Clinical questions are central to learning among veterinarians and drive informal learning during clinical practice. We set out to classify the clinical questions of practicing veterinarians using a taxonomy previously validated in human medicine. This prospective observational study used a convenience sample of 12 veterinarians in private, small-animal practices. We used three methods to gather clinical questions from the veterinarians: direct observation (asking veterinarians after each encounter), self-report via e-mail, and self-report via data-collection pocket cards. We then classified these questions using a validated taxonomy of question types, as well as by clinical category. A total of 157 clinical questions were collected; 99 were about dogs, 33 were about cats, and 25 were about multiple species or did not specify a species. Nearly half of the questions were rated as high priority, and only 11.5% as low priority. Over half of the questions (53%) were about treatment and 20% were about diagnosis. The two most common question types were "Is drug X indicated in situation Y or for condition Y?" and "How should I treat finding/condition Y (given situation Z)?" Overall, 5 of 57 question-type categories accounted for over half of the questions. The most common clinical categories were pharmacology, endocrine, musculoskeletal, and general surgery. This is the first study to systematically identify and classify the clinical questions of veterinarians. A better understanding of these questions can be used to inform the development of continuing-education (CE) activities that are directly responsive to the information needs of participants. PMID:23975074
Ebell, Mark H; Budsberg, Steven; Cervero, Ronald; Shinholser, Joanna; Call, Marlene
Descriptive data about the use of medical information software were gathered from physicians who were early users of these resources. Eight clinically active internists and medical subspecialists were lent a microcomputer loaded with six commercially available medical information software products. Participants used the software for two weeks to answer questions arising in their practice and completed written questionnaires. They recorded a total of 50 questions (between 3 and 11 per participant per two-week study period). Using the workstation, participants answered 20 questions (40% of the total), partially answered 16 questions (32%), and did not obtain useful information for 14 questions (28%). Participants found answers outside the workstation to 8 of the 14 questions (57%) not answered by using the software. The most common question topic was drug information (16 questions, or 32% of the total). The most common problems encountered using the workstation were retrieval of incomplete information (20 questions, or 40% of the total) and difficulty navigating the software (16 questions, or 32%). Other problems included difficulty translating clinical problems into questions, inappropriate resource selection, inadequate training for using the software, and excessive time required to access information. The study highlights several opportunities for medical librarians and others involved in clinical information management to facilitate the use of computer software for solving clinical problems.
Osheroff, J A; Bankowitz, R A
Objective Clinicians pose complex clinical questions when seeing patients, and identifying the answers to those questions in a timely manner helps improve the quality of patient care. We report here on two natural language processing models, namely, automatic topic assignment and keyword identification, that together automatically and effectively extract information needs from ad hoc clinical questions. Our study is motivated in the context of developing the larger clinical question answering system AskHERMES (Help clinicians to Extract and aRrticulate Multimedia information for answering clinical quEstionS). Design and Measurements We developed supervised machine-learning systems to automatically assign predefined general categories (e.g., etiology, procedure, and diagnosis) to a question. We also explored both supervised and unsupervised systems to automatically identify keywords that capture the main content of the question. Results We evaluated our systems on 4,654 annotated clinical questions that were collected in practice. We achieved an F1 score of 76.0% for the task of general topic classification and 58.0% for keyword extraction. Our systems have been implemented into the larger question answering system AskHERMES. Our error analyses suggested that inconsistent annotation in our training data have hurt both question analysis tasks. Conclusion Our systems, available at http://www.askhermes.org, can automatically extract information needs from both short (the number of word tokens <20) and long questions (the number of word tokens >20), and from both well-structured and ill-formed questions. We speculate that the performance of general topic classification and keyword extraction can be further improved if consistently annotated data are made available.
