Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial.

San Gallicano Dermatological Institute, IRCCS, Rome, Italy.

BACKGROUND: Vitiligo is an acquired depigmenting disease with uncertain aetiopathogenesis, possibly associated with oxidative stress. Narrowband ultraviolet B phototherapy (NB-UVB) is the most widely used and effective treatment. AIM: To evaluate the clinical effectiveness of NB-UVB and the repairing of oxidative stress-induced damage, using oral supplementation with an antioxidant pool (AP). METHODS: Patients (n = 35) with nonsegmental vitiligo were enrolled in a randomized, double-blind, placebo-controlled multicentre trial. The treatment group received, for 2 months before and for 6 months during the NB-UVB treatment, a balanced AP containing alpha-lipoic acid, vitamins C and E, and polyunsaturated fatty acids. The area and number of lesions, as well as some parameters of the oxidation-reduction (redox) status of the peripheral blood mononuclear cells (PBMCs) were estimated at the beginning, after 2 months, and at the end of the trial. RESULTS: In total, 28 patients completed the study. After 2 months of AP supplementation, the catalase activity and the production of reactive oxygen species (ROS) were 121% and 57% of the basal values (P < 0.05 and P < 0.02 vs. placebo, respectively). The AP increased the therapeutic success of NB-UVB, with 47% of the patients obtaining > 75% repigmentation vs. 18% in the placebo group (P < 0.05). An increase in catalase activity to 114% (P < 0.05 vs. placebo) and decrease in ROS level of up to 60% (P < 0.02 vs. placebo) of the basal value was observed in PBMCs. Finally, the AP intake maintained the membrane lipid ratio (saturated : unsaturated fatty acids 1.8 : 3.1; P < 0.05), counteracting phototherapy-induced saturation. CONCLUSIONS: Oral supplementation with AP containing alpha-lipoic acid before and during NB-UVB significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo-associated oxidative stress.

PMID: 17953631 [PubMed - indexed for MEDLINE]

Treatment of vitiligo vulgaris with narrow-band UVB and oral Polypodium leucotomos extract: a randomized double-blind placebo-controlled study.

Netherlands Institute for Pigment Disorders, Department of Dermatology, Academic Medical Center, 1100 DD Amsterdam, The Netherlands. m.a.middelkamphup@amc.uva.nl

BACKGROUND: The first choice treatment for vitiligo vulgaris is narrow-band UVB (NB-UVB), but no satisfactory treatment exists. OBJECTIVES: To investigate if Polypodium leucotomos, an antioxidative and immunomodulatory plant extract, improves NB-UVB-induced repigmentation. METHODS: Fifty patients with vitiligo vulgaris randomly received 250 mg oral P. leucotomos or placebo three times daily, combined with NB-UVB twice weekly for 25-26 weeks. RESULTS: Repigmentation was higher in the P. leucotomos group vs. placebo in the head and neck area (44% vs. 27%, P = 0.06). Small repigmentation increases (P = n.s.) were observed for the trunk (6% increased repigmentation), extremities (4%), and hands and feet (5%) in the P. leucotomos group vs. placebo. Patients attending more than 80% of required NB-UVB sessions showed increased repigmentation in the head and neck area in the P. leucotomos group vs. placebo (50% vs. 19%, P < 0.002); no significant differences were seen in the other body areas. Patients with skin types 2 and 3 showed more repigmentation in the head and neck area in the P. leucotomos group vs. placebo (47% vs. 21%, P = 0.01), and no significant differences were seen in the other body areas. No conclusions could be drawn on skin types 4 and 5 due to low patient numbers. CONCLUSION: There is a clear trend towards an increase in repigmentation of vitiligo vulgaris affecting the head and neck area when NB-UVB phototherapy is combined with oral P. leucotomos. This effect may be more pronounced in light skin types.

