Eccentric Type Research Articles

Assessment of potential confounders when imaging pectus excavatum with chest radiography alone

BackgroundChest radiography (CXR) has emerged as an attractive alternative imaging option for objective pre-operative assessment of pectus excavatum (PE) with comparable accuracy, reduced cost, and less radiation exposure when compared to computed tomography (CT). This study asked whether image quality, scoliosis, and asymmetry of the PE deformity would decrease the accuracy of CXR as compared to CT. MethodsA database of PE patients receiving preoperative CXR and CT was created, and Haller-indices (HI) and correction-indices (CI) were calculated using each imaging modality. Each potential confounding variable were analyzed using Spearman correlations the Fisher r-to-z transformation test. ResultsThe database was comprised of 77 patients. Image quality, scoliosis and the ‘eccentric type’ of asymmetry did not demonstrate any significant worsening of measurement accuracy. However, the correlation coefficients for CIs for those with and without the ‘unbalanced type’ of asymmetry were 0.593 and 0.890, respectively, with a Fisher r-to-z of 2.16 (p=.031). ConclusionsThe accuracy of CXR-derived pectus indices remains quite favorable despite the heterogeneity from radiographic quality, scoliosis and chest wall asymmetry. Nonetheless, the unbalanced type of chest wall asymmetry did emerge as a significant confounder. As such, use of CXR alone in cases of gross chest wall asymmetry should be cautioned.

ECFマイクロ液圧源を内蔵した偏心チューブ形マイクロハンドに関する研究

Microactuators driven by fluid have been developed. This paper presents an eccentric tube type microactuator having ECF micropump inside and applies to a novel microhand. First, an eccentric tube type microactuator was made by high precision molding of PDMS. Second, the ECF micropump was designed for high output pressure and fabricated by MEMS technology. The size is 10×10 mm2 and the electrodes (TPSEs) are serially cascaded in 88 electrode pairs. The characteristics of the ECF micropump are experimentally investigated. The output pressure without flow was 78.3 kPa, while the flow rate without load pressure was 23.3 mm3/s at 1.25 kV. Last, we formed a novel microhand composed of three eccentric tube type microactuators, ECF micropump and fluidic channel parts. Three fingers are stuck together at 0.75 kV. As the dynamic characteristics, the edge time with voltage-on and voltage-off are 1.8 s and 0.6 s at 0.72 kV, respectively.

Structural and functional state of heart left ventricle depending on polymorphism rs966221 phosphodiesterase 4D gene in emergency workers of the Chornobyl NPP suffering from coronary heart disease

This study consisted in examination the features of structural and functional state of the cardiovascular system in emergency workers (EW) of the Chernobyl nuclear power plant (ChNPP) who suffered from coronary heart disease (CHD) and having different genotypes due to polymorphism rs966221 phosphodiesterase 4D (PDE4D) gene. The study involved 121 EW and 63 non irradiated patients with CHD. Standardized survey included echo doppler cardiography (EchoCG) that was done by Diagnostic Ultrasound System DS N3 (Mindray). Polymorphism rs966221 PDE4D determined by polymerase chain reaction followed by restriction reaction products. The distribution of genotypes PDE4D in EW was as follows: CC - 42, CT - 49 and TT - 30 patients. In the con trol group, carriers of the same genotypes were 27, 21 and 15 persons respectively. All echocardiographic parame ters in EW workers and non irradiated patients did not differ significantly. Amongst TT genotype carriers of both groups the proportion of patients with increased myocardial mass index was the highest (82.9%) compared to CC genotype (78.4%) and CT (71.4%). The concentric type of left ventricular (LV) hypertrophy was found in 54.9% of patients with CC genotype, in 51.8% with CT genotype and 45.7% with TT genotype, while the eccentric type in 23.5, 21.4 and 37.1% respectively. The relative number of people with high LV end diastolic volume (EDV) normalized by body surface area (BSA) was 27.5% in CC genotype carriers, 26.8% in CT genotype and 40% in TT genotype carriers (p > 0.05). The increase of BSA indexed LV end systolic volume (ESV) was found in 27.5, 30.4 and 28.6%, and the ejection fraction in 15.7, 23.2 and 22.9% respectively. The largest number of CHD patients with inadequate dias tolic function was in carriers of TT genotype (75%) compared with the data in CC (66.7%) and CT genotypes (42.9%) carriers. In patients with the same genotype, both EW and non irradiated persons there were virtually no dif ferences in indicators of the structural and functional status of LV. The analysis of changes of LV structure the fol lowing feature was revealed: eccentric type of LV hypertrophy was more common for patients with TT genotype, but concentric type for CC genotype carriers. In one third of patients with CC and CT genotypes and in 40% of TT geno type carriers it was observed LV systolic function disorders. Diastolic dysfunction manifested as often in patients with TT genotype compared with CC and CT genotypes carriers.