Cao, Yong-gang; Cimino, James J; Ely, John; Yu, Hong
Objective: This study explored the information needs of rehabilitation therapists (occupational therapists, physical therapists, and speech-language pathologists) working with patients who have had strokes in order to characterize their clinical questions, defined as their formalized information needs arising in the context of everyday clinical practice. Methods: The researchers took a constructivist, interpretive approach, in which fifteen rehabilitation therapists working in various settings were recruited. Data were gathered using diaries, followed by diary-guided interviews, and thematically analyzed using template analysis. Results: Rehabilitation therapists' clinical questions were characterized as having one or more of twelve foci and containing one or more of eight possible structural elements. Conclusions: Findings demonstrate that the evidence-based practice framework currently applied for questions relating to rehabilitation is inadequate for representing rehabilitation therapists' clinical questions. A new framework that is more comprehensive and descriptive is proposed. Implications: Librarians working with students and clinicians in rehabilitation can employ knowledge of the twelve foci and the question structure for rehabilitation to guide the reference interview. Instruction on question formulation in evidence-based practice can employ the revised structure for rehabilitation, offering students and clinicians an alternative to the traditional patient, intervention, comparison, outcome (PICO) structure. Information products, including bibliographic databases and synopsis services, can tailor their interfaces according to question foci and prompt users to enter search terms corresponding to any of the eight possible elements found in rehabilitation therapists' clinical questions.
Kloda, Lorie Andrea; Bartlett, Joan C
Objective Clinical questions are often long and complex and take many forms. We have built a clinical question answering system named AskHERMES to perform robust semantic analysis on complex clinical questions and output question-focused extractive summaries as answers. Design This paper describes the system architecture and a preliminary evaluation of AskHERMES, which implements innovative approaches in question analysis, summarization, and answer presentation. Five types of resources were indexed in this system: MEDLINE abstracts, PubMed Central full-text articles, eMedicine documents, clinical guidelines and Wikipedia articles. Measurement We compared the AskHERMES system with Google (Google and Google Scholar) and UpToDate and asked physicians to score the three systems by ease of use, quality of answer, time spent, and overall performance. Results AskHERMES allows physicians to enter a question in a natural way with minimal query formulation and allows physicians to efficiently navigate among all the answer sentences to quickly meet their information needs. In contrast, physicians need to formulate queries to search for information in Google and UpToDate. The development of the AskHERMES system is still at an early stage, and the knowledge resource is limited compared with Google or UpToDate. Nevertheless, the evaluation results show that AskHERMES’ performance is comparable to the other systems. In particular, when answering complex clinical questions, it demonstrates the potential to outperform both Google and UpToDate systems. Conclusions AskHERMES, available at http://www.AskHERMES.org, has the potential to help physicians practice evidence-based medicine and improve the quality of patient care.
Cao, YongGang; Liu, Feifan; Simpson, Pippa; Antieau, Lamont; Bennett, Andrew; Cimino, James J.; Ely, John; Yu, Hong
The paradigm of evidence-based medicine (EBM) recommends that physicians formulate clinical ques- tions in terms of the problem\\/population, intervention, comparison, and outcome. Together, these elements comprise a PICO frame. Although this framework was developed to facilitate formulation of clinical questions, the ability of PICO structures to represent physicians' information needs has not been empiri- cally investigated. This paper evaluates adequacy
Xiaoli Huang; Jimmy Lin; Dina Demner-Fushman; Dagobert Soergel
Continuous glucose sensors (CGS) offer the potential to greatly change the lives of people with diabetes. Even though two of these systems (Guardian RT, Medtronic, Northridge, CA, and DexCom STS, DexCom, San Diego, CA) have been approved by the Food and Drug Administration for use as adjuncts to self-blood glucose monitoring (SBGM), questions remain concerning the accuracy of these devices. When considering accuracy, two distinct approaches should be emphasized: (1) numerical and (2) clinical. Because CGS data are a process in time, each of these two approaches includes two subtypes of accuracy: point and rate. Conventional statistics such as correlation coefficients, mean and median relative absolute differences, and International Standards Organization criteria are measures of numerical point accuracy. A new measure, the R deviation, is introduced to quantify numerical rate accuracy. Error-grid analysis (Clarke EGA) measures clinical point accuracy. The only measure of both clinical point accuracy and rate accuracy is continuous glucose error-grid analysis. This analysis is a combination of two components, P-EGA measuring point accuracy and R-EGA measuring rate accuracy, which are designed to assess the information that distinguishes continuous glucose measurements from intermittent SBGM determinations. Further, a better understanding of the source of the error associated with time lag and its effect on CGS readings may improve sensor output. Finally, the reliability of the CGS sensors, in terms of initial calibration and long-term application, needs to be assessed carefully if current CGS systems are to be used as hypoglycemia monitors or incorporated in the future design of closed loop (artificial pancreas) systems.