PMID: 17659004 [PubMed - indexed for MEDLINE]

[Competent and diverse. Portrayal of older adults in Dutch television commercials ten years later]

Radboud Universiteit Nijmegen, Sectie Methoden & Technieken, Faculteit der Sociale Wetenschappen. m.vanselm@maw.ru.nl

The present study replicates our study of older adults' portrayal in Dutch television commercials conducted in 1993. The central question is whether older adults are being portrayed more visibly in Dutch television commercials and whether this portrayal has become more diverse compared to ten years ago. Based on a list of descriptions of all commercials broadcasted by public television channels in 2003 (N= 4767) 117 commercials featuring older adults were selected. By means of a quantitative content analysis it was examined whether and how older men and women are portrayed. It was concluded that although older adults are not more prevalent compared to ten years ago, their portrayal is more diverse with respect to their roles and the advertised products. Older adults were portrayed as more competent and less age-stereotypical in television commercials.

PMID: 17605283 [PubMed - indexed for MEDLINE]

Delineation of potential hot spots for hyperthermia treatment planning optimisation.

Radiotherapy Department, Academic Medical Center, Amsterdam, The Netherlands. wiersmaj@amc.uva.nl

The optimal feed parameters of the generators for a complex-phased hyperthermia array system consisting of 4, 8 or even more applicators cannot be found using only the expertise of the treatment staff or using the limited amount of field and temperature data obtained during treatment. A number of strategies have been proposed to help us with the task to optimise the hyperthermia treatment, including several strategies specifically addressing the occurrence of hot spots. Each of the latter strategies strongly relies on the specification of the potential hot spots. This specification is either based on anatomy or the selection of an arbitrary number of potential hot spots. Therefore it is not guaranteed that all potential hot spots are included. This paper introduces a procedure for the delineation and visualisation of potential (SAR) hot spots. The potential hot spots are delineated by selecting those points for which the maximal SAR exceeds a specific SAR selection level. This SAR selection level is defined relative to the highest achievable SAR in the target volume for a certain fixed heating power. A larger number of potential hot spots and hot spots of larger size are delineated if the selection level is decreased. Although the procedure still includes an arbitrary selection criterion, i.e. the selection level, the selection is solely based on calculated EM-field data. As a result all potential hot spots can be delineated a priori. Three different objective functions are applied to maximise the SAR in the target. The first only maximises the SAR in the target volume for a given system power output. The other two intrinsically set a constraint on the set of potential hot spots as a whole. Additionally the SAR in each delineated potential hot spot separately can be constrained. In two patient cases the SAR in potential hot spots can be kept below the selection value applied for delineation of the potential hot spots. If assessed in terms of constraining the SAR value below the selection level while maximising target heating efficiency the combination of an objective function only maximising the SAR in the target with a separate constraint on each potential hot spots appears to be the most efficient.

PMID: 17523021 [PubMed - indexed for MEDLINE]

Apparently isolated partial articular fractures of the radial head: prevalence and reliability of radiographically diagnosed displacement.

Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Boston, MA 02116, USA.

The purpose of this study was to measure the prevalence and reliability of the radiographic diagnosis of displacement of apparently isolated partial articular radial head fractures and use these factors to assess treatment considerations. Among 119 radiographically visible partial fractures of the radial head not associated with other wrist, forearm, or elbow injury, 101 were classified as Mason type 1 (85%), 11 as borderline between Mason type 1 and Mason type 2 fractures (9%), and 7 as Mason type 2 fractures (6%) according to Broberg and Morrey's modification of the Mason classification. The intraobserver reliability of the classification of Mason type 1 and type 2 fractures was excellent (mean kappa, 0.85), but the interobserver reliability was only moderate (multirater kappa, 0.45). Because apparently isolated, stable partial fractures of the radial head are infrequently displaced and observers have moderate disagreement regarding the diagnosis of displacement, it is likely that displacement is overdiagnosed.

PMID: 17448692 [PubMed - indexed for MEDLINE]

Imaging from an orthopaedic point of view. What the orthopaedic surgeon expects from the radiologist?

