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[Evaluation of an immunoassay kit to measure free testosterone].

INTRODUCTION AND OBJECTIVES: The best indicators to the diagnosis of hypogonadism are free and bioavailable testosterone circulating levels. Free and bioavailable testosterone measurements are complex. However, simple kits for direct measurement of free testosterone by analog immunoassay are available. We examined the utility of an enzymoimmunoassay kit for free testosterone measurement. MATERIAL AND METHOD: One hundred thirty-three healthy males were included. Total testosterone, SHBG, albumin and free testosterone was measured. We used two different methods to free testosterone estimation: direct measurement by enzymoimmunoassay and mathematical calculation with Vermeulen's formula, which uses albumin concentration, total testosterone and SHBG to calculate free testosterone (method recommended by the International Society for the Study of the Aging Male). We compared the two methods means values and a linear regression study was performed. RESULTS: Mean age was 37 +/- 11 years. Mean serum concentration for total testosterone was 21.43 +/- 6.8 nm ol/L. The mean value for free testosterone measured by direct and mathematical method was 0.0508 +/- 0.0118 nmol/L and 0.474 +/- 0.123 nmol/L respectively. In linear regression study exists a positive correlation between both methods (p< 0.05), although correlation coefficient is very low (r = 0.25). CONCLUSIONS: There are significant statistical differences between the measurements of free testosterone by direct and mathematical methods. Although certain correlation is observed, this is very low. In conclusion, free testosterone measurement by enzymoimmunoassay is not reliable.

Adult↗

An index of early left ventricular filling that combined with pulsed Doppler peak E velocity may estimate capillary wedge pressure.

OBJECTIVES: This study sought to determine the applicability of the combined information obtained from transmitral Doppler flow and color M-mode Doppler flow propagation velocities for estimating pulmonary capillary wedge pressure. BACKGROUND: Although Doppler-derived measurements of left ventricular (LV) filling have been applied to determine left atrial pressure, their accuracy has been limited by the variable effect of ventricular relaxation in these indexes. Recently, flow propagation velocity measured by color M-mode Doppler echocardiography has been suggested as an index of ventricular relaxation. METHODS: We studied 45 patients admitted to the intensive care unit who underwent invasive hemodynamic monitoring. We measured peak early (E) and late (A) transmitral Doppler velocities, E/A ratio and flow propagation velocity (vp) and compared them by linear regression with pulmonary capillary wedge pressure (pw). RESULTS: We found a modest positive correlation between pw and E (r = 0.62, p < 0.001) and the E/A ratio (r = 0.52, p < 0.001) and a negative correlation between pw and vp (r = -0.34, p = 0.02). By stepwise linear regression, only E and vp were statistically significant predictors of pw. However, the E/vp ratio provided the best estimate of pw (r = 0.80, p < 0.001; pw = 5.27 x [E/vp] + 4.6, SEE 3.1 mm Hg). CONCLUSIONS: The ratio of component velocity (E) over the color M-mode propagation velocity during early LV filling, by correcting for the effect of LV relaxation, provides a better estimate of pw than standard measurements of transmitral Doppler flow.

Aged↗

QSAR analysis of SH2-binding phosphopeptides: using interaction energies and cross-correlation coefficients.

Quantitative structure-activity relationships (QSAR) analyses were carried out on the SH2-phosphopeptide complexes using multiple linear regressions. The residue-residue interaction energies and cross-correlation coefficients were used as descriptors. Since the number of descriptors was very large (602 for interaction energies and 951 for cross-correlation coefficients), the stepwise addition method was applied for the multiple linear regressions. The residue-residue interaction energies were good descriptors for structure-activity relationships. The high r(2) regression models were achieved by using interaction energy. In addition, the concerted atomic motions, which show the dynamic properties during the SH2-phosphopeptide interaction, were used as descriptors. They were identified by the cross-correlation coefficients for atomic displacement. The best regression model, derived by using four cross-correlation coefficients, gave a high r(2) value of 0.925. This suggests that the dynamic properties showing concerted atomic motions can be used as good descriptors in QSAR study.

Amino Acid Sequence↗

Circulating TNF-alpha and leptin levels in offspring of NIDDM patients do not correlate to individual insulin sensitivity.

