A Proposed Phonography-Based Measurement of Fetal Breathing Movement Using Segmented Structures with Frequency Splitting.

This paper proposes a detection method of fetal breathing movement (FBM) as an important data of fetal well-being. To analyze the chaotic nature of the individual episodes, the frequency band has been split into single test frequencies in order to find its starting point (SP) as a signal free (quiet) zone. Computing some features of the signal the sound will be distinguishable from the disturbing signals as hiccups, body's rotation and limb movements or even additional noises of maternal heart beats. The SPs of the episodes are characterized by an approximation process in order to select the real ones.Clinical relevance- The method is an irradiation free measurement, carried out on the maternal abdomen. Furthermore, connected with the fetal phonocardiographic (fPCG) monitoring the method offers a non-invasive way for FBM detection applicable also at home. More than 50 pregnancies were examined with the proposed method for at least for 20-min with synchronous measurements by the proposed phonographic device and a 3D ultrasound machine in the third trimester.

Low Back Pain (LBP), work and absenteeism.

BACKGROUND: Occupational physical demands are commonly assumed the cause of work-related Low Back Pain (LBP) and absenteeism. OBJECTIVES: To analyse relationships between LBP at work, physical demands and absenteeism. METHODS: Workers filled out a questionnaire on socio-demographic and work-related factors, general health, LBP (number of episodes in a 12-month period, pain severity and intensity), and occupational hazards related with physical demands. RESULTS: 735 workers completed the questionnaire (male n = 359). A high proportion of workers n = 507 (69%), from different occupational backgrounds, reported at least one LBP episode in the previous 12-month period. The highest ratio of subjects with more than 6 episodes of LBP per year was found among public services employees (31.8%) and the lowest ratio among administrative workers (10.3%). The highest ratio of workers (39%) were classified as sedentary workers, 34% of workers having a low or moderate level of physical demands in their work, and 27% reported high levels of physical demands in their work. There was a 4 % absenteeism rate in a 12-month period, which was significantly higher in the group with physically demanding work. Those subjects with higher physical requirements at work have increased odds of having more than 3 episodes of LBP during the previous year (p < 0.05) in comparison with subjects with more sedentary jobs and those with low or moderate physical demands. High intensity work, compared to sedentary work, is associated with an increased probability of being absent of work because of LBP in a previous 12-month period (OR = 3.12; CI 1.23-7.89; p = 0.016). CONCLUSIONS: Our findings suggest there is an association between highly physically demanding jobs, LBP and absenteeism. These results may contribute to the improvement of LBP assessment and prevention programs in Occupational Health Services.

Space use of wild boar (Sus Scrofa) in Budapest: are they resident or transient city dwellers?

In our study, we examined the movement of two wild boars marked with GPS/GSM transmitters in city of Budapest. We hypothesised that: the wild boars do not leave the urban area (H1); the wild boars prefer places that are less disturbed by people, and which are rich in potential hiding places (H2); and their home ranges would be smaller than that of wild boars living in non-urban environment (H3). Based on our results, we accepted our first hypothesis, as the wild boars had not left the area of Budapest. However, we partly rejected our second hypothesis: the wild boars preferred urban areas that were forested and richly covered with vegetation; however, human presence therefore disturbance was also high in those areas. The home range sizes of both marked wild boar sows were remarkably smaller than those of the wild boars living in natural environment (H3). City habitat modification, e.g. clearing undergrowth vegetation, could result that wild boars cannot find any hiding places. The significant part of food sources will disappear with the elimination of these places. By eliminating the two main factors together could prevent wild boars finding their living conditions within the city.

The association between sleep quality, low back pain and disability: A prospective study in routine practice.

BACKGROUND: The objective of this study was to estimate the association between sleep quality (SQ) and improvements in low back pain (LBP) and disability, among patients treated for LBP in routine practice. METHODS: This prospective cohort study included 461 subacute and chronic LBP patients treated in 11 specialized centres, 14 primary care centres and eight physical therapy practices across 12 Spanish regions. LBP, leg pain, disability, catastrophizing, depression and SQ were assessed through validated questionnaires upon recruitment and 3 months later. Logistic regression models were developed to assess: (1) the association between the baseline score for SQ and improvements in LBP and disability at 3 months, and (2) the association between improvement in SQ and improvements in LBP and disability during the follow-up period. RESULTS: Seventy-three per cent of patients were subacute. Median scores at baseline were four points for both pain and disability, as assessed with a visual analog scale and the Roland-Morris Questionnaire, respectively. Regression models showed (OR [95% CI]) that baseline SQ was not associated with improvements in LBP (0.99 [0.94; 1.06]) or in disability (0.99 [0.93; 1.05]), although associations existed between 'improvement in SQ' and 'improvement in LBP' (4.34 [2.21; 8.51]), and 'improvement in SQ' and 'improvement in disability' (4.60 [2.29; 9.27]). CONCLUSIONS: Improvement in SQ is associated with improvements in LBP and in disability at 3-month follow-up, suggesting that they may reflect or be influenced by common factors. However, baseline SQ does not predict improvements in pain or disability. SIGNIFICANCE: In clinical practice, sleep quality, low back pain and disability are associated. However, sleep quality at baseline does not predict improvement in pain and disability.

