Fast absolute 3D CGO-based electrical impedance tomography on experimental tank data.

Objective.To present the first 3D CGO-based absolute EIT reconstructions from experimental tank data.Approach.CGO-based methods for absolute EIT imaging are compared to traditional TV regularized non-linear least squares reconstruction methods. Additional robustness testing is performed by considering incorrect modeling of domain shape.Main Results.The CGO-based methods are fast, and show strong robustness to incorrect domain modeling comparable to classic difference EIT imaging and fewer boundary artefacts than the TV regularized non-linear least squares reference reconstructions.Significance.This work is the first to demonstrate fully 3D CGO-based absolute EIT reconstruction on experimental data and also compares to TV-regularized absolute reconstruction. The speed (1-5 s) and quality of the reconstructions is encouraging for future work in absolute EIT.

3D ELECTRICAL IMPEDANCE TOMOGRAPHY RECONSTRUCTIONS FROM SIMULATED ELECTRODE DATA USING DIRECT INVERSION texp AND CALDERÓN METHODS.

The first numerical implementation of a t exp method in 3D using simulated electrode data is presented. Results are compared to Calderón's method as well as more common TV and smoothness regularization-based methods. The t exp method for EIT is based on tailor-made non-linear Fourier transforms involving the measured current and voltage data. Low-pass filtering in the non-linear Fourier domain is used to stabilize the reconstruction process. In 2D, t exp methods have shown great promise for providing robust real-time absolute and time-difference conductivity reconstructions but have yet to be used on practical electrode data in 3D, until now. Results are presented for simulated data for conductivity and permittivity with disjoint non-radially symmetric targets on spherical domains and noisy voltage data. The 3D t exp and Calderón methods are demonstrated to provide comparable quality to their 2D counterparts, and hold promise for real-time reconstructions due to their fast, non-optimized, computational cost.

Spectroscopic properties of nuclear skyrme energy density functionals.

We address the question of how to improve the agreement between theoretical nuclear single-particle energies (SPEs) and observations. Empirically, in doubly magic nuclei, the SPEs can be deduced from spectroscopic properties of odd nuclei that have one more or one less neutron or proton. Theoretically, bare SPEs, before being confronted with observations, must be corrected for the effects of the particle vibration coupling (PVC). In the present work, we determine the PVC corrections in a fully self-consistent way. Then, we adjust the SPEs, with PVC corrections included, to empirical data. In this way, the agreement with observations, on average, improves; nevertheless, large discrepancies still remain. We conclude that the main source of disagreement is still in the underlying mean fields, and not in including or neglecting the PVC corrections.

Late-onset lower motor neuronopathy: a new autosomal dominant disorder.

OBJECTIVE: Characterization of a new type of late-onset autosomal dominant lower motor neuron disease. METHODS: Patients from 2 families underwent detailed neurologic, electrophysiologic, muscle biopsy, and laboratory investigations. MRI of lower limbs was performed in selected patients. DNA samples from leukocytes were used for molecular genetic linkage studies. RESULTS: First symptoms were muscle cramps and fasciculations after age 25-30, followed by a slowly progressive proximal and distal weakness without overt atrophy during the first decades of symptoms. Nerve conduction velocities were within normal range and EMG showed widespread neurogenic alterations. Muscle biopsy revealed characteristic neurogenic findings: fiber type grouping and group atrophy. MRI showed diffuse fatty-degenerative changes, marked in medial gastrocnemius. CONCLUSION: Exactly the same clinical phenotype has not previously been described, and linkage studies showed exclusion of known chromosomal loci for hereditary motor neuropathies, suggesting the disease we report may represent a new disorder.

Functional treatment of closed humeral shaft fractures.

We treated 93 consecutive patients, average age 53 (16-90) years, with closed humeral shaft fractures applying a functional brace immediately after injury. Seventy-two (77%) fractures healed without problems. There were significantly more consolidation problems in fractures in the proximal third (46% consolidated) compared to those at the middle (81% consolidated) and distal third (86% consolidated) of the shaft. Logistic regression analysis revealed the only predictive factor in respect to successful brace treatment was fracture location. No significant difference was found in respect to healing between different AO-type fractures.

