Geometric morphometrics reveals restrictions on the shape of the female os coxae.

The methodology for sex determination in human skeletal remains depends on the different bone morphologies presented by men and women. Due to their direct implications in reproduction, the whole pelvis, particularly the os coxae, shows different characteristics in either sex. The sacrum and the os coxae constitute the birth canal. In this research study, the os coxae shape is analyzed using geometric morphometrics, providing information on morphology, regardless of size or any other factor beyond the geometry itself. A total of 46 adult ossa coxae from a Spanish archaeological collection were studied using geometric morphometrics. The results show that there is a restriction on the shape of female os coxae. In contrast, male os coxae presents a greater range of variation. The biological reason for this difference is the obstetrical dilemma; a concept defined as the anatomical conflict between bipedalism and the full-term birth of a neonate whose large head requires greater dimensions in the pelvic cavity. Our experimental data reinforce the validity of the obstetrical dilemma as source of the restriction on the shape of female ossa coxae. Additionally, according to the results obtained, size itself does not represent a condition for belonging to one sex or another.

An approach to the histomorphological and histochemical variations of the humerus cortical bone through human ontogeny.

For many years, clinical and non-clinical investigations have investigated cortical bone structure in an attempt to address questions related to normal bone development, mineralisation, pathologies and even evolutionary trends in our lineage (adaptations). Research in the fields of medicine, materials science, physical anthropology, palaeontology, and even archaeobiology has contributed interesting data. However, many questions remain regarding the histomorphological and histochemical variations in human cortical bone during different stages of life. In the present work, we describe a study of long bone cortex transformations during ontogeny. We analysed cross-sections of 15 human humeri histomorphologically and histochemically from perinatal to adult age, marking and quantifying the spatial distribution of bone tissue types using GIS software and analysing the mineral composition and crystallinity of the mineralised cortex using Raman spectroscopy and X-ray diffraction. Our results allowed us to propose that human cortical bone undergoes three main 'events' through ontogeny that critically change the proportions and structure of the cortex. In early development, bone is not well mineralised and proportionally presents a wide cortex that narrows through the end of childhood. Before reaching complete maturity, the bone mineral area increases, allowing the bone to nearly reach the adult size. The medullary cavity is reduced, and the mineral areas have a highly ordered crystalline structure. The last event occurs in adulthood, when the 'oldest' individuals present a reduced mineralised area, with increasing non-mineralised cavities (including the medullary cavity) and reduced crystalline organisation.

Understanding bipolar disorder in late life: clinical and treatment correlates of a sample of elderly outpatients.

The aim of this study was to examine the demographic, clinical, and treatment correlates of bipolar disorder (BD) in outpatients 65 years or older and to compare patients with BD subtype I (BD-I) versus BD subtype II (BD-II) and patients with early onset (EO; <=50 years old) versus late onset (LO; >50 years old) of the illness. Sixty-nine consecutive outpatients with BD were included. Diagnosis was delayed for a mean of 14.1 years, significantly longer in patients with EO (18.6 years) than with LO (3.3 years). Mild to moderate depressive symptoms were detected in 29% of the patients. The patients were receiving a mean of 3 different psychotropic medications. Antidepressantswere more frequently prescribed to patients with BD-II than to patients with BD-I (75.80% vs. 48.60%) and to patients with EO (71.7%) than to LO (35.3%). Geriatric BD has similar clinical characteristics with those of younger ages, and these do not seem to greatly differ with subtype or age of onset.

Mapping human long bone compartmentalisation during ontogeny: a new methodological approach.

Throughout ontogeny, human bones undergo differentiation in terms of shape, size and tissue type; this is a complex scenario in which the variations in the tissue compartmentalisation of the cortical bone are still poorly understood. Currently, compartmentalisation is studied using methodologies that oversimplify the bone tissue complexity. Here, we present a new methodological approach that integrates a histological description and a mineral content analysis to study the compartmentalisation of the whole mineralised and non-mineralised tissues (i.e., spatial distribution in long bone sections). This new methodology, based on Geographical Information System (GIS) software, allows us to draw areas of interest (i.e., tracing vectorial shapes which are quantifiable) in raw images that are extracted from microscope and compared them spatially in a semi-automatic and quantitative fashion. As an example of our methodology, we have studied the tibiae from individuals with different age at death (infant, juvenile and adult). The tibia's cortical bone presents a well-formed fibrolamellar bone, in which remodelling is clearly evidenced from early ontogeny, and we discuss the existence of "lines of arrested growth". Concurrent with the histological variation, Raman and FT-IR spectroscopy analyses corroborate that the mineral content in the cortical bone changes differentially. The anterior portion of the tibia remains highly pierced and is less crystalline than the rest of the cortex during growth, which is evidence of more active and continuous remodelling. Finally, while porosity and other "non-mineralised cavities" are largely modified, the mineralised portion and the marrow cavity size persist proportionally during ontogeny.