Degenerative disease of the lumbar spine. / Patología degenerativa en la columna lumbar.

In the last 25 years, scientific research has brought about drastic changes in the concept of low back pain and its management. Most imaging findings, including degenerative changes, reflect anatomic peculiarities or the normal aging process and turn out to be clinically irrelevant; imaging tests have proven useful only when systemic disease is suspected or when surgery is indicated for persistent spinal cord or nerve root compression. The radiologic report should indicate the key points of nerve compression, bypassing inconsequential findings. Many treatments have proven inefficacious, and some have proven counterproductive, but they continue to be prescribed because patients want them and there are financial incentives for doing them. Following the guidelines that have proven effective for clinical management improves clinical outcomes, reduces iatrogenic complications, and decreases unjustified and wasteful healthcare expenditures.

Spanish adaptation of the Quality of Life Index-Spinal Cord Injury version.

STUDY DESIGN: A cross-sectional, validation study. OBJECTIVES: To (a) develop the Spanish version of the Quality of Life Index-Spinal Cord Injury version (SV-QLI/SCI) and (b) assess its psychometric characteristics among permanent wheelchair users and specifically among those with SCI. SETTING: Associations of wheelchair users in Mallorca (Spain). METHODS: Two forward and backward translations of the QLI/SCI into Spanish were carried out separately. Seventy-seven subjects were randomly selected among the members of the associations. They completed the SV-QLI/SCI and validated instruments to measure depression and spinal pain upon recruitment and 14 days later. Assessments included comprehensibility, reproducibility, floor and ceiling effects and correlations between quality of life, pain and depression (Spearman's correlation coefficient). Analyses were repeated excluding data from subjects without SCI. RESULTS: Three items of the SV-QLI/SCI required rephrasing. Reproducibility was 'almost perfect' for the entire questionnaire and its 'Health and functioning' subscale, 'substantial' for the 'Social and economic' and 'Family' subscales and 'moderate' for the 'Psychological/spiritual' subscale. Floor effect was not observed, and only for the 'Family' subscale >3% of the subjects reached the maximum possible score. The correlation between quality of life and depression was the strongest (r=-0.628). Results were virtually identical in the subsample with SCI. CONCLUSION: These results support the use of the SV-QLI/SCI among Spanish-speaking wheelchair users.

Endogenous thrombin potential and examination of a further 31 analytes in liver transplant candidates.

BACKGROUND: To predict the change in patient status and differentation of the basic diseases, endogenous thrombin potential (ETP), clinical chemistry, and coagulation variables were measured in liver transplant-listed patients with different etiologies. METHODS: Differences in values of ETP and analytes of 30 control persons and 164 cirrhotic patients were examined by means of binary logistic regression. The relationship between the analytes and ETP parameters were analyzed by means of Spearman correlation. The different etiologies of cirrhosises were studied by factor and discriminant analyses. Binary logistic regression was applied to forecast changes in clinical status. Survival analysis was carried out with the appropriate variable. RESULTS: International Normalized Ratio and activated partial thromboplastin time values were higher, whereas the area-under-the-curve values were lower in cirrhosis than in healthy subjects. A strong relationship was found only between the peak height and the anti-thrombin III (ATIII) values. In the factor analysis, 3 factors were found, which explained 81.6% of the total variance. Combination of aspartate aminotransferase and ATIII mostly separated the basic disease groups from each other in the discriminant analysis. From 35 variables, the lactate dehydrogenase (LDH) and ATIII have been suited for predicting the change in patient status. Eighty percent of patients with low ATIII and high LDH levels had deterioration of their clinical status. CONCLUSIONS: Our study demonstrated that the ETP parameters did not provide additional information compared with "conventional" coagulation tests in cirrhosis. On the basis of our study, LDH and ATIII appear to be promising analytes to assess the clinical status of patients with cirrhosis. In our opinion, the classification system of liver transplant-listed patients can be improved with their use.

