Associations between digit ratio (2D4D), mood, and autonomic stress response in healthy men.

The ratio between the length of the second (index) and the fourth (ring) finger (2D4D) is a putative biomarker of prenatal testosterone (T) exposure, with higher exposure leading to a smaller ratio. 2D4D has further been linked to mental and somatic disorders. Healthy male Swiss recruits (N = 245; Mage = 20.30 years) underwent a psychosocial stress test. Mood and salivary alpha-amylase (sAA) were assessed before and after the stress test, while heart rate (HR) and heart rate variability (HRV) were measured continuously. Additionally, 2D4D (right: R2D4D; left: L2D4D) was determined and divided into quartile groups. Correlation analysis showed no associations between R/L2D4D and outcome measures. Comparing calculated quartiles for R2D4D, subjects in the lowest R2D4D quartile expressed trendwise (p < 0.10) lower positive and higher negative affect, significantly elevated sAA activity (p < 0.05), but no HR and HRV differences at baseline as compared to subjects in the upper three quartiles. With regard to acute stress, subjects in the lowest as compared to subjects in the upper three R2D4D quartiles showed a higher increase of negative affect and a stronger cardiac response (p < 0.05), but no alterations in positive affect and sAA activity. Young healthy men in the lowest R2D4D quartile revealed a more negative affect and increased physiological activity at baseline and in response to acute stress. An exposure to high levels of prenatal T might constitute a risk factor potentially increasing vulnerability to stress-related disorders in men.

Corrigendum: A comparative study of exceptional experiences of clients seeking advice and of subjects in an ordinary population.

[This corrects the article on p. 65 in vol. 4, PMID: 23423775.].

Trunk muscle strength tests to predict injuries, attrition and military ability in soldiers.

AIM: Physical fitness is related to injuries, attrition and military ability in military organisations. Therefore, all military organizations of the North Atlantic Treaty Organizations (NATO) test their employees' physical fitness at least once a year. The sit-up test is part of most of the fitness test batteries used. A possible alternative to the sit-up test is the global trunk muscle strength test (TMS). The aim of the present study was to compare the predictability of injuries, attrition and military ability between TMS and sit-up test performances. METHODS: A total of 230 male recruits in a Swiss Army fusilier company completed TMS and sit-up tests in week 1 of military training school. During the following 13 weeks, injuries, attrition and military ability data were collected. Statistical analysis included backward binary regression and receiver operating characteristic (ROC) curve analysis to compare the discriminative power of TMS and the sit-up test to predict injuries, attrition and military ability. RESULTS: ROC analysis revealed larger areas under the curve for total injuries, attrition and military ability for the TMS (areatotal injuries=0.58; areaattrition=0.60; areamilitary ability=0.59) than for the sit-up test (areatotal injuries=0.53; areaattrition=0.50; areamilitary ability=0.56). Binary logistic regression analysis revealed low body mass index, low TMS performance and cigarette smoking to be potential risk factors for injuries; while sit-up performance was extracted from the model. CONCLUSION: The TMS seems to be a valid alternative to the sit-up test in a military setting due to its appropriate results in predicting injuries in the present study.

A comparative study of exceptional experiences of clients seeking advice and of subjects in an ordinary population.

Exceptional experiences (EE) occur frequently within the populations of many countries and across various socio-cultural contexts. Although some EE show similarities with mental disorders, it would be a mistake to identify them in general as disorders. In fact, the vast number of individuals reporting EE includes subclinical and completely healthy subjects. We conducted a comparative empirical study of several characteristics of EE for two samples - one from ordinary population and the other from clients seeking advice. We found surprisingly similar phenomenological patterns of EE in both samples, but the frequency and intensity of EE for clients seeking advice significantly exceeded those for the ordinary population. Our results support the hypothesis of a continuous spectrum between mental health and mental disorder for the types of experiences analyzed.

The Swiss Army physical fitness test battery predicts risk of overuse injuries among recruits.