Posttraumatic stress disorder following accidental injury: rule or exception in Switzerland?

BACKGROUND: There is still marked variability in the findings concerning psychiatric disorders associated with traumatic injury. The aim of this study was to determine the incidence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) following accidental injuries, and to predict the PTSD symptom level at 6 months, taking into particular consideration the role of pre-existing psychiatric morbidity and insufficient command of the local language. METHOD: A total of 255 accident survivors who were hospitalized for at least 2 consecutive nights at a Swiss university hospital for treatment of recently acquired physical injuries were interviewed within 2 weeks of the trauma and 6 months after the accident. Patients who did not have a good command of German but were fluent in Italian, Spanish, Portuguese, Serbo-Croatian or Albanian were assessed using interpreters. The main outcome measure was the Clinician-Administered PTSD Scale. RESULTS: Ten patients (3.9%) were diagnosed as having ASD. At 6 months, 8 patients (3.1%) had PTSD. A regression model using 12 potential predictor variables explained 40% of the variance of PTSD symptoms; mild traumatic brain injury (p < 0.001), pain (p < 0.05), ASD symptom level (p < 0.001) and emotional coping (p = 0.001) predicted higher PTSD symptom levels, while high Sense of Coherence (p < 0.05) and perceived responsibility for the accident (p < 0.01) were associated with lower PTSD symptom levels at follow-up. CONCLUSIONS: ASD and PTSD seem to occur less frequently following accidental injuries than previously reported in the literature. Pre-existing psychiatric morbidity and lack of proficiency in the locally spoken language do not appear to play an important role in the development of PTSD.

The prevalence of metabolic syndrome in patients with bipolar disorder.

BACKGROUND: Previous studies on the prevalence of metabolic syndrome (MetS) in patients with bipolar disorder have reported rates 11% and 79% higher than in their respective general populations. This study evaluates the prevalence of MetS in a group of 194 Spanish patients with bipolar disorder. METHODS: Naturalistic, multicentre, cross-sectional study. Patients were evaluated for presence of MetS according to modified NCEP ATP III criteria. RESULTS: Mean age was 46.6 (SD 13.9); 49.2% were male. Forty-six percent were in remission. Patients were receiving 2.9 (SD 1.3) drugs. Overall prevalence of MetS was 22.4%. Fifty-four percent met the criterion for abdominal obesity, 36.1% for hypertriglyceridemia, 38.2% for low HDL cholesterol, 20.9% for hypertension, and 12.2% for high fasting glucose. The multivariate analysis for MetS retained only the BMI variable in the model. LIMITATIONS: Cross-sectional study design. CONCLUSIONS: The prevalence of MetS in patients with bipolar disorder is 58% higher than that reported for the general Spanish population. MetS is associated with BMI. Clinicians should be aware of this issue and appropriately monitor patients with bipolar disorder for MetS as part of the standard of care for these patients.

Serotonin transporter linked promoter (polymorphism) in the serotonin transporter gene may be associated with antidepressant-induced mania in bipolar disorder.

OBJECTIVE: Several pharmacogenetic studies suggest that response to pharmacotherapy in bipolar disorder may be mediated by genetic factors. The aim of this study was to investigate further the association of the genetic variations of the serotonin transporter (5-HTT) gene with antidepressant-induced mania, already reported in recent studies. We also studied the possible association of these genetic variants with diagnosis expression and treatment response to lithium therapy. METHODS: The sample consisted of 103 and 85 outpatients with diagnosis of bipolar and unipolar disorder, respectively, and 101 controls. Two described polymorphisms of the 5-HTT, the variable number of tandem repeat (VNTR) and serotonin transporter linked promoter (5-HTTLPR) polymorphisms, were genotyped using standard procedures. RESULTS: The association analysis performed showed a significantly higher rate of homozygous s/s genotype for 5-HTTLPR among patients with a history of antidepressant-induced mania (60% patients s/s versus 40% l/l, chi, P=0.04). No significant difference in the distribution of genotypes of the two polymorphisms was observed between the three groups. We found no significant association between these polymorphisms and lithium response. CONCLUSIONS: The 5-HTTLPR polymorphism could be a useful contributor, among other clinical variables, to predict the risk for manic switches when a patient with bipolar disorder is treated with antidepressant drugs. The contribution of these genetic markers in diagnosis expression and treatment response to lithium is likely to be minor.

