89 research outputs found
Validation and calibration of the Kabi Pharmacia International Growth Study prediction model for children with idiopathic growth hormone deficiency
In 1999 a model was published for prediction of growth in children with
idiopathic GH deficiency (IGHD) during GH therapy, derived using data from
the Kabi Pharmacia International Growth Study (KIGS) database (Pharmacia
\\|[amp ]\\| Upjohn, Inc., International Growth Database). We validated and
calibrated this KIGS model for growth in the first year of GH therapy
using data from 136 Dutch children with IGHD. Observed vs. predicted
outcomes were plotted, and the fitted regression line was significantly
different from the line of identity (P = 0.03). It appeared that the
predictions were too extreme: relatively low predictions were too low,
relatively high predictions were too high. This is a well known phenomenon
in the context of prediction models, called overoptimism. For valid
application to other data the KIGS predictions should be calibrated.
Calibrated predictions are obtained using Y(cal) = Y(orig) + (2.153 -
0.192 x Y(orig)), where Y(cal) is the calibrated prediction, and Y(orig)
is the KIGS prediction. The calibrated prediction will be higher than the
original KIGS prediction when the original prediction is less than 11.2
cm/yr and will be lower otherwise. The variability of the prediction
errors of the calibrated predictions was positively related to the value
of the prediction (P < 0.001), described by the equation SD(pred err) =
-1.017 + 0.286 x Y(cal). Our calibrated model will give better predictions
for children with IGHD fulfilling the same criteria
Effect of fetal breathing movements on fetal cardiac hemodynamics
__Abstract__
Maximum flow velocity waveforms were studied at atrioventricular and outflow tract level in 12 cases during fetal breathing activity and in 12 cases during fetal apnea matched for maternal and gestational age and maternal parity. Gestational age ranged between 27 and 40 weeks (median 30 weeks). All flow velocity waveforms were obtained using a mechanical sector scanner with a pulsed Doppler system (carrier frequency 3.5 MHz). Time-averaged flow velocities were clearly different between inspiration and expiration at all four recording levels, reflecting changes in venous return as a result of fluctuations in intrathoracic pressure during fetal breathing activity. Percentage change between inspiration and expiration at outflow tract level was positively correlated with gestational age. Time-averaged flow velocity at mitral level and ascending aorta level was significantly higher during fetal breathing activity than during apnea, suggesting increased shunting of blood flow through the foramen ovale. Acceleration time at outflow tract level demonstrated very little change relative to inspiration and expiration
Effect of dietary fish oil on blood levels of free fatty acids, ketone bodies and triacylglycerol in humans
Although the reduction of serum triacylglycerol concentrations by dietary fish oil is a well-known effect, the exact mechanism of this effect has not been previously studied in human subjects. Therefore, the aim of this study was (i) to examine the effect of short-term fish oil supplementation on blood concentrations of ketone bodies, free fatty acids and triacylglycerol in healthy humans and (ii) to verify whether the observed relationships between these variables would be consistent with reduced lipolysis and/or enhanced hepatic fatty acid oxidation after fish oil supplementation. Twenty subjects (21-23 years, normal liver function tests) were randomly divided into two groups to supplement their usual diet with either 30 g/d of fish oil (n=11) or olive oil (n=9). Venous blood samples were drawn after an overnight fast, before and after 1, 3 and 7 d of fish oil/olive oil supplementation. Blood concentrations of triacylglycerol and free fatty acids decreased consistently after fish oil supplementation; the