Obesity plays a central role in the development of skeletal muscle insulin resistance. The molecular mechanism causing skeletal muscle insulin resistance in obese people is still poorly understood. It has been speculated that circulating factors derived from adipose tissue impair insulin signalling in the skeletal muscle cell. TNF-alpha and leptin, which are overproduced in fat tissue of obese insulin resistant animal models and in obese humans, might mediate such an inhibitory effect on insulin signalling in skeletal muscle. The aim of the present study was to evaluate whether circulating TNF-alpha and leptin correlates to the individual skeletal muscle insulin sensitivity in individuals with different degrees of obesity and insulin resistance. We measured circulating TNF-alpha and leptin values in non diabetic offsprings of NIDDM patients. 36 German and 47 Finnish subjects participated in the study. The GDR of each participant was determined by the euglycemic hyperinsulinemic clamp technique, a range between 1.37 to 14.01 mg/kg LBM x min was observed. Percent of desirable body weight (PDW) covered also a wide range (87.58% to 197.06%). Although linear regression analysis suggested a dependence between TNF-alpha and GDR (Germany group: r = -0.37, p < 0.05, Finnish group: r = -0.32, p < 0.05) and a dependence between TNF and PDW (German group: r = 0.46, p < 0.05, Finnish group: r = 0.38, p < 0.05), in multiple linear regression analysis only the correlation with PDW was significant. Leptin levels were measured from 29 German and 36 Finnish subjects and a strong association was found between leptin and PDW (German group: r = 0.55, p < 0.05, Finnish group: r = 0.73, p < 0.05). In contrast, leptin levels did not correlate with GDR and TNF-alpha. In summary, even though, in a few insulin resistant subjects, higher circulating TNF-alpha or leptin levels with the individual insulin sensitivity can be demonstrated, the data suggest that the circulating pool of TNF-alpha and leptin in blood is unlikely to be a major contributing factor for obesity induced insulin resistance in the vast majority of individuals at high risk to develop NIDDM.

Adult↗

Identifying obstructive sleep apnea in patients presenting for laser-assisted uvulopalatoplasty.

The authors report on a series of 850 patients with snoring who were evaluated for laser-assisted uvulopalatoplasty (LAUP). Stepwise multivariate linear regression was employed to correlate patient symptoms and characteristics to the respiratory disturbance index (RDI). Body mass index, falling asleep while driving, snoring every night, and stopping breathing during sleep were found to correlate strongly with an increasing RDI (variance of 25%). Logistic multivariate linear regression analysis was used to predict the outcome of apnea (RDI>10). This model selected all of the above variables, as well as age, male sex, and the total number of symptoms, as being strong predictors of apnea. A receiver operating characteristic curve was used to describe the ability of this model to predict apnea. The authors conclude that otolaryngologists play an important role in the evaluation of OSAS, especially when a snoring patient may undergo LAUP, and they present an algorithm for the evaluation of such a patient. The authors believe that the clinical assessment, including a thorough history and a complete physical examination, remains extremely important in this evaluation. At present, the authors strongly recommend referral for a PSG if there is any suspicion of OSAS.

Adult↗

Factors of importance in the hyperglycaemia induced by upper abdominal surgery.

The variation in the hyperglycaemic response, between different individuals, is large in the immediate postoperative period. In the present study, factors of possible importance in the hyperglycaemic response to standardized elective surgery (cholecystectomy) were determined by stepwise multiple linear regression analysis. The statistical analysis comprised 29 variables which included hormones (catecholamines, cortisol, insulin, thyroid hormones), blood-borne energy metabolites (glucose, lactate, free fatty acids (FFA), glycerol, 3-hydroxybutyrate, alanine) as well as anthropometric data and variables related to surgery and anaesthesia. In linear regression analysis, with one independent variable, the glucose concentration correlated significantly with: the duration of surgery, the dose of pancuronium bromide, the dose of fentanyl, the lactate, adrenaline and cortisol concentrations respectively. The variables which, when successively included in stepwise regression, significantly reduced the residual variance for glucose were, in order of introduction; the duration of surgery and the cortisol and adrenaline concentrations respectively. It is concluded that, in standardized surgical trauma the duration of surgery may influence the metabolic response to surgery. Duration of surgery has, thus, to be taken into account when interpreting results from studies where different treatments are compared. Our results confirm that there is a synergistic effect of cortisol and adrenaline in mediating the hyperglycaemic response to surgery.

Adult↗

Magnitude of error introduced by application of heart rate correction formulas to the canine QT interval.