Academic Medical Center, University of Amsterdam, P.O. Box 22700, 1100 DD Amsterdam, The Netherlands. m.lammerts@amc.uva.nl

The paradigm of coping with sometimes gross pathology, while having some small and at first sight insignificant lesions demands for accurate radiological detection and orthopaedic treatment makes it interesting and challenging to be involved in the treatment of professional athletes. In the diagnostic process we differentiate between acute, posttraumatic and overuse injuries. We must realize the importance of reproducible routine X-rays as a first step in the diagnostic process. In case of additional diagnostics, appropriate consultation between the orthopaedic surgeon and the radiologist is essential in order to determine the best strategy.

PMID: 17324549 [PubMed - indexed for MEDLINE]

Pdx-1 modulates histone H4 acetylation and insulin gene expression in terminally differentiated alpha-TC-1 cells.

The Research Institute for Children, Children's Hospital, 200 Henry Clay Avenue, Research and Education Building, Rm 2211, New Orleans, LA 70118, USA.

OBJECTIVES: Islet-associated transcription factors play a critical role in regulating pancreatic endocrine cell differentiation and islet hormone gene expression. Both alpha- and beta-cells differentiate from a common endocrine precursor cell. Therefore, it is important to reveal the differential gene expression profiles between alpha- and beta-cells that can direct their terminal cell fates. alpha-TC-1 and beta-TC-1 are 2 terminally differentiated islet tumor cell lines derived from islets transformed by promoter-specific driven SV40 T antigen overexpression. In this study, we demonstrated that Pdx-1 is a potent transcriptional regulator of endogenous insulin gene expression in alpha-TC-1 cells. METHODS: Reverse transcriptase-polymerase chain reaction and chromatin immunoprecipitation assays were used to analyze gene expression patterns and chromatin modifications in the insulin promoter. RESULTS: Differential transcription factor expression profiles of alpha-TC-1 and beta-TC-1 cells revealed that INSM-1 and Pdx-1 transcription factors were expressed exclusively in beta-TC-1 cells. Overexpression of Ad-Pdx-1 in alpha-TC-1 cells induced insulin gene expression. Chromatin immunoprecipitation assays in Ad-Pdx-1 alpha-TC-1 cells demonstrated Pdx-1 occupancy and the hyperacetylation of histone H4 in the insulin promoter region. CONCLUSIONS: Collectively, these experiments revealed that Pdx-1 is a potent transcriptional regulator that is capable of modulating histone H4 acetylation and activates the insulin gene in a terminally differentiated glucagonoma cell line.

PMID: 17312465 [PubMed - indexed for MEDLINE]

Neurogenin 3 recruits CBP co-activator to facilitate histone H3/H4 acetylation in the target gene INSM1.

The Research Institute for Children, Children's Hospital in New Orleans, 200 Henry Clay Avenue, Research and Education Building, Rm. 2211, New Orleans, LA 70118, USA.

INSM1 is a downstream target gene of neurogenin 3 (ngn3). A promoter construct containing the -426/+40bp region transiently co-transfected into NIH-3T3 cells with a ngn3 expression plasmid resulted in a 12-fold increase in promoter activity. The ngn3/E47 heterodimer selectively binds and activates the E-box3 of the INSM1 promoter. The endogenous ngn3 and CREB-binding protein (CBP) co-activator occupy the INSM1 promoter, resulting in hyper-acetylation of histone H3/H4 chromatin in a human neuroblastoma cell line, IMR-32. Additionally, adenoviral ngn3 can induce endogenous INSM-1 expression in pancreatic ductal carcinoma-1 cells through the recruitment of CBP to the INSM1 promoter and increase the acetylation of the INSM1 promoter region.

PMID: 17300785 [PubMed - indexed for MEDLINE]

PMCID: PMC1839826

Cues to deception and ability to detect lies as a function of police interview styles.