AIM: The aim of this study was to quantify the discriminative power of physical performance tests to recognize conscripts with enhanced risk of acute and overuse injuries in specific, physically demanding occupational specialties of the Swiss Army. The five performance tests investigated represent the Swiss Army Physical Fitness Test Battery. METHODS: Physical fitness performances were assessed during recruitment procedures prior to military service, and injury occurrences were assessed during 18 weeks of boot camp. Complete fitness and injury data of 459 volunteers from four military occupational specialties were collected. Discriminative power of volunteers' aerobic endurance capacity, trunk muscle fitness, muscle power of upper and lower extremities, and balance for predicting risk of acute injuries and for predicting risk of overuse injuries was calculated using receiver operating characteristic curve analysis. RESULTS: The presented fitness tests had no discriminative power for predicting the risk of acute injuries. However, the trunk muscle fitness test was discriminative in predicting overuse injuries in all four military occupational specialties, progressive endurance run in three, balance test in two, and standing long jump in one. Only the seated shot put had no significant power for predicting overuse injuries in all four study groups. However, for different occupational specialties, different fitness parameters were discriminative to predict overuse injuries. CONCLUSION: It is possible to conclude that the fitness tests used allow detection of conscripts with enhanced overuse injury risk in physically demanding occupational specialties and therefore provide an indicator to select suitable personnel for physically demanding jobs in a military organization.

Ambulatory physical activity in Swiss Army recruits.

The aim of this study was to objectively assess and compare the type, duration and intensity of physical activity during the basic training provided by each of 5 selected Swiss Army occupational specialties. The first objective was to develop and validate a method to assess distance covered on foot. The second objective was to describe and compare physical activity levels among occupational specialties. In the first part of the study, 30 male volunteers completed 6 laps of 290 m at different gait velocities. Data from 15 volunteers were used to develop linear regression equations for the relationship between step frequency and gait velocity, and data from the other 15 volunteers were used to verify the accuracy of these equations. In the second part of the study, 250 volunteers from 5 military schools (each training school for a different occupational specialty) wore heart-rate, acceleration and step-count monitors during workdays of weeks 2, 4, 8 and 10 of their basic training. Sensor data were used to identify physically demanding activities, estimate energy expenditure (based on already published algorithms) and estimate distance covered on foot (based on the algorithm developed in the first part of this study). A branched model using 2 regression equations (gait velocity=0.705∙step frequency for walking speeds below 1 m/s and gait velocity=1.675∙step frequency - 1.464 for faster gait velocities) was shown to be accurate for estimating distance covered on foot. In the training schools investigated, average physical activity energy expenditure was 10.5 ± 2.4 MJ per day, and trainees covered 12.9 ± 3.3 km per day on foot. Recruits spent 61.0 ± 23.3 min per day marching and 33.1 ± 19.5 min per day performing physically demanding materials-handling activities. Average physical activity energy expenditure decreased significantly from week 2 to week 8. The measurement system utilised in the present study yielded data comparable to those of prior studies that applied alternative methods. Nevertheless, the new sensor-based, objective measurement system used provided more information on daily physical activity and demands than traditional, single measurement instruments. The average daily total energy expenditure values in all training schools investigated were within the range found for the armed forces of other nations and for professional athletes.

Challenging narrow distal aorta in abdominal aortic aneurysm--endovascular repair using a reversed flared endoprosthesis.

INTRODUCTION: Narrow aortic bifurcations are a challenging issue while treating abdominal aortic aneurysm by endovascular means. Off-the-shelf products are often not suitable and special considerations and custom-made endoprostheses are necessary. REPORT: Alternatively, some morphologies qualify for a flared tube graft. We report two successful aneurysm exclusions using custom-made (Anaconda, Vascutek/Terumo) step-down diameter grafts in patients with tight distal aortas without the need for pre-interventional endograft adjustments. DISCUSSION: In these two cases, implantation of a custom-made proximally flared tube endograft in treating a localised abdominal aortic aneurysm with a narrow and calcified bifurcation seems feasible. They represent uncommon, yet challenging, issues worthy of attention.

