Quantifying osteosynthesis plate prominence - mathematical definitions and case study on a clavicle plate.

Hardware prominence remains a clinical challenge in focus for implant design in subcutaneous plate applications. Existing evaluation of hardware prominence relies on plate-to-bone distance at a single point or on average. A reproducible measure for plate prominence remains undefined. This study mathematically defines the plate prominence linked to the cross-sectional area change due to the plate presence on the bone. Two anatomical plate designs were fitted to 100 clavicles, and afterwards plate prominence parameters were evaluated and compared. This methodology enables the quantification of hardware prominence for different plate designs to inform the development of implants targeting low prominence.

Mumbling: Macho or Morphology?

Purpose: Mumbling as opposed to clear speech is a typical male characteristic in speech and can be the consequence of a small jaw opening. Whereas behavioral reasons have often been offered to explain sex-specific differences with respect to clear speech, the purpose of this study is to investigate a potential anatomical reason for smaller jaw openings in male than in female speakers. Method: Articulatory data from 2 data sets (American English and German) were analyzed with respect to jaw opening in low vowels during speech. Particular focus was placed on sex-specific differences, also incorporating potential interactions with different accent conditions in 1 of the data sets. In addition, a modeling study compared the articulatory consequences of similar jaw-opening settings in a typical male and a typical female articulatory model. Results: Greater jaw openings were found for the female speakers, in particular in the accented condition, where jaw opening was found to be larger. In line with this finding, the modeling study showed that similar jaw-opening settings in male and female speakers led to differences in pharyngeal constriction, resulting in complete radico-pharyngeal closure in the male model. Conclusion: The empirical and modeling findings suggest a possible physiological component in sex-specific differences in speech clarity for low vowels.

Reperfusion therapy for acute ST-elevation and non ST-elevation myocardial infarction: what can be achieved in daily clinical practice in unselected patients at an interventional center?

BACKGROUND: In the year 2000 a new definition of acute myocardial infarction (AMI) was introduced, now differentiating ST segment elevation AMI (STEMI) from non-ST segment elevation AMI (NSTEMI). The characterization of AMI patients according to this definition is still incomplete. METHODS AND RESULTS: 888 consecutive AMI patients at a single interventional center were included: 493 (55.5%) STEMI and 395 (44.5%) NSTEMI patients. Median age of STEMI patients was four years lower compared to NSTEMI patients (62.8 versus 66.6 years, P<0.001). STEMI patients more often presented in cardiogenic shock (11.0% versus 2.0%, P<0.001) and after pre-hospital resuscitation (4.9% versus 0.8%, P<0.001). Catheterization was performed in 98.4% of STEMI and in 95.9% of NSTEMI patients (P<0.001). The circumflex artery was more often the culprit lesion in NSTEMI patients compared to STEMI patients (58.3% versus 48%, P=0.003). They also showed significantly more often a 3 vessel disease (41.4% versus 29.9%, P=0.002). Out of STEMI patients 10.1% were treated with medical therapy only compared to 27.2% of NSTEMI patients (P<0.001). Whereas PCI was performed more often in STEMI patients (84.3% versus 57.8%, P<0.001), CABG was used more often in NSTEMI patients (21.6% versus 9.1%, P<0.001). In-hospital death was 8.7% in STEMI compared to 4.8% in NSTEMI patients (P<0.001). CONCLUSIONS: In clinical practice STEMI and NSTEMI seem to occur with similar frequency. Invasive strategies were applied in a high percentage in both groups, however with different therapeutic consequences. In-hospital mortality was twice as high in STEMI compared to NSTEMI patients.

Statin use and survival in patients with chronic heart failure--results from two observational studies with 5200 patients.

