Women's and healthcare providers' perceptions of long-term complications associated with hypertension and diabetes in pregnancy: a qualitative study.

OBJECTIVES: A diagnosis of hypertensive disorders during pregnancy (HDPs) or gestational diabetes mellitus (GDM) is highly predictive of women at increased risk of developing chronic hypertension, Type 2 diabetes, and cardiovascular disease. This study investigates perceptions of women and healthcare providers in rural India regarding these long-term risks. DESIGN: Qualitative study using modified grounded theory. SETTING: Two states in rural India: Haryana and Andhra Pradesh. POPULATION: Pregnant and postpartum women, community health workers (CHWs), primary care physicians, obstetricians, laboratory technicians, and healthcare officials. METHODS: In-depth interviews and focus group discussions explored: (1) priorities for high-risk pregnant women; (2) detection and management of HDPs and GDM; (3) postpartum management, and (4) knowledge of long-term sequelae of high-risk conditions. A thematic analysis was undertaken. RESULTS: Seven focus group discussions and 11 in-depth interviews (n = 71 participants) were performed. The key priority area for high-risk pregnant women was anaemia. Blood pressure measurement was routinely embedded in antenatal care; however, postpartum follow up and knowledge of the long-term complications were limited. GDM was not considered a common problem, although significant variations and challenges to GDM screening were identified. Knowledge of the long-term sequelae of GDM with regard to an increased risk of Type 2 diabetes and cardiovascular disease among doctors was minimal. CONCLUSIONS: There is a need for improved education, standardisation of testing and postpartum follow up of HDPs and GDM in rural Indian settings. FUNDING: SN is supported by an MRC Clinical Research Training Fellowship (MR/R017182/1). The George Institute for Global Health Global Women's Health programme provided financial support for the research assistant and fieldwork costs in India. TWEETABLE ABSTRACT: Improved education and postpartum care of women with hypertension and diabetes in pregnancy in rural India are needed to prevent long-term risks.

Tension changes within the bundles of anatomic double-bundle anterior cruciate ligament reconstruction at different knee flexion angles: a study using a 3-dimensional finite element model.

PURPOSE: The aim of this study was to determine the change in length and tension of the reconstructed anterior cruciate ligament (ACL) double bundles at different knee flexion angles by use of a 3-dimensional finite element model. METHODS: The right knees of 12 living subjects were scanned with a high-resolution computed tomography scanner at 0°, 45°, 90°, and 135° of knee flexion. Several modeling programs were used to simulate double-bundle ACL reconstruction. A finite element model of each bundle with a tension of 20 N was put into each tunnel followed by fixation of the bundles. The tension and length changes of each bundle at different knee flexion angles were assessed. RESULTS: For the anteromedial bundle, the length decreased gradually between 45° and 90° of knee flexion and then reached a plateau, whereas the length of the posterolateral bundle significantly decreased at 45° and 90° of flexion but then increased at full flexion. The reaction force of the anteromedial graft slightly decreased at 45° and then remained constant between 90° and 135° of knee flexion. The reaction force of the posterolateral bundle at full extension slightly decreased at 45° and 90° of flexion, followed by a rebound increase at 135°. CONCLUSIONS: We found that both bundles functioned throughout the arc of flexion with consistency in tension, although their lengths decreased. The 2 ACL grafts did not function in a reciprocal manner, unlike previous descriptions. CLINICAL RELEVANCE: The data obtained for length and tension versus flexion angle have the potential to suggest the appropriate knee position for graft fixation and tensioning to be near extension in clinical situations.

Trans-tendon arthroscopic repair for partial-thickness articular side tears of the rotator cuff.

PURPOSE: The purpose of this study was to describe a modified trans-tendon method of repairing partial articular surface lesions, which restored the footprint of the rotator cuff anatomically. METHODS: The 24 consecutive patients with modified trans-tendon method which allowed a wider pressurized contact area by use of additional knotless anchor were included in this study. All patients were evaluated with ASES score and visual analog scale (VAS) preoperatively, postoperative 3 and 12 months. The strength was measured using Isobex digital strength analyzer preoperatively and postoperative 12 months. RESULTS: The ASES scores significantly improved from preoperative 38 ± 13 to 63 ± 5 at 3 months, and 89 ± 5 at 12 months postoperatively. The VAS scores also significantly improved from preoperative 6.6 ± 1.1 to 2 ± 0.7 at 3 months, 0.6 ± 0.7 at 12 months. The strengths significantly increased postoperatively, and there were no significant differences between affected and unaffected shoulders at 12 months postoperatively (P > 0.05). The 22 of 24 patients were either satisfied or very satisfied with postoperative result at 12 months postoperatively. CONCLUSION: This arthroscopic-modified trans-tendon suture bridge technique for partial-thickness articular side tears of the rotator cuff has shown excellent functional results and very high satisfaction rate of patient during the 12-month follow-up period. LEVEL OF EVIDENCE: Evidence therapeutic study, Level IV.