BACKGROUND: Accurate detection of drug-induced QT interval changes is often confounded by concurrent heart rate changes. Application of heart rate correction formulas has been the traditional approach to account for heart rate-induced QT interval changes, and thereby identify the direct effect of the test article on cardiac repolarization. Despite numerous recent studies identifying the imprecision of these formulas they continue to be applied. METHODS: Using a chronic atrioventricular dissociated His-paced canine model, heart rate correction methods were evaluated for their ability to generate a corrected QT interval independent of original heart rate. Additionally, His bundle pacing at a heart rate of 60 beats/min allowed calculation of the magnitude of error introduced by application of heart rate correction formulas. RESULTS: Of the fixed parameter heart rate correction formulas, only Van de Water was able to predict corrected QT values independent of the original heart rate. The magnitude of error discovered by application of heart rate correction formulas varied, but in many cases was very large. Bazett's formula was associated with a mean overcorrection of 67.9 ms; Fridericia's 28.7 ms. Van de Water was the best fixed parameter formula with a mean error of 10.8 ms. As expected, group and individual corrections derived from linear regression of the HR-QT data offered improvement over the traditional formulas. Both were able to predict QTc values independent of the heart rate. However, errors of the magnitude of 10 and 6 ms, respectively, were still introduced. CONCLUSION: Van de Water and linear regression correction methods were superior to others in this study, but all methods generated QTc errors equal to or much greater than the magnitude of interest for drug safety evaluation.

Animals↗

Positive correlation of skeletal muscle UCP3 mRNA levels with overweight in male, but not in female, rats.

The objective of this study was to investigate the sex-dependent regulation of skeletal muscle uncoupling protein (UCP)3 mRNA expression in response to overweight and its relationship with serum levels of free fatty acids, leptin, and insulin. Two obesity models were used: rats made obese by feeding them with a cafeteria diet for 14 wk, and postcafeteria overweight rats fed a chow diet for 10 wk after consuming the cafeteria diet for 14 wk. The effects of 24-h fasting were studied in postcafeteria rats and their age-matched controls. The cafeteria rats ate a high-fat diet and attained an excess body weight that was higher in females (+59%) than in males (+39%). A trend to higher induction of abdominal muscle UCP3 mRNA in male rats than in females after cafeteria diet was apparent (+116% increase vs. +26% increase). Postcafeteria male but not female rats still showed the tendency to have increased UCP3 mRNA levels relative to their age-matched controls. A linear regression analysis showed a significant positive correlation of the UCP3 mRNA levels with overweight and with serum levels of leptin and insulin in males, but not in females, and no correlation with serum free fatty acid levels. A subsequent correlation analysis and a multiple linear regression analysis showed that overweight was the only parameter actually related to UCP3 mRNA levels in males. Fasting-induced upregulation of muscle UCP3 mRNA levels was higher in males (5- to 7-fold) than in females (3- to 4-fold). Our results point to the existence of sex-associated differences in the control of muscle UCP3 expression in response to overweight and fasting, with an impaired induction in female rats under both conditions. The correlation of abdominal muscle UCP3 mRNA expression with overweight in males could be related to their relative resistance to gain weight after chronic overeating of a cafeteria diet, by the purported role of UCP3 in the regulation of lipid utilization.

Animal Feed↗

Brainstem dysfunction in the infant apnea syndrome.

Thirty-six infants identified as infant apnea syndrome (IAS) and 25 controls with a comparable age distribution were evaluated with Brainstem Auditory Evoked Potential (BAEP) testing. There was a significant predilection for leftsided BAEP abnormalities in IAS patients. Fifteen IAS patients had bilateral abnormalities, and of the 21 IAS patients with unilateral abnormalities, 17 had abnormalities on the left side (p less than 0.01 by McNemar's test). Significant differences (p less than 0.05 by analysis of covariance adjusting for age) between normal controls and IAS infants were found for peak latencies I, III, and V, and amplitude III. Linear regression analyses of the above parameters versus age in months for normal controls were constructed with 68% and 95% prediction interval bands to permit analysis of individual data points. Data points from the IAS infants with bilateral BAEP abnormalities have been plotted on these linear regression curves. No single measurement of latency or amplitude is abnormal in the majority of IAS infants, but many of the individual points fall outside of the 95% prediction curve.

Brain Stem↗

Impact of neurologic signs and symptoms on functional status in peripheral neuropathies.

