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Quantitative measurements of joint mobility in adolescents.

Six measurements of joint mobility were made in a group of 446 normal adolescents. A method of measuring hip and knee rotation is presented. All these data are normally distributed, and would suggest that joint hypermobility lies at the end of the normal spectrum. There was a weak but significant correlation between each of the different measures of joint mobility except elbow hyperextention. Criteria for joint laxity are discussed in this age group, and the importance of quantitative techniques of measuring joint mobility are emphasised.

Adolescent↗

Reference range for serum cortisol in well preterm infants.

AIM: To establish a reference range for serum cortisol concentrations in preterm infants with a gestational age of less than 30 weeks during the first two weeks of life. METHODS: Infants were prospectively classified by the following exclusion criteria: surfactant administration, arterial hypotension, acute or uncontrolled infection, ventricular haemorrhage II degrees or above, serum glucose < 2.2 mmol/l, exchange transfusion, stress as a result of any kind of examination or nursing for at least 4 hours before blood sampling. The cortisol value was measured once using radioimmunoassay in each infant. RESULTS: In appropriate for gestational age (AGA) infants (n = 37, median gestational age 27.7 weeks, median birthweight 1030 g) the distribution of the cortisol concentrations was non-Gaussian. These had a nearly normal distribution, when log(10) values of the data were used. The points determined by mean (2 SD) on the logarithmic scale were transformed back to the original units to provide a reference range: 73-562 nmol/l. Gestational age was significantly (p = 0.033) associated with cortisol values (log(10)) with a regression coefficient (standard error) of -0.045 (0.020). Small for gestational age (SGA) infants (n = 8) had significantly higher cortisol values (median 357 nmol/l) than AGA infants (median 199 nmol/l) (p=0.028). CONCLUSIONS: There is a strictly defined reference range of serum cortisol concentrations in AGA preterm infants.

Gestational Age↗

Pulmonary asbestos and dust content in East Anglia.

Measurements were made of the asbestos fibre and dust content of samples from 96 surgically excised lungs; 42 necropsies on patients with lung cancer, 11 necropsies on patients with non-pulmonary malignancies, and 59 necropsies on patients without any malignant disease. The patients' ages ranged from 45 to 74 years at the time of study. None of the patients had asbestosis. The distribution of fibres and dust content of the lungs showed a log-normal distribution. There was no significant difference in fibre counts or dust content between men and women, and between lung cancer and non-cancer patients. The only group with an association with a high asbestos fibre count was four necropsy cases of pleural mesothelioma. There was no significant relationship between asbestos fibre count and dust content of the lung. The present data suggest that asbestos fibre counts below 100,000 per gram of dried lung are not related to specific asbestos disease, although in the surgical cases who were closely questioned on their residential and occupational histories most of those with fibre counts above 30,000 per gram dried lung had had occasions of definite or very likely asbestos exposure.

Adenocarcinoma↗

Comparison of discriminative properties among disease-specific questionnaires for measuring health-related quality of life in patients with chronic obstructive pulmonary disease.

Three disease-specific, health-related quality of life (HRQL) questionnaires have been introduced to assess patients with chronic obstructive pulmonary disease (COPD): the St. George's Respiratory Questionnaire (SGRQ), the Breathing Problems Questionnaire (BPQ), and the Chronic Respiratory Disease Questionnaire (CRQ). The purpose of the present study was to make comparisons between the SGRQ, the BPQ, and the CRQ in their discriminative properties, and to clarify the characteristics of each questionnaire. One hundred forty-three patients with mild to severe COPD completed pulmonary function tests, progressive cycle ergometer testing for exercise capacity, assessment of dyspnea, anxiety, and depression, and assessment of HRQL. The frequency distributions of the questionnaire scores showed that the SGRQ and the CRQ were normally distributed and that the BPQ was skewed toward low scores. Relationships between all dimensions of the three questionnaires were significant (correlation coefficients [Rs] = 0.74 to 0.86). The three questionnaires had significant but weak correlations (Rs = -0.24 to -0.36) with some physiologic variables (VC, FEV1, and DL(CO)/VA) and mild to moderate correlations with exercise capacity and assessment of dyspnea, anxiety, and depression. Stepwise multiple regression analyses revealed that the Baseline Dyspnea Index (BDI) score, anxiety by the Hospital Anxiety Depression Scale (HAD), and maximal oxygen uptake (VO2max) accounted for 61% of the variance in the SGRQ and that the BDI and anxiety of the HAD accounted for 53 and 49% of the variance in the BPQ and the CRQ, respectively. Dyspnea and psychologic status impacted the HRQL in patients with COPD. Although no substantial differences between the SGRQ, the BPQ, and the CRQ were evident in the correlations with physiologic parameters and the influential factors, the BPQ was found to be less discriminatory than the SGRQ and the CRQ in evaluating HRQL cross-sectionally.

