Psychological Consequences of Screening for Abdominal Aortic Aneurysm and Conservative Treatment of Small Abdominal Aortic Aneurysms

AbstractObjective to describe the potential psychological consequences of screening for abdominal aortic aneurysms (AAAs). Methods the participants were prospectively and randomly sampled from a randomised screening trial for AAA and asked to complete a validated generic and global anonymous quality of life (QL) questionnaire by self-assessment (ScreenQL). Material case–control study: ScreenQL was completed once by 168 (48%) of 350 non-responders to screening, 271 (81%) of 335 attenders before screening, 286 (85%) of 335 attenders after screening, 127 (85%) of 149 with a small AAA diagnosed at screening, and 231 (66%) of 350 who were randomised not to be offered screening for AAA (controls). Prospective study (paired data): 127 men having a small AAA diagnosed. Twenty-nine (81%) of 36 men operated after initial conservative treatment. Results initially, the QL score was 5% lower among men with a small AAA compared to the controls (p<0.05), mainly because of poorer health perception. The QL score declined significantly further to 7% below control values during the period of conservative treatment. This impairment was mainly due to a 21% and 15% reduction in scores relating to health perception and psychosomatic distress, respectively. However, all scores improved to control levels in patients operated on. The QL of attending men for screening was significantly lower than that of the controls and the attenders after the screening. No differences were noticed concerning the non-attenders.Conclusion the offer of screening causes transient psychological stress in subjects found not to have AAA. However, diagnosis of an AAA seems to impair QL permanently and progressively in conservatively treated cases. This impairment seems reversible by operation. Nevertheless, the impairment seems considerable, and must be considered in the management of AAA and in the final evaluation of screening for AAA

The Plasma Level of Matrix Metalloproteinase 9 may Predict the Natural History of Small Abdominal Aortic Aneurysms. A Preliminary Study

AbstractObjectives: increased levels of various proteinases have been detected in abdominal aortic aneurysms (AAA) and are assumed to cause the degradation of the aortic wall. To determine whether systemic measurement of these proteinases and their inhibitors may predict the natural cause of AAA. Methods and material: serum (S) and plasma (P) samples were obtained from 121 men following the diagnosis of a small AAA (3–5 cm) at population screening. Annual control scans were performed to check for expansion. Circulating levels of elastase-alpha 1 antitrypsin-complexes, alpha 1antitrypsin, matrix metalloproteinase (MMP) 2 & 9, tissue-inhibitor-matrixproteinase 1 & 2, procollagen III-N-terminal-propeptide, and elastin-peptides were measured in a random group of 36 men. Results: alpha 1 antitrypsin was significantly and positively associated with expansion. Similarly, P-MMP9 levels were significantly associated with size and expansion. There was a difference between median serum and plasma values, probably because of secretion from platelets. Conclusion: P-MMP9 and P-alpha 1 antitrypsin may predict the natural history of AAA

Five-year Results of Elastin and Collagen Markers as Predictive Tools in the Management of Small Abdominal Aortic Aneurysms

AbstractObjective small abdominal aortic aneurysms (AAAs) do rupture and only half of AAAs above 5 cm would have ruptured unoperated. Furthermore, conservative treatment of AAAs may cause psychological side effects and impaired quality of life. To optimise the indication and time for operation for AAAs, we analysed whether serum elastin peptides (EP), procollagen-IIIN-terminal propeptide (PIIINP), and the initial AAA size could predict operation for AAAs in initially conservatively treated AAA. Material and methods in 1994, 4404 65–73 year old males were invited to hospital-based screening for AAAs by ultrasonography. Seventy-six percent attended. One hundred and forty-one (4.2%) had AAAs (def: +30 mm). Nineteen were offered operation (AAA +50 mm), and 112 were followed with annual control scans for 1–5 years (mean 2.5 years). Of these, 99 had their EP (ng/ml) and PIIINP (ng/ml) determined using ELISA and RIA techniques. Two observers and one scanner were used. Results the mean expansion rate was 2.7 mm/year. The initial AAA size (r=0.46; 0.26–0.61), EP ( r =0.31; 0.11–0.49), and NPIIIP ( r =0.24; 0.02–0.44) was independently significant associated to expansion rate in a multiple linear regression analysis including the three mentioned variables. The multivariate formula could by ROC curve analysis predict cases reaching 5 cm in diameter within 5 years with a sensitivity and specificity of 91% and 87%, respectively, increasing to 91% and 94%, respectively, by accepting a 2 mm variation in those measurements. Twenty-three were lost to follow up, 21 of these due to death or severe illness. Of these, seven would have been predicted to reach an AAA size recommendable for surgery. If all 23 were included in the analysis, the sensitivity and specificity would have been 87% and 85%, respectively. Conclusion a predictive model using EP, PIIINP, and initial AAA size seems capable of predicting nine out of 10 AAAs that will be operated on within 5 years. However, a larger sample size is needed for clinical recommendations