The good character at work: an initial study on the contribution of character strengths in identifying healthy and unhealthy work-related behavior and experience patterns.

PURPOSE: Positive psychological functioning has been related to various positive work-related outcome variables, such as job satisfaction or work engagement. The aim of the present study was to examine the relations between morally positively valued traits (i.e., strengths of character) and work-related behaviors. METHOD: A sample of 887 adult women completed the Values in Action Inventory of Strengths (VIA-IS) and the Work-related Behavior and Experience Patterns Questionnaire (AVEM) in an online survey. RESULTS: Those assigned to healthy work-related behavior and experience patterns differed in their strengths profiles from those that demonstrated unhealthy patterns (i.e., burnout type) in a predictable way. Especially the strengths of zest, persistence, hope, and curiosity seemed to play a key role in healthy and ambitious work behavior. CONCLUSIONS: The study underlines the relevance of character strengths in work settings and suggests that interventions based on character strengths could substantiate interventions already existing at the workplace in order to enhance positive work outcomes further (e.g., work satisfaction, engagement).

Anteroposterior stability after posterior cruciate-retaining total knee arthroplasty.

PURPOSE: A functional posterior cruciate ligament (PCL) is important for the knee stability after PCL-retaining total knee arthroplasty (TKA). The objectives of this study were to determine the anteroposterior (AP) displacement of the knee after a mobile- or fixed-bearing PCL-retaining TKA operated with a ligament-balancing technique and the correlation of AP stability with the clinical outcome. METHODS: The AP displacement of 160 TKAs in 143 patients was measured pre- and intra-operatively, and the results were compared to the AP displacement measured 4 years post-surgery. RESULTS: The change in AP displacement from intra-operative measurement to follow-up at the 25° measuring point was -1.2 mm; at 90°, it was -0.2 mm. Mobile bearings showed significantly greater AP displacement than fixed bearings. Older patients, male patients and patients receiving a fixed prosthesis had lower post-operative laxity compared with the overall population. CONCLUSIONS: The small change in AP displacement indicates that the PCL remains functional over time. In our study, we could not find any correlation between knee AP stability and clinical outcome, including passive flexion, Knee Society Score or Visual Analogue Scale of pain and satisfaction.

Three-dimensional imaging core laboratory of the endovascular aneurysm repair trials: validation of methodology.

OBJECTIVE: The aim of this study was to establish and validate a three-dimensional imaging protocol for the assessment of Computed Tomography (CT) scans of abdominal aortic aneurysms in UK EVAR trials patients. Quality control and repeatability of anatomical measurements is important for the validity of any core laboratory. METHODS: Three different observers performed anatomical measurements on 50 preoperative CT scans of aortic aneurysms using the Vitrea 2 three-dimensional post-imaging software in a core laboratory setting. We assessed the accuracy of intra and inter observer repeatability of measurements, the time required for collection of measurements, 3 different levels of automation and 3 different automated criteria for measurement of neck length. RESULTS: None of the automated neck length measurements demonstrated sufficient accuracy and it was necessary to perform checking of the important automated landmarks. Good intra and limited inter observer agreement were achieved with three-dimensional assessment. Complete assessment of the aneurysm and iliacs took an average (SD) of 17.2 (4.1) minutes. CONCLUSIONS: Aortic aneurysm anatomy can be assessed reliably and quickly using three-dimensional assessment but for scans of limited quality, manual checking of important landmarks remains necessary. Using a set protocol, agreement between observers is satisfactory but not as good as within observers.

Does total knee joint replacement with the soft tissue balancing surgical technique maintain the natural joint line?