[Relationship between C-reactive protein level and early recurrence of atrial fibrillation after electrical cardioversion]. / Relación entre concentraciones de proteína C reactiva y recurrencia precoz de la fibrilación auricular tras cardioversión eléctrica.

INTRODUCTION AND OBJECTIVES: Atrial remodeling is responsible for the early recurrence of atrial fibrillation (AF) after cardioversion. Recently, it has been shown that the C-reactive protein (CRP) level is elevated in patients with AF, indicating that inflammation may play a role in the pathogenesis of this arrhythmia. We postulated that a high CRP level would predict early recurrence of AF after electrical cardioversion. PATIENTS AND METHOD: Forty-two patients with persistent AF, but without known heart disease, who underwent elective electrical cardioversion were investigated. The CRP level was measured immediately before cardioversion. The study population comprised the 37 patients in whom sinus rhythm was restored. RESULTS: After a follow-up period of 30 days, 16 patients (43%) had recurrence of AF; the other 21 (57%) remained in sinus rhythm. The mean CRP level was significantly higher in patients with AF recurrence (6.3 [3.3] mg/L vs 2.4 [2.1] mg/L, P=.0001). On dividing patients according to whether their CRP level was < or =3 mg/L or >3 mg/L, it was observed that only 33% of those in sinus rhythm had a level >3 mg/L compared with 81% of those with AF recurrence (P=.004). Patients with a CRP level >3 mg/L had a significant increase in the 1-month risk of AF recurrence (RR=3.7; 95% CI, 1.3-10.8). There was no association between CRP level and left atrial diameter (P =.50) or AF duration (P=.458). CONCLUSIONS: A high CRP level is associated with early recurrence of AF after electrical cardioversion, suggesting that inflammation could play a role in atrial remodeling.

Tolerance and Safety of 5 Models of Sedation During Endobronchial Ultrasound.

INTRODUCTION: Sedation during endobronchial ultrasound (EBUS) is essential due to the long duration of this procedure. We evaluated different models of sedation and their complications. METHOD: A multicenter, prospective, observational study of 307 patients undergoing EBUS was conducted. Patients were sedated with: a) midazolam bolus; b) propofol infusion; c) midazolam bolus and propofol infusion; d) propofol infusion and remifentanil infusión, or e) midazolam bolus and fentanyl bolus, and clinical variables were collected. Patients were asked to complete a satisfaction survey following the test. RESULTS: Patients per sedation model were: A 24, B 37, C 107, D 62 and E 77. Scores for perceived sensations of recall, pain, cough, dyspnea and prolonged examination (0.65±1.11; 0 3±0.73, 0.46±0.9, 0.29±0.73, and 0.59±0.96, respectively) were lower compared to fear and nervousness before the examination (1.26±1.37 and 1.5±1.41, respectively). High levels of indifference to repeating the procedure (1.49±1.3) and a reported pleasant feeling during the test (1.23±1.17), with low levels of anxiety (0.49±0.85) and discomfort (0.62±1.1), show that different models of sedation were well tolerated. Almost half the patients (46.6%) did not report any "worst moment" during the procedure, and 89.6% were willing to undergo a repeat test. The E and C models presented fewest complications (12.9 and 31.7%, respectively), and all were resolved with simple therapeutic measures. CONCLUSIONS: The models of sedation evaluated were well tolerated and most patients were willing to undergo repeat EBUS. Complications were few and easily resolved.

[Follow-up findings one year after discharge from a chest pain unit]. / Seguimineto a un año de los pacientes dados de alta de una unidad de dolor torácico.

One hundred and twenty five consecutive patients discharged from a chest pain unit (group I, 32 with the diagnosis of probable ischemic heart disease and group II, 93 with the diagnosis of non-vascular pain) were prospectively followed up for one year. In group I (treadmill exercise testing were positive at a high workload in 15, negative in 9 and inconclusive in 4), one patient had non-ST elevation acute coronary event 15 days after discharge and two patients had unstable angina at 3 and 5 months. There were no events among the patients who had positive or inconclusive exercise testing. In group II (treadmill exercise testing were negative in 85 and inconclusive in 5) one patient had non-ST elevation acute coronary event at 7 months and one had unstable angina at 11 months. In conclusion, patients discharged from a chest pain unit, including those patients with positive treadmill exercise at a high workload, have a favorable mid-term outcome.

Return to work following unintentional injury: a prospective follow-up study.