Clarke, William L.; Kovatchev, Boris
The Multi-source Integrated Platform for Answering Clinical Questions (MiPACQ) is a QA pipeline that integrates a variety of information retrieval and natural language processing systems into an extensible question answering system. We present the system’s architecture and an evaluation of MiPACQ on a human-annotated evaluation dataset based on the Medpedia health and medical encyclopedia. Compared with our baseline information retrieval system, the MiPACQ rule-based system demonstrates 84% improvement in Precision at One and the MiPACQ machine-learning-based system demonstrates 134% improvement. Other performance metrics including mean reciprocal rank and area under the precision/recall curves also showed significant improvement, validating the effectiveness of the MiPACQ design and implementation.
Cairns, Brian L.; Nielsen, Rodney D.; Masanz, James J.; Martin, James H.; Palmer, Martha S.; Ward, Wayne H.; Savova, Guergana K.
Studies of cell lines and of animal models of pancreatic cancer have raised a number of provocative questions about the nature and origins of human pancreatic cancer and have provided several leads into exciting new approaches for the treatment of this deadly cancer. In addition, clinicians with little or no contact with human pathology have challenged the way that pancreatic pathology is practiced, suggesting that “genetic signals” may be more accurate than today’s multi-modal approach to diagnoses. In this review we consider eight provocative issues in pancreas pathology, with an emphasis on “the evidence derived from man.”
McDonald, Oliver G.; Maitra, Anirban; Hruban, Ralph H.
Objective To characterise clinical questions raised by providers in the care of complex older adults in order to guide the design of interventions that can help providers answer these questions. Materials and methods To elicit clinical questions, we observed and audio recorded outpatient visits at three healthcare organisations. At the end of each appointment, providers were asked to identify clinical questions raised in the visit. Providers rated their questions based on their urgency, importance to the patient's care and difficulty in finding a useful answer to. Transcripts of the audio recordings were analysed to identify ageing-specific factors that may have contributed to the nature of the questions. Results We observed 36 patient visits with 10 providers at the three study sites. Providers raised 70 clinical questions (median of 2 clinical questions per patient seen; range 0–12), pursued 50 (71%) and successfully answered 34 (68%) of the questions they pursued. Overall, 36 (51%) of providers’ questions were not answered. Over one-third of the questions were about treatment alternatives and adverse effects. All but two clinical questions were motivated either directly or indirectly by issues related to ageing, such as the normal physiological changes of ageing and diseases with higher prevalence in the elderly. Conclusions The frequency of clinical questions was higher than in previous studies conducted in general primary care patient populations. Clinical questions were predominantly influenced by ageing-related issues. We propose a series of recommendations that may be used to guide the design of solutions to help providers answer their clinical questions in the care of older adults.
Del Fiol, Guilherme; Weber, Alice I; Brunker, Cherie P; Weir, Charlene R
How do clinical questions emerge and move toward resolution in the intensive care setting over the course of 24 hours? In a 20-bed surgical intensive care unit in a large, tertiary-care teaching hospital, informationists shadowed clinicians for 2 48-hour periods to record questions, noting when they were asked and whether they were answered. Thirty-eight percent of 112 recorded questions remained unanswered. Some unanswered questions persisted across shifts, and clinicians' information-seeking behaviors changed over time. Clinical information services can be improved and integrated more fully into clinical workflows based on a fuller understanding of the life cycle of clinical inquiry. PMID:25031562
Anton, Blair; Woodson, Sue M; Twose, Claire; Roderer, Nancy K
How do clinical questions emerge and move toward resolution in the intensive care setting over the course of 24 hours? In a 20-bed surgical intensive care unit in a large, tertiary-care teaching hospital, informationists shadowed clinicians for 2 48-hour periods to record questions, noting when they were asked and whether they were answered. Thirty-eight percent of 112 recorded questions remained unanswered. Some unanswered questions persisted across shifts, and clinicians' information-seeking behaviors changed over time. Clinical information services can be improved and integrated more fully into clinical workflows based on a fuller understanding of the life cycle of clinical inquiry.
Anton, Blair; Woodson, Sue M.; Twose, Claire; Roderer, Nancy K.
OBJECTIVE This article addresses questions that radiologists frequently ask when planning, performing, processing, and interpreting MRI perfusion studies in CNS imaging. CONCLUSION Perfusion MRI is a promising tool in assessing stroke, brain tumors, and neurodegenerative diseases. Most of the impediments that have limited the use of perfusion MRI can be overcome to allow integration of these methods into modern neuroimaging protocols.
