Can we really walk straight?

Twenty healthy men were asked to walk as straight as possible to a target 60 m away at normal speed. A series of footprints was recorded for each subject by having him wear socks soaked with red ink and walk on white paper fixed flat to the floor. Fourier analysis was applied to determine whether the subjects actually were able to walk straight, and the results revealed that all walked in a sinuous line rather than a straight line. Periodicity and amplitude of the meandering differed from subject to subject. These facts suggest that none of us can walk in a strictly straight line; rather, we meander, primarily due to a slight structural or functional imbalance of our limbs, which produces a gait asymmetry, and secondarily due to feedback from our sense of sight, which acts to correct the shifted walking course.     

Counselling as death approaches: is the New Yorker really the best we can do?

An expert in palliative care has taken exception to a recent CMAJ article dealing with euthanasia. That column praised a magazine article in which a son explained why he and his family had helped their mother commit suicide in the face of a terminal illness. Dr. Balfour Mount says the article was misleading and offers no credible solutions to the issues surrounding palliative care.     

Can we really predict risk of cancer?

Background: Growing awareness of the potential to predict a person's future risk of cancer has resulted in the development of numerous algorithms. Such algorithms aim to improve the ability of policy makers, doctors and patients to make rational decisions about behaviour modification or surveillance, with the expectation that this activity will lead to overall benefit. There remains debate however, about whether accurate risk prediction is achievable for most cancers. Methods: We conducted a brief narrative review of the literature regarding the history and challenges of risk prediction, highlighting our own recent experiences in developing tools for oesophageal adenocarcinoma. Results and conclusions: While tools for predicting future risk of cardiovascular outcomes have been translated successfully to clinical practice, the experience with cancer risk prediction has been mixed. Models have now been developed and validated for predicting risk of melanoma and cancers of the breast, colo-rectum, lung, liver, oesophagus and prostate, and while several of these have adequate performance at the population-level, none to date have adequate discrimination for predicting risk in individual patients. Challenges of individual risk prediction for cancer are many, and include long latency, multiple risk factors of mostly small effect, and incomplete knowledge of the causal pathways.     

Can statin therapy really reduce the risk of Alzheimer's disease and slow its progression?

PURPOSE OF REVIEW: Statins are the most used cholesterol-lowering agents worldwide. Earlier studies suggested that they may have preventive effects in Alzheimer's disease. However, prospective studies have questioned this hypothesis. RECENT FINDINGS: Statins regulate beta-amyloid metabolism and microglial activation. Pathologically, patients with Alzheimer's disease have more severe atherosclerosis in cerebral arteries than do controls. Such lesions may cause cerebral hypoperfusion, a risk factor for dementia and cognitive decline. Although most population-based studies have failed to show a beneficial effect of statins in Alzheimer's disease, two randomized controlled trials suggested that statins slow cognitive decline in mild to moderate Alzheimer's disease. SUMMARY: There is still some hope that statins reduce the incidence of Alzheimer's disease and slow its progression. Large-scale randomized controlled trials of simvastatin and atorvastatin for mild to moderate Alzheimer's disease are underway, which might provide more conclusive results than earlier studies.     

Does the nail bed really regenerate?

From observations of nail bed injuries, the regeneration of the nail bed seemed evident. The nail bed regenerated well in the presence of the nail matrix and poorly in its absence, suggesting that the nail bed regenerated from the nail matrix. Full-thickness skin graft or flap coverage of nail bed defects resulted in the good nail bed regeneration. The nail bed grew back, pushing the graft or the flap distally. The regenerated nail beds were about 70 percent of normal size in guillotine-type amputations and about 90 percent in the presence of an intact distal phalanx. The difference between full- and split-thickness skin grafts seemed to be adherence to the phalangeal bone, the former giving way to the advancing nail bed and the latter staying in the way. In addition, the destination of the moving nail bed cells was discussed.     

Can the fall in Avon's sudden infant death rate be explained by changes in sleeping position?

OBJECTIVE--To examine the impact of changing practice with regard to infant sleeping position on mortality from the sudden infant death syndrome. DESIGN--A population based study of all infants dying suddenly and unexpectedly during February 1990 to July 1991, and two groups of controls; one comprising every 125th baby born to Avon residents and the other comprising pairs of infants matched to each index case for age, neighbourhood, and date of study. Information about sleeping position was collected at home visits soon after the index baby''s death or, for the population based controls, on several occasions in the first six months of life. The design was comparable to that of an earlier study of the same population. SETTING--County of Avon. SUBJECTS--35 infants who died suddenly and unexpectedly (32 of the sudden infant death syndrome), 70 matched controls, and 152 population based controls. RESULTS--The prevalence of prone sleeping in the matched controls was much lower than that found in an earlier study in Avon (28% (18/64) 1990-1 v 58% (76/131) 1987-9; p less than 0.001) and was comparable with the prevalence in population based controls (29%). This would be expected to lead to a reduction in the incidence of the sudden infant death syndrome to 2.0/1000 live births (95% confidence interval 1.8/1000 to 2.5/1000). The actual mortality fell from 3.5/1000 in 1987-9 to 1.7/1000. CONCLUSION--The fall in mortality can be almost entirely accounted for by the reduction in prone sleeping, suggesting a causal relation exists between them. Side and supine positions confer protection but the side position is unstable and the infant may roll prone. We therefore recommend supine as the safest sleeping position for babies.