INTRODUCTION: The outcomes of 106 total knee arthroplasties implanted using a soft tissue balancing surgical technique at one surgical centre were used to assess the accuracy maintaining the knee's original joint line (JL). The aim of the study was to determine whether there is a shift of the presumed joint line after surgery. MATERIALS AND METHODS: Preoperative and post-operative radiographs were compared to determine any changes in the articulation height. The preoperative distance of the fibular head to the natural joint line was measured and compared with the post-operative measurement of the fibular head to the femoral articulation line (measured on the radiograph and defined as Rxmm). Based on the actual medio-lateral dimension of the tibial metal back, the measured difference (RXmm) could be converted into true distances (in mm). The Blackburn-Peel index was assessed as an additional outcome prior to and following surgery. RESULTS: Preoperatively, the average distance from the fibular head to the joint line was 15.1 Rxmm (SD 4.3) while the post-surgical distance was 15.5 Rxmm (SD 5.6). The average deviation of the post-surgical JL in relation to the original JL amounted to 0.4 Rxmm (SD 3.7). The average deviation of the joint line converted into the true distance was -0.3 mm (with a range of -5.9 mm in distal direction to + 8.3 mm in the proximal direction). Valgus position appeared to generate rather a shift in proximal direction whereas varus deformity favours a shift in distal direction. Seven patients exhibited a deviation of more than 5 mm in either the distal or proximal direction. All of the patients of this subgroup had a preoperative anatomical abnormality including a severe malalignment, serious bone destruction or had previously undergone a high tibial osteotomy. CONCLUSION: An exact reconstruction of the natural Joint Line is achievable when using the described soft tissue balancing surgical technique with the posterior cruciate ligament (PCL) retaining prosthesis design used in this series.

[Significance of axial rotation alignment of components of knee prostheses]. / Die Bedeutung der axialen Rotationsausrichtung der Knieprothesenkomponenten.

Increased internal malrotation of the tibial and femoral components affects kinematics of the patellofemoral joint and the flexion gap. A combined tibial and femoral malrotation may lead to maltracking of the patella. Isolated internal malrotation of the femoral component results in an asymmetric flexion gap. Clinically, the patients suffer from either lateral instability or medial stiffness in flexion. Lateral flexion instability leads to medial tibial pain,difficulties standing up from a chair,or instability during descending stairs or walking downhill. Medial stiffness in flexion may lead to secondary arthrofibrosis. There are three methods for determining femoral rotation by bony landmarks: (1) posterior condyles with 3 degrees of external rotation, (2) anterior-posterior axis according to Whiteside, and (3) transepicondylar axis. The transepicondylar axis approximates the flexion axis of the knee. All three bony landmarks have the disadvantage that they will not create a symmetric flexion gap in all cases. The balanced flexion gap technique seeks to achieve a perfectly balanced extension gap first, and then aligns the femoral component parallel to the tibial resection plane when the knee is under symmetric distraction in 90 degrees of flexion. The soft tissue releases for varus or valgus contraction have to be performed in extension first until the mechanical axis passes through the center of the knee, the center of the femoral head, and the center of the ankle. Using these methods, both,extension and flexion gap will become rectangular. The balanced flexion gap method has the disadvantage that the femoral component will not be aligned parallel to the epicondylar axis in some cases. It is not known which of the two methods will produce better clinical results. Rotational positioning of the tibial component referenced on the tibial tuberosity represents the most reliable method. Placing the tibial component according to the femoral component using the floating technique may increase an internal malrotation problem of the femur if present.

The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.

Impingement by prominence at the femoral head-neck junction on the anterior acetabular rim may cause early osteoarthritis. Our aim was to develop a simple method to describe concavity at this junction, and then to test it by its ability to distinguish quantitatively a group of patients with clinical evidence of impingement from asymptomatic individuals who had normal hips on examination. MR scans of 39 patients with groin pain, decreased internal rotation and a positive impingement test were compared with those of 35 asymptomatic control subjects. The waist of the femoral head-neck junction was identified on tilted axial MR scans passing through the centre of the head. The anterior margin of the waist of the femoral neck was defined and measured by an angle (alpha). In addition, the width of the femoral head-neck junction was measured at two sites. Repeated measurements showed good reproducibility among four observers. The angle alpha averaged 74.0 degrees for the patients and 42.0 degrees for the control group (p < 0.001). Significant differences were also found between the patient and control groups for the scaled width of the femoral neck at both sites. Using standardised MRI, the symptomatic hips of patients who have impingement have significantly less concavity at the femoral head-neck junction than do normal hips. This test may be of value in patients with loss of internal rotation for which a cause is not found.

