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Since the Vietnam War experience we have known that there is a high association between knee dislocations and popliteal artery injuries. In an effort to improve the quality of care we asked whether every patient with a knee dislocation needs an arteriogram. This is a retrospective chart review of all injured patients who presented to Louisiana State University Health Science Center with knee dislocations between January 1, 1993 and March 31, 1998. Twenty-one patients met the study criteria. There were no deaths in this series. Twelve patients presented with normal palpable pulses. Nine of these 12 patients underwent an arteriogram. There was only one abnormal arteriogram (intimal defect) in this group. None of the patients who presented with normal pulses were operated on. There were no in-hospital complications from this nonoperative management. In the group of patients with either diminished pulses or no pulses arteriograms were performed on all patients. Fifty-five per cent of these arteriograms were abnormal, and one-third of these patients (two) were taken to the operating room for repair. In the group of patients who present with knee dislocations and normal peripheral vascular examination arteriograms are not helpful. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the case of a 55-year-old woman with Noonan syndrome and the possible association between Noonan syndrome and annular pustular psoriasis.

Introduction/Background Individuals with chronic heart failure (CHF) and inspiratory muscle weakness exhibit na exacerbated peripheral chemoreflex sensitivity (PCS) in relation to patients with preserved inspiratory muscle strength. However, it remains unclear wether patients with CHF patients with preserved inspiratory muscle strength show PCS similar to healthy individuals. The objective of this study was to compare PCS between patients with CHF and preserved inspiratory muscle strength and healthy individuals. Material and Method Ten subjects with CHF (55 ± 8 years old) and 10 healthy subjects (54 ± 7 years old) matched for sex and age participated in this study. All subjects showed preserved inspiratory muscle strength, which was measured through a pressure transducer. PCS was obtained through the technique of transient hypoxia induced by the inhalation of pure nitrogen, which was repeated for 10 times. PCS was calculated by linear regression analysis between maximal ventilation and lower oxygen saturation. Results PCS in patients with CHF and preserved inspiratory muscle strength (1.09 ± 0.95 L.min −1 .% SaO 2 −1 ) did not differ from healthy subjects (0.70 ± 0.73 L.min −1 .% SpO 2 −1 ; P = 0.31). There was a significant association between PCS and inspiratory muscle strength ( r = 0.58, P = 0.006), however only 19% of variance in PCS may be explained by inspiratory muscle strength. Conclusion Patients with CHF and preserved inspiratory muscle strength show PCS similar to healthy individuals. [ABSTRACT FROM AUTHOR]

Measurements of hydrodynamic instability growth for a high-density carbon ablator for indirectly driven inertial confinement fusion implosions on the National Ignition Facility are reported. We observe significant unexpected features on the capsule surface created by shadows of the capsule fill tube, as illuminated by laser-irradiated x-ray spots on the hohlraum wall. These shadows increase the spatial size and shape of the fill tube perturbation in a way that can significantly degrade performance in layered implosions compared to previous expectations. The measurements were performed at a convergence ratio of ~2 using in-flight x-ray radiography. The initial seed due to shadow imprint is estimated to be equivalent to ~50-100 nm of solid ablator material. This discovery has prompted the need for a mitigation strategy for future inertial confinement fusion designs as proposed here. [ABSTRACT FROM AUTHOR]

An abstract of the article "Clinical and ultrasound features of different subclasses of serous ovarian tumours" by F. Moro and colleagues is presented.

Reports on the matching pursuit-based signal processing method to improve ultrasonic flaw detection in non-destructive testing (NDT) applications. Signal processing techniques for ultrasonic NDT of highly scattering materials; Matching pursuit technique; Proposed method for ultrasonic flaw detection.