Performance of Sokolow-Lyon index in detection of echocardiographically diagnosed left ventricular hypertrophy in a normal Eastern German population - results of the CARLA study.

BackgroundArterial hypertension is a common disease with high prevalence in the general population. Left ventricular hypertrophy (LVH) is an independent risk factor in arterial hypertension. Electrocardiographic indices like the Sokolow-Lyon index (SLI) are recommended as diagnostic screening methods for LVH.We assessed the diagnostic performance of the SLI in a cohort of a large general population.MethodsWe used electrocardiographic and echocardiographic data from the prospective, population-based cohort study CARdio-vascular Disease, Living and Ageing in Halle (CARLA). Linear and logistic regression models were used to assess the association of SLI with LVH. To assess the impact of the body-mass-index (BMI), we performed interaction analyses.ResultsAUC of SLI to predict LVH was 55.3 %, sensitivity of the SLI was 5 %, specificity 97 %. We found a significant association of SLI after covariate-adjustment with echocardiographically detected LVH (increase of left-ventricular mass index, LVMI 7.0 g/m2 per 1 mV increase of SLI, p < 0.0001). However, this association was mainly caused by an association of SLI with the left-ventricular internal diameter (LVIDd, increase of 0.06 cm/m2 per 1 mV increase of SLI, p < 0.0001). In obese (BMI > 30 kg/m2) we found the strongest association with an increase of 9.2 g/m2 per 1 mV.ConclusionsAlthough statistically significant, relations of SLI and echocardiographic parameters of LVH were weak and mainly driven by the increase in LVIDd, implicating a more eccentric type of LVH in the collective. The relations were strongest when obese subjects were taken into account. Our data do not favour the SLI as a diagnostic screening test to identify patients at risk for LVH, especially in non-obese subjects without eccentric LVH.

Left ventricular hypertrophy as a marker of adverse cardiovascular risk in persons of different age groups

The paper considers modern conceptions about the prognostic value of left ventricular hypertrophy (LVH) different types. The role of interaction of demographic, hemodynamic, regulatory, intracardiac factors in the formation of prognostic peculiarities in patients with different types of LVH is marked. The data of own investigations indicating that the left ventricular myocardial mass has not less important value in long-term general prognostication than belonging to a concentric or eccentric LVH type in elderly patients with hypertension are presented. Some data concerning left atrial dilatation as an inalienable component of the cardiovascular continuum in essential hypertension are submitted. Pathogenic and prognostic contribution of metabolic disorders associated with hypertension and abdominal obesity in the development of the heart's left parts structural and functional disorders is shown. Issues of long-term outcome in elderly hypertensive patients with metabolic syndrome taking into account the peculiarities of left ventricular geometry are highlighted.