Experimental Setup to Characterize the Radiation Hardness of Cryogenic Bypass Diodes for the HL-LHC Inner Triplet Circuits

For the high luminosity upgrade of the Large Hadron Collider (LHC), it is planned to replace the existing triplet quadrupole magnets with Nb₃Sn quadrupole magnets, which provide a comparable integrated field gradient with a significantly increased aperture. These magnets will be powered through a novel superconducting link based on MgB₂ cables. One option for the powering layout of this triplet circuit is the use of cryogenic bypass diodes, where the diodes are located inside an extension to the magnet cryostat and operated in superfluid helium. Hence, they are exposed to radiation. For this reason the radiation hardness of existing LHC type bypass diodes and more radiation tolerant prototype diodes needs to be tested up to the radiation doses expected at their planned position during their lifetime. A first irradiation test is planned in CERN's CHARM facility starting in spring 2018. Therefore, a cryo-cooler based cryostat to irradiate and test LHC type diodes in-situ has been designed and constructed. This paper will describe the properties of the sample diodes, the experimental roadmap and the setup installed in CHARM. Finally, the first measurement results will be discussed

Manejo Integral de Agua y Suelo en Centroamérica. Bases científicas para el desarrollo rural comunitario.

Este libro recoge los frutos de la colaboración y trabajo conjunto de un grupo de Universidades Iberoamericanas entre 2007 y 2012 el marco de las actividades del Programa de Cooperación Comunidad, Agua y Bosque en Centroamérica (CAB Centroamérica, http://www2.caminos.upm.es/Departamentos/imt/Topografia/Cab/cab.html ). Las actividades se han realizado con el apoyo del Programa de Cooperación Universitaria PCI-AECID IBEROAMÉRICA, de la Dirección de Cooperación para el Desarrollo de la Universidad Politécnica de Madrid y de los fondos propios de las Universidades latinoamericanas, con especial mención a la Universidad de Costa Rica, coordinadora de los trabajos en Centroamérica. El inicio de esta colaboración se produjo en 2007 a partir de la identificación de un objetivo común: profundizar la investigación sobre la dinámica agua-suelo-planta para mejorar la producción y la calidad del agua de los sistemas de abastecimiento comunitarios en Centroamérica

Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area

BACKGROUND: The relationship between geographical location, private costs, health provider costs and uptake of health screening is unclear. This paper examines these relationships in a screening programme for abdominal aortic aneurysm in the Highlands and Western Isles of Scotland, a rural and remote area of over 10,000 square miles. METHODS: Men aged 65–74 (n = 9323) were invited to attend screening at 51 locations in 50 settlements. Effects of geography, deprivation and age on uptake were examined. Among 8,355 attendees, 8,292 completed a questionnaire detailing mode of travel and costs incurred, time travelled, whether accompanied, whether dependants were cared for, and what they would have been doing if not attending screening, thus allowing private costs to be calculated. Health provider (NHS) costs were also determined. Data were analysed by deprivation categories, using the Scottish Indices of Deprivation (2003), and by settlement type ranging from urban to very remote rural. RESULTS: Uptake of screening was high in all settlement types (mean 89.6%, range 87.4 – 92.6%). Non-attendees were more deprived in terms of income, employment, education and health but there was no significant difference between non-attendees and attendees in terms of geographical access to services. Age was similar in both groups. The highest private costs (median £7.29 per man) and NHS screening costs (£18.27 per man invited) were observed in very remote rural areas. Corresponding values for all subjects were: private cost £4.34 and NHS cost £15.72 per man invited. CONCLUSION: Uptake of screening for abdominal aortic aneurysm in this remote and rural setting was high in comparison with previous studies, and this applied across all settlement types. Geographical location did not affect uptake, most likely due to the outreach approach adopted. Private and NHS costs were highest in very remote settings but still compared favourably with other published studies

