The aim of this study was to measure the heritability estimates for metabolic traits and the features of the insulin resistance syndrome in families with an increased genetic susceptibility to Type 2 ...diabetes.
A total of 811 non-diabetic relatives from 278 pedigrees of northern European extraction in which there was a sib-pair with Type 2 diabetes were recruited and studied at the six Diabetes UK Warren Type 2 diabetes centres. Heritability estimates were calculated, allowing for key covariates (age, sex, BMI and recruitment centre). Values greater than 0.10 were considered statistically significant in comparison to zero.
Fasting glucose concentration and homeostasis model assessment of pancreatic beta cell function (HOMA %B) had the highest heritability estimates of 0.72 and 0.78 respectively. Heritability estimates for the features of the insulin resistance syndrome (BMI, WHR, systolic and diastolic blood pressure, serum lipids and homeostasis model assessment of insulin sensitivity HOMA %S) were also high. The heritability estimate for fasting glucose was markedly higher in the present study (0.77 vs 0.21 adjusted for age and sex; p<0.001) than in a comparable study of families from the same background population but with no increased susceptibility to diabetes. However, the estimates for the features of the insulin resistance syndrome were similar in the two studies.
In families with a high risk of Type 2 diabetes, the heritability estimates for fasting glucose, pancreatic beta cell function and the features of the insulin resistance syndrome were all high. The higher heritability estimate for pancreatic beta cell function suggests that this resource may be most effective when investigating genetic susceptibility to beta cell dysfunction.
Full text
Available for:
EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
The response to 9/11 continues into its 14th year. The World Trade Center Health Program (WTCHP), a long-term monitoring and treatment program now funded by the Zadroga Act of 2010, includes >60,000 ...World Trade Center (WTC) disaster responders and community members (“survivors”). The aim of this review is to identify several elements that have had a critical impact on the evolution of the WTC response and, directly or indirectly, the health of the WTC-exposed population. It further explores post-disaster monitoring efforts, recent scientific findings from the WTCHP, and some implications of this experience for ongoing and future environmental disaster response.
Transparency and responsiveness, site safety and worker training, assessment of acute and chronic exposure, and development of clinical expertise are interconnected elements determining efficacy of disaster response.
Even in a relatively well-resourced environment, challenges regarding allocation of appropriate attention to vulnerable populations and integration of treatment response to significant medical and mental health comorbidities remain areas of ongoing programmatic development.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Management of an infected shoulder arthroplasty remains challenging. Treatment goals include resolution of the infection, improvement in pain, and restoration of function. Two-stage revision with an ...antibiotic spacer and subsequent revision has shown variable success in achieving these goals. The practice of using a hemiarthroplasty and coating the stem with antibiotic cement without cementing the implant to the humerus (functional antibiotic spacer) during the first stage has the potential to achieve treatment goals without the need for a second revision. The goal of this study was to examine the outcomes of a maintained functional antibiotic spacer without a second revision for the management of infected shoulder arthroplasty. Fourteen patients with an infected shoulder arthroplasty underwent implantation of a functional antibiotic spacer, extensive surgical debridement, and a minimum of 6 weeks of treatment with postoperative intravenous antibiotics. The 9 patients who elected not to undergo revision surgery were included in this analysis. Pain scores, functional outcome scores, range of motion, strength, and patient satisfaction were measured for these patients at last follow-up and compared with preoperative scores. At an average follow-up of 25 months (range, 12-48 months), significant improvements were observed in functional outcome scores, shoulder abduction, and elevation, with a trend toward improvement in pain scores. One patient was unsatisfied with the result. No recurrent infection, progressive radiolucency, or change in position of the functional antibiotic spacer was observed. A functional antibiotic spacer effectively manages the infected shoulder arthroplasty while achieving significant improvements in function and motion. Patient satisfaction was high, with a relatively low rate of conversion to second-stage revision.
BackgroundPatients with disabling pain and loss of shoulder function with associated proximal humeral bone loss following shoulder arthroplasty have limited reliable treatment options. Our objective ...was to report the results, obtained as part of a prospective outcomes study, of the use of a reverse shoulder prosthesis-allograft composite in these patients.MethodsBetween 2002 and 2005, 353 patients treated with a reverse shoulder prosthesis were enrolled in a prospective cohort study. Twenty-five patients received, in addition, a proximal humeral allograft for the management of severe proximal humeral bone loss, and they comprise the study group. The average bone loss measured 53.6 mm (range, 34.5 to 150.3 mm). Patients were followed clinically with use of the American Shoulder and Elbow Surgeons (ASES) score, the Simple Shoulder Test (SST), and a scale with which the patients rated their satisfaction, and they were followed radiographically to detect mechanical failure, loosening, notching, and graft healing. All patients were followed for a minimum of two years (average, 30.2 months).ResultsThe total average ASES score improved from 31.7 points preoperatively to 69.4 points at the time of follow-up (p < 0.0001), and the average SST score improved from 1.4 to 4.5 points (p < 0.0001). Nineteen patients (76%) reported a subjective good or excellent result, five reported a satisfactory result, and one reported that the result was unsatisfactory. The range of motion improved in forward flexion (from 32.7° to 82.4°; p < 0.0001), abduction (from 40.4° to 81.4°; p < 0.0001), and internal rotation. Radiographic evaluation at the time of final follow-up showed incorporation of the allograft in the metaphyseal region in 84% (twenty-one) of the twenty-five patients and incorporation of the allograft in the diaphyseal region in 76% (nineteen) of the patients. Four patients had complications.ConclusionsUse of a reverse shoulder prosthesis-proximal humeral allograft composite for the treatment of shoulder dysfunction following arthroplasty associated with substantial proximal humeral bone loss has shown promising early results. The allograft may restore proximal humeral bone stock, thereby helping to maintain the height of the prosthesis bone construct and thus deltoid tension. Additional, long-term studies are needed to evaluate the longevity of this construct.Level of EvidenceTherapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.