Содержание маркеров воспаления и цитокинов в крови больных алкогольной кардиомиопатией и ишемической болезнью сердца на разных стадиях сердечной недостаточности

We conducted a comparative study of content proinflammatory cytokines, biomarkers of inflammatory process, biochemical indicators of congestive heart failure (CHF) and hemodynamic parameters in patients with alcoholic cardiomyopathy (ACMP) and ischemic heart disease (IHD) with various NYHA classes. We examined 62 men with ACMP (n = 45) and IHD (n = 17) and NYHA class III-IV CHF. Patients of both groups had lowered ejection fraction (EF), dilated cardiac chambers, and increased left ventricular (LV) myocardial mass index (MMI). Relative LV wall thickness was within normal limits but in the ACMP group it was significantly lower than in IHD group what corresponded to the eccentric type of myocardial hypertrophy. Higher NYHA class was associated with lower EF and larger end diastolic and end systolic LV dimensions. In ACMP it was also associated with larger dimension of the right ventricle while in IHD--with substantially larger (by 30%) dimension of atria. Substantial amount of endotoxin found in blood plasma of patients with IHD corresponded to the conception of increased intestinal permeability of in CHF. Alcohol abuse was an aggravating factor of endotoxin transmission and its concentration in patients with ACMP was 3 times higher than in patients with IHD. Patients with ACMP had substantially elevated blood concentrations of interleukins (IL) 6, 8, 12, tumor necrosis factor α (TNF-α), and its soluble receptor s-TNF-R; they also had twofold elevation of C-reactive protein concentration. ACMP was associated with manifold rise of blood content of brain natriuretic peptide (BNP). Patients with IHD also had elevated blood concentrations of IL 6, 8 and 12 but their values were 1.5-2 times lower than ACMP group. Blood content of TNF-α and s-TNF-R in IHD group was within normal limits. Higher NYHA class in ACMP patients was associated with higher concentrations of IL 6 and 8, TNF-a, and BNP. In both groups of patients contents of IL-12, s-TNF-R, TGF-1β and factors of acute phase of inflammation did not reflect severity of CHF. Functional insufficiency of myocardium in IHD patients was best characterized by blood content of IL-6 while in ACMP patients--of BNP.

Preoperative Diagnosis of Thyroglossal Duct Cancer: A Case Report and Literature Review

Objective: To clarify the preoperative diagnostic rate and elucidate the morphological features of thyroglossal duct cancer through a literature search on cases reported in Japan. Methods: A search of a medical database (Japan Medical Abstracts Society) identified 40 studies on thyroglossal duct cancer in Japanese patients between 1976 and 2014. A total of 47 cases, including the present case, are summarized herein. Patient characteristics, preoperative diagnosis, and morphological features were reviewed and analyzed. Morphological features of the internal portions in the cystic lesions were classified using the previously reported Yokosuka Kyosai Hospital criteria for ultrasonography findings of thyroid cystic tumors. Results: Preoperative diagnosis was described for 43 of the 47 cases. Malignancy was suspected in 18 (41.9%) of the 43 cases on the basis of fine needle aspiration (FNA) cytology (presence of suspected papillary carcinoma cells) and imaging studies (presence of calcifications), 12 and 6 cases, respectively. Preoperative FNA was performed in 24 cases with a correct diagnosis obtained in only 12 (50%) cases. Morphological features were evaluated by preoperative imaging studies and/or postoperative histopathology. We found 6 cases (15%) with solid lesions, 32 cases (80%) with cystic lesions containing a solid part, and 2 cases (5%) with solo cystic lesions, respectively. Calcification was observed in 28 (72.5%) cases. We further examined the internal morphology of 32 cases with cystic lesions according to the criteria for ultrasonography findings of thyroid cystic tumors described in Methods. Of the 32 cases, 25 (62.5%) and 7 (17.5%) were classified as “eccentric acute angle type (Ea)” and “multiseptate type (M)”, respectively. The boundary between the solid part and the cystic part was irregular in all 7 “M” cases. No “eccentric and blunt angle type (Eb)” or “concentric type (C)” lesions were observed. Conclusions: The preoperative diagnostic rate for thyroglossal duct cancer using FNA is low, and it is important that diagnosis be performed in conjunction with imaging findings. The presence of solid parts or calcified lesions classified as “Ea” or “M with irregular boundaries” on the basis of imaging findings is suggestive of malignancy.