Essig, Marco; Nguyen, Thanh Binh; Shiroishi, Mark S.; Saake, Marc; Provenzale, James M.; Enterline, David S.; Anzalone, Nicoletta; Dorfler, Arnd; Rovira, Alex; Wintermark, Max; Law, Meng
Context: Highly developed critical thinking and the ability to discriminate among many possible therapeutic interventions is a core behavior for the practicing athletic trainer. However, while athletic training students receive a great deal of clinically applicable information, many are not explicitly trained in efficient methods for channeling…
We implemented peer instruction in an introductory level conceptual physics course for nonscience majors on the basis of the success others reported with this method. We expected to see that learning from peer conversation, as evidenced by answering conceptual questions correctly following discussion, would correlate with course grade, but we did…
Morgan, Jeffrey T.; Wakefield, Cynthia
Objectives: Despite the growing use of online databases by clinicians, there has been very little research documenting how effectively they are used. This study assessed the ability of medical and nurse-practitioner students to answer clinical questions using an information retrieval system. It also attempted to identify the demographic, experience, cognitive, personality, search mechanics, and user-satisfaction factors associated with successful use of a retrieval system. Methods: Twenty-nine students completed questionnaires of clinical and computer experience as well as tests of cognitive abilities and personality type. They were then administered three clinical questions to answer in a medical library setting using the MEDLINE database and electronic and print full-text resources. Results: Medical students were able to answer more questions correctly than nurse-practitioner students before and after searching, but both had comparable improvements in the number of correct questions before and after searching. Successful ability to answer questions was also associated with having experience in literature searching and higher standardized test-score percentiles. Conclusions: Medical and nurse-practitioner students obtained comparable benefits in the ability to answer clinical questions from use of the information retrieval system. Future research must examine strategies that improve successful search and retrieval of clinical questions posed by clinicians in practice.
Hersh, William R.; Crabtree, M. Katherine; Hickam, David H.; Sacherek, Lynetta; Rose, Linda; Friedman, Charles P.
IMPORTANCE In making decisions about patient care, clinicians raise questions and are unable to pursue or find answers to most of them. Unanswered questions may lead to suboptimal patient care decisions. OBJECTIVE To systematically review studies that examined the questions clinicians raise in the context of patient care decision making. DATA SOURCES MEDLINE (from 1966), CINAHL (from 1982), and Scopus (from 1947), all through May 26, 2011. STUDY SELECTION Studies that examined questions raised and observed by clinicians (physicians, medical residents, physician assistants, nurse practitioners, nurses, dentists, and care managers) in the context of patient care were independently screened and abstracted by 2 investigators. Of 21?710 citations, 72 met the selection criteria. DATA EXTRACTION AND SYNTHESIS Question frequency was estimated by pooling data from studies with similar methods. MAIN OUTCOMES AND MEASURES Frequency of questions raised, pursued, and answered and questions by type according to a taxonomy of clinical questions. Thematic analysis of barriers to information seeking and the effects of information seeking on decision making. RESULTS In 11 studies, 7012 questions were elicited through short interviews with clinicians after each patient visit. The mean frequency of questions raised was 0.57 (95% CI, 0.38-0.77) per patient seen, and clinicians pursued 51% (36%-66%) of questions and found answers to 78% (67%-88%) of those they pursued. Overall, 34% of questions concerned drug treatment, and 24% concerned potential causes of a symptom, physical finding, or diagnostic test finding. Clinicians' lack of time and doubt that a useful answer exists were the main barriers to information seeking. CONCLUSIONS AND RELEVANCE Clinicians frequently raise questions about patient care in their practice. Although they are effective at finding answers to questions they pursue, roughly half of the questions are never pursued. This picture has been fairly stable over time despite the broad availability of online evidence resources that can answer these questions. Technology-based solutions should enable clinicians to track their questions and provide just-in-time access to high-quality evidence in the context of patient care decision making. Opportunities for improvement include the recent adoption of electronic health record systems and maintenance of certification requirements. PMID:24663331
Del Fiol, Guilherme; Workman, T Elizabeth; Gorman, Paul N
Describes an electronic database of clinical questions (CQs) and medical evidence, the Critical Appraisal Resource (CAR). Evaluation of ten months of use found that medical residents did engage the medical literature on behalf of their patients, which influenced approximately half of their patient-care decisions. (EV)
Crowley, Steven H.; Owens, Thomas A.; Schardt, Connie M.; Wardell, Sarah I.; Peterson, Josh; Garrison, Scott; Keitz, Sheri A.
