Occult cardiac contractile dysfunction in dystrophin-deficient children revealed by cardiac magnetic resonance strain imaging.

BACKGROUND: Duchenne muscular dystrophy (DMD) is an inherited disease characterized by early onset of skeletal muscle degeneration and progressive weakness. Although dilated cardiomyopathy may occur during adolescence, it is often undetected early in its course because of physical inactivity and generalized debilitation. The purpose of this study was to apply the technique of cardiac magnetic resonance (CMR) tagging to detect occult cardiac dysfunction in young subjects with DMD by measuring myocardial strain and torsion. METHODS AND RESULTS: Thirteen DMD pediatric subjects without clinically apparent heart disease and 9 age-matched healthy males were recruited. Each was scanned on a 1.5-T clinical scanner to acquire contiguous short-axis planes from the apex to the mitral valve plane and then 3 tagged images at base, midventricle, and apex. Global and segmental myocardial net twist and circumferential strain were computed with the use of 2D homogeneous strain analysis. Ventricular torsion was computed by normalizing net twist by the distance from apex to mitral valve plane. DMD patients exhibited normal left ventricular volumes and ejection fractions but manifested reduced midventricular and basal cross-sectional global circumferential strain compared with the reference group (P<0.005). These alterations also appeared in segmental analyses in the septal, anterior, lateral, and inferior walls (P<0.05). CONCLUSIONS: In patients predisposed to cardiomyopathies because of dystrophinopathy, occult regional cardiac dysfunction can be diagnosed with CMR tagging. This method of strain imaging analysis may offer a sensitive approach for delineating the presence and progression of cardiovascular disease and for assessing therapies designed to modulate the onset and course of heart failure.

The impact on civilians of the bombing of Kosovo and Serbia.

Before the 1999 bombing, Kosovo was among the poorest regions in Europe, with low scores on indices of health care. After the war, housing for much of the population is below even basically acceptable standards and health care is disrupted, with serious risk of epidemic diseases. Societal disintegration has led to high levels of stress. In Serbia, also a poor country, which already suffered from high levels of pollution before the war, large amounts of several highly toxic chemicals were liberated into the environment by the bombing. Targeting of electrical generating plant, water treatment facilities, Danube bridges, railways and roads has adverse effects on civilian life, endangers health and seriously affects health care. The military strategy of attack on civilian infrastructures is a war on public health.

Future directions for IPPNW. International Physicians for the Prevention of Nuclear War.

This paper is offered as my personal reflections for future directions of International Physicians for the Prevention of Nuclear War. The deep discussions that surrounded the war in Kosovo and Serbia have led me to examine some of the issues that confront IPPNW today in a different light. Rather than cataloguing all the work of IPPNW and the future steps in each, I focus on areas where we have a new opportunity, a new challenge, or a difficult decision to make in choosing a strategic direction for IPPNW. After a brief summary of our history and principles, I address the new challenges within IPPNW's triangle of concern--disarmament, environment and development. I then outline a series of strategies that have been proposed to advance our goals. Finally, I raise other issues that seem to warrant further discussion and policy development.

Preventing violence, preventing war.

This paper describes the association between adolescent boredom and violence, using evidence from rock music. Parallels are drawn between successful programmes for the prevention of adolescent violence and strategies for prevention of nuclear war.

Determinants of femoral geometry and structure during adolescent growth.

Our goal was to understand developmental determinants of femoral structure during growth and sexual maturation by relating femoral measurements to gender and developmental factors (age, pubertal stage, height, and body mass). The bone mineral content of the femur was measured by dual energy x-ray absorptiometry in 101 healthy Caucasian adolescents and young adults, 9-26 years of age. After some simplifying assumptions had been made, cross-sectional geometric properties of the femoral midshaft were estimated. Two geometry-based structural indicators, the section modulus and whole bone strength index, were calculated to assess the structural characteristics of the femur. Femoral strength, as described by these structural indicators, increased dramatically from childhood through young adulthood. Regressions were performed between these femoral measurements and the developmental factors. Our data show that of age, pubertal stage, body mass, and height, body mass is the strongest predictor of femoral cross-sectional properties, and the correlation of body mass with femoral cross-sectional structure is independent of gender. A model including all four developmental factors and gender did not substantially increase the accuracy of predictions compared with the model with body mass alone. In light of previous research, we hypothesize that body mass is an indicator of in vivo loading and that this in vivo loading influences the cross-sectional growth of the long bones.