Influence of the left ventricular types on QT intervals in hypertensive patients.

Objective:To investigate the possible electrophysiological background of the greater excitability of concentric and eccentric left ventricular hypertrophy types in relation to the asymmetric type.Methods:187 patients with essential hypertension, without ishaemic heart disease were divided into three groups with regard to left ventricule type: concentric (relative wall thickness >0.42, interventricular septum/left ventricular posterior wall ≤1.3), eccentric (left ventricular diameter in systoles >32, relative wall thickness <0.42), asymmetric left ventricular hypertrophy (interventricular septum/left ventricular posterior wall >1.3), and three subgroups: mild (interventricular septum or left ventricular posterior wall 11-12 mm), moderate (interventricular septum or left ventricular posterior wall 13-14 mm) and severe left ventricular hypertrophy (interventricular septum or left ventricular posterior wall ≥15 mm). In all patients QT intervals, QT dispersion, left ventricular mass index and ventricular arrhythmias were measured. An upper normal limit for QT corrected interval: 450/460 ms for men/women; for QT dispersion: 70 ms.Results:The QT corrected interval and QT dispersion were increased in severe concentric and eccentric left ventricular hypertrophy (443 and 480 ms for QT corrected; 53 and 45 ms for QT dispersion, respectively), not significantly. QT dispersion in men with severe left ventricular hypertrophy was significantly enlarged (67.5 vs. 30 ms, p=0.047). QT interval was significantly longer in patients with complex ventricular arrhythmias (p=0.037).Conclusion:No significant association of QT intervals or QT dispersion with the degree/type of left ventricular hypertrophy was found. QT corrected interval and QT dispersion tend to increase proportionally to the left ventricular mass only in the concentric and eccentric type.

Echocardiographic Assessment of Left Ventricular Systolic Dysfunction in Chronic Kidney Disease Patients of a Rural Tertiary Medical Care Centre in West Bengal

Objective: To evaluate the prevalence of LV systolic dysfunction in patients with CKD (Hemodialysis naive patients) & assess the severity of dysfunction in respect to stages of CKD. Methodology: This is a cross sectional study conducted at the Medicine Department, B.S. Medical College, West Bengal during the period of one year from 1st May 2012 to 30th April 2013. 50 patients of both sexes and ages above 18 years and below 65 years presenting with chronic kidney disease who did not underwent dialysis, were included in the study. A proforma was designed to collect data containing basic information, history & physical examination and the relevant hematological, biochemical and radiological investigations like Electrocardiography and Echocardiography (2D & M mode). Based on the eGFR value (by Cockroft-Gault equation), Patients were divided in two categories - mild/moderate Chronic Kidney Disease [those with eGFR >30ml/min/1.73m 2 = CKD stages 1-3] (N = 27) and severe Chronic Kidney Disease [those with eGFR <30ml/min/1.73m 2 =CKD stages 4 - 5] (N = 23). And echocardiographic LV systolic parameters were analysed and compared between the two groups. Result: 15% of mild/moderate CKD patients showed low EF & 48% of severe CKD had evidence of low EF. 22% patients with mild/moderate CKD, and 26% with severe CKD had impaired fractional shortening. LVH was 58% among total study population, & it was 33% and 87% among two groups. Among all LVH, 31% was concentric and 69% was eccentric type. Conclusion: Chronic Kidney Disease patients has higher prevalence of left ventricular hypertrophy (LVH) and higher prevalence of systolic dysfunction, which was more pronounced in CKD stage 4-5.