Psychology Department, King Henry Building, University of Portsmouth, King Henry 1 Street, Portsmouth, PO1 2DY, United Kingdom. aldert.vrij@port.ac.uk

In Experiment 1, we examined whether three interview styles used by the police, accusatory, information-gathering and behaviour analysis, reveal verbal cues to deceit, measured with the Criteria-Based Content Analysis (CBCA) and Reality Monitoring (RM) methods. A total of 120 mock suspects told the truth or lied about a staged event and were interviewed by a police officer employing one of these three interview styles. The results showed that accusatory interviews, which typically result in suspects making short denials, contained the fewest verbal cues to deceit. Moreover, RM distinguished between truth tellers and liars better than CBCA. Finally, manual RM coding resulted in more verbal cues to deception than automatic coding of the RM criteria utilising the Linguistic Inquiry and Word Count (LIWC) software programme.In Experiment 2, we examined the effects of the three police interview styles on the ability to detect deception. Sixty-eight police officers watched some of the videotaped interviews of Experiment 1 and made veracity and confidence judgements. Accuracy scores did not differ between the three interview styles; however, watching accusatory interviews resulted in more false accusations (accusing truth tellers of lying) than watching information-gathering interviews. Furthermore, only in accusatory interviews, judgements of mendacity were associated with higher confidence. We discuss the possible danger of conducting accusatory interviews.

PMID: 17211691 [PubMed - indexed for MEDLINE]

Management of hyperglycaemia in type 2 diabetes: the end of recurrent failure?

Diabetes Centre, Department of Endocrinology, VU University Medical Centre, Amsterdam, De Boelelaan 1117, Netherlands. RJ.Heine@vumc.nl

PMID: 17158386 [PubMed - indexed for MEDLINE]

PMCID: PMC1693603

A mathematical model of twin-twin transfusion syndrome with pulsatile arterial circulations.

Laser Center, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.p.vandenwijngaard@amc.uva.nl

The twin-twin transfusion syndrome (TTTS) is a severe complication of monochorionic twin pregnancies caused by a net transfusion of blood from one twin (the donor) to the other (the recipient) through placental anastomoses. To examine the pathophysiology of TTTS evolving through clinical stages I to IV, we extended our mathematical model to include pulsating circulations propagating along the arterial tree as well as placental and cerebral vascular resistances, and arterial wall thickness and stiffness. The model demonstrates that abnormal umbilical arterial flow (TTTS stage III) in the donor twin results from increased placental resistance as well as reduced resistance in the cerebral arteries. In contrast, recipient twin abnormal umbilical arterial flow requires a significantly greater increase in placental resistance, resulting from the compressive effects of high amniotic fluid pressure. Thus simulated abnormalities of donor umbilical arterial pulsations occur in the donor more commonly and earlier than in the recipient. The "normal" staging sequence (I, II, III, IV) correlates with the presence of compensating placental anastomoses, constituting the majority of monochorionic twin placentas. However, TTTS stage III may occur before manifestations of stage II (lack of donor bladder filling), in our model correlating with severe TTTS from a single arteriovenous anastomosis, an infrequent occurring placental angioarchitecture. In conclusion, this mathematical model describes the onset and development of the four stages of TTTS, reproduces a variety of clinical manifestations, and may contribute to identifying the underlying pathophysiology of the staging sequence in TTTS.

PMID: 17158266 [PubMed - indexed for MEDLINE]

Risk of rebleeding after treatment of acute hydrocephalus in patients with aneurysmal subarachnoid hemorrhage.

Department of Neurosurgery, University Medical Center Utrecht, Utrecht, The Netherlands.