OBJECTIVE: To determine whether the Neurologic Disability Score (NDS), the Neuropathic Symptom Score (NSS), and the Medical Research Council (MRC) "sumscore" are reliable, and to determine whether they provide information regarding the functional status of patients with peripheral neuropathies. METHODS: The authors analyzed homogeneity of the frequently used outcome measures in 97 patients using Cronbach's alpha coefficient and corrected item-total correlations. Their association with functional status (sickness impact profile and modified Rankin score) was analyzed univariately with Pearson's and Spearman's correlation coefficients, and multivariately with linear regression analysis. RESULTS: The NDS and MRC scales were homogeneous (range of Cronbach's alpha, 0.81 to 0.97) compared with the NSS scales (range, 0.20 to 0.63). The correlation patterns between neurologic signs and symptoms and functional status ranged from 0.13 to 0.65. Multivariate linear regression analyses showed that 40% or less of patients' functional status could be explained by the three tested outcome measures. CONCLUSION: The NDS and MRC are reliable measures, but these measures do not correlate with measures of functional status.

Activities of Daily Living↗

Responses of the liver to perfluorinated fatty acids with different carbon chain length in male and female mice:in relation to induction of hepatomegaly, peroxisomal beta-oxidation and microsomal 1-acylglycerophosphocholine acyltransferase.

The potency of the induction of hepatomegaly, peroxisomal beta-oxidation and microsomal 1-acylglycerophoshocholine (1-acyl-GPC) acyltransferase was compared among perfluorinated fatty acids (PFCAs) with 6-9 carbon chain length in the liver of male and female mice. All PFCAs examined induced hepatomegaly and peroxisomal beta-oxidation and the potency was in the order of perfluorononanonic acid (PFNA), perfluorooctanoic acid (PFOA), perfluoroheptanoic acid (PFHA) and perfluorohexanoic acid (PFHeA) when compared with the relative doses to induce the two parameters. Microsomal 1-acyl-GPC acyltransferase was induced by PFHA, PFOA and PFNA, as was peroxisomal beta-oxidation. No significant sex-related difference was observed in the induction of peroxisomal beta-oxidation by any PFCAs examined. PFNA and PFOA accumulated in the liver of both male and female mice in a dose-dependent manner. PFHA accumulated in the liver to a lesser extent; little PFHeA accumulated in the liver. Hepatic concentrations of PFNA, PFOA and PFHA were higher in male mice than those in female mice. One linear regression line was confirmed between the activities of peroxisomal beta-oxidation and hepatic concentrations of PFHeA, PFHA, PFOA and PFNA in male mice regardless of their carbon chain lengths, and the activities were saturable at the concentrations over approximately 500 nmol/g liver. Similar linear regression line was obtained between the two parameters in female mice. These results suggest (i) that the longer the perfluoroalkyl chain becomes, the more PFCA accumulates in the liver of both male and female mice, (ii) that the accumulated PFCAs induce hepatomegaly, peroxisomal beta-oxidation and microsomal 1-acyl-GPC acyltransferase, and (iii) that the difference observed in the accumulation of PFHA, PFOA and PFNA in the liver between male and female mice is not enough to produce obvious sex-related difference in the induction of peroxisomal beta-oxidation.

1-Acylglycerophosphocholine O-Acyltransferase↗

Statistical analysis of the reproducibility of the intravenous glucose tolerance test and the serum insulin response to this test in the middle-aged men.

The reproducibility of the intravenous glucose tolerance test (IVGTT) and the serum insulin response to this test have been studied in 48 healthy middle-aged men participating in a health screening program. Two tests were done 4-6 weeks apart. The subjects were ambulatory, and no diet prescriptions other than recommendation of an overnight fast were given. Under these circumstances the correlation between the K values of the two tests was low (r equals 0.55), and the equation for linear regression was y equals 0.56 x + 0.61. The intraindividual variation was 21 per cent, expressed as the coefficient of variation. The early increases in glucose-stimulated serum insulin concentrations in the two tests were significantly correlated (r equals 0.87), and this equation for linear regress was y equals 0.81 x + 10. The coefficient of variation intraindividually for this determination was 20 per cent. We conclude that the K values of the IVGTTs must be judged with caution when obtained in ambulatory practice, especially when the result is used for preventive measures and long-term follow-up of asymptomatic individuals.

Clinical Trials as Topic↗

Role of parathyroid hormone in the anemia of chronic terminal renal dysfunction in dogs.