The effects of different maturity times of fruit ripening and limb connection heights on the percentages of fruit removal in mechanical harvesting of hazelnut (Cv. Yomra)

In this research, the effects of maturity times of fruit ripening (MTR) and limb connection heights of shaker on efficacy of eccentric type shaker which is calculated by the percentages of fruit removal (PFR) in hazelnut (Corylus avellana L.) harvesting were assessed. Also, work efficiency of mechanical harvesting was evaluated. Three different timing strategies were determined for shaking and collecting the maturing hazelnuts. The first harvest time was chosen as August 28th which is indicating the approximately half of the matured hazelnuts. The second harvest time (September 7th) includes the term which nearly all the hazelnuts were matured. The natural fruit dropping time was considered as third harvest time (September 15th). Experiments were performed at four different limb connecting heights from the ground (LCH, 0.5 m, 1 m, 1.5 m and 2 m). Effects of maturity times of fruit ripening, limb connecting heights of shaker and their interactions on PFR were found significantly (P<0.01). The first harvest time (26.90%) decreased (P<0.01) the PFR as compared to the second (64.13%) and the third harvest time (69.83%). The LCH of 0.5 m (40.71%) and LCH of 1 m (43.43%) had a lower PFR value as compared to the LCH of 1.5 m (53.50%) and 2 m (57.41%). The effects of harvest times and LCH on the PFR were found to be linear (P < 0.01). The obtained results have showed that for larger orchards, the third harvest time which is used in the present study could be considered to be the best of the three ones with the LHC of 2 m.

Speckle Tracking Echocardiographic Analysis of Left Ventricular Systolic and Diastolic Functions of Young Elite Athletes with Eccentric and Concentric Type of Cardiac Remodeling

In individuals who exercise regularly and for extended periods of time, some structural alterations in the heart, called the athlete's heart, develop in time. These alterations vary in type, can be eccentric or concentric, depending on the nature of exercise. Speckle tracking echocardiography (STE) is a novel, angle-independent method that accurately and reliably measures systolic and diastolic functions of the left ventricle (LV) with considerably lower inter-operator variability. Twenty-two marathon runners, 24 wrestlers, and 20 healthy sedentary individuals were included in the study. The average age of subjects is 17.5±2.2 in marathon runners, 16.8±1.9 in wrestlers, and 16.4±1.8 in control group. The parameters of LV longitudinal strain (S), LV longitudinal strain rate systolic (SRS), LV longitudinal strain rate diastolic early filling (SRE), and longitudinal strain rate diastolic late filling (SRA) were evaluated by apical two-, three-, and four-chamber grayscale imaging using the global longitudinal strain (GLS) and GLS rate (GLSR). Conventional echocardiographic parameters demonstrated increased LV diameters and wall thickness in the marathon runners and increased wall thickness without increased LV diameters in the wrestlers. Systolic and diastolic functions were comparable between the marathon runners and wrestlers with conventional echocardiography. Analysis with STE, however, yielded higher systolic strain and strain rates in the athletes. Normalized GLS parameters and end-diastolic volume (EDV) were shown to be correlated. Overall, conventional echocardiography can detect some differences between young athletes with eccentric and concentric type of athlete's heart but it is incapable of revealing differences in intrinsic myocardial functions. However, analysis using STE demonstrated increased systolic functions in athletes commensurate with increased load, with unaltered diastolic functions.

Comparative analysis of clinical, electrocardiographic, angiographic and echocardiographic data of indigenous and non-indigenous residents of Yakutia with coronary artery atherosclerosis