BACKGROUND AND PURPOSE: Cerebrospinal fluid drainage is often indicated in patients with acute hydrocephalus after aneurysmal subarachnoid hemorrhage but is believed to increase the risk of rebleeding. We studied the risk of rebleeding in patients with subarachnoid hemorrhage during treatment for acute hydrocephalus. METHODS: We included patients with hydrocephalus treated with external ventricular drainage or lumbar punctures within 4 days after the hemorrhage and before aneurysm occlusion. Each treated patient was matched with a control patient with untreated hydrocephalus and a control patient without ventricular enlargement. Patients and controls were matched for interval since subarachnoid hemorrhage, duration of exposure, use of tranexamic acid, clinical condition on admission, and age. We used Cox regression to calculate hazard ratios and we adjusted for rebleeding that had occurred before starting the cerebrospinal fluid drainage. RESULTS: In the group treated with external ventricular drainage, rebleeding occurred in seven of 34 patients (21%) with treatment, in seven of 34 controls (21%) with untreated hydrocephalus, and in six of 34 controls (18%) without hydrocephalus. In the group treated with one or more lumbar punctures, rebleeding occurred in one of 21 patients (5%) with treatment, in three of 21 controls (14%) with untreated hydrocephalus, and in none of the 21 controls without hydrocephalus. The hazard ratios for rebleeding were 1.0 (95% CI: 0.4 to 2.7) for external ventricular drainage treatment and 0.7 (95% CI: 0.1 to 6.4) for lumbar puncture treatment. CONCLUSIONS: This study does not confirm an importantly increased risk of rebleeding during external ventricular drainage or lumbar punctures for acute hydrocephalus after aneurysmal subarachnoid hemorrhage.

PMID: 17122426 [PubMed - indexed for MEDLINE]

Associations of adiponectin levels with incident impaired glucose metabolism and type 2 diabetes in older men and women: the hoorn study.

Institute of Health Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, Netherlands. marieke.snijder@falw.vu.nl

OBJECTIVE: Adiponectin is an adipose tissue-derived protein. Low levels are associated with obesity, insulin resistance, and type 2 diabetes. Our objective was to investigate the prospective association between adiponectin levels and the 6.4-year risk of type 2 diabetes and of impaired glucose metabolism (IGM). RESEARCH DESIGN AND METHODS: The Hoorn Study is a cohort study among Caucasians, aged 50-75 years. BMI, waist-to-hip ratio (WHR), fasting glucose, 2-h glucose, triglycerides, HDL cholesterol, LDL cholesterol, alanine aminotransferase, leptin, and adiponectin were measured at baseline. Lifestyle (alcohol intake, smoking, and physical activity) was assessed by questionnaires. After a mean follow-up of 6.4 years, glucose tolerance was assessed by a 75-g oral glucose tolerance test. Analyses were performed in 1,264 subjects (584 men and 680 women) without type 2 diabetes at baseline. For analyses of incident IGM, 239 subjects with IGM at baseline and/or type 2 diabetes at follow-up were excluded. RESULTS: Age- and lifestyle-adjusted odds ratios and 95% CIs comparing highest with lowest adiponectin quartile were 0.52 (0.23-1.18) in men and 0.15 (0.06-0.39) in women for type 2 diabetes and 0.90 (0.51-1.61) and 0.28 (0.16-0.48) for IGM, respectively. The risks were only slightly reduced after adjustment for WHR and leptin as markers of (abdominal) adiposity. Adjustment for baseline fasting and postload glucose levels (potential mediators) substantially diminished these inverse associations with type 2 diabetes (0.79 [0.32-1.91] and 0.62 [0.21-1.81]) and with IGM (1.20 [0.61-2.35] and 0.48 [0.26-0.90]), respectively. CONCLUSIONS: A high adiponectin level was strongly associated with a lower risk of IGM and type 2 diabetes, particularly in women. These results suggest that adiponectin is involved in the pathophysiology linking obesity to type 2 diabetes.

PMID: 17065691 [PubMed - indexed for MEDLINE]

Shrinkage of abdominal aortic aneurysm after successful endovascular repair: results from single center study.

Department of Vascular Surgery, Erasmus University Medical Center, Rotterdam, the Netherlands.

