Citations

Background— Coronary artery calcification (CAC), a marker of coronary artery atherosclerosis, can be measured accurately and noninvasively with the use of electron beam computed tomography. Serial measures of CAC quantify progression of calcified coronary artery plaque. Little is known about the role of genetic factors in progression of CAC quantity. Methods and Results— We quantified the relative contributions of measured risk factors and unmeasured genes to CAC progression measured by 2 electron beam computed tomography examinations an average of 7.3 years apart in 877 asymptomatic white adults (46% men) from 625 families in a community-based sample. After adjustment for baseline risk factors and CAC quantity, the estimated heritability of CAC progression was 0.40 ( P <0.001). Baseline risk factors and CAC quantity explained 64% of the variation in CAC progression. Thus, genetic factors explained 14% of the variation [(100−64)×(0.40)] in CAC progression. After adjustment for risk factors, the estimated genetic correlation (pleiotropy) between baseline CAC quantity and CAC progression was 0.80 and was significantly different than 0 ( P <0.001) and 1 ( P =0.037). The environmental correlation between baseline CAC quantity and CAC progression was 0.42 and was significantly different than 0 ( P =0.006). Conclusions— Evidence was found that many but not all genetic factors influencing baseline CAC quantity also influence CAC progression. The identification of common and unique genetic influences on these traits will provide important insights into the genetic architecture of coronary artery atherosclerosis.

The objective of this study is to present an algorithm for choosing graft materials for the reconstruction of severe caudal and/or dorsal septal cartilage abnormalities and to examine the long-term results obtained with these techniques. Retrospective review of 21 consecutive cases of caudal and/or dorsal septal reconstruction via the external approach using the algorithms is presented. The techniques used are carefully described. Patient survey at least 1 year after the initial procedure, rhinologic examination before and after the procedure, and photographic analysis of preoperative and postoperative views are presented. The graft choice algorithm presented helps the surgeon to consider appropriate graft choice alternatives before surgery.

Background: Reliable measurement of subfascial pressures represents an essential part of compartment syndrome management. To date, there is neither consensus on the number or location of foot compartments, nor a standardized protocol for needle placement. The purpose of this study was to devise a new system using 3-Tesla MRI that assesses the number and location of these compartments. Methods: To document the specific location of foot compartments, high resolution 3-Tesla MRI (General Electric, Milwaukee, WI) was coupled with a dedicated transmit-receive high signal-to-noise foot/ankle coil (IGC-Medical Advances, Milwaukee, WI). Individual compartments were highlighted and mapped to T1-weighted MRI. Three-dimensional image analysis allowed standardized needle placement recommendations. Results: Six feet from healthy volunteers were imaged. From these, ten compartments were described: (1) medial, (2) central superficial, (3) central deep (adductor), (4) lateral, (5–8) interossei, (9) calcaneal, and (10) skin. Optimal needle placement and depth were identified. Conclusions: The proposed system allowed us to assess the number and location of foot compartments. Computer image analysis enabled us to define exact points for needle insertion and depth of penetration for accurate pressure monitoring.

Purpose The purposes of this study were to investigate the differences between open and arthroscopic closure of the rotator interval (RI) on glenohumeral translation and range of motion. We also sought to determine if the addition of either an open or arthroscopic RI closure increases stability of the shoulder. Methods Fourteen fresh‐frozen (10 paired) cadaveric shoulder specimens were mounted in a custom testing apparatus, and glenohumeral translation and rotation were obtained by using an optoelectric tracking system (Optotrak Certus; Northern Digital, Ontario, Canada). Specimens were randomly allocated to either open (n = 7) or arthroscopic (n = 7) plication of the RI. The following were measured first with an intact and vented specimen and subsequently after an RI closure using either open or arthroscopic techniques: (1) range of motion in neutral and 90° abduction; (2) anterior and posterior translation at neutral rotation; (3) anterior translation at 90° abduction with external rotation; and (4) posterior translation at 90° flexion with internal rotation. Results Posterior stability was not improved from the intact state by either open (1.0‐mm change) or arthroscopic (0.1‐mm change) repair. The sulcus stability was improved in the open group (5.7 mm to 2.9 mm, P = .028), but not arthroscopically (5.1 to 4.1 mm, P = .499). Neutral anterior stability was improved after open repair (7.2 to 2.6 mm, P = .018), but not arthroscopically (2.3 to 2.4 mm, P = 0.5). However, anterior stability in external rotation (ER) at 90° abduction was improved in the arthroscopic repair group (5.5 to 3.1 mm, P = .006). The mean loss of ER in neutral was greater in the open group (40.8°) versus the arthroscopic group (24.4°, P = .0038). The arthroscopic group showed an 11.7° loss of ER in 90° abduction ( P = .018) versus the open group loss of 4.8°. There were no significant differences in loss of IR in either neutral or 90° abduction. Conclusions Posterior stability was not improved by either open or arthroscopic rotator interval repair, and sulcus stability only improved with the open technique. Anterior stability in neutral was improved after open repair and in the arthroscopic repair group with the arm abducted. There was a large loss of external rotation with both techniques. Clinical Relevance This study suggests that arthroscopic RI closure adds little to the overall posterior and inferior stability of the shoulder joint, although anterior stability may be improved. There is a potentially large loss of external rotation after either repair method.