Terminal renal dysfunction (TRD) was induced in 2 groups of dogs by partial surgical ablation of the kidney. Dogs of a control group and of 1 of the TRD groups were maintained on a diet containing normal phosphorus concentration, whereas dogs of the other TRD group were maintained on a low-phosphorus diet. Mild anemia developed in dogs of both TRD groups and could not be attributed to iron deficiency, increased erythrocyte concentration of 2,3-diphosphoglycerate, or absolute deficiency of erythropoietin (EP). Subsequently, all dogs were acutely depleted of approximately 25% of their blood volume. Erythropoietin concentration in dogs of the TRD groups was lower than that of controls, however, erythroid regenerative capacity was comparable with that of control dogs when plasma parathyroid hormone (PTH) concentration was lowered by reduced dietary intake of phosphorus. The PCV in dogs of the chronic TRD groups had a slight positive correlation with serum EP concentration, and a significant (P less than 0.05) negative correlation with plasma PTH and serum phosphorus and creatinine concentrations, using a correlation matrix. There was no longer a significant correlation between plasma PTH concentration and PCV after controlling for serum creatinine concentration by use of a multiple linear regression analysis. A significant (P less than 0.05) negative correlation also was observed between plasma PTH and serum EP concentrations, but not between serum EP and phosphorus or creatinine concentrations. Significance of the EP and PTH association was reduced when analyzed, using a multiple linear regression analysis that included serum creatinine values.(ABSTRACT TRUNCATED AT 250 WORDS)

Anemia↗

Dimensions of executive function in Parkinson's disease.

BACKGROUND: Executive impairment is common in Parkinson's disease (PD). However, it is unknown which dimensions of executive function are assessed by commonly used neuropsychological instruments and if clinical correlates of specific dimensions exist. METHOD: A convenience sample of 46 PD patients was evaluated with three executive function tests: the Tower of London-Drexel, the Trail-Making Test and the Stroop Color-Word Test. Factor analysis was used to probe for dimensions of executive control, and linear regression models were used to explore the association between the generated factors and other clinical features. RESULTS: Factor analysis revealed two executive factors, one related to planning (eigenvalue=4.2) and the other to inhibitory control (eigenvalue=1.8), together accounting for 75% of the variance in scores. In linear regression models, poorer planning was associated with increasing severity of apathy (t=2.11, p=0.041), and diminished inhibitory control was associated with increasing severity of parkinsonism (t=2.78, p=0.008) and lower educational level (t=-2.23, p=0.032). CONCLUSIONS: Planning deficits and diminished inhibitory control are two dimensions of executive impairment in PD, the former associated with decreased motivation and the latter with increased motor slowing. Similar performance on both executive and non-executive components of these instruments suggests that results of executive testing in PD may be confounded by non-executive deficits.

Adult↗

Neural networks involving the medial temporal structures in temporal lobe epilepsy.

OBJECTIVES: In a previous study using the averaged coherence technique to study interactions between medial/limbic and lateral/neocortical regions, we observed that epileptogenic networks in temporal lobe epilepsy seizures (TLES) could be divided into 4 subtypes, i.e. medial (M), medial-lateral (ML), lateral-medial (LM), and lateral (L). In the ML and LM subtypes, medial structures and the anterior temporal neocortex are co-activated at the onset of seizures. However, using this approach, we were unable to determine the direction of coupling and may have overlooked non-linear variations in interdependency. The purpose of the present study using non-linear regression for analysis of stereoelectroencephalographic (SEEG) signal pairs was to measure the degree and direction of coupling between medial and neocortical areas during TLES in patients with the M, ML, and LM subtypes. METHODS: Eighteen patients with drug-resistant TLEs who underwent SEEG recording were studied. We used a non-linear correlation method as a measure of the degree and the direction of coupling on SEEG signal pairs. Patients with pure lateral TLEs were not studied. We analyzed the functional coupling between 3 regions of the temporal lobe: the anterior temporal neocortex, the amygdala, and the anterior hippocampus. A physiological model of EEG generation was used to validate the non-linear quantification method and assess its applicability to real SEEG signals. RESULTS: Results are first based on a physiological model of EEG data in which both degree and direction of coupling are explicitly represented, thus allowing construction of the neural systems inside which causality relationships are controlled and generation of multichannel EEG signals from these systems. These signals provide an objective way of studying the performance of non-linear regression analysis on real signals. In medial networks (10 patients), the ictal discharge is limited to the medial limbic structures and may propagate secondarily to the cortex. Quantified results demonstrated no significant coupling between medial and lateral structures at the beginning of the seizures. Conversely, almost constant unidirectional or bidirectional coupling was observed between hippocampus and amygdala. In medial-lateral (5 patients) and lateral-medial (3 patients) networks, the initial ictal discharge includes both limbic and neocortical regions. A rapid "tonic" discharge is observed over the temporal neocortex at the onset of seizure. Quantitative analysis showed an initial increase in the non-linear correlation coefficient between neocortex and medial structures. Quantification of the coupling direction demonstrated influence of medial over lateral structures (medial-lateral) or of the lateral neocortex over medial structures (lateral-medial). CONCLUSIONS: These results confirm the existence of several generic and organized networks involving the medial structures during TLE seizures.