Effects of hormone replacement therapy and high-impact physical exercise on skeletal muscle in post-menopausal women: a randomized placebo-controlled study.

An age-related decline in muscle performance is a known risk factor for falling, fracture and disability. In women, a clear deterioration is observed from early menopause. The effect of hormone replacement therapy (HRT) in preserving muscle performance is, however, unclear. This trial examined the effects of a 12-month HRT and high-impact physical exercise regimen on skeletal muscle in women in early menopause. A total of 80 women aged 50-57 years were assigned randomly to one of four groups: exercise (Ex), HRT, exercise+HRT (ExHRT) and control (Co). The exercise groups participated in a high-impact training programme. The administration of HRT (oestradiol/noretisterone acetate) or placebo was carried out double-blind. Knee extension torque and vertical jumping height were evaluated. Lean tissue cross-sectional area (LCSA) and the relative proportion of fat within the muscle compartment were measured for the quadriceps and lower leg muscles. The ExHRT group showed significant increases in knee extension torque (8.3%) and vertical jumping height (17.2%) when compared with the Co group (-7.2%). Vertical jumping height also increased after HRT alone (6.8%). The LCSA of the quadriceps was increased significantly in the HRT (6.3%) and ExHRT (7.1%) groups when compared with the Ex (2.2%) and Co (0.7%) groups. Lower leg LCSA was also increased in the ExHRT group (9.1%) when compared with the Ex (3.0%) and Co (4.1%) groups. In addition, the increase in the relative proportion of fat in the quadriceps in the Co group (16.6%) was significant compared with those in the HRT (4.9%) and ExHRT (-0.6%) groups. Thus, in post-menopausal women, muscle performance, muscle mass and muscle composition are improved by HRT. The beneficial effects of HRT combined with high-impact physical training may exceed those of HRT alone.

Treatment of low-energy tibial shaft fractures: plaster cast compared with intramedullary nailing.

We analyzed data from 87 patients who had displaced closed or open grade I simple or spiral wedge tibial shaft fractures caused by low-energy impact. Fifty-four patients were treated with plaster cast and 33 with intramedullary locking nail (IMLN). Delayed union only occurred in 8 patients after plaster cast treatment. Forty-two patients in the IMLN group and one in the plaster cast group suffered from anterior knee pain. Final treatment outcome, healing time, hospitalization time and duration of sick leave were assessed on the basis of 25 matched pairs of patients. Mean healing time, hospitalization time and sick leave in the plaster cast and IMLN groups were 19 (SD 6.7) and 12 (SD 4.4) weeks (P<0.001); 8 (SD 4.8) and 7 (SD 2.7) days (P=0.686); and 195 (SD 81) and 106 (SD 31) days (P=0.001), respectively. No difference was found between plaster cast and IMLN groups when the outcome was evaluated using the criteria of Johner and Wruhs.

Comparison of erythritol and xylitol saliva stimulants in the control of dental plaque and mutans streptococci.

The effect of 2-month usage of saliva-stimulating pastils containing either erythritol or xylitol was studied in a cohort of 30 subjects assigned to the respective polyol groups (n = 15). The daily consumption level of both polyols was 5.2 g, used in 5 daily chewing episodes. The mean weight of total plaque mass (collectable during a standard period of 3 min from all available tooth surfaces) was reduced significantly in the xylitol-group, while no such effect was observed in the erythritol-group. This reduction in plaque mass was accompanied by a significant reduction in the turbidity readings (A(660)) of aqueous plaque suspensions; no such effect was observed in the erythritol-group. However, plaque protein levels did not differ between baseline and endpoint in either polyol group. The plaque and salivary levels of Streptococcus mutans and plaque levels of total streptococci were reduced significantly in the xylitol-group, while no such effect was detected in the erythritol-group. However, either polyol regimen had no effect on plaque levels of S. sobrinus. The results suggest that systematic use of xylitol-containing saliva stimulants may be more effective in controlling some oral-hygiene-related and caries-associated parameters than similar use of erythritol-containing products. The results also speak for a special relationship between xylitol and S. mutans. However, owing to the great potential of erythritol as a caries-reducing agent -- based on the tetritol nature of erythritol -- the present laboratory results should be considered preliminary and subject to verifying clinical studies.