Number and twistedness of strands in weavings on regular convex polyhedra.

This paper deals with two- and threefold weavings on Platonic polyhedral surfaces. Depending on the skewness of the weaving pattern with respect to the edges of the polyhedra, different numbers of closed strands are necessary in a complete weaving. The problem is present in basketry but can be addressed from the aspect of pure geometry (geodesics), graph theory (central circuits of 4-valent graphs) and even structural engineering (fastenings on a closed surface). Numbers of these strands are found to have a periodicity and symmetry, and, in some cases, this number can be predicted directly from the skewness of weaving. In this paper (i) a simple recursive method using symmetry operations is given to find the number of strands of cubic, octahedral and icosahedral weavings for cases where generic symmetry arguments fail; (ii) another simple method is presented to decide whether or not a single closed strand can run along the underlying Platonic without a turn (i.e. the linking number of the two edges of a strand is zero, and so the loop can be stretched to a circle without being twisted); and (iii) the linking number of individual strands in an alternate 'check' weaving pattern is determined.

Effect of different weaning ages (21, 28 or 35 days) on production, growth and certain parameters of the digestive tract in rabbits.

The effect of different weaning ages, that is, 21 (G21), 28 (G28) or 35 (G35) days, on growth and certain parameters of the digestive tract was examined in rabbits to assess the risk of early weaning attributable to the less-developed digestive system. On days 35 and 42, G35 rabbits had 10% to 14% and 10% higher BW, respectively (P < 0.05), than those weaned at days 21 and 28. In the 4th week of life, early weaned animals had 75% higher feed intake than G28 and G35 rabbits (P < 0.05). The relative weight of the liver increased by 62% between 21 and 28 days of age, and thereafter it decreased by 76% between 35 and 42 days of age (P < 0.05), with G21 rabbits having 29% higher weight compared with G35 animals on day 35 (P < 0.05). The relative weight of the whole gastrointestinal (GI) tract increased by 49% and 22% after weaning in G21 and G28 rabbits, respectively (P < 0.05). On day 28, the relative weight of the GI tract was 19% higher in G21 than in G28 rabbits, whereas on day 35 G21 and G28 animals had a 12% heavier GI tract compared with G35 rabbits (P < 0.05). Age influenced the ratio of stomach, small intestine and caecum within the GI tract; however, no effect of different weaning age was demonstrated. The pH value of the stomach and caecum decreased from 5.7 to 1.6 and from 7.1 to 6.3, respectively, whereas that of the small intestine increased from 6.8 to 8.4 (P < 0.05); the differences between groups were not statistically significant. Strictly anaerobic culturable bacteria were present in the caecum in high amounts (108), already at 14 days of age; no significant difference attributable to weaning age was demonstrable. The concentration of total volatile fatty acids (tVFA) was higher in G21 than in G28 and G35 throughout the experimental period (P < 0.05). The proportion of acetic and butyric acid within tVFA increased, whereas that of propionic acid decreased, resulting in a C3 : C4 ratio decreasing with age. Early weaning (G21) resulted in higher butyric acid and lower propionic acid proportions on day 28 (P < 0.05). No interaction between age and treatment was found, except in relative weight of the GI tract and caecal content. In conclusion, early weaning did not cause considerable changes in the digestive physiological parameters measured, but it resulted in 10% lower growth in rabbits.

Vertebral endplate changes are not associated with chronic low back pain among Southern European subjects: a case control study.

BACKGROUND AND PURPOSE: Data on the association between vertebral endplate changes and low back pain are contradictory. This study was designed to assess whether this association exists among Southern European subjects. MATERIALS AND METHODS: Patients in this study serving as cases were 35-50 years of age with low back pain lasting >90 days, for whom a lumbar MR imaging had been prescribed. Controls were subjects 35-50 years of age, having a cranial MR imaging for headache with normal findings, and no history of clinically relevant LBP. Two hundred forty cases and 64 controls were recruited consecutively in the radiology services across 6 cities in Spain. Imaging findings and subject characteristics were gathered through previously validated instruments. Radiologists who interpreted MRI were blinded to the subject characteristics. A multivariate logistic regression model was developed to assess the association of vertebral endplate changes with LBP, adjusting for sex, age, body mass index, lifetime exposure to smoking, physical activity, disk degeneration, and the interaction between disk degeneration and vertebral endplate changes. RESULTS: Vertebral endplate changes were found in 80.4% of the cases and in 87.5% of the controls. In the regression model, disk degeneration was the only variable showing a confounding effect. Results showed that after adjusting for disk degeneration, the presence of vertebral endplate changes is associated with the absence of chronic LBP (OR for LBP: 0.31; 95% CI, 0.10-0.95). CONCLUSIONS: In Southern European subjects, vertebral endplate changes are not associated with chronic LBP.