Aged↗

Serum gamma-glutamyl transferase and a somatic health score in middle-aged men.

In an ongoing population investigation of middle-aged men in Malmö, Sweden, several health screening variables showed strong but crude individual covariations with the level of the hepatic enzyme, serum gamma-glutamyl transferase (GGT). These variables were combined, according to an analysis of their normal distributions, into a score index which exhibited a much smoother correlation with low, normal, and elevated levels of GGT when tested in a random population subsample. It is concluded that this scoring system may find further utilisation as a general descriptive method of recording statistical covariations between health screening tests and sum them up.

Adult↗

Rabbit sphincter of Oddi has a certain autonomy: characteristic features.

Simultaneous recordings of electromyography and manometry were obtained from rabbit sphincter of Oddi (SO) and duodenum. Three different patterns of activity were observed in SO and in duodenum: 1) a low-amplitude (less than 3 cm H2O) pattern of background oscillations with 2) superimposed high-amplitude (4-20 cm H2O) contractions and 3) occasional complex contractions consisting of an elevation of the basal pressure with superimposed smaller contractions. A certain SO autonomy was evident: 57.6% of SO pressure peaks could not be assigned to any duodenal activity. The distribution of SO pressure peak amplitudes could not be described by a simple normal distribution. The distribution of SO pressure peak amplitudes with concomitant duodenal activity differed from the overall distribution (p less than 0.001). Whereas a substantial part of SO pressure peaks greater than 4 cm H2O had no or low-amplitude corresponding duodenal pressure activity, duodenal pressure peaks greater than 4 cm H2O almost invariably were associated with SO pressure peaks. It is concluded that rabbit SO does possess a certain autonomy, but at the same time a close functional connection exists between the two compartments.

Ampulla of Vater↗

[The role of genetic factors in the manifestation of delirium tremens].

Among 27,692 patients suffering from alcoholism, delirium tremens occurs only in 8.1% of the cases. From 2417 patients with this psychosis repeated delirium tremens was noted in 12.9%. In the studied group (n = 2417) delirium tremens was observed in men (84.2%) 5.3 times more often than in women (15.8%). The mean age of the onset of the delirium was 43.2 years in women and was older than in the group of men (42.0 years). Age distribution of the disease onset in men and women follows a curve of normal distribution. In 125 patients with schizophrenia combined with delirium tremens there was a high rate of repeated alcoholic delirium (22.4%), epileptic seizures (21.6%), diabetes mellitus of type II (10.4%). These facts confirm the role of hereditary predisposition to development of delirium tremens and allow to relate alcoholic delirium to multifactorial diseases.

Adolescent↗

[Observation of the serum acidic isoferritin levels in patients with hepatocellular carcinoma].

The levels of serum acidic isoferritin (SAIF) in 48 patients with hepatocellular carcinoma (HCC), 30 patients with hepatitis, 28 patients with liver cirrihosis, and 33 healthy subjects were measured by using enzyme-linked immunosorbent assay (ELISA--double-determinant). The result revealed that the SAIF values of HCC, HP and LC did not show normal distribution. The median values were 440 micrograms/L, 21 micrograms/L, 120 micrograms/L and, in normal subjects, 66 micrograms/L respectively. There were statistically significant differences between HCC and the control groups. The sensitivity of SAIF to HCC was 85.46%, with the cut-off point being 250 micrograms/L. SAIF was not correlated to AFP in HCC cases. The values of SAIF had no relationship with the volume of the tumors and the clinical stages. SAIF may be an available and useful serum marker and be beneficial to the diagnosis of early-staged HCC.

Adolescent↗

Comparison of blood-ethanol concentration in deaths attributed to acute alcohol poisoning and chronic alcoholism.