Which displaced spiral tibial shaft fractures can be managed conservatively?

The aim of the present study was to establish a threshold for the initial displacement of a spiral tibial shaft fracture beyond which its retention in an acceptable position cannot be guaranteed by plaster immobilization. We reviewed the records and radiographs of 131 plaster cast-treated patients with spiral tibial shaft fracture, initially displaced 50% or less, for patients whose fracture had either lost its acceptable retention or consolidated in an unacceptable position. The fractures were classified, according to the true initial displacement as measured on the first radiographs, into four pairs of categories using cut-off points of 10, 20, 30 and 40% of the diameter of the tibial diaphysis. Comparison was then made of the proportions of failed treatments between each of these pairs. Plaster cast treatments failed in 28% when the true initial displacement was 30% or less, and in 46% when the true initial displacement was more than 30%. The risk of failed plaster cast treatment increased when true initial displacement exceeded 30%. In all patients whose plaster cast treatment was interrupted the true initial displacement was more than 30%. We therefore conclude that diaphyseal fractures of the tibia for which the initial displacement exceeds 30% are not suitable for plaster cast treatment.

Cast treatment and intramedullary locking nailing for simple and spiral wedge tibial shaft fractures--a cost benefit analysis.

BACKGROUND AND AIMS: The aim of this retrospective study was to compare the relative costs of treating simple and spiral wedge (requiring closed reduction under anaesthesia) tibial shaft fractures in a plaster cast or with intramedullary locking nail. MATERIAL AND METHODS: The material consisted of 26 fractures treated in a plaster cast and 51 fractures treated with an intramedullary locking nail. The costs caused by the direct costs (treatment, hospitalisation, and outpatient appointments) as well as indirect costs (lost productivity) were taken into account. Costs caused by complications were also included in the analysis. RESULTS: Mean direct costs per patient were FIM 22920 and FIM 26952 and mean overall costs per patient were FIM 120486 and FIM 82224 in plaster cast and intramedullary locking nailing groups, respectively (FIM 1 = USD 0.19). The higher mean overall costs of the plaster cast group were attributable to the longer sick leave periods in this group (218 days in plaster cast group and 124 in intramedullary nailing group). CONCLUSION: Plaster cast treatment of simple and spiral wedge tibial shaft fractures requiring closed reduction under anaesthesia is more expensive to society than operative treatment with intramedullary locking nail.

Lymph flow dynamics in exercising human skeletal muscle as detected by scintography.

1. The effects of dynamic and isometric muscle contractions on the lymph flow dynamics in human skeletal muscle were studied with a scintographic method. 2. Radioactively labelled human serum albumin (99mTc-HSA) was injected bilaterally into the vastus lateralis muscles of eight men (n = 16), four of whom had had an endurance training background. The subjects performed 100 submaximal contractions in 10 min as (i) dynamic knee extensions (CONS), (ii) isometric contractions with the knees at full extension (IMExt), or (iii) isometric contractions with knees fixed at 90 deg angle flexion (IMFlex). The exercises were separated by 65 min periods in supine rest. The level of radioactivity at the injection site was monitored by a gamma-camera, and the clearance rate of radioactivity (CR) was calculated as the fractional decrease during the periods of interest (CR unit = % min-1). 3. The clearance rate was low during the rest periods (0.04 +/- 0.05% min-1), though higher in the trained than in the sedentary subjects (0.06 +/- 0.05 vs. 0.03 +/- 0.03% min-1; P = 0.008). Exercise increased the clearance rate three- to sixfold, to 0.16 +/- 0.16% min-1 during CONS, 0.20 +/- 0.15% min-1 during IMExt and 0.09 +/- 0.11% min-1 during IMFlex. There were no differences between the subject subgroups. 4. The higher clearance rate during IMExt than during IMFlex (P = 0.02) demonstrates the importance of muscle deformations on lymph propulsion and experimentally confirms the current concepts of lymph formation and propulsion in voluntarily active skeletal muscle. It is suggested that lymph propulsion by working muscle is most efficient when the muscle is able to shorten close to its minimum length.