Experiments reporting magnetic-field generation by the ablative nonlinear Rayleigh–Taylor (RT) instability are reviewed. The experiments show how large-scale magnetic fields can, under certain circumstances, emerge and persist in strongly driven laboratory and astrophysical flows at drive pressures exceeding one million times atmospheric pressure. [ABSTRACT FROM PUBLISHER]

Introduction: Obstructive sleep apnea (OSA) has been associated with increased mortality. It is not known, however, how sleep apnea affects the relation between short and long sleep duration and mortality risk. Despite the existence of many studies, the association between sleep duration and mortality is still unclear due to the large number of confounders, such as OSA. In the context, the relationship between mortality and sleep efficiency in sleep apnea patients remained less studied. The present study aims to investigate the association between survival time, sleep apnea severity, and sleep efficiency in patients with sleep disorders who underwent full night polysomnography. Materials and methods: A list with 17,778 names and demographics of people who underwent polysomnography between January 1985 and June 2012 was sent to the Health Information Group of the State Health Department. The search in the database of death certificates from 2000 to 2012 obtained 227 patients. Subjects had signed a form consenting in the anonymous use of their data. The subjects were divided at the median survival time in SHORT (<5years) and LONG survival (>5years). Results: Among the deceased, 173 were men and 54 women, with ages of (mean SD) 58 14 and 59 12years, respectively. Two cases had sleep apnea as cause of death. The mean survival time was similar for men and women (6.2 4.3 and 6.3 4.4 years). Comparing the SHORT and LONG survival, all variables examined were similar, including the apnea-hypopnea index (37 28 and 39 31 events/hour; P = 0.6), gender, age, body mass index, systolic and diastolic blood pressure, waist and neck circumference, average and minimum oxygen saturation, as well as time and cause of death. The number of years of survival only correlates significantly with sleep efficiency (rho= 0.17; P = 0.01). The sleep efficiency, however, was lower in the LONG survival group (76 16% and 80 16%; P = 0.049) and the total sleep time was 27min shorter (P = 0.01). In the linear regression to predict survival time, sleep efficiency remains the only variable with a significant beta value (−0.16; P = 0.03). The odds ratio for SHORT survival was 2.8 times higher in the group with sleep efficiency >84% (95% CI 1.5-5.0). Conclusion: In the present study, the only variable that explains years of survival is sleep efficiency. This may suggest that hyperexcitability evidenced in the polysomnography by reduced sleep efficiency is a feature that enhances survival. Acknowledgements: This study was supported in part by CNPq, CAPES, and FIPE-HCPA (Brazil). [Copyright &y& Elsevier]

Introduction: Obstructive sleep apnea (OSA) affects the sleep quality and is associated with psychosocial problems. Testosterone participates both in the pathophysiology of OSA, affecting the upper airway collapsibility, and is the leading hormone related to aggressive conduct. The relationship between decreased sleep quality and irritability or aggressiveness is a frequent anecdotal quote, but the experimental evidence validating this relation is still scarce. Thus, we hypothesized that OSA severity influences aggressiveness in men, independently of the sleepiness and testosterone levels. The present study aimed to evaluate the association of OSA with aggressivity scores on a questionnaire, controlling for sleepiness and testosterone level. Materials and methods: A case-control study was conducted from August 2012 to February 2013 in patients who underwent full overnight polysomnography to investigate sleep disorders. Inclusion criteria were: men aged 18 to 50 years, without organic or mental disorders, social problems, and use of behavior-altering medication, alcohol or illicit drugs. All answered the Brazilian version of the Kurzfragebogen zur Erfassung von Aggressivitatsfaktoren (K-FAF) and of the Epworth Sleepiness Scale (ESS). In this analysis, seven questions scoring peaceful manners were excluded. In the morning after the polysomnography, blood was sampled for the dosage of testosterone. Cases had an apnea hypopnea index (AHI) 15 events/hour and controls, an AHI <15/h. Results: The 127 men included, 87 cases and 40 controls, were aged (mean SD) 37 8.5 years. In uncontrolled analyses, cases are older than controls (P <0.001), had higher body mass index (P <0.001), had lower testosterone levels (p =0.001), and lower K-FAF scores (P =0.005) than controls. In bivariate correlation, the AHI correlates significantly with testosterone levels (ρ =−0.40; P <0.001) and with scores in K-FAF questionnaire (ρ =−0.23; P =0.008). The only significant variable to predict K-FAF scores was AHI (β =−0.27; P =0.022), adjusting for age, body mass index, ESS scores, and testosterone levels in the linear regression model (adjusted R2=0.103; p =0.008). Conclusion: The results of this study demonstrate an effect of sleep apnea in reducing scores of aggressive behavior in a specific questionnaire, controlling for confounders. Acknowledgement: Casa do Psicologo, Capes, CNPq, and FIPE- HCPA. [Copyright &y& Elsevier]