The Efficacy of Pharmacotherapy for Decreasing the Expansion Rate of Abdominal Aortic Aneurysms: A Systematic Review and Meta-Analysis

BACKGROUND: Pharmacotherapy may represent a potential means to limit the expansion rate of abdominal aortic aneurysms (AAAs). Studies evaluating the efficacy of different pharmacological agents to slow down human AAA-expansion rates have been performed, but they have never been systematically reviewed or summarized. METHODS AND FINDINGS: Two independent reviewers identified studies and selected randomized trials and prospective cohort studies comparing the growth rate of AAA in patients with pharmacotherapy vs. no pharmacotherapy. We extracted information on study interventions, baseline characteristics, methodological quality, and AAA growth rate differences (in mm/year). Fourteen prospective studies met eligibility criteria. Five cohort studies raised the possibility of benefit of beta-blockers [pooled growth rate difference: -0.62 mm/year, (95%CI, -1.00 to -0.24)], but this was not confirmed in three beta-blocker RCTs [pooled RCT growth rate difference: -0.05 mm/year (-0.16 to 0.05)]. Statins have been evaluated in two cohort studies that yield a pooled growth rate difference of -2.97 (-5.83 to -0.11). Doxycycline and roxithromycin have been evaluated in two RCTs that suggest possible benefit [pooled RCT growth rate difference: -1.32 mm/year (-2.89 to 0.25)]. Studies assessing NSAIDs, diuretics, calcium channel blockers and ACE inhibitors, meanwhile, did not find statistically significant differences. CONCLUSIONS: Beta-blockers do not appear to significantly reduce the growth rate of AAAs. Statins and other anti-inflammatory agents appear to hold promise for decreasing the expansion rate of AAA, but need further evaluation before definitive recommendations can be made

Evaluation and optimization of a commercial enzyme linked immunosorbent assay for detection of Chlamydophila pneumoniae IgA antibodies

<p>Abstract</p> <p>Background</p> <p>Serologic diagnosis of <it>Chlamydophila pneumoniae </it>(Cpn) infection routinely involves assays for the presence of IgG and IgM antibodies to Cpn. Although IgA antibodies to Cpn have been found to be of interest in the diagnosis of chronic infections, their significance in serological diagnosis remains unclear. The microimmunofluorescence (MIF) test is the current method for the measurement of Cpn antibodies. While commercial enzyme linked immunosorbent assays (ELISA) have been developed, they have not been fully validated. We therefore evaluated and optimized a commercial ELISA kit, the SeroCP IgA test, for the detection of Cpn IgA antibodies.</p> <p>Methods</p> <p>Serum samples from 94 patients with anti-Cpn IgG titers ≥ 256 (study group) and from 100 healthy blood donors (control group) were tested for the presence of IgA antibodies to Cpn, using our in-house MIF test and the SeroCP IgA test. Two graph receiver operating characteristic (TG-ROC) curves were created to optimize the cut off given by the manufacturer.</p> <p>Results</p> <p>The MIF and SeroCP IgA tests detected Cpn IgA antibodies in 72% and 89%, respectively, of sera from the study group, and in 9% and 35%, respectively, of sera from the control group. Using the MIF test as the reference method and the cut-off value of the ELISA test specified by the manufacturer for seropositivity and negativity, the two tests correlated in 76% of the samples, with an agreement of Ƙ = 0.54. When we applied the optimized cut-off value using TG-ROC analysis, 1.65, we observed better concordance (86%) and agreement (0.72) between the MIF and SeroCP IgA tests.</p> <p>Conclusion</p> <p>Use of TG-ROC analysis may help standardize and optimize ELISAs, which are simpler, more objective and less time consuming than the MIF test. Standardization and optimization of commercial ELISA kits may result in better performance.</p