BACKGROUND: There is minimal evidence that HMG-CoA reductase inhibitors (statins) are beneficial in patients with chronic heart failure (CHF). Treatment with statins may lead to a lower mortality in CHF, independent of cholesterol levels, CHF etiology and clinical status. METHODS: In a first study, we included 3132 patients with CHF from the ELITE 2 study in whom information on body mass index (BMI) and statin use at baseline were available. In a second study, we pooled the databases of 5 tertiary referral centers with 2068 CHF patients. In this cohort 705 patients were on a statin (34%), 585 of 1202 (49%) patients with ischemic etiology, and 120 of 866 (14%) patients with non-ischemic etiology (established by coronary angiography). FINDINGS: Patients in ELITE 2 who received statin therapy at baseline (n=397, 13%) had lower mortality (hazard ratio [HR] 0.61, 95% CI 0.45-0.83; p=0.0007). In univariate analysis, increasing age, NYHA class, creatinine, and decreasing BMI, LVEF, and cholesterol, as well as lack of beta-blocker treatment and ischemic etiology (all p<0.002) related to higher mortality. In multivariable analysis, statin therapy related to lower mortality independently of all these variables (adjusted HR 0.66, 95% CI 0.47-0.93; p=0.017). In the second study CHF patients on statins had lower mortality (adjusted HR 0.58, 95% CI 0.44-0.77; p=0.0001). Both in patients with ischemic (p<0.0001) and non-ischemic etiology (p=0.028) statin treatment related to better survival. INTERPRETATION: In chronic heart failure, treatment with statins is related to lower mortality, independent of cholesterol levels, disease etiology and clinical status.

EGG open quotient in aging voices--changes with increasing chronological age and its perception.

This paper presents the results of open quotient (OQ) measurements in electroglottographic (EGG) signals of young (18-30 years) and elderly (60-82 years) male and female speakers. The paper further presents quantitative results of the relation between the EGG OQ and the perception of a speaker's age. Higgins and Saxman found a decreased EGG OQ with increased age for females, while the EGG OQ increased for males as the speaker's age increased in sustained vowel material 1. Although laryngeal degeneration due to increased age seems to occur to a lesser extent in females, the significant decrease of the OQ in elderly female voices could not be explained in terms of age-related physiological changes. Linville found increased spectral amplitudes in the region of F0 for the elderly (obtained by long-term average spectra (LTAS) measurements of read speech material), independent of gender, which could be indirectly interpreted as an increasing OQ 3. We measured the EGG OQ, not only for sustained vowels but also in vowels taken from isolated words and read speech material. To analyse the relation between breathiness in terms of an increased EGG OQ and the mean perceived age per stimulus, a perception test was carried out, in which listeners were asked to estimate speaker's age based on sustained /a/-vowels varying in vocal effort (soft-normal-loud) during production. 1) The decreased EGG OQ for elderly females originally found by Higgins and Saxman 1 is not apparent in our data for sustained /a/-vowels; for males, however, we also found an increased EGG OQ for the elderly speakers. 2) In addition, an increased EGG OQ for the group of elderly in comparison to the younger males occurs for the unstressed syllable of the word material. 3) Our results show a strong positive relation between perceived age and EGG OQ in male vowel stimuli. Regarding 2), depending on the speech task at least a male speaker's voice gets more breathy as age increases. Considering 3), increased breathiness may contribute to the listener's perception of increased age.

Isotope characteristics of vegetables and wheat from conventional and organic production.

Multielement isotope ratio analysis was checked for its suitability as a means for the discrimination between agricultural products from integrated/conventional or organic production, respectively. Differences were mainly found for delta15N-values. Paprika and tomatoes from organic production in greenhouses showed delta15N-values above+7 per thousand, whereas corresponding products from conventional cultivation had delta15N-values near 0 per thousand. Lettuce, onions, cabbage and Chinese cabbage from field production had delta15N-values in the range of+5 to+6 and+5.5 to+7.5 per thousand, respectively (conventional and organic production); these overlapping differences do not permit a reliable discrimination. The same is true for wheat, showing average delta15N-values of+2.3+/-1.0 and+3.6+/-1.6 per thousand, respectively. The unexpected relative high 15N-enrichments of vegetables from integrated production are discussed as originating, at least partially, from 15N-enrichment in the soil by NH3 evaporation and denitrification.