Introduction: More common health complaints in institutionalized patients are insomnia and sleep disorders comparing with home-living elderly patient. The aim of this study was for analyze sleep pattern in elderly population, comparing institutionalized elderly and home-living elderly. Materials and methods: Case and control study comparison between 266 elderly patients (65year older), 142 institutionalized whereas the control group was 124 patients living at home. Subjects were monitored with the Actigraph GT3x device (placed on the right wrist) 24h a day during seven consecutive days, using 1s lasted epochs. The sleep patterns of both groups have been extracted through the well known Sadeh’s algorithm and analysed by means of the U-test of Mann–Whitney (a non-parametric variant of the Student’s t-test) in order to determine the existence of statistically significant differences between the groups under analysis. Results: Statistically significant differences arise only during the three last days of the week (Friday, Saturday and Sunday). The number of minutes awake (p <0.02) and the average awakening (p <0.04) are higher in the case group on both Friday and Saturday, whilst the total sleep time (p <0.03) and the largest sleep time (p <0.05) are higher in the control group on Sunday. We not found statistically significant differences during working days in the analyzed variables. Conclusion: The effects of institutionalization over the sleep pattern in elderly population are only significant on weekends (Friday, Saturday and Sunday). Institutionalized subjects suffer from either less or poorer sleep than those subjects that live at home. Working days, significant differences are not observed in the sleep pattern between both groups of patients. A possible explanation for this fact stems from the disruption of the institutionalized subject’s daily routine as a consequence of both their weekend habits (activities with their families, for instance) and some variations on the schedule of the staff (on-call staff instead of regular staff, for instance). Acknowledgements: Research supported by the Health Service (SACYL) of the Regional Government of Castilla y Leon in Spain. [Copyright &y& Elsevier]

Introduction: Among the mechanisms causing hypertension in obstructive sleep apnea (OSA) patients, the roles of hypoxia and of arousals, leading to intermittent oxidative stress and repeated elevations of blood pressure, have been difficult to disentangle. The apnea–hypopnea index (AHI) reflects the number of arousals. The minimum arterial oxygen saturation (SaO2min) and the percent of total sleep time with SaO2 below 90% (STB90) reflect the degree of hypoxic insult. Mild and moderate OSA are established causes of hypertension. Intense desaturation, however, occurs only in severe OSA. Most of the literature on the OSA-hypertension link uses only the AHI as OSA severity marker. The aim of this study was to quantify, in severe OSA, the influence of desaturation on blood pressure levels. Materials and methods: We analyzed retrospectively a total of 1517 polysomnographies of patients with AHI>30, ages between 18 and 60years, of both genders, who underwent baseline polysomnography in a sleep clinic. Area under the ROC curve was used to identify desaturation cut points for prediction of systolic blood pressure (SBP) >140mm Hg. Multivariate models with SBP as dependent variable, using, AHI, SaO2min, and SBT90 as regressors were attempted. Results: In the linear regression model to predict SBP in severe OSA (adjusted R square 0.04; P <0.001), all three regressors are weakly but significantly associated, being the beta for lnAHI (0.08; P =0.006) STB90 (0.09; P =0.008) and SaO2min (−0.06; P =0.048). The binary logistic model, adjusted for age, BMI, and gender, the odds ratio for SBP >140mm Hg was 1.6 times higher in the group with SBT90 (95% CI 1.3–2.0). Conclusion: These data suggest that, in severe OSA, the effect of desaturation on blood pressure is weak, probably, because it “saturates” at low severity levels. The duration of the STB90 and the lowest saturation are similarly weak predictors of hypertension in severe OSA. This is in agreement with epidemiological and pathophysiological data indicating that arousals in mild and moderate OSA are the main factors in the pathogenesis of hypertension in OSA. Acknowledgements: This study was supported in part by CNPq, CAPES, and FIPE-HCPA (Brazil). [Copyright &y& Elsevier]

