The influence of cigarette smoking on the association between body weight and mortality. The Framingham Heart Study revisited

PURPOSE: To calculate for two measures of obesity, the Metropolitan Relative Weight (MRW) and body mass index (BMI), the value at which minimum mortality occurs. This was done to retest the hypothesis, in the Framingham Heart Study data, that the association between obesity and mortality can be obscured by an interaction between the measure of obesity and smoking. In the original analysis of the Framingham data it was suggested that there was a U- or J-shaped relationship between MRW and death in smokers but a linear relationship in nonsmokers. The design and setting were those of the NHLBI Framingham Heart Study. METHODS: The 5209 members of the Framingham Heart Study underwent a baseline examination in 1948-1952 (Exam 1) and they were reexamined at approximately two-year intervals over a 30-year period. The study included both men (n = 2336) and women (n = 2873) in the age range of 28 to 62 years. After excluding persons with missing baseline data, the analytic sample size was 5163. Additional analyses were conducted by deleting persons with cardiovascular disease (CVD) at baseline (n = 135), the sample used by the original paper by Garrison and colleagues, and persons who died within the first four years of follow-up (n = 62). The main outcome measures consisted of thirty-year survival through Exam 16, approximately in 1980, as influenced by MRW or BMI, age, and smoking status at baseline (Exam 1). RESULTS: We were able to show that the sample sizes of male nonsmokers were too small to test the hypothesis within age groups < 40 and 40-49 years. In men ages 50-62 there was a significant age-adjusted quadratic relationship between BMI or MRW, and risk of death. The estimated BMI at the minimum risk of death for smokers (24.5) and nonsmokers (23.8) were not statistically different. Identical results were found for MRW (minimum: smokers = 112.5, nonsmokers = 111.4). In men and women ages 28-62 there appeared to be a u- or j-shaped relationship between the 30-year crude mortality rate and MRW. After excluding persons with missing data, CVD at baseline, and persons who died within the first four years of follow-up, the age adjusted estimated BMI value at the minimum risk of death was nearly identical for men and women and for smokers and nonsmokers (Men: smokers = 22.8, nonsmokers = 22.8; Women: smokers = 22.9, nonsmokers = 23.3). Additionally, the estimates of the minimum were always below the mean. Identical results were found without deleting persons with CVD at baseline and deaths in the first four years of follow-up. Identical results were found for MRW. CONCLUSIONS: Reanalysis of the Framingham Heart Study data does not support the hypothesis that there is an interaction between smoking and measures of obesity. Moreover, the estimated BMI or MRW at the minimum risk of death was similar for men and women smokers and nonsmokers alike even after deleting prevalent cases of CVD and deaths within the first four years of follow-up.     

A study of 362 consecutive laparoscopic Nissen fundoplications

BACKGROUND: Open Nissen fundoplication has been shown to be a very effective operation in the treatment of intractable gastroesophageal reflux. Because of its technical rather than amputative nature, this procedure offers itself to a completely laparoscopic approach. Several studies have shown the feasibility; however, very few have dealt with the effectiveness of the laparoscopic approach. METHODS: Results of laparoscopic Nissen fundoplications performed during a 6-year period were reviewed including duration of operation, number of hospital days, number of conversions to open procedures, complications, and symptoms. All 362 patients had evidence of gastroesophageal reflux disease documented by radiographic, endoscopic, or pH monitoring testing before the operation. Patients with dysphagia or odynophagia underwent manometric evaluation before operation. Postoperative evaluation included esophagography and endoscopy at 2 to 3 months with an esophagogram yearly thereafter. Follow-up time was 6 months to 6 years. RESULTS: The mean time of operation decreased from 2.7 +/- 0.4 hours during the period from 1991 to 1994 to 1.8 +/- 0.3 hours from 1994 to 1997. During those same periods, the number of days of hospitalization decreased from 2.2 days to a mean of 1.5 days. Manometric studies done before the operation (n = 58) showed a pressure of 4 +/- 1.2 mm Hg compared with postoperative values (n = 39) of 14 +/- 1.8 mm Hg. The conversion rate was 0.8% (n = 3), and the complication rate of 1.9% (n = 7) included the 3 conversions, 2 pneumothoraces, 1 patient with postoperative bleeding, and 1 patient with a large abdominal wall hematoma. There were 5 failures of the procedure (1.2%). Thirteen patients (3.6%) described postoperative symptoms that persisted beyond 2 months, including bloating, flatulence, dysphagia, and diarrhea. CONCLUSIONS: With strict selection criteria and increasing experience and standardization of technique, laparoscopic Nissen fundoplication can provide both safe and effective results for patients with chronic symptoms of gastroesophageal reflux disease.     