Ethanol concentrations were measured in femoral venous blood in deaths attributed to acute alcohol poisoning (N = 693) or chronic alcoholism (N = 825), according to the forensic pathology report. Among acute alcohol poisonings were 529 men (76%) with mean age 53 years and 164 women (24%) with mean age 53 years. In the chronic alcoholism deaths were 705 men (85%) with mean age 55 years and 120 women (15%) with mean age 57 years. The blood-ethanol concentrations were not related to the person's age (r = -0.17 in acute poisonings and r = -0.09 in chronic alcoholism). The distribution of blood-ethanol concentrations in acute poisoning cases agreed with a normal or Gaussian curve with mean, median, standard deviation, coefficient of variation, and spread of 0.36 g/100 mL, 0.36 g/100 mL, 0.086 g/100 mL, 24% and 0.074 to 0.68 g/100 mL, respectively. The corresponding concentrations of ethanol in chronic alcoholism deaths were not normally distributed and showed a mode between 0.01 and 0.05 g/100 mL and mean, median, and spread of 0.172 g/100 mL, 0.150 g/100 mL, and 0.01 to 0.56 g/100 mL, respectively. The 5th and 95th percentiles for blood-ethanol concentration in acute poisoning deaths were 0.22 and 0.50 g/100 mL, respectively. However, these values are probably conservative estimates of the highest blood-ethanol concentrations before death owing to metabolism of ethanol until the time of death. In 98 chronic alcoholism deaths (12%) there was an elevated concentration of acetone in the blood (>0.01 g/100 mL), and 50 of these (6%) also had elevated isopropanol (>0.01 g/100 mL). This compares with 28 cases (4%) with elevated blood-acetone in the acute poisoning deaths and 22 (3%) with elevated blood-isopropanol. We offer various explanations for the differences in blood-ethanol and blood-acetone in acute poisoning and alcoholism deaths such as chronic tolerance, alcohol-related organ and tissue damage (cirrhosis, pancreatitis), positional asphyxia or suffocation by inhalation of vomit, exposure to cold coupled with alcohol-induced hypothermia, as well as various metabolic disturbances such as hypoglycemia and ketoacidosis.

2-Propanol↗

[Quantitative method to describe the inner characteristics of hereditary nonpolyposis colorectal cancer family].

OBJECTIVE: To establish a quantitative method to describe the inner characteristics of hereditary nonpolyposis colorectal cancer (HNPCC) family. METHODS: All members of 25 HNPCC families with assembly of malignant tumors therein [with at least one patients with colorectal cancer (CRC)] in China underwent questionnaire survey. Other 32 HNPCC families with complete clinical data were collected from the published Chinese and foreign literatures related to clinical phenotype of Chinese HNPCC family. Altogether 57 HNPCC families fulfilling the Amsterdam Criteria (AC) I or II underwent analysis of the inner characteristics cumulatively. The following parameters were analyzed: familial median age when diagnosed as with the first malignant tumor (FMA-DFMT), familial median age when diagnosed as with the first CRC (FMA-DFCRC), familial proportion of CRC in first malignant tumors (FPCRC-FMT), familial proportion of CRC patients (FP-CRCP), number of involved generations, number of cancer patients, and type of family. RESULTS: In the ACI HNPCC families, the distribution patterns of both FMA-DFMT and FMA-DFCRC were not normal distribution. Most of the FMA-DFMT and FMA-DFCRC were from 35 years to 50 years with the medians of 44.0 years and 43.5 years respectively. The FPCRC-FMT and FP-CRCP were less than 0.6 in 13.2% (7/53) and 7.5% (4/53) of the families respectively. The FMA-DFMT and FMA-DFCRC were not correlated with FPCRC-FMT, FP-CRCP, number of involved generations and cancer patients, and type of family (all P > 0.05). CONCLUSION: Compared to the traditional methods, the features of HNPCC families can be accurately described by a series of quantitative parameters.

Adult↗

Relation between serum and whole-blood ethanol concentrations.

An algorithm is suggested for interpretation of serum ethanol concentrations under legal statutes that specify whole-blood alcohol concentrations. The algorithm uses the distribution of individual serum:whole-blood alcohol concentration ratios to allow calculations at various levels of confidence that can be related to legal standards of evidence. Serum:whole-blood alcohol concentration ratios were determined for 211 patients. The ratios ranged from 0.88 to 1.59 (median 1.15). The distribution of ratios was positively skewed, but the logarithms of the ratios were normally distributed. This allowed the parametric calculation of a range of ratios of 0.90-1.49 for the central 99% of the population and a range of 0.95-1.40 for the central 95%. The serum:whole-blood alcohol concentration ratio was independent of both the serum alcohol concentration (R2 = 0.005) and the hematocrit (R2 = 0.03).