AIM: In the literature, the behavior of the aneurysm sac after endovascular grafting has been the subject of significant speculation. It has been suggested that shrinkage of the abdominal aortic aneurysm (AAA) is different for various endografts. This study was undertaken to evaluate endograft-specific differences in aneurysm sac shrinkage and to evaluate other factors that may influence AAA shrinkage. METHODS: Forty patients with an AAA treated with endovascular grafts with a complete 18 months follow-up and complete CT angiography (CTA) follow-up were available for analysis. All patients with a persistent endoleak, endograft migration or any other reason for intervention or conversion were excluded from this analysis. Shrinkage was defined as a reduction in the AAA diameter of 5 mm or more. Chi-squared tests were used to test whether shrinkage was different for the kind of stent graft used (Gore Excluder vs Cook-Zenith), preexistent AAA diameter (<65 mm vs =or>65 mm), and AAA status (ruptured vs non-ruptured) (two-sided; a= 0.05). RESULTS: At 18 months after treatment, shrinkage was observed in 14 patients (52%) of the 27 patients treated with a Gore Excluder endograft and in 8 patients (62%) of the 13 patients treated with a Cook Zenith endograft (P=0.74). In 31 patients with a diameter <65 mm, shrinkage was observed in 19 patients (61%) whereas of the 9 patients with a diameter =or>65 mm, shrinkage was observed in 3 patients (33%) (P=0.253). Of the 34 patients with a non-ruptured AAA, shrinkage was observed in 18 patients (53%) versus of the 6 patients with a ruptured AAA shrinkage was observed in 4 patients (66%) (P=0.673). CONCLUSIONS: From this study can be concluded that the influence of the endograft on shrinkage of the AAA sac might be less prominent than suggested in the literature. Furthermore, our study shows that other factors such as preexistent AAA diameter may influence AAA shrinkage after endovascular repair.

PMID: 17033603 [PubMed - indexed for MEDLINE]

Vessel wall calcifications at multi-detector row CT angiography in patients with peripheral arterial disease: effect on clinical utility and clinical predictors.

Program for the Assessment of Radiological Technology and the Department of Radiology, Erasmus MC Rotterdam, Dr Molewaterplein 50, Room Ee 21-40a, 3015 GE Rotterdam, the Netherlands.

PURPOSE: To evaluate retrospectively the effect of vessel wall calcifications on the clinical utility of multi-detector row computed tomographic (CT) angiography performed in patients with peripheral arterial disease and to identify clinical predictors for the presence of vessel wall calcifications. MATERIALS AND METHODS: The study was approved by the hospital institutional review board, and informed consent was obtained from all patients. For this study the authors included patients from two randomized controlled trials that measured the costs and effects of diagnostic imaging in patients with peripheral arterial disease. All patients underwent CT angiography and were followed up for 6 months. Clinical utility was measured on the basis of therapeutic confidence (rated on a 10-point scale) in the results of initial CT angiography and the need for additional vascular imaging. Univariable and multivariable logistic and linear regression analysis and the area under the receiver operating characteristic curve were used to evaluate the effect of vessel wall calcifications on the clinical utility of CT angiography and the use of patient characteristics to predict the number of calcified segments at CT angiography. RESULTS: A total of 145 patients were included (mean age, 64 years; 70% men). The authors found that the number of calcified segments was a significant predictor of the need for additional imaging (P = .001) and of the confidence scores (P < .001). The number of calcified segments discriminated between patients who required additional imaging after CT angiography and those who did not (area under the receiver operating characteristic curve, 0.66; 95% confidence interval: 0.54, 0.77). Age, diabetes mellitus, and cardiac disease were significant predictors of the number of calcified segments in both the univariable and multivariable analyses (P < .05). CONCLUSION: Vessel wall calcifications decrease the clinical utility of CT angiography in patients with peripheral arterial disease. Diabetes mellitus, cardiac disease, and elderly age (older than 84 years) are independently predictive for the presence of vessel wall calcifications.