reduction was already significant after one day of fish oil (P0.10). No significant changes in glucose, insulin or ketone body levels were observed in either group after supplementation. After fish oil, but not after olive oil supplementation, the ratio of blood ketone body levels to free fatty acid levels increased significantly (P<0.05). Furthermore, after fish oil supplementation only, free fatty acid levels were significantly correlated with levels of ketone bodies (day 7 of supplementation: r=0.90, P<0.001) and triacylglycerol (maximum value on day 3: r=0.77, P<0.01). These findings suggest that reduced lipolysis and increased hepatic β-oxidation/ketogenesis may contribute to reduced triacylglycerol levels after ω3 fatty acid supplementation in humans. Turnover studies are needed in order to further quantitate these processes
Ductus Arteriosus Doppler in der ersten Schwangerschaftshälfte
Zusammenfassend stellen wir fest, daß es möglich ist, Flußgeschwindigkeiten durch den ductus arteriosus ab der 11. SSW zu messen. Enddiastolischer Flow tritt an der 13. SSW auf, vermutlich aufgrund abnehmender Afterload. Sowohl eine Abnahme der peripheren Afterload (Plazenta) als auch eine Zunahme der rechtsventrikulären Kontraktilität und das Auswurfvolumen sind für den Anstieg aller Blutflußgeschwindigkeiten im ductus arteriosus verantwortlich
Balloon dilation and stent implantation for treatment of femoropopliteal arterial disease: meta-analysis
PURPOSE: To perform a meta-analysis of long-term results of balloon
dilation and stent implantation in the treatment of femoropopliteal
arterial disease. MATERIALS AND METHODS: The English-language literature
was searched for studies published between 1993 and 2000. Inclusion
criteria for articles were presentation of long-term primary patency
rates, standard errors (explicitly reported or derivable), and baseline
characteristics of the study population. Two reviewers independently
extracted data, and discrepancies were resolved by consensus. Primary
patency rates were combined by using a technique that allows adjustment
for differences across study populations. Analyses were adjusted for
lesion type and clinical indication. RESULTS: Nineteen studies met the
inclusion criteria, representing 923 balloon dilations and 473 stent
implantations. Combined 3-year patency rates after balloon dilation were
61% (standard error, 2.2%) for stenoses and claudication, 48% (standard
error, 3.3%) for occlusions and claudication, 43% (standard error, 4.1%)
for stenoses and critical ischemia, and 30% (standard error, 3.7%) for
occlusions and critical ischemia. The 3-year patency rates after stent
implantation were 63%-66% (standard error, 4.1%) and were independent of
clinical indication and lesion type. Funnel plots demonstrated an
asymmetric distribution of the data points associated with stent studies.
CONCLUSION: Balloon dilation and stent implantation for claudication and
stenosis yield similar long-term patency rates. For more severe
femoropopliteal disease, the results of stent implantation seem more
favorable. Publication bias could not be ruled out
Three-dimensional US assessment of hepatic volume, head circumference, and abdominal circumference in healthy and growth-restricted fetuses
PURPOSE: To establish reproducibility and normal values for fetal hepatic
volume and its significance in identification of fetal growth restriction
relative to head and upper abdominal circumferences according to a
cross-sectional study design. MATERIALS AND METHODS: Pregnant women (n =
135) underwent ultrasonography. The coefficient of variation (CV) for
hepatic volume scans obtained at 0 and 20 minutes and hepatic area
tracings, performed twice for each scan, was determined (n = 20; range,
23-36 weeks). Normal data for hepatic volume and head and upper abdominal
circumferences were obtained (n = 85; range, 20-36 weeks) and related to
data from growth-restricted fetuses (birth weight < P5 centile; n = 24;