Algorithms↗

[Age at menarche among schoolgirls in Odense. Is age at menarche still decreasing in Denmark?].

The average age at the menarche has decreased from the 1850s to the 1950s. It is controversial whether there has been a continued decrease since the 1950s. The object of this investigation is to illustrate whether this trend has continued into the 1980s. This study is based on the ages at the menarche as recalled by 908 girls aged 14-16 years in 40 schools in Odense. The information was obtained during intervals of differing lengths and consequently, the parameters of the distribution of the age at the menarche were estimated in a randomly grouped normal distribution. The average age at the menarche was found to be the same throughout the municipality (13.27 years; 95% confidence limit 13.20-13.35). The variations were found to be significantly differentiated by the type of school district. The variations were low in the suburbs and in the surrounding rural districts, higher in the inner city areas and highest among girls attending private schools. Compared with the results from other recent Danish studies, these findings suggest a halt in the decline of the average age at the menarche, which may be temporary.

Adolescent↗

Minimum distance estimation of mutational parameters for quantitative traits.

Individual spontaneous mutations affecting the expression of quantitative traits cannot be systematically identified and, therefore, their effect on the trait cannot be measured. Thus, the rate of occurrence of such mutations and the moments of the probability distribution of the corresponding effects, which are important in evolutionary studies, remain unknown. Here we propose a method to estimate those mutational properties from the observed distribution of the trait mean in a set of independent inbred lines (all derived from the same homozygous base population) in which mutations had been allowed to accumulate randomly. It is based on the use of the well-known minimum distance method, i.e., on the minimization of a distance between the observed distribution and that expected on the basis of a genetic model. We analyze data for three morphological traits (wing length and abdominal and sternopleural bristle number) in Drosophila melanogaster. The method appears to be powerful, giving evolutionary coherent estimates of relevant mutational properties that had not been estimated previously. For all traits, mutational rates were low (smaller than 0.05). Most mutations affecting wing length or abdominal bristle number and negative effect, while almost half of those affecting sternopleural bristle number had positive effect. For each trait, results obtained from data on different generations are in qualitative agreement, although mutational effects seem to depend on generation-specific environmental factors. The method detected between-trait differences in the kurtosis coefficient of the distribution of mutational effects, which varied from values close to that of the normal distribution (wing length) to relatively high values (sternopleural bristle number). It reveals that an important proportion of the mutational input variance of each trait is due to mutations with absolute effect smaller than 0.5 environmental standard deviation units. For morphological traits undergoing weak direct selection, this suggests that large amounts of genetic variance due to genes segregating at intermediate frequencies can be present at the equilibrium.

Animals↗

Role of the pulmonary circulation in the distribution of human fetal cardiac output during the second half of pregnancy.

BACKGROUND: By using Doppler echocardiography, we determined the normal distribution of human fetal combined cardiac output (CCO) from the left and right ventricles. We also established weight-indexed pulmonary and systemic vascular resistances (Rpi and Rsi, respectively) and changes during the second half of pregnancy. METHODS AND RESULTS: Blood flows at the aortic and pulmonary valve annuli (LVCO and RVCO, respectively), right and left pulmonary arteries (QP), and ductus arteriosus (QDA) were calculated in 63 normal fetuses. Foramen ovale blood flow (QFO = LVCO-QP) was estimated. From 20 to 30 weeks of gestation, the proportion of QP of the CCO increased (from 13% to 25%, P < .001), while the proportion of QFO decreased (from 34% to 18%, P < .001). After 30 weeks, the proportions of QP and QFO were unchanged. At 38 weeks, the proportion of RVCO (60%) was higher (P < .05) than that of LVCO (40%). The proportion of QDA did not change significantly. The correlation between RVCO calculated from blood flow through the pulmonary valve and from QDA and QP was good (r = .97, P < .0001). RPi (P < .001) decreased from 20 to 30 weeks of gestation. From 30 to 38 weeks, RPi increased (P < .0001). Rsi increased (P < .001) from 20 to 38 weeks. The ratio of RPi to RSi decreased (P < .01) from 20 to 30 weeks and later remained unchanged. CONCLUSIONS: The human fetal pulmonary circulation has an important role in the distribution of cardiac output.