AimThe aim of the study is to compare clinical, angiographic, electrocardiographic, echocardiographic data between indigenous and non-indigenous residents of Yakutia.Study designWe performed cross-sectional analysis of the Registry of Selective Coronary Angiography (SCAG) of the Yakutsk Republican Hospital for the period from 2004 to 2007. All patients (n=1,233) were admitted to hospital from all 35 regions of the Sakha Republic (Yakutia). Initially, 12 (1%) patients, who had abnormal coronary arteries and 259 (21%) patients with normal coronary arteries were excluded from this study. From the remaining 962 (78%) patients with detected coronary artery atherosclerosis 394 (41%) patients were excluded for having congenital heart malformations due to possible influence on the outcomes of examination for myocardial hypertrophy. Finally, only 568 patients were selected for further examinations.MethodsWe analyzed clinical data, and the findings of selective angiography, multi-detector computed tomography (CT), electrocardiography (ECG), 24-hour Holter ECG monitoring and echocardiography.Results(a) In the Sakha Republic (Yakutia) single-vessel coronary disease, coronary stenosis with 50–75% and 75–90% of constriction were detected more often among indigenous males, while multiple-vessel coronary stenosis was detected more often among non-indigenous males as well as stenosis with more than 90% of constriction. Lower calcium score mean (349.1±129.8 vs. 621.8±115.2) was observed among indigenous patients compared to non-indigenous patients; (b) Painless myocardial infarction, painless ischaemia, arterial hypertension and atrial fibrillation were detected more often among indigenous male compared to non-indigenous participants; (c) Based on the results of ECG and echocardiographic examinations, left ventricular (LV) hypertrophy, particular eccentric type of hypertrophy, was found more commonly among indigenous than non-indigenous males; and (d) By laboratory findings, indigenous males had significantly lower triglyceride levels, while platelet counts were higher compared to non-indigenous patients. Obesity was observed less frequently among indigenous men compared to non-indigenous men.ConclusionThe differences observed in this study are disputable and call for further studies. Collection of reliable data for women should be the aim of future studies.

Hemodynamic Instability during Carotid Angioplasty and Stenting-Relationship of Calcified Plaque and Its Characteristics

PurposeDuring carotid angioplasty and stenting (CAS), hemodynamic instability (HDI) can occur, possibly causing post-procedural ischemic complications. The goal of this study was to investigate the risk factors of HDI focusing on characteristics of plaque.Materials and MethodsThirty nine CAS patients were retrospectively evaluated for HDI. Prolonged HDI that lasted over 30 minutes was analyzed in relation to characteristics of calcified plaque.ResultsNineteen (48.7%) patients had HDI. Ten of the 19 had both bradycardia and hypotension, and nine had only bradycardia. All bradycardia was treated well with a transcutaneous temporary cardiac pacemaker. But eight patients presented with prolonged hypotension in spite of recovery of bradycardia. Calcified plaque was a related factor associated with HDI (odds ratio, 8.571; 95% confidence interval, 1.321-55.62; p=0.024). Extensive and eccentric type calcified plaques were associated with prolonged hypotension (p=0.04, and p=0.028, respectively).ConclusionThe calcification of plaque is a predictable factor of HDI during CAS, and its extensive and eccentric calcified plaques may be related to prolonged HDI.

The Release of Immunosuppressive Factor(s) in Young Males Following Exercise

It has been shown that a suppressive protein, acting as an immune suppressor, is generated in animals and humans under particular stresses. However, studies related to immunosuppressive factors in response to the stress resulting from acute exercise are limited. This study compares the effects of pre- and post-exercise human serum on concanavalin A stimulated lymphocyte proliferation of mice. In the present study, blood samples in eight male undergraduates (age 21 ± 0.7 years) were taken before and immediately after ten sets of exercise consisting of 15 free and 30 10-kg loaded squat jumps in each set. The suppression of lymphocyte proliferation was analysed with high pressure liquid chromatography. It was noted from the result of gel chromatography columns that the post-exercise values of the suppression of lymphocyte proliferation, in comparison to corresponding pre-exercise values, were generally greater with significant differences observed in 7.5th–9th min post-exercise eluates (P < 0.05). Such findings suggest that intense eccentric type exercise may lead to generation of immunosuppressive factor(s) in young males.

Credit Cards, Overdraft Facilities and European Consumer Protection: A Blank Cheque for Unfairness?