PMID: 16966479 [PubMed - indexed for MEDLINE]

Comment in:

Hypertension. 2006 Oct;48(4):543-5.

Quantification of wave reflection in the human aorta from pressure alone: a proof of principle.

BMEYE BV, Academic Medical Centre, Suite K2-245, University of Amsterdam, Meibergdreef 9, NL-1105 AZ Amsterdam, The Netherlands. berend.westerhof@bmeye.com

Wave reflections affect the proximal aortic pressure and flow waves and play a role in systolic hypertension. A measure of wave reflection, receiving much attention, is the augmentation index (AI), the ratio of the secondary rise in pressure and pulse pressure. AI can be limiting, because it depends not only on the magnitude of wave reflection but also on wave shapes and timing of incident and reflected waves. More accurate measures are obtainable after separation of pressure in its forward (P(f)) and reflected (P(b)) components. However, this calculation requires measurement of aortic flow. We explore the possibility of replacing the unknown flow by a triangular wave, with duration equal to ejection time, and peak flow at the inflection point of pressure (F(tIP)) and, for a second analysis, at 30% of ejection time (F(t30)). Wave form analysis gave forward and backward pressure waves. Reflection magnitude (RM) and reflection index (RI) were defined as RM=P(b)/P(f) and RI=P(b)/(P(f)+P(b)), respectively. Healthy subjects, including interventions such as exercise and Valsalva maneuvers, and patients with ischemic heart disease and failure were analyzed. RMs and RIs using F(tIP) and F(t30) were compared with those using measured flow (F(m)). Pressure and flow were recorded with high fidelity pressure and velocity sensors. Relations are: RM(tIP)=0.82RM(mf)+0.06 (R(2)=0.79; n=24), RM(t30)=0.79RM(mf)+0.08 (R(2)=0.85; n=29) and RI(tIP)=0.89RI(mf)+0.02 (R(2)=0.81; n=24), RI(t30)=0.83RI(mf)+0.05 (R(2)=0.88; n=29). We suggest that wave reflection can be derived from uncalibrated aortic pressure alone, even when no clear inflection point is distinguishable and AI cannot be obtained. Epidemiological studies should establish its clinical value.

PMID: 16940207 [PubMed - indexed for MEDLINE]

Comment on:

Diabetologia. 2006 May;49(5):837-45.

Comment on: Knol MJ, Twisk JWR, Beekman ATF, Heine RJ, Snoek FJ, Pouwer F. (2006) depression as a risk factor for the onset of type 2 diabetes mellitus. A meta-analysis. Diabetologia; 49: 837-845.

PMID: 16917758 [PubMed - indexed for MEDLINE]

National survey on the natural radioactivity and 222Rn exhalation rate of building materials in The Netherlands.

Nuclear Research and consultancy Group (NRG), P.O. Box 9034, 6800 ES Arnhem, The Netherlands. p.dejong@nrg-nl.com

The present study reports on results of a nation-wide survey on the natural radioactivity concentrations and Rn exhalation rates of the prevailing building materials in the Netherlands. In total 100 samples were taken and analyzed for the activity concentrations of Ra, Ra, Th, and K and for their Rn exhalation rate. The sampled materials consisted of gypsum products, aerated concrete, sand-lime and clay bricks, mortars and concrete, representing about 95% of the stony building materials used in the construction of Dutch homes. The laboratory analyses were performed according to two well-documented standard procedures, the interlaboratory reproducibility of which is found to be within 5% on average. The highest radionuclide concentrations were found in a porous inner wall brick to which fly ash was added. The second highest were clay bricks with average Ra and Ra levels around 40 Bq kg. Concrete and mortar show the highest exhalation rates with a fairly broad range of 1 to 13 microBq (kg s). Low natural radioactivity levels are associated with either natural gypsum (products) or gypsum from flue gas desulphurization units, and low exhalation rates with clay bricks. To evaluate the radiological impact the radioactivity concentrations in each sample were combined into a so-called dose factor, representing the absorbed dose rate in a room with a floor, walls and ceiling of 20 cm of the material in question. For that purpose, calculations with the computer codes MCNP, Marmer and MicroShield on the specific absorbed dose rates were incorporated in the paper. The results of these codes corresponded within 6% and average values were calculated at 0.90, 1.10, and 0.080 nGy h per Bq kg for the U series, the Th series, and K, respectively. Model calculations on the external dose rate, based on the incidence of the various building materials in 1,336 living rooms, are in accordance with measured data.