Significance of Decreased Orientation Performance During Rehabilitation.

Objective: To demonstrate the importance of careful attention to changes in orientation in neurorehabilitation inpatients. Study Design: Archival data analysis including 2 retrospective case studies. Setting: Inpatient rehabilitation unit. Participants: Four hundred twenty-eight neurorehabilitation inpatients. Main Outcome Measure: Orientation Log (O-Log). Results: Decrease in O-Log performance of 5 or more points followed by any decline on the subsequent administration occurred in fewer than 1% of the cases. Conclusions: Consecutive declines in orientation are extremely unusual in a rehabilitation population and warrant careful examination of patient medical status. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Optimal selection procedures for abbreviated area under the curve (AAUC) of blood concentration versus time for drug blood concentration levels

Because of the complexity in assessing elders for depressive symptoms, we recommend that nurses use a differentiated approach as an adjunct to clinical judgment and other assessment strategies. Based on our research and clinical experience, we advocate the joint use of the Hamilton Rating Scale for Depression and the Dementia Mood Assessment Scale, and propose a two-tiered assessment process. The first differentiation in this process is made by means of a cut-off score to determine whether or not depressive symptoms exist. If depressive symptoms are present, a second system of differentiation may be employed to identify discrete symptom factors. Application of this differentiated approach will enable the nurse to better understand and design interventions for each elder's specific presentation of depressive symptoms.     

PCR-based DNA amplification and presumptive detection of Escherichia coli O157:H7 with an internal fluorogenic probe and the 5' nuclease (TaqMan) assay

Presumptive identification of Escherichia coli O157:H7 is possible in an individual, nonmultiplexed PCR if the reaction targets the enterohemorrhagic E. coli (EHEC) eaeA gene. In this report, we describe the development and evaluation of the sensitivity and specificity of a PCR-based 5' nuclease assay for presumptively detecting E. coli O157:H7 DNA. The specificity of the eaeA-based 5' nuclease assay system was sufficient to correctly identify all E. coli O157:H7 strains evaluated, mirroring the previously described specificity of the PCR primers. The SZ-primed, eaeA-targeted 5' nuclease detection assay was capable of rapid, semiautomated, presumptive detection of E. coli O157:H7 when >/=10(3) CFU/ml was present in modified tryptic soy broth (mTSB) or modified E. coli broth and when >/=10(4) CFU/ml was present in ground beef-mTSB mixtures. Incorporating an immunomagnetic separation (IMS) step, followed by a secondary enrichment culturing step and DNA recovery with a QIAamp tissue kit (Qiagen), improved the detection threshold to >/=10(2) CFU/ml. Surprisingly, immediately after IMS, the sensitivity of culturing on sorbitol MacConkey agar containing cefeximine and tellurite (CT-SMAC) was such that identifiable colonies were demonstrated only when >/=10(4) CFU/ml was present in the sample. Several factors that might be involved in creating these false-negative CT-SMAC culture results are discussed. The SZ-primed, eaeA-targeted 5' nuclease detection system demonstrated that it can be integrated readily into standard culturing procedures and that the assay can be useful as a rapid, automatable process for the presumptive identification of E. coli O157:H7 in ground beef and potentially in other food and environmental samples.     

Laparoscopic gastrostomy according to Janeway

Percutaneous endoscopic gastrostomy is not suitable for all patients requiring gastrostomies. Patients with endoscopically impassable tumors require a safe and effective alternative procedure for paraesophageal alimentation. We present the surgical technique and results of the laparoscopic gastrostomy according to Janeway. Using an endoscopic stapling device a gastric tube is created from a stomach fold, led out through the trocar site, and fixed to the skin in the left upper quadrant. Via an inserted catheter enteral alimentation can be performed intermittently since the gastrostoma is continent. Between July 1995 and November 1996 laparoscopic gastrostomy was performed in 15 patients (10 male, five female) with tumors in the pharynx or esophagus. Mean operation time was 35 min. One stoma necrosis developed; the other postoperative courses were complication-free. All gastrostomies were continent. Laparoscopic gastrostomy is easy to perform and involves minimal discomfort and complications for the patient.     