Estimation of structural and geometrical properties of cortical bone by computerized tomography in 78-year-old women.

The structural and geometrical properties of the tibia shaft were investigated at two sections by means of computerized tomography (CT) in 78-year-old women with high (n = 19) and low (n = 17) calcaneal bone mineral density (BMD, g/cm3) previously measured by 125I-photon absorption. The high BMD group had a 20-21% higher tibial BMD and 9-12% higher bone cross-sectional area than was observed in the low BMD group. The distribution of bone mass indicated that the low BMD group had lost bone mainly from the endosteal surface, especially in the anterior part of the tibia. However, both groups had a similar basic pattern of mass distribution at the measured sections. The high BMD group had higher moments of inertia at the upper section than the low BMD group. The differences between the groups were more pronounced when only the high density areas were included. At the lower section, the differences between the groups also appeared significant at the high density levels. There were no group differences in the area moments of inertia. The results suggest that the true distribution of bone mass should be taken into account in determining the moments of inertia. In the tibia, determination of the cross-sectional mass distribution of bone combined with BMD should have a better discriminatory capability than BMD only in studying bone strength and fracture risk.

Value of joint scintigraphy in the prediction of erosiveness in early rheumatoid arthritis.

The value of scintigraphy in predicting development of new erosions in small peripheral joints was studied by visual evaluation of scintigrams and by three computerised methods. In 13 patients with newly diagnosed rheumatoid arthritis a total of 387 joints were examined clinically, scintigraphically, and radiographically. The follow up period was 24 months. Four eroded joints in three patients were found at the onset. Of the joints which were to become eroded, 46/47 were scintigraphically active at all the check ups. Erosions were detected earlier in foot joints than in finger joints. New erosions were especially prone to appear in joints with persisting and high scintigraphic activity. On the contrary, inactive joints by repeated scanning never eroded. Scintigraphic and clinical activity and radiographic erosiveness correlated significantly with each other. The sensitivity and specificity of visual scintigraphic assessment and the relative pixel activity method proved to be superior to the region of interest methods and clinical evaluation for prediction of erosiveness.

Effects of selenium, vitamin E and vitamin C on human prostacyclin and thromboxane synthesis in vitro.

The effects of three antioxidants, selenium, vitamin E and vitamin C, on the production of anti-aggregatory prostacyclin (PGI2) by human endothelial cells and lung tissue as well as on the production of pro-aggregatory thromboxane A2 (TxA2) by human platelets and lung tissue in vitro were studied. Selenium had no effect on endothelial PGI2 synthesis but it dose-dependently inhibited the platelet production of TxA2 (84% at 10(-3) mol/l) and productions of PGI2 (64%) and TxA2 (72%) by human lung. Selenium inhibited platelet TxA2 synthesis much less in the presence of exogenous arachidonic acid (AA) (14% instead of 84%), suggesting that selenium exerts its effect predominantly on phospholipase A2. Vitamin E had no effect on endothelial PGI2, pulmonary PGI2 or TxA2 syntheses but it strongly inhibited platelet TxA2 production (50% at 10(-3) mol/l). This inhibition was only partly (from 50% to 30%) counteracted by exogenous AA suggesting that vitamin E affects both phospholipase A2 and a further step(s) in the TxA2 synthetizing cascade. Vitamin C stimulated endothelial cell PGI2 production (80% at 10(-2) mol/l) but it could not counteract the inhibition of PGI2 production (83%) exerted by 10(-2) mol/l tert-butyl hydroperoxide (TBHP), a promoter of lipid peroxidation. Vitamin C had no effect on pulmonary PGI2 production but it inhibited pulmonary TxA2 formation (38% at 10(-3) mol/l). Slight inhibition of platelet TxA2 production from endogenous AA (6%) turned to slight stimulation (8%) with exogenous AA. The in vivo significance of these results is not yet known.

Scintigraphy of rheumatoid peripheral joints. Reliability of visual assessment vs. computerized methods.