Blood Pressure↗

Epidemiological study of blood pressure in domestic dogs.

Previous experience has shown that a non-invasive (indirect) technique using an oscillometric monitor in conjunction with a tail cuff makes routine clinical blood pressure measurement practicable in dogs. The relationship between indirect and direct readings has been evaluated in both anaesthetised and conscious dogs (Bodey and others 1994, 1996). In this study, more than 2000 pressure measurements were taken from 1903 dogs. It was found that systolic is the most variable pressure parameter and that it depends on age, breed, sex, temperament, disease state, exercise regime and, to a minor extent, diet. Diet was not a significant determinant of diastolic and mean arterial pressure. Age and breed were the major predictors for all parameters. Heart rate was primarily affected by the temperament of the animal, though other factors also play a part in prediction. The distribution of systolic, diastolic, mean arterial pressure and heart rate across the dog population approximates to a log normal distribution. On the basis of these results it is possible to describe normal ranges for canine blood pressure; definition of hypertension, though, demands attention to age and breed normal values. The existence of statistically defined hypertension in an individual or breed does not imply adverse effects justifying therapy. Among the secondary causes of hypertension, such as diabetes, obesity and hyperadrenocorticism, hepatic disease was a new addition also undocumented in humans. The hypothesis that dogs, though classic model animals for hypertension, are resistant to its development found support from the modest increase in mean pressure values observed among dogs with renal disease, notably those with substantial reduction of glomerular filtration rate. The existence of breeds such as deerhounds with average pressures in the borderline range for hypertension in humans (and many individuals, therefore, well above) suggests that dogs may also be resistant to some of the adverse effects of high blood pressure.

Age Factors↗

Familial association of disease and the structure of trivariate distributions.

In its usual form, the multifactorial model of disease transmission assumes that the liabilities to disease have a multivariate normal distribution. This paper studies how sensitive to this assumption are the quantitative results from the model. Accordingly, bounds are established for the probability of a child having a disease, given that both parents have it and taking the heritability of the disease to be known. Unfortunately, these bounds turn out to be wide. For example, a probability that is 0.38 under the trivariate normal model may be as low as 0.12 or as high as 0.78 under other trivariate models, even if attention is restricted to those of variables-in-common form. The broader statistical issue of the meaning of trivariate dependence, as distinct from bivariate dependence, is also discussed.

Adult↗

Putting background information about relative risks into conjugate prior distributions.

In Bayesian and empirical Bayes analyses of epidemiologic data, the most easily implemented prior specifications use a multivariate normal distribution for the log relative risks or a conjugate distribution for the discrete response vector. This article describes problems in translating background information about relative risks into conjugate priors and a solution. Traditionally, conjugate priors have been specified through flattening constants, an approach that leads to conflicts with the true prior covariance structure for the log relative risks. One can, however, derive a conjugate prior consistent with that structure by using a data-augmentation approximation to the true log relative-risk prior, although a rescaling step is needed to ensure the accuracy of the approximation. These points are illustrated with a logistic regression analysis of neonatal-death risk.

Bayes Theorem↗

[The significance of moment analysis of spirogram].

In order to assess the significance of moment analysis of transit times on spirograms, we investigated the characteristics of this analysis and the distribution of mechanical time constants of the lung derived from this method. Assuming the log-normal distribution of time constants, mu is the mean and sigma is the standard deviation of the natural logarithms of the time constants. The normal value for mu was -0.64 +/- 0.41 and for sigma was 1.54 +/- 0.42 (mean +/- 1 S.D.) in 94 normal males. The smoking habits enhanced the response of sigma on age-effect, but did not enhance the response of V25/HT. Compared with the normal group, excessive sigma was observed in the patients with bronchial asthma, pulmonary emphysema and interstitial lung disease. Mu was especially greater in the patients with the former two diseases. In bronchial asthma, mu decreased and forced expiratory volume in 1 second (FEV 1.0) increased after inhalation of salbutamol, but these did not always correlate. Mu correlated with some clinical conditions. Moment analysis was available on the volume-time profile of quiet breathing with good reproducibility. The first moment (alpha 1) and standardized first moment (alpha 1') showed an increase in bronchial asthma and pulmonary emphysema, and decreased with treatment in bronchial asthma. It was concluded that the moment analysis of transit times on spirogram is useful as an index of time-course aspects of expiration.

Adult↗