Background Estimation of cerebral perfusion pressure during elective shoulder surgery in the beach chair position is regularly performed by noninvasive brachial blood pressure (NIBP) measurements. ...The relationship between brachial mean arterial pressure and estimated temporal mean arterial pressure (eTMAP) is not well established and may vary with patient positioning. Establishing a ratio between eTMAP and NIBP at varying positions may provide a more accurate estimation of cerebral perfusion using noninvasive measurements. Methods This prospective study included 57 patients undergoing elective shoulder surgery in the beach chair position. All patients received an interscalene block and general anesthesia. After the induction of general anesthesia, values for eTMAP and NIBP were recorded at 0°, 30°, and 70° of incline. Results A statistically significant, strong, and direct correlation between NIBP and eTMAP was found at 0° ( r = 0.909, P ≤ .001), 30° ( r = 0.874, P < .001), and 70° ( r = 0.819, P < .001) of incline. The mean ratios of eTMAP to NIBP at 0°, 30°, and 70° of incline were 0.939 (95% confidence interval CI, 0.915-0.964), 0.738 (95% CI, 0.704-0.771), and 0.629 (95% CI, 0.584-0.673), respectively. There was a statistically significant decrease in the eTMAP/NIBP ratio as patient incline increased from 0° to 30° ( P < .001) and from 30° to 70° ( P < .001). Conclusion The eTMAP-to-NIBP ratio decreases as an anesthetized patient is placed into the beach chair position. Awareness of this phenomenon is important to ensure adequate cerebral perfusion and prevent hypoxic-related injuries.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
This paper investigates the variation of the first resonance frequency of the Chamousset limestone column (21,000 m3, Vercors, French Alps) before its collapse in November 2007. The site was ...instrumented with seismometers and extensometers during a 4‐month period with some gaps in the measurements. Experimental results and numerical modeling showed that the resonance frequency of a prone‐to‐fall column can be derived from the spectra of continuous seismic noise records. At the Chamousset site, the evolution of the resonance frequency appeared to be strongly controlled by the temperature. When temperatures were positive, slight resonance frequency variations correlated well with thermal fluctuations. Irreversible damage can occur during freeze‐thaw cycles and to a lesser extent during strong wind. It coincided with a significant drop in resonance frequency, which was interpreted as the result of rock bridge breakage. This hypothesis is supported by fresh rupture observations after the collapse, seismic event records, and numerical modeling. This study suggests that seismic noise recording could be used for assessing the potential failure of unstable columns in rigid rocks.
This study examined the time course of clinical events in cardiac resynchronization therapy (CRT) trials.
Recent randomized controlled trial results suggest that in heart failure with narrow QRS, ...biventricular pacing (CRT) may increase mortality. The authors proposed implant complications as the cause, rather than a progressive adverse physiological effect.
The study identified all trials comparing CRT with no CRT, which reported Kaplan-Meier curves in groups defined by QRS: narrow, non-left bundle branch block (LBBB) broad, and LBBB broad. For each trial, the change in life span every 3 months up to 3.5 years (the longest time for which data are available) was calculated and a power law was fitted, that is, ∝ time(n).
Four trials (MADIT-CRT Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy, RAFT Resynchronization-Defibrillation for Ambulatory Heart Failure Trial, REVERSE REsynchronization reVErses Remodeling in Systolic left vEntricular dysfunction, and EchoCRT Echocardiography Guided Cardiac Resynchronization Therapy), totaling 4,717 patients, reported curves for mortality or heart failure-related hospitalization, or for mortality. In patients with LBBB broad QRS (within MADIT-CRT), life span gain increased in proportion to time(1.94). In contrast, in patients with non-LBBB broad QRS (within MADIT-CRT) and patients with narrow QRS (EchoCRT), life span was lost in proportion to time(1.92) and time,(1.96) respectively. Hospitalization-free survival showed similar patterns.