This contribution takes a close look at overdraft facilities, the most eccentric type of credit under the scope of Directive 2008/48 EC on credit agreements for consumers. Even in the absence of a ‘smoking gun’ linking consumer credit to personal insolvency, the tacit nature of this type of credit represents a significant “spiral of debts” risk. Armed with some overdraft facility basics we provide several theoretical insights on imperfect markets for consumer finance and consumer (un)awareness and biases when contracting for money. Today’s information requirements only partly capture the reality of Homo sapiens kind of borrowers. European consumer protection ought to safeguard consumers from behavior diverging from (perfect) rationality. It should therefore abandon narrow legal reasoning and include ethical, economical and social norms. In an attempt to reach a substantial information equilibrium we call for multi-layered and intelligent credit regulation incorporating aforementioned behavioral evidence. While such rules might be better aligned with product legislation, new IT solutions pave the way for targeted point of sale disclosure and tailored monthly statements. A strict regulatory dichotomy between regulation with regard to a consumer’s assets (e.g. investor protection) and debts (e.g. consumer credit) seems superseded. The last part of our contribution shines a light on the evolved Belgian approach with regard to overdraft facilities, foreclosing an unlimited freedom of the market for price setting.

One-Step Fabrication of Al/Sn-Bi Core–Shell Spheres via Phase Separation

Al/Sn-Bi core–shell spheres, which have potential for use in advanced electronic packaging, were fabricated in one step via phase separation by spraying liquid (Al0.345Bi0.655)67.8Sn32.2 alloy into silicone oil. The core–shell spheres changed morphology from three-layer to concentric or eccentric dual-layer type with decreasing melt superheat and increasing oil temperature. The spheres are Al-rich in the core, covered with a Sn-Bi-rich periphery, showing a two-stage melting behavior suitable for electronic packaging. The (Al0.345 Bi0.655)67.8Sn32.2 alloy was identified through thermal analysis to undergo liquid-phase separation, monotectic reaction, and eutectic reaction one after another during cooling. Finally, the solidification path of (Al0.345Bi0.655)67.8 Sn32.2 alloy was analyzed and was schematically illustrated.

Test-Retest Reliability of Isometric and Isokinetic Knee Extension and Flexion in Patients With Fibromyalgia: Evaluation of the Smallest Real Difference

Adsuar JC, Olivares PR, del Pozo-Cruz B, Parraca JA, Gusi N. Test-retest reliability of isometric and isokinetic knee extension and flexion in patients with fibromyalgia: evaluation of the smallest real difference. Objective To investigate the reliability of isokinetic peak torque and work and isometric peak torque measurements for knee flexion and extension in fibromyalgia (FM) patients by determining the smallest real difference (SRD). Design Test-retest reliability study. Setting University laboratory. Participants Women with FM (N=37) aged between 34 and 74 years. Interventions Not applicable. Main Outcome Measures The participants performed isometric, concentric, and eccentric tests of the knee. Unilateral maximal peak torque and average work were measured for each direction (flexion, extension) and contraction (isometric, concentric, eccentric) type. Relative reliability, absolute reliability, and SRD were calculated. The 3 tests were repeated after an interval of 7 days. Results With the exception of eccentric flexion, all peak torque measures had an intraclass correlation coefficient (ICC) of > 0.90, and all work measures had an ICC of > 0.85. The SRD ranged between 21% and 37% for all peak torque measures and between 40% and 73% for all work measures. Conclusions Isokinetic dynamometry provides reliable measurement of peak torque and work for isometric, concentric, and eccentric knee flexion and extension in patients with FM. The present study has generated novel SRD data, which will assist physicians, therapists, and clinicians in interpreting posttreatment changes in patients with FM.

