed incidence of coronary heart disease rises sharply as the global risk increases, thus permitting the use of this algorithm in clinical practice for the assessment of the individual risk of myocardial infarction. Risk factors such as lipoprotein(a) and coagulation factors may improve the predictive value of this algorithm. Furthermore it is expected that the exploration of genetic defects will strongly increase the predictive value and precise determination of individual risk.

Adult↗