Large discrete resistance jump at grain boundary in copper nanowire.

Copper is the current interconnect metal of choice in integrated circuits. As interconnect dimensions decrease, the resistivity of copper increases dramatically because of electron scattering from surfaces, impurities, and grain boundaries (GBs) and threatens to stymie continued device scaling. Lacking direct measurements of individual scattering sources, understanding of the relative importance of these scattering mechanisms has largely relied on semiempirical modeling. Here we present the first ever attempt to measure and calculate individual GB resistances in copper nanowires with a one-to-one correspondence to the GB structure. Large resistance jumps are directly measured at the random GBs with a value far greater than at coincidence GBs and first-principles calculations. The high resistivity of the random GB appears to be intrinsic, arising from the scaling of electron mean free path with the size of the lattice relaxation region. The striking impact of random GB scattering adds vital information for understanding nanoscale conductors.

An analysis of the posterior cruciate ligament isometric position using an in vivo 3-dimensional computed tomography-based knee joint model.

PURPOSE: This study aimed to review the isometric point of the posterior cruciate ligament (PCL) based on insertional locations identified in recent anatomic studies by use of a 3-dimensional knee model. METHODS: Ten living subjects with healthy knees were evaluated. High-resolution computed tomography scans were performed at 3 positions of 0°, 90°, and 135°, and 3-dimensional knee images were constructed. Customized software was used to define tibial and femoral insertion points of the PCL, based on recently described anatomy. The femoral attachment site of the PCL was divided into 4 sectors (labeled A through D), and the tibial attachment site was divided into 6 sectors (labeled 1 through 6). Twenty-four virtual PCL bundles were created between these sectors, and their length was measured in the 3 knee flexion positions. RESULTS: In 0° and 90° of knee flexion, the virtual bundle showing the least amount of length change (1.10 ± 0.66 mm) was at sector D-6, that is, a posteromedial bundle inserting into the most posterior femoral sector (sector D) and the most distal tibial sector (sector 6). This change was not significantly different compared with all other virtual bundles with tibial points connected to femoral sector D (P > .05). An isometric position for the PCL (length change <2 mm) could not be found in 135° of knee flexion because of lengthening of all virtual bundles. CONCLUSIONS: Our data suggest that the femoral attachment point is more important than the tibial attachment point: any of the 6 tibial bundles attached to the most posterior femoral sector had similar isometric properties. CLINICAL RELEVANCE: Reproducing normal tibial and femoral anatomy underpins PCL surgical reconstruction. These findings suggest that to perform an isometrically accurate PCL reconstruction, particular attention should be paid to the location of the femoral attachment site, once the tibial footprint has been established. There were no isometric points in any virtual PCL bundle in the fully flexed knee because of excessive lengthening. Therefore, to avoid lengthening of the reconstructed graft, we recommend that fixation is performed at knee flexion angles between 0° and 90° and that patients avoid high flexion during postoperative rehabilitation.

Changes in ACL length at different knee flexion angles: an in vivo biomechanical study.

Recently, there has been a tremendous impetus on anatomical reconstruction of the anterior cruciate ligament (ACL), and the double-bundle reconstruction concept has been advocated by many authors. It is, therefore, important to understand how the lengths of the two bundles of the ACL vary during different knee flexion angles as this could influence the angle of graft fixation during surgery. The aim of this study is to determine the change in length of the ACL bundles during different knee flexion angles. Ten subjects with normal knees were evaluated. A high-resolution computer tomography scan was performed, and 3D knee images were obtained. These images were then imported to customized software, and digital length measurement of four virtual bundles (anatomical single bundle, AM, PL and over the top) was evaluated from fixed points on the femur and tibia. Length-versus-flexion curves were drawn, and statistical analysis was performed to evaluate changes in length for each bundle at varying angles of knee flexion (0 degrees, 45 degrees, 90 degrees and 135 degrees). All virtual bundles achieved greatest lengths at full extension. There was a significant difference between the posterolateral bundle length when compared to the other bundles at full extension. There were no significant differences between the lengths of the anteromedial and the over the top single bundles at all angles of knee flexion. Three-dimensional computer tomography can be used to assess the length changes of the virtual anterior cruciate ligament bundles, thereby allowing a better understanding of bundle function in clinical situations.

Open anatomical coracoclavicular ligament reconstruction using a tendon graft with an Endobutton loop.

We describe a technique of open anatomical coracoclavicular ligament reconstruction restoring both parts of the native ligament, aiming at achieving maximum stability of the acromioclavicular joint without disturbing the normal anatomy. Using the same anatomical principle of ligament reconstruction as in other joints, transosseous tunnels are created at the native footprints of the conoid and trapezoid ligaments. An autologous graft is fixed using an Endobutton continuous loop and a PEEK screw; adequate healing of the ligament is ensured with an appropriate working length. Although an open procedure, this technique offers several advantages. It can be easily reproduced using basic anatomical principles and simple cost-effective instrumentation. The implant does not have to be removed, important anatomical structures are respected, normal acromioclavicular joint kinematics are restored, the scar is cosmetically acceptable and post-operative morbidity is very low.