Double orifice mitral valve visualized on echocardiography and MRI

A 21-year-old, previously healthy, female presented with complaints of palpitations. The physical examination, ECG and a 24-hour Holter investigation were unremarkable. A transthoracic echocardiogram demonstrated a double orifice mitral valve (DOMV) (Fig. 1). Cardiac magnetic resonance imaging was performed in order to exclude other congenital heart problems (Fig. 2). There was no evidence of mitral valve stenosis, regurgitation or other cardiac morphological abnormalities. Fig. 1 Transthoracic echocardiogram. a Apical 4-chamber view with ‘seagull’ appearance of the mitral valve (white arrow); b Parasternal short axis with bridge of tissue (dark arrow) dividing the mitral valve into two equal orifices Fig. 2 Cardiac MRI. a Short-axis mitral valve gradient echo cine MRI image demonstrating the two orifices b) Corresponding phase contrast velocity encoded MRI (maximum velocity 100 cm/s) image demonstrating normal flow through the mitral valve First described in 1876 by Greenfield [1], DOMV is an uncommon anomaly which, as its name indicates, has a single mitral annulus and opens into the left ventricle through two orifices. Depending on the relative size and location of the two orifices, DOMV can be classified into an eccentric type (found in 85% of cases) and a central or bridge type (as in our patient’s case) [2]. Mitral stenosis or regurgitation and other congenital malformations such as atrioventricular or ventricular septal defects may be associated with DOMV [3, 4].

Credit Cards, Overdraft Facilities and European Consumer Protection – A Blank Cheque for Unfairness?

Abstract: This contribution takes a closer look at overdraft facilities, the most eccentric type of credit under the scope of Directive 2008/48 EC on credit agreements for consumers. Even in the absence of a ‘smoking gun’ linking consumer credit to personal insolvency, the tacit nature of this type of credit represents a significant ‘spiral of debts’ risk. Armed with some overdraft facility basics we provide several theoretical insights on imperfect markets for consumer finance and consumer (un)awareness and biases when contracting for money. Today’s information requirements only partly capture the reality of Homo sapiens kind of borrowers. European consumer protection ought to safeguard consumers from behaviour diverging from (perfect) rationality. It should therefore abandon narrow legal reasoning and include ethical, economical and social norms. In an attempt to reach a substantial information equilibrium we call for multi-layered and intelligent credit regulation incorporating aforementioned behavioural evidence. While such rules might be better aligned with product legislation, new IT solutions pave the way for targeted point of sale disclosure and tailored monthly statements. A strict regulatory dichotomy between regulation with regard to a consumer’s assets (e.g., investor protection) and debts (e.g., consumer credit) seems superseded. The last part of our contribution shines a light on the evolved Belgian approach with regard to overdraft facilities, foreclosing an unlimited freedom of the market for price setting.

Impact of amlodipine or ramipril treatment on left ventricular mass and carotid intima-media thickness in nondiabetic hemodialysis patients

Objective: Left ventricular hypertrophy (LVH) and atherosclerosis are frequently observed in uremic patients and they have appeared as an independent predictor of cardiovascular morbidity and mortality. The aim of this study was to compare the effects of ramipril and amlodipine on left ventricular mass index (LVMI) and carotid intima-media thickness (CIMT) in nondiabetic hypertensive hemodialysis patients. Methods: A total of 112 hemodialysis (HD) patients were included in this study. Patients were randomly allocated to receive ramipril or amlodipine for 1 year. Blood pressure (BP) measurements, LVMI, and CIMT were assessed at baseline and 6-month intervals. Biochemical parameters and inflammatory markers were also determined at the initiation and during the study period. Results: Similar BP decrease was observed in treatment groups. During follow-up, LVMI and CIMT progressed likewise in both treatment groups despite BP control. However, subgrouping analyses due to the pattern of left ventricular geometry showed that LVMI in patients with eccentric LVH increased, whereas LVMI decreased in subjects with concentric LVH under antihypertensive treatment. Discussion: BP control with ramipril or amlodipine could not provide adequate protection for development or progression of atherosclerosis and eccentric type of LVH in nondiabetic HD patients.