range, 22-36 weeks). RESULTS: CV was 2.9% for volume scans and 1.6% for
area tracings. In 85 uncomplicated cases, mean fetal hepatic volume (P50
centile) was 9.7 mL +/- 4.4 (SD) at 20 weeks and 96.4 mL +/- 8.2 at 36
weeks of gestation. In 24 growth-restricted fetuses, hepatic volume, head
circumference, and upper abdominal circumference expressed as percentages
of the normal P50 centile were 45%, 90%, and 82%, respectively. Mean
difference in hepatic volume between fetal growth restriction and normal
fetal development, as expressed with the z score, -4.32 +/- 1.4, was
significantly different (P <.05) from that for head circumference, -3.04
+/- 1.3, but not from that for upper abdominal circumference, -4.7 +/-
1.2. Fetal hepatic measurement was obtained in 109 pregnancies.
CONCLUSION: Acceptable reproducibility exists for hepatic volume
determinations. In fetal growth restriction, reduction is more pronounced
for hepatic volume than for head or upper abdominal circumference; hepatic
volume is a better discriminator than head circumference but not upper
abdominal circumference
Genetic risk estimation by healthcare professionals
OBJECTIVES: To assess whether healthcare professionals correctly
incorporate the relevance of a favourable test outcome in a close relative
when determining the level of risk for individuals at risk for
Huntington's disease. DESIGN AND SETTING: Survey of clinical geneticists
and genetic counsellors from 12 centres of clinical genetics (United
Kingdom, 6; The Netherlands, 4; Italy, 1; Australia, 1) in May-June 2002.
Participants were asked to assess risk of specific individuals in 10
pedigrees, three of which required use of Bayes' theorem. PARTICIPANTS: 71
clinical geneticists and 41 other healthcare professionals involved in
genetic counselling. MAIN OUTCOME MEASURES: Proportion of respondents
correctly assessing risk in the three target pedigrees; proportion of
respondents who were confident of their estimate. RESULTS: 50%-64% of
respondents (for the three targets separately) did not include the
favourable test information and inc
Serum inhibin B as a marker of spermatogenesis
Inhibin B is produced by Sertoli cells, provides negative feedback on FSH
secretion, and may prove to be an important marker for the functioning of
seminiferous tubules. The purpose of the present study was to examine the
relationship between the spermatogenic function of the testis of
subfertile men and the plasma concentrations of inhibin B and FSH. These
parameters were estimated in a group of 218 subfertile men. Serum inhibin
B levels were closely correlated with the serum FSH levels (r = -0.78, P <
0.001), confirming the role of inhibin B as feedback signal for FSH
production. The spermatogenic function of the testis was evaluated by
determining testicular volume and total sperm count. Inhibin B levels were
significantly correlated with the total sperm count and testicular volume
(r = 0.54 and r = 0.63, respectively; P < 0.001). Testicular biopsies were
obtained in 22 of these men. Inhibin B was significantly correlated with
the biopsy score (r = 0.76, P < 0.001). Receiver operating characteristic
analysis revealed a diagnostic accuracy of 95% for differentiating
competent from impaired spermatogenesis for inhibin B, whereas for FSH, a
value of 80% was found. We conclude that inhibin B is the best available
endocrine marker of spermatogenesis in subfertile men
Does phase 2 of the expiratory PCO2 versus volume curve have diagnostic value in emphysema patients?
It has been postulated that serial inhomogeneity of ventilation in the
peripheral airways in emphysema is represented by the shape of expiratory
carbon dioxide tension versus volume curve. We examined the diagnostic
value of this test in patients with various degrees of emphysema. The
volumes between 25-50% (V25-50) and 25-75% (V25-75) of the expiratory
carbon dioxide tension versus volume curve were determined in 29
emphysematous patients (20 severely obstructed and 9 moderately
obstructed), 12 asthma patients in exacerbation of symptoms, and 28
healthy controls. Discriminant analysis was used to examine whether these
diagnostic groups could be separated. With regard to phase 2 of the
expiratory CO2 versus volume curve (mixture of anatomic deadspace and
alveolar air), a plot of intercept versus slope of the relationships of
(V25-50) and (V25-75) versus inspiratory volume (VI) from functional
residual capacity (FRC), obtained during natural breathing frequency,
proved to be most discriminating in the separation between healthy
controls and severely obstructed emphysema patients. Separating healthy
controls and severely obstructed emphysema patients on the basis of the
discriminant line for V25-50, 9 of the 12 asthma patients in exacerbation
were classified as normal, and only 5 of the 9 moderately obstructed
emphysema patients as emphysematous. For V25-75 involvement of phase 3 of
the curve (alveolar plateau) in asthma patients in exacerbation caused a
marked overlap with the severely obstructed emphysema patients. In the
healthy controls, a fixed breathing frequency of 20 breaths.min-1 led to
an increase of both volumes.(ABSTRACT TRUNCATED AT 250 WORDS
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