Influence of nomenclature in the interpretation of lumbar disk contour on MR imaging: a comparison of the agreement using the combined task force and the nordic nomenclatures.

BACKGROUND AND PURPOSE: The CTF nomenclature had not been tested in clinical practice. The purpose of this study was to compare the reliability and diagnostic confidence in the interpretation of disk contours on lumbar 1.5T MR imaging when using the CTF and the Nordic nomenclatures. MATERIALS AND METHODS: Five general radiologists from 3 hospitals blindly and independently assessed intravertebral herniations (Schmorl node) and disk contours on the lumbar MR imaging of 53 patients with low back pain, on 4 occasions. Measures were taken to minimize the risk of recall bias. The Nordic nomenclature was used for the first 2 assessments, and the CTF nomenclature, in the remaining 2. Radiologists had not previously used either of the 2 nomenclatures. κ statistics were calculated separately for reports deriving from each nomenclature and were categorized as almost perfect (0.81-1.00), substantial (0.61-0.80), moderate (0.41-0.60), fair (0.21-0.40), slight (0.00-0.20), and poor (<0.00). RESULTS: Categorization of intra- and interobserver agreement was the same across nomenclatures. Intraobserver reliability was substantial for intravertebral herniations and disk contour abnormalities. Interobserver reliability was moderate for intravertebral herniations and fair to moderate for disk contour. CONCLUSIONS: In conditions close to clinical practice, regardless of the specific nomenclature used, a standardized nomenclature supports only moderate interobserver agreement. The Nordic nomenclature increases self-confidence in an individual observer's report but is less clear regarding the classification of disks as normal versus bulged.

Small difference in international normalized ratio may yield a significant impact on prioritizing patients listed for liver transplantation.

Priority for liver transplantation is currently based on the Model for End-stage Liver Disease (MELD) score. The aim of our study was to assess in detail the contribution of international normalized ratio (INR) differences for MELD scores because of interlaboratory variability. The samples from 92 cirrhotic patients were measured on different systems combining three coagulometers and three thromboplastin products to determine variations in INR and MELD score. The INR differences among the first four systems varied between 0 and 0.2, resulting in MELD differences of 0 to 2. The MELD scores of 92 patients changed only among 10 possible integers so that normally 2 to 10 patients shared the same MELD value. In some cases, one MELD score difference resulted in a 10 superpositioning on the waiting list. Including one more system (mechanical vs optical) into our investigations achieved a five MELD difference. Supposing an extreme situation where one patient competes with his or her lowest, all the other with their highest possible score (and visa versa), the difference may be even 20 positions, overturning the complete waiting list. In conclusion substantial interlaboratory differences in MELD score have profound clinical consequences.

Endocannabinoid-mediated synaptically evoked suppression of GABAergic transmission in the cerebellar cortex.

Presynaptic CB(1) cannabinoid receptors are frequently targets of endogenous cannabinoids (endocannabinoids) released from postsynaptic neurons. It is known that the glutamatergic afferent input to a neuron can trigger endocannabinoid production and that the released endocannabinoid can suppress the glutamatergic input. We tested the hypothesis that activation of the glutamatergic input to a neuron leads to an endocannabinoid-mediated suppression of the GABAergic afferent input to the same neuron. Spontaneous postsynaptic currents (sPSCs) were recorded with patch-clamp techniques in Purkinje cells in mouse cerebellar brain slices. Activation of the climbing fiber-mediated glutamatergic input to Purkinje cells led to a suppression of the sPSCs by 34+/-3%. This suppression was mostly due to suppression of GABAergic spontaneous inhibitory postsynaptic current (sIPSCs), because 93% of the sPSCs recorded in Purkinje cells were GABAergic sIPSCs. Blockade of ionotropic, but not metabotropic glutamate receptors, prevented the suppression. The climbing fiber activation led to an increase in calcium concentration in the Purkinje cells, and this increase was necessary for the suppression of sPSCs, because the suppression did not occur when the calcium increase was prevented by BAPTA. No sPSC suppression was observed in the presence of the CB(1) antagonist rimonabant or the diacylglycerol lipase inhibitor orlistat. In a further series of experiments GABAergic sIPSCs were recorded: these sIPSCs were also suppressed after climbing fiber activation, and the suppression was sensitive to the CB(1) antagonist SLV319. Finally, the GABAergic synaptic transmission between molecular layer interneurons and Purkinje cells was directly studied on simultaneously patch-clamped neuron pairs. Climbing fiber activation led to suppression of the interneuron --> Purkinje cell synaptic transmission. The results point to a novel form of endocannabinoid-mediated heterosynaptic plasticity. The endocannabinoid production in a neuron is triggered by its glutamatergic synaptic input and is dependent on an increase in intracellular calcium concentration. The produced endocannabinoid, in turn, suppresses the GABAergic synaptic input to the neuron by activating CB(1) cannabinoid receptors.