99mTc-methylene diphosphonate (99mTc-MDP) scintigraphy of peripheral joints was studied by visual evaluation (Visual Assessment) of the scintigrams and by a computerized region-of-interest (ROI) method without, or with a reference region (ROI method or Corrected ROI method). Sixteen rheumatoid patients and a total of 477 peripheral joints were studied and the results compared with clinical joint activity evaluated by joint palpation. The ROI method without a reference proved to be insensitive and hence unsuitable for clinical use. The results of Visual Assessment and the Corrected ROI method correlated well with each other and with clinical joint activity. The sensitivity of the methods in detecting a clinically inflamed finger joint was: ROI 6%, Corrected ROI 71% and Visual Assessment 75%. The corresponding figures for peripheral joints of the feet were as follows: 28%, 41% and 58%. We conclude that, for clinical use, Visual Assessment of the scintigram is adequate and the method of choice.

Effects of smoking and nicotine on human prostacyclin and thromboxane production in vivo and in vitro.

We studied the effects of smoking and nicotine on the production of proaggregatory thromboxane A2 (TxA2), antiaggregatory prostacyclin (epoprostenol, PGI2), and on lipid peroxidation in vivo and in vitro. In the in vivo study, serum concentrations of thromboxane B2 (TxB2), a stable metabolite of TxA2, increased immediately after smoking three cigarettes but not after smoking the equivalent amount of tobacco in a pipe, whereas serum lipid peroxide values did not change in either group. In vitro, nicotine (2 X 10(-3) mol/liter) inhibited pulmonary TxB2 production by 70% and simultaneously stimulated the production of 6-keto-prostaglandin F1 alpha, a stable metabolite of PGI2, by 40%, which suggest that nicotine does not exert its effect at the cyclooxygenase level. During aggregation in platelet-rich plasma, TxB2 production was inhibited by 53% with 2 X 10(-3) mol/liter of nicotine, and during whole blood clotting the inhibition was 34% with 2 X 10(-4) mol/liter of nicotine. Thus the rise in cigarette smokers' serum TxB2 was probably caused by some constituent of cigarette smoke other than nicotine. The increased production of TxA2 following cigarette smoking may provide one explanation for the increased incidence of atherosclerosis and its complications in cigarette smokers.

Differential inhibition of platelet thromboxane and lung prostacyclin production by sulphinpyrazone, acetylsalicylic acid and indomethacin by human tissues in vitro.

To compare the inhibition of human platelet and lung cyclo-oxygenases by sulphinpyrazone (SP), acetylsalicylic acid (ASA) and indomethacin, we investigated their effects on platelet thromboxane A2 (TxA2) production during spontaneous clotting and on prostacyclin (PGI2) and TxA2 productions of superfused minced human lung. The synthesis of proaggregatory, vasoconstricting TxA2 and antiaggregatory, vasodilating PGI2 were evaluated by measuring the concentration of their stable metabolites thromboxane B2 (TxB2) and 6-keto-prostaglandin F1 alpha respectively, by radioimmunoassays. The basal platelet TxB2 production was 241.0 +/- 56.3 ng/ml (mean +/- SEM, n = 12). The concentrations needed for 50% inhibition of this production (IC50) were 41.3 mumol/l for sulphinpyrazone, 6.3 mumol/1 for ASA and 0.094 mumol/l for indomethacin. The lung generated 23.8 +/- 5.5 ng/g/min (mean +/- SEM, n = 6) of 6-keto-PGF1 alpha and 8.5 +/- 1.8 ng/g/min of TxB2. The IC50 values for pulmonary 6-keto-PGF1 alpha and TxB2 productions were 530.0 mumol/l for SP, 370.0 mumol/l for ASA and 50.0 mumol/l for indomethacin. Thus pulmonary cyclo-oxygenase, presumably originating from endothelial cells, was 13, 59, and 532 times more resistant to these prostaglandin synthesis inhibitors (PGI's) than platelet cyclo-oxygenase. These data suggest that there are considerable differences in the concentration ranges of various PGI's by which the PGI2/TxA2 balance can be shifted to a dominance of PGI2.