The authors designed an electronic database of clinical questions (CQs) and medical evidence and implemented it in 2001-02 at Duke University Medical Center and the Veterans Administration Medical Center in Durham, North Carolina. This Web-based data collection system is called the Critical Appraisal Resource (CAR) and is still in operation. This report is of ten months of the system's operation.
Steven D. Crowley; Thomas A. Owens; Connie M. Schardt; Sarah I. Wardell; Josh Peterson; Scott Garrison; Sheri A. Keitz
Objectives: This study sought to assess the ability of medical and nurse practitioner students to use medline to obtain evidence for answering clinical questions and to identify factors associated with the successful answering of questions. Methods: A convenience sample of medical and nurse practitioner students was recruited. After completing instruments measuring demographic variables, computer and searching attitudes and experience, and cognitive traits, the subjects were given a brief orientation to medline searching and the techniques of evidence-based medicine. The subjects were then given 5 questions (from a pool of 20) to answer in two sessions using the Ovid medline system and the Oregon Health & Science University library collection. Each question was answered using three possible responses that reflected the quality of the evidence. All actions capable of being logged by the Ovid system were captured. Statistical analysis was performed using a model based on generalized estimating equations. The relevance-based measures of recall and precision were measured by defining end queries and having relevance judgments made by physicians who were not associated with the study. Results: Forty-five medical and 21 nurse practitioner students provided usable answers to 324 questions. The rate of correctness increased from 32.3 to 51.6 percent for medical students and from 31.7 to 34.7 percent for nurse practitioner students. Ability to answer questions correctly was most strongly associated with correctness of the answer before searching, user experience with medline features, the evidence-based medicine question type, and the spatial visualization score. The spatial visualization score showed multi-collinearity with student type (medical vs. nurse practitioner). Medical and nurse practitioner students obtained comparable recall and precision, neither of which was associated with correctness of the answer. Conclusions: Medical and nurse practitioner students in this study were at best moderately successful at answering clinical questions correctly with the assistance of literature searching. The results confirm the importance of evaluating both search ability and the ability to use the resulting information to accomplish a clinical task.
Hersh, William R.; Crabtree, M. Katherine; Hickam, David H.; Sacherek, Lynetta; Friedman, Charles P.; Tidmarsh, Patricia; Mosbaek, Craig; Kraemer, Dale
In the age of smartphones and tablets, it has become common place to find apps that help you do or find almost anything. The quality and breadth of medical apps has improved greatly in recent years. You can now find medical apps that recreate textbooks, search for current articles, calculate likelihood ratios and find point-of-care answers to clinical questions. This article describes and reviews apps aimed at helping clinicians search for evidence to support the practice of EBM. PMID:24530997
OBJECTIVES.?Olfactory hallucinations (OHs) are underrepresented in conventional clinical instruments, infrequently researched, and poorly understood. To advance understanding of OHs, we examined their past-month prevalence and co-occurring symptoms in two datasets. DESIGN.?One dataset comprised categorical codes and was examined using homogeneity analysis and logistic regression; the other dataset comprised numeric ratings and was examined using principal components analyses and linear regression. METHOD.?The two datasets included: (1) 962 cases with Present State Examination - 9th Edition (PSE-9), codes (recoded present/absent) from the World Health Organization 10 Country (WHO-10) Study and (2) 265 cases with ratings on Scales for Assessing Positive/Negative Symptoms of Schizophrenia (SAPS/SANS). Two PSE-9 items (external- and self-smells) were recoded into a single OH item to examine consistency with the SAPS/SANS dataset, which contained a single OH item. RESULTS.?Prevalence of OHs and hallucinations in other modalities differed according to the WHO-10 international centre. Across centres, OHs were present in 13% of the WHO-10 dataset, similar to the 17% prevalence rate in the SAPS/SANS dataset. Referential/control delusions and other hallucinations (particularly, somatic/tactile/gustatory hallucinations) were significant independent correlates of OHs in both datasets. OHs also co-occurred with social anxiety and depression in the WHO-10 dataset, with self-smells being particularly associated with self-depreciation. CONCLUSIONS.?Sociocultural factors may modulate the self-reporting and/or detection of OHs and hallucinations in other modalities. Referential/control delusions promote the generation and/or maintenance of OHs independent of factors shared with other hallucinations. OHs and hallucinations of taste, touch, and bodily sensation frequently co-occur. Self-smells warrant sensitive probing. PMID:21545448