Shear-flow, Kelvin-Helmholtz (KH) turbulent mixing experiments were performed on the OMEGA Laser Facility [Boehly et al., Opt. Commun. 133, 495 (1997)] in which laser-driven shock waves propagated through a low-density plastic foam placed on top of a higher-density plastic foil. The plastic foil was comprised a thin iodine-doped plastic tracer layer bonded on each side to an undoped density-matched polyamide-imide plastic. Behind the shock front, lower-density foam plasma flowed over the higher-density plastic plasma, such that the interface between the foam and plastic was KH unstable. The initial perturbations consisted of pre-imposed, sinusoidal 2D perturbations, and broadband 3D perturbations due to surface roughness at the interface between the plastic and foam. KH instability growth was measured using side-on radiography with a point-projection 5-keV vanadium backlighter. Time-integrated images were captured on D-8 x-ray film. Spatial density profiles of iodine-doped plastic mixed with foam were inferred using x-ray radiographs. The mixing layer ensuing from the KH instability with layer width up to ∼100 μm was observed at a location ∼1 mm behind the shock front. The measured mixing layer width was in good agreement with predictions based on a simple self-similar model of KH instability growth using an estimate of the shear velocity obtained from numerical simulations of the experiments. [ABSTRACT FROM AUTHOR]

The author discusses a study presented at the May 2011 World Organisation for Animal Health (OIE) assembly in Paris, France, about how a shortage of veterinarians in many countries is hindering development and putting global food security at risk. Many of the participating countries reported having insufficient numbers of public and private veterinarians involved in food production. The study also found that veterinary services' resources are mainly devoted to slaughter inspection services.

Aim To assess the relationship between risk perception and reported traffic collisions (TC) and traffic injuries (TI) the year before. Methods Design: Cohorts. Setting Primary Care (PC). Urban area. Barcelona (Spain). Population 1938 subjects possessing driving license, who attended a participating practice from March to November/2009. Measurements Outcome: TC, TI the year before. Main exposures Perception of risk for TCs (self-perception (SPR) and as assessed by a health professional (HPPR)), scored 0–10. Covariates Age, gender, seatbelt use, adherence to speed limits, long-term conditions (LTC) and drugs which increase risk for TC (LTD), psychoactive substance (PS). Data collection Interview with a health professional during the recruitment visit. Checked with medical records. Statistics Wilcoxon-test to assess differences in risk perception between categories. Logistic regression to assess relationship between risk perception scores, covariates and TC, TI. Results Patients that take LTD scored SPR lower (mean difference (MD) -0.561(−0.938 to −0.183);p=0.019); those with LTC, and PS users dont score higher (p=0.09, p=0.35 respectively). Health professionals score higher those with LTC (MD 0.879(0.634 to 1.123); p<0.001), LTD (MD 0.967 (0.722 to 1.212); p<0.001) and PS users (MD 0.857 (0.497 to 1.216); p<0.001). HPPR is independently associated with TCs (p=0.026), and TIs (p=0.025). SPR is not related with TCs, nor it is with TIs (both p>0.5). Discussion PC patients are not aware of the increased risk associated with their LTD, nor with the LTC they are prescribed; PS users arent either. By contrast, HPPRs know about the excess of risk associated with these. Their advice could be an effective intervention. [ABSTRACT FROM PUBLISHER]

A diagnosis of parathyroid hormone-related protein (PTH-rP)-secreting metastatic uterine epithelioid leiomyo-sarcoma was made in a 61-year-old woman with humoral hypercalcemia of malignancy. A primary uterine tumor had been removed 10 years previously, which had been associated with a short history of hypercalcemia. The original uterine tumor was diagnosed as a smooth muscle tumor of uncertain malignant potential. To the best of our knowledge, this is the first reported case of a PTH-rP-secreting uterine leiomyosarcoma. We demonstrate the dramatic changes in serum calcium, phosphorus, PTH, and PTH-rP levels after tumor resection. Extensive biochemical analysis and detailed immunohistochemical and ultrastructural characterization demonstrate several features of this tumor. [ABSTRACT FROM AUTHOR]