PMID: 16891895 [PubMed - indexed for MEDLINE]

Two and three-dimensional computed tomography for the classification and management of distal humeral fractures. Evaluation of reliability and diagnostic accuracy.

Massachusetts General Hospital, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA 02116, U SA.

BACKGROUND: Complex fractures of the distal part of the humerus can be difficult to characterize on plain radiographs and two-dimensional computed tomography scans. We tested the hypothesis that three-dimensional reconstructions of computed tomography scans improve the reliability and accuracy of fracture characterization, classification, and treatment decisions. METHODS: Five independent observers evaluated thirty consecutive intra-articular fractures of the distal part of the humerus for the presence of five fracture characteristics: a fracture line in the coronal plane; articular comminution; metaphyseal comminution; the presence of separate, entirely articular fragments; and impaction of the articular surface. Fractures were also classified according to the AO/ASIF Comprehensive Classification of Fractures and the classification system of Mehne and Matta. Two rounds of evaluation were performed and then compared. Initially, a combination of plain radiographs and two-dimensional computed tomography scans (2D) were evaluated, and then, two weeks later, a combination of radiographs, two-dimensional computed tomography scans, and three-dimensional reconstructions of computed tomography scans (3D) were assessed. RESULTS: Three-dimensional computed tomography improved both the intraobserver and the interobserver reliability of the AO classification system and the Mehne and Matta classification system. Three-dimensional computed tomography reconstructions also improved the intraobserver agreement for all fracture characteristics, from moderate (average kappa [kappa2D] = 0.554) to substantial agreement (kappa3D = 0.793). The addition of three-dimensional images had limited influence on the interobserver reliability and diagnostic characteristics (sensitivity, specificity, and accuracy) for the recognition of specific fracture characteristics. Three-dimensional computed tomography images improved intraobserver agreement (kappa2D = 0.62 compared with kappa3D = 0.75) but not interobserver agreement (kappa2D = 0.24 compared with kappa3D = 0.28) for treatment decisions. CONCLUSIONS: Three-dimensional reconstructions improve the reliability, but not the accuracy, of fracture classification and characterization. The influence of three-dimensional computed tomography was much more notable for intraobserver comparisons than for interobserver comparisons, suggesting that different observers see different things in the scans-most likely a reflection of the training, knowledge, and experience of the observer with regard to these relatively uncommon and complex injuries.

PMID: 16882904 [PubMed - indexed for MEDLINE]

[Resorption of two upper incisors in a 14-year-old boy]

Uit de afdelinng Mondziekten en Kaakchirurgie/Pathologie van het Vrije Universiteit medisch centrum(VUmc)/Academisch Centrum Tandheelkunde Amsterdam (ACTA).

A 14-year-old boy was referred because of a slight swelling of the alveolar mucosa of the right central and lateral maxillary incisor. Radiographically, a well-circumscribed radiolucency was seen between the vital, but partially resorbed roots of the two incisors. Treatment consisted of careful enucleation, including removal of the two teeth. Histopathological examination showed a central giant-cell granuloma. Healing was uneventful. Additional examination for the presence of hyperparathyroidism was negative. During one year follow-up, no signs of recurrence have been noticed.

PMID: 16821471 [PubMed - indexed for MEDLINE]