[Combined deficiency of thyroid stimulating hormone and growth hormone in a diabetic patient with Hashimoto thyroiditis]. / Déficits combinés en thyréostimuline et en hormone de croissance chez une diabétique atteinte de thyroïdite de Hashimoto.

We report the case of a 36-year-old female patient with insulin dependent diabetes who developed hypothyroidism of pituitary origin after giving birth. She had low levels of free T4 and TSH with no response to i.v. TRH. Antimicrosome antibodies were increased (1/25000), suggesting Hashimoto's thyroiditis. The other hormones were normal except for a low level of growth hormone and insulin growth factor 1. There were no antibodies against the pituitary. MRI of the pituitary was normal. We suspect a vascular origin for this partial pituitary deficiency.

Endothelium-independent relaxation and hyperpolarization to C-type natriuretic peptide in porcine coronary arteries.

Endothelial cells produce C-type natriuretic peptide (CNP), which has been proposed as an endothelium-derived hyperpolarizing factor. In porcine coronary arteries, we investigated the vasodilatory effects of CNP and compared them with endothelium-dependent relaxations and hyperpolarizations to bradykinin. Isolated epicardial porcine coronary arteries were studied in organ chambers, and concentration-response curves to CNP and bradykinin were obtained. Membrane potential was measured in endothelial cells and smooth muscle of intact porcine coronary arteries during stimulation with CNP or bradykinin. In precontracted porcine coronary arteries with or without endothelium, CNP (10[-10]-10[-6] M) evoked relaxations (maximum, 42 +/- 4%) smaller than those evoked by bradykinin (100 +/- 1%), blunted in preparations contracted by KCl instead of U46619 (9,11-dideoxy-11a,9a-epoxymethano-prostaglandin F2alpha; p < 0.05) and unaffected by inhibition of NO synthase (NS). CNP evoked hyperpolarization of vascular smooth muscle of similar magnitude in endothelium-intact (-4.4 +/- 1 mV) and endothelium-denuded (-4.6 +/- 1 mV) porcine coronary arteries. Bradykinin (10[-10]-10[-6] M) evoked concentration-dependent relaxations in preparations with endothelium only. Although atrial natriuretic peptide-receptor antagonist HS-142-1 (25 microM) slightly reduced the sensitivity to bradykinin (log shift at IC50, twofold; p < 0.05), it had no effect on the maximal response to bradykinin. Inhibition of NO synthase partially attenuated, whereas high potassium chloride (30 mM) markedly inhibited relaxations to bradykinin (p < 0.05). Hyperpolarization to bradykinin was much more pronounced than that to CNP (-17 +/- 3 mV; p < 0.05 vs. CNP) and was observed in endothelium-intact preparations only and unaffected by HS-142-1. In conclusion, in contrast to bradykinin, CNP induces endothelium-independent and weaker relaxation and hyperpolarization of coronary artery vascular smooth muscle, suggesting that CNP is an unlikely mediator of endothelium-dependent hyperpolarization of porcine coronary arteries.

Dichotomous effect of monocyte Fc receptor interaction on anti-CD3-induced immunoglobulin synthesis.