The nonlinear growth of life span gained when a CRT device is implanted in patients with LBBB broad QRS is unfortunately mirrored by a similarly progressive loss in life span in narrow QRS heart failure. This suggests the culprit is a progressive physiological effect of pacing rather than implant complications. If these data are not sufficient, a randomized controlled trial of deactivating CRT in patients with narrow QRS may now be needed, with a primary endpoint of increasing survival.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Axillary radiographs traditionally have been considered sufficient to identify concentric glenoid wear in osteoarthritic shoulders; however, with variable glenoid wear patterns, assessment with use ...of computed tomography (CT) has been recommended. The purpose of the present study was to compare the use of axillary radiographs and mid-glenoid axial CT scans to identify glenoid wear.
Preoperative axillary radiographs and mid-glenoid axial CT scans for 330 patients who underwent anatomic total shoulder arthroplasty were reviewed. Five independent examiners with differing levels of experience characterized the glenoid morphology as either concentric or eccentric. The morphologies determined with use of axillary radiographs and CT scans were assessed for correlation, and both intraobserver and interobserver consistency were calculated.
Concentric wear identified with use of radiographs was confirmed with use of CT scans in an average of 61% of cases (range, 53% to 76%). Intraobserver consistency averaged 75% for radiographs and 73% for CT scans. There was significant interobserver consistency, as higher levels of training corresponded with greater consistency between imaging analyses (p < 0.001). The most senior observer identified the highest proportion of concentric wear on radiographs (p < 0.001), showed the greatest consistency between attempts when using CT (p < 0.001), and had the greatest agreement of radiographs and CT evaluating glenoid morphology (p < 0.001).
For the experienced shoulder surgeon, concentric glenoid wear identified on axillary radiographs will appear concentric on 2-dimensional CT in approximately 75% of cases. Obtaining a CT scan to confirm glenoid wear patterns most greatly benefits less-experienced surgeons. Across all levels of experience, axillary radiographs and single-slice, mid-glenoid CT scans appear insufficient for consistently predicting wear patterns.
Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
The new technological advances achieved during the last decade allowed the scientific community to investigate and employ neurophysiological measures not only for research purposes but also for the ...study of human behaviour in real and daily life situations. The aim of this review is to understand how and whether neuroscientific technologies can be effectively employed to better understand the human behaviour in real decision-making contexts. To do so, firstly, we will describe the historical development of neuromarketing and its main applications in assessing the sensory perceptions of some marketing and advertising stimuli. Then, we will describe the main neuroscientific tools available for such kind of investigations (e.g., measuring the cerebral electrical or hemodynamic activity, the eye movements, and the psychometric responses). Also, this review will present different brain measurement techniques, along with their pros and cons, and the main cerebral indexes linked to the specific mental states of interest (used in most of the neuromarketing research). Such indexes have been supported by adequate validations from the scientific community and are largely employed in neuromarketing research. This review will also discuss a series of papers that present different neuromarketing applications, such us in-store choices and retail, services, pricing, brand perception, web usability, neuropolitics, evaluation of the food and wine taste, and aesthetic perception of artworks. Furthermore, this work will face the ethical issues arisen on the use of these tools for the evaluation of the human behaviour during decision-making tasks. In conclusion, the main challenges that neuromarketing is going to face, as well as future directions and possible scenarios that could be derived by the use of neuroscience in the marketing field, will be identified and discussed.
Full text
Available for:
FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UL, UM, UPUK
Using the polymerase chain reaction (PCR) test for diagnosis of canine leishmaniasis has greater sensitivity and specificity than culture and visualization of the parasite. This study compares PCR ...for the diagnosis of the genus and species of Leishmania with serological techniques used for the control of canine visceral leishmaniasis (CVL) in Brazil, considering two regions. We analysed peripheral blood samples collected from 195 dogs in the Campinas (SP) and Teresina (PI) regions. ELISA was performed as a serological method and PCR was performed using specific primers for the genus Leishmania spp. and the species Leishmania chagasi. In Campinas, a greater sensitivity of PCR (88·24%) (P = 0·0455) compared to Teresina (14·71%) (P < 0·0001) was observed, and an agreement was observed for Cohen's kappa index (0·9096). Both PCR and ELISA showed discordance for sensitivity (Campinas 100%, Teresina 21·74%), specificity (Campinas 30·77%, Teresina 100%), positive predictive value (Campinas 68·97%, Teresina 100%), negative predictive value (Campinas 100%, Teresina 37·94%) and Cohen's kappa index (0·1238). This study confirms the importance of PCR in analysis of the canine reservoir, and as an effective method for the detection of active and recent infection.
Full text
Available for:
BFBNIB, NMLJ, NUK, PNG, SAZU, UL, UM, UPUK
You have reached the maximum number of search results that are displayed.
For better performance, the search offers a maximum of 1,000 results per query (or 50 pages if the option 10/page is selected).
Consider using result filters or changing the sort order to explore your results further.
PDF