Amygdala↗

Prediction of permanent deformation in cast clasps for denture prostheses using a validated nonlinear finite element model.

OBJECTIVES: Permanent deformation is one of the most common mechanical complications that affect denture clasps. This can lead to loss of retention and stability of the prosthesis. The purpose of this study was to apply and validate a nonlinear finite element model for permanent deformation prediction in cast denture clasps. Such a model can enhance the process of design optimization and contribute to minimizing the possibility of this problem. METHODS: Cast clasps made from Ti-6Al-7Nb, Co-Cr and Type IV gold alloys were loaded in three different directions (outside, inside and outside inclined 30 degrees ), and the resulting permanent deformation values were recorded. Nonlinear finite element analysis simulations based on the maximum distortion energy criterion for yielding, were conducted for clasp models that were reproduced according to the dimensions of each experimental specimen. Linear regression analysis for the results of the experiment and simulation was performed to verify the validity of the mathematical models. RESULTS: Deflections required to produce specific amounts of permanent deformation were in close agreement with those recorded experimentally. The R2 value for all bending tests was 0.985 and the linear regression equation expressed in micrometers was [DeflectionFEA=0.976 (DeflectionReal)+34]. SIGNIFICANCE: Permanent deformation behavior in the cast clasps with a relatively wide range of deflections (0-2 mm) can be predicted using the proposed model, which shall enhance the design optimization process of cast clasps for denture prostheses.

Dental Alloys↗

Spontaneous long-term changes of corneal power and astigmatism after suture removal after penetrating keratoplasty using a regression model.

PURPOSE: To assess the diagnosis-based spontaneous long-term changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. main outcome measures: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)] were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval > or = 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 +/- 0.50/-0.63 +/- 0.46 diopters, P = .02) and an increase/a decrease in TEQ (0.37 +/- 0.54/-0.69 +/- 0.49 diopters, P = .04) corresponding to a decrease/an increase in SEQ (-0.31 +/- 0.47/0.63 +/- 0.43 diopters, P = .02). KAST/TAST/RAST showed a minimal annual decrease (-0.06 +/- 0.41/-0.05 +/- 0.45/-0.06 +/- 0.41 diopters) in FD but an increase in KC (0.46 +/- 0.41/0.51 +/- 0.43/0.46 +/- 0.38 diopters) (P = .05/0.06/0.12). CONCLUSIONS: In the follow-up after post-keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.

Astigmatism↗

[Spatial analysis of socioeconomic determinants of homicide in Brazil].

OBJECTIVE: To investigate the association between homicide rates and socio-economic variables taking into account the spatial site of the indicators. METHODS: An ecological study was conducted. The dependent variable was the rate of homicides among the male population aged 15 to 49 years, residing in the districts of the State of Pernambuco from 1995 to 1998. The independent variables were an index of the living conditions, per capita family income, Theil inequality index, Gini index, average income of the head of the family, poverty index, rate of illiteracy, and demographic density. The following techniques were used in the analysis: a spatial autocorrelation test determined by the Moran index, multiple linear regression, a spatial regression model (CAR) and a generalized additive model for the detection of spatial trend (LOESS). RESULTS: The illiteracy and the poverty index explained 24.6% of the total variability of the homicide rates and there was an inverse relationship. Moran's I statistics indicated spatial autocorrelation between municipalities. The multiple linear regression model best fitted for the purposes of this study was the Conditional Auto Regressive (CAR) model. The latter confirmed the association between the poverty index, illiteracy and homicide rates. CONCLUSIONS: The inverse association observed between socio-economic indicators and homicides may be expressing a process that propitiates improvement in living conditions and that is linked predominantly to conditions that generate violence, such as drug traffic.

Adolescent↗