Effects of anticalcifying and antifibrobrotic drugs on pre-established atherosclerosis in the rabbit.

The effects of the anticalcifying drug, ethane-hydroxydiphosphonate (EHDP) and the inhibitors of collagen biosynthesis, colchicine, penicillamine and azetidine were studied in the rabbit with pre-established atherosclerosis. The drugs were administered with a cholesterol-free diet (regression diet) for 8 weeks following the induction of atherosclerosis by feeding a hypercholesterolemic diet containing 2% cholesterol and 8% peanut oil for 8 weeks. The extent and severity of aortic atherosclerosis, as revealed by the morphological and biochemical findings, increased significantly during the regression period. In rabbits treated with EHDP (5 mg/kg/day) the aorta had fewer gross lesions and contained significantly less cholesterol, collagen and elastin than did the aorta of the rabbits fed the regression diet alone. These changes were associated with a significant reduction in aortic calcium caused by EHDP. The aortic content of cholesterol, collagen and elastin in the EHDP-treated rabbits, although less than that of the rabbits fed the regression diet alone, was about the same as that of the rabbits fed a high cholesterol diet for 8 weeks. Both colchicine (0.2 mg/kg/day) and penicillamine (100 mg/kg/day) had a selective action on the induced plaques in that they suppressed the fibrous proliferation in the lesions without preventing lipid and calcium accumulation in the lesions. Neither colchicine nor penicillamine reduced the extent of aortic atherosclerosis as determined by gross examination of the vessel. Azetidine had no significant effect on the pre-established atherosclerotic lesions. The lipid, fibrous protein and calcium content of the aorta of the azetidine-treated animals was not significantly different from that of the untreated animals. The biochemical findings in the aorta were consistent with the microscopic changes.

Nitrate contamination in groundwater of some rural areas of Rajasthan, India.

Efforts were made to evaluate the level of nitrate in some agro-economy based rural habitations of northern Rajasthan, India. A total of 64 groundwater samples from 21 different villages/sub-villages of district Sri Ganganagar, India were collected and analyzed for nitrate (as NO(3)(-)), sulphate (as SO(4)(2-)) and few other parameters. NO(3)(-) level in groundwater was 7.10-82.0 mg l(-1) for individual samples. But average NO(3)(-) for total samples was 60.6+/-33.6 (SD) mg l(-1), which indicates the non-suitability of groundwater for drinking purposes, if BIS permissible limit (22.6 mg l(-1)) is considered as reference level. SO(4)(2-) ranged form 28.6 to 660.3 mg l(-1) in this area. The regression analysis indicates the difference sources for NO(3)(-) and SO(4)(2-) contamination in different regions rather than a common source. The point and non-point sources of NO(3)(-) and SO(4)(2-) in groundwater of this region may be N-fertilizer, sewerage, animal waste, organic manure, geology of sub-surface soil layers, pit latrines, etc. Results thus indicated that groundwater of this part of the State is severely polluted due to anthropogenic activities. The continuous consumption of such water may pose serious health hazardous in local residents.

Role of hypertension in ischemic heart disease and cerebral vascular disease in the cynomolgus monkey with coarctation of the aorta.

The role of hypertension in cardiovascular disease was studied in the hypertensive coarcted monkey during the feeding of an atherogenic and nonatherogenic diet. During the 15-month period of observation, half of the hypertensive coarcted monkeys developed cardiovascular disease which included heart failure, ischemic heart disease, stroke, and sudden death. There were no cardiovascular complications in the control normotensive monkeys except for one cholesterol-fed animal. The incidence of ischemic heart disease and sudden cardiac death was higher in monkeys with both hypertension and hypercholesterolemia than in those with hypertension or hypercholesterolemia alone. Postmortem studies revealed that the former monkeys had both hypertensive and atherosclerotic heart disease, whereas the monkeys with hypertension or hypercholesterolemia had either hypertensive or atherosclerotic heart disease. Hypertensive heart disease was characterized not only by hypertrophy of the left ventricle but also by focal myocardial degeneration and fibrosis and by focal thickening and narrowing of the small coronary arteries, particularly the sinus node artery and the atrioventricular node artery. The finding of transmural myocardial infarction in two monkeys with patient coronary arteries suggests a possible role of coronary artery spasm in ischemic heart disease in hypertension. The cerebral vascular complications of hypertension included hypertensive encephalopathy, transient "ischemic" attacks, and hemorrhagic stroke. The complications were associated with severe hypertension and with hypertensive vascular disease or hypertensive and atherosclerotic vascular disease of the cerebral arteries.