Computer method for perinatal screening of cardiac murmur using fetal phonocardiography.

The main purpose of this paper is to demonstrate the capability of fetal phonocardiographic measurements to indicate some congenital heart defects. It deals with the results of investigations carried out during the last four years involving 820 pregnant women. During the investigations fetal cardiac murmurs presenting typical waveforms and incidences of acoustic signals were recorded. Causes of these murmurs are suggested based on comparison with the well-known waveforms of infants and children. A sophisticated signal processing method for murmur discovery is presented, that is also useful for automatic perinatal screening after the 28th week of gestation. By these means low-risk population may also be fully tested for cardiac malfunctions.

Agreement in the interpretation of magnetic resonance images of the lumbar spine.

BACKGROUND: Correlation between clinical features and magnetic resonance imaging (MRI) findings is essential in low-back-pain patients. Most previous studies have analyzed concordance in the interpretation of lumbar MRI among a few radiologists who worked together. This may have overestimated concordance. PURPOSE: To evaluate intra- and interobserver agreement in the interpretation of lumbar MRI performed in an open 0.2 T system. MATERIAL AND METHODS: Seven radiologists from two different geographic settings in Spain interpreted the lumbar MRIs of 50 subjects representative of the general Danish population aged 40 years. The radiologists interpreted the images in routine clinical practice, having no knowledge of the clinical and demographic characteristics of the subjects and blinded to their colleagues' assessments. Six of the radiologists evaluated the same MRIs 14 days later, having no knowledge of the previous results. Data on the existence of disc degeneration, high-intensity zones, disc contour, Schmorl nodes, Modic changes, osteophytes, spondylolisthesis, and spinal stenosis were collected in the Nordic Modic Consensus Group Classification form. Intra- and interobserver agreement was analyzed for variables with a prevalence >or=10% and

Experiences with fetal phonocardiographic telemonitoring and future possibilities.

Phonocardiography (PCG) makes possible the examination of some fetal cardiac anomalies which otherwise usually remain undetected during pregnancy. The application of PCG in a telemonitoring system enhances its diagnostic capabilities, allowing long-term measurements even at home. The paper summarizes the intensive fetal monitoring campaign carried out in Hungary during the last three years that yielded useful experience regarding recent and future possibilities of fetal monitoring. Results collected from a large number of measurements suggest that PCG home monitoring may be a suitable screening method for fetal congenital heart diseases, even if surgical intervention in this phase of pregnancy is not easy.

Absorption, distribution and elimination of fumonisin B(1) metabolites in weaned piglets.

The absorption, distribution and elimination of fumonisin B(1) (and B(2)) after oral administration of Fusarium verticillioides (MRC 826) fungal culture, mixed into the experimental feed for 10 days, was studied in weaned barrows. In order to determine the absorption of FB(1) from the feed marked by chromium oxide, a special T-cannula was implanted into the distal part of pigs' ileum. During the feeding of toxin-containing diet (45 mg FB(1) kg(-1)) and until the tenth day after the end of treatment, the total quantity of urine and faeces was collected and their toxin content analysed. At the end of the trial, samples of lung, liver, kidney, brain, muscle, and fat were also collected and their fumonisin content analysed by LC-MS. The fumonisins appeared to decrease the reduced glutathione content in blood plasma and red blood cell haemolysate, possibly associated with in vivo lipid peroxidation. From a data set of 80 individual data and the concentration and rate of C(r) and fumonisins (FB(1), partially hydrolysed FB(1) and aminopentol) in the chymus, it could be established that the accumulative absorption of fumonisin B(1) was 3.9% +/- 0.7%. In the chymus, the FB(1) conversions into aminopentol and partially hydrolysed FB(1) were 1.0 and 3.9%, respectively. The degree of metabolism in faeces was variable, although the main product was the partially hydrolysed form, with very small amounts of the aminopentol moiety being recovered. In the investigated tissues the FB(1) conversion to aminopentol and partially hydrolysed FB(1) was 30 and 20%, respectively.