OBJECTIVE: The aim of this study was to predict time off work following unintentional injuries due to accidents leading to hospital admission. DESIGN: Prospective 6-month follow-up study. SETTING: Department of Trauma Surgery of a University Hospital. PARTICIPANTS: Consecutively recruited victims of unintentional injuries (n=221) hospitalised for a minimum of 32 h including two consecutive nights. All the participants were aged 18-65 years and were able to participate in an assessment within 30 days of the accident. MAIN OUTCOME MEASURES: Interview-assessed number of days off work during the 6 months immediately following the accident. RESULTS: The patients' subjective appraisals of (1) accident severity and (2) their ability to cope with the resulting injury and its job-related consequences predicted time off work following the accident beyond the impact of the objective severity of their injury and the type of accident involved. CONCLUSIONS: The patients' subjective appraisals of the accident severity and of their ability to cope with its consequences are highly relevant for return to work after accidents. Extending the findings from previous studies on severely injured and otherwise preselected accident victims, this seems to apply to the whole spectrum of patients hospitalised with unintentional injuries.

Differences in attention and impulsivity between borderline personality disorder and bipolar disorder.

This study aims at investigating attention and impulsivity differences between borderline personality disorder and bipolar disorder, as both diseases may share neuropsychological deficits. Differential cognitive outcomes on the Continuous Performance Test-II were observed between disorders, and also when compared to healthy controls.

[Variables associated with disability in elderly bipolar patients on ambulatory treatment]. / Discapacidad en pacientes bipolares ancianos en tratamiento ambulatorio. Variables asociadas.

INTRODUCTION: Studies on adult bipolar patients have demonstrated a disability associated with the bipolar disorder, even in euthymic patients, but there is a lack of data in the elderly population. MATERIAL AND METHOD: A cross-sectional, multicentre study on a consecutive sample of ambulatory bipolar patients (DSM-IV-TR criteria), aged 65 years or over. Retrospective and cross-sectional sociodemographic and clinical data were collected, as well as the Clinical Global Impression for Bipolar Modified scale (CGI-BP-M) and the level of disability using the World Health Organisation Disability Assessment Schedule (WHO/DAS). The disability was assessed globally and by areas. The presence of a moderate to maximum disability compared to a mild to no disability was considered a dependent variable. RESULTS: A moderate to maximum global disability was present in 43.6% of the sample. By areas, occupational functioning was the area most frequently affected, and personal care the least affected. The only variables which were associated with disability were the presence of medical comorbidity (P = .01), increased age (P = .005) global clinical severity (P = .0001) and in the depressive pole (P = .03). There was no relationship between clinical subtype, duration of the disease, number of previous episodes, number of hospitalisations, or other clinical variables and the degree of disability. CONCLUSIONS: These data underline the need to establish specific therapeutic strategies in the approach to depressive symptoms and medical comorbidity, with the aim of minimising the disability in elderly bipolar patients. Given the lack of current data, new studies are needed with larger samples and control groups.

No-scalpel vasectomy: review of the first 1,000 cases in a family medicine unit

In Mexico, the Mexican Institute of Social Security (IMSS) had adopted the no-scalpel vasectomy technique by the end of 1989. The technique was described by dr. Li Shunquiang in 1974, and more than 60 million no-scalpel vasectomies have been performed in 26 countries. Among the advantages with no-scalpel vasectomy is that it has fewer complications (0.4 percent) compared to the traditional technique (3.1 percent). We studied 1,00o clinical chart of the subjects operated on between January, 1990 and January, 1993, with the objective of reporting our experiences as well as analyzing whether there existed a correlation between the subject's social and demographic characteristics and the number of control spermatic counts he attended postoperatively. In 97.9 percent of the cases, subjects has no postoperative hemorrhage or hematoma. None of the subjects had a surgical woun infection. In addition, 54.4 percent of the subjects came to the first control spermatic count, 39.7 percent came to the second, and only 18.4 percent came to all three controls. In an attempt to find a characteristic which defined the subject who attends his postoperative control spermatic count, we found an association using X² between the attendance at two controls with the subjects who had been married from 6 - 10 years (p=0.059), and with the subjects who had an income of three minimun wages. Regarding the attendance at all three controls, we found an association with subjects who had an income of two minimun wages (p=0.037). We also found a weak correlation between the attendance at all three controls and the reason reported for not having more children (the couple did not want more children) (r=0.07; p=0.025) and with the manner in which the subjects were referred to the clinic (came on their own initiative) (r=0.09; p=0.006). Finally, we consider that no-scalpel vasectomy can be implemented as an adequate family planning mehtod in Mexico's primary care centers. The lack of adequate attendance at postoperative control spermatic counts does not seem to have an important association with the subjects demographic characteristics, so it appears warranted that this issue be studied from a psychological point of view