Monoclonal antibodies against the TCR/CD3 complex are capable of activating T cells which in turn may induce immunoglobulin synthesis in B cells under appropriate conditions. Here we present evidence that distinct immune responses, induced by four commonly used TCR/CD3 mAb (Leu4, OKT3, BMA030, BMA031) were related to the mAb interaction with monocyte Fc receptors for IgG. Depending on their isotype and on the technique by which they were crosslinked, TCR/CD3 mAb induced variable IgM and IgG synthesis in PBMC: If the mAb were crosslinked by monocyte IgG-Fc receptors they induced a high Ig production, while crosslinking the same mAb by plastic-bound goat anti-mouse antibodies (panning) failed to do so. Nevertheless, both crosslinking techniques triggered a strong proliferation and IL-2, IL-4, and IFN gamma lymphokine gene expression. The lack of Ig production under panning conditions was due to an additional IgG-Fc receptor interaction with monocytes: (a) If namely mAb F(ab')2 fragments, or mAb isotypes unable to bind to monocyte Fc receptors (IgG2b, IgG1 in nonresponders) were crosslinked by panning, both a good proliferation as well as Ig production ensued; (b) if TCR/CD3 mAb isotypes which could additionally bind to monocyte Fc receptor (IgG2a) were crosslinked, no Ig production occurred; (c) if mAb F(ab')2 fragments were crosslinked with a second anti-T cell antibody of IgG2a isotype, which could bind to monocyte Fc receptors, Ig synthesis was reduced. Interestingly enough, this diminishing effect, due to monocyte Fc receptor interaction, was only observed if CD4-positive cells were proliferating, but not if CD8-positive cells were activated.

Lymphokine gene expression related to CD4 T cell subset (CD45R/CDw29) phenotype conversion.

In this study, we investigated whether the phenotype-related differentiation of human 2H4+ (CD45R) naive cells to 2H4- (CDw29) memory CD4 cells corresponded to modulation of interleukin (IL) 2, IL 4, interferon (IFN)-gamma and granulocyte-monocyte colony-stimulating factor (GM-CSF) gene expression, a phenomenon which might correlate to the distinct functional activities of naive cells or memory cells. To mimic in vitro CD4 T cell subset differentiation, freshly isolated 2H4+ and 2H4- CD4 cells were stimulated with the anti-CD3 antibody (Leu-4), expanded in IL 2-containing medium and restimulated with Leu-4 after 7 and 13 days. Absence of monocyte-T cell interaction was compensated by adding monocyte supernatant to the culture medium and by cross-linking the anti-CD3 antibodies with goat anti-mouse antibody coated on culture dishes. It has been previously shown that in vitro stimulated 2H4+ cells acquire CDw29 surface antigens. Measurement of lymphokine gene expression by dot-blot hybridization revealed that although stimulated 2H4+ cells proliferated less than stimulated 2H4- cells, and expressed less actin mRNA, they expressed more IL 2 but less IL 4 and GM-CSF than 2H4- cells. No significant difference was observed between the two subsets for the expression of IFN-gamma. If subsets were restimulated with Leu-4 antibodies, expression of IL 2 was decreased and expression of IL 4 was increased in both subsets; however, the differences among the subsets persisted. They were even more enhanced for IL 2 but less pronounced for GM-CSF. Thus, in spite of phenotype conversion, CD4 T cell subsets maintained a distinct capacity to express IL 2 and IL 4 genes.

Amino acids and lipoproteins in plasma of duodenopancreatectomized patients: effects of glucagon in physiological amounts.

Duodenopancreatectomy induces a severe glucagon deficiency and elevated plasma concentrations of alanine, aspartate, glycine, proline, serine, arginine, citrulline, ornithine, phenylalanine and tyrosine. Restoring high physiological plasma glucagon in six such patients by infusing 0.3 mg/24 h of exogenous glucagon reduced significantly (P less than 0.01 or 0.001) the mentioned amino acids (except phenylalanine) and further asparagine, glutamine, methionine and threonine. In six normal subjects the same infusion reduced significantly (P less than 0.05 to 0.001) plasma alanine, asparagine, glutamate, glutamine, glycine, proline, serine, threonine, arginine, ornithine, lysine and tyrosine. However, the effect was significantly (P less than 0.01 or 0.001) less marked for alanine, glutamine, glycine, methionine, serine, threonine and arginine. This particular glucagon sensitivity of duodenopancreatectomized patients suggests that glucagon deficiency is the cause of their hyperaminacidaemia. By contrast, lipoprotein concentrations were virtually unaffected by either glucagon deficiency or its replacement. In the light of the marked hypoaminacidaemia in glucagonoma patients these results attribute to glucagon a major role as a regulator of protein metabolism.