Myocardial infarction and percent arteriographic stenosis of culprit lesion: report from the Program on the Surgical Control of the Hyperlipidemias (POSCH)

Domestic violence is a significant public health issue affecting women. Numerous medical organizations have recommended that routine screening of women be conducted to assist in the prevention, identification, and care for victims of violence. This article examines the scope of domestic violence in women, reviews ways to recognize abuse, examines the potential impact of abuse upon health and discusses the management of victims.     

Hypopharyngeal carcinoma with clinical peritoneal carcinomatosis: a report of two patients

An inbred Arab family with three neonates affected by microlissencephaly syndrome is reported. Brain magnetic resonance imaging in the index case revealed very thin brain mantle with agyria-pachygyria, agenesis of the corpus callosum, and hypoplasia of the brainstem and cerebellum. All three neonates had microcephaly, arthrogryposis multiplex congenita, and micropenis. The presence of three affected newborn infants in a consanguineous family suggests an autosomal-recessive mode of inheritance of this syndrome. The spectrum of microlissencephaly syndrome is reviewed.     

Carbonic anhydrase inhibitors: ureido and thioureido derivatives of aromatic sulfonamides possessing increased affinities for isozyme I. A novel route to 2,5-disubstituted-1,3,4-thiadiazoles via thioureas, and their interaction with isozymes I, II and IV

Reaction of 12 aromatic sulfonamides containing a free amino group with cyanate or thiocyanate in the presence of acid afforded the corresponding urea/thiourea derivatives which were assayed as inhibitors of three isozymes of carbonic anhydrase (CA), i.e., CA I, II and IV. Oxidation of the obtained thioureas with iodine in acidic medium afforded symmetrical 2,5-bis(substituted-phenyl)-1,3,4-thiadiazole derivatives possessing sulfonamido groups on the aromatic ring, via a new synthesis of the heterocyclic moiety. Good inhibition of all these three CA isozymes was observed with the new compounds, but a novel finding was that the ureas/thioureas reported here had an increased affinity for the slow isozyme CA I, which generally is less sensitive to inhibition by sulfonamides when compared to the rapid isozymes CA II and IV. The disubstituted-1,3,4-thiadiazoles on the other hand were better inhibitors of CA II than CA IV and especially CA I, similarly to the large majority of aromatic/heterocyclic sulfonamides. Some of the new compounds could constitute good lead molecules for developing more selective CA I inhibitors.     

Lung function of Zimbabwean farm workers exposed to flue curing and stacking of tobacco leaves

Our aim was to evaluate the efficacy of a revised tuberculosis (TB) contact tracing procedure in South Glamorgan whereby routine annual radiological surveillance was abandoned and contacts were either discharged or referred to chest clinic following their initial screening. We reviewed and evaluated data from the TB contact tracing clinic, the Public Health Service Mycobacterium Reference Unit, Cardiff and the Consultant in Communicable Diseases Control, South Glamorgan Health Authority and compared these results with those of our previous study. One hundred and three index cases and 732 contacts were identified. Seven hundred and seven contacts, 526 close and 181 casual, were screened, of whom 102 casuals should not have been. One hundred and sixty-one contacts were given BCG vaccination. Fifty-four contacts were referred to the chest clinic. Seven cases of TB were detected, all in young, unvaccinated, close contacts of pulmonary disease. Twenty-one contacts were given chemoprophylaxis, 20 of whom were close contacts of pulmonary TB and one of extrapulmonary disease. Five contacts who were screened and initially discharged developed TB later: in two the protocol had not been followed and three presented with extrapulmonary TB. Compared with the results of the previous protocol fewer contacts were unnecessarily screened and referrals to the chest clinic increased, as did the number given chemoprophylaxis. The case finding rate is similar to that found prior to the revision of the protocol. The yield from tracing casual contacts continues to be nil. It is very low in contacts of extrapulmonary disease. When the protocol was followed no case of pulmonary TB was missed. The revised protocol seems to be as effective as the previous, more complex protocol. In our area, one of low incidence of TB, screening of casual contacts and of contacts of extrapulmonary TB is not cost-effective. We will concentrate even more on screening close contacts of pulmonary TB.