Langdon, Robyn; McGuire, Jonathan; Stevenson, Richard; Catts, Stanley V
(Full text is available at http://www.manu.edu.mk/prilozi). Objectives: The aim of this study was to evaluate the relationship between periapical lesions with and without clinical symptoms. Material and Method: This study was performed on cases with chronic periapical lesion diagnosis. During oral surgery procedures, 80 tissue samples were obtained. Anamnesis data were taken from each subject included in the study. Periapical tissue samples were processed for laboratory procedures including: histological and pathological examination of lesions by light microscopy analysis and microbiological status assessment by qualitative and semi-quantitative analysis of bacteriological findings. Results and conclusion: The results obtained illustrate that symptomatic apical periodontitis was more frequent with teeth without previous endodontic therapy. Even though a pathological type of periapical inflammation is significantly associated with the presence or absence of clinical symptoms (p = 0.0002), they do not have an effect on making a clinical diagnosis. Statistical analysis showed no significant difference (p > 0.05). Comparative analysis of symptom persistence and infection severity was performed. It was found that positive symptoms were in relation to the quantity of the bacterial growth only in the group previous endodontically treated and these two factors do show relation with an accuracy of 95%. The growth of a mixture of several, mainly anaerobic, bacterial species is closely related to the presence of clinical symptoms. Key words: bacteria, clinical/radiograph diagnosis, periapical lesion. PMID:24802205
Popovska, L; Zabokova Bilbilova, E; Mircheva, E; Stojanovska, V
Purpose: A hallmark of albinism is excessive decussation of retinostriate projections at the optic chiasm. This misprojection might lead to abnormalities in the retinal correspondence and may account for the usual absence of stereovision. We report on 2 groups of patients with albinism who have either fine or gross stereopsis and compare the clinical findings of these groups to other
Katherine A. Lee; Richard A. King; C. Gail Summers
Objective: Primary hypophysitis comprises of three distinct histomorphological entities: lymphocytic, granulomatous and xanthomatous. Clinical features of the three subtypes for diagnostic and treatment strategies have yet not been well characterized. Methods: Endocrine function, visual fields and acuity as well as magnetic resonance imaging characteristics were assessed before and after transphenoidal surgery in the largest series of 31 patients with primary
Angelika Gutenberg; Volkmar Hans; Maximilian J A Puchner; J urgen Kreutzer; Wolfgang Bruck; Patrizio Caturegli; Michael Buchfelder
As an assay for endotoxin, the Limulus amebocyte lysate assay has several desirable properties: sensitivity, specificity, and potential for adaptation to a quantitative format. Several modifications have been developed to enhance its potential for clinical application. The modifications that allow quantitative measurement of endotoxin and also improve its application to blood samples are described in this review. In fluids other than blood, the detection of endotoxin with the Limulus amebocyte lysate assay can be used as an aid to identify the presence of gram-negative bacteria, and the assay has established utility. With blood, however, there are a range of factors that interfere with the detection of endotoxemia and there are disparate views with respect to the diagnostic and prognostic significance of the test results. In general, the clinical significance of the finding of endotoxemia broadly parallels the frequency and importance of gram-negative sepsis in the patient groups studied and a decline in endotoxin levels accompanies clinical improvement. However, with therapies designed to reduce levels of endotoxin, or to antagonize its effects, it is unclear whether clinical improvement occurs as a consequence of changes in the levels of endotoxemia.
Hurley, J C
The workplace, especially the academic department or division, provides an intriguing research site for study of correlates\\u000a of scholarly performance. The objective of this study was to estimate a correlate model of three-year scholarly performance\\u000a of clinical faculty in colleges of pharmacy. Two-hundred and ninety-six clinical faculty in pharmacy responded to an author-developed\\u000a questionnaire. The scholarly performance items factored into
Paul W. Jungnickel; John W. Creswell
Decades of experiments in small animals had tipped the balance of opinion away from antibodies as a cause of transplant rejection, but clinical experience, especially with sensitized patients, has convinced basic immunologists of the need to develop models to investigate mechanisms underlying antibody-mediated rejection (AMR). This resurgent interest has resulted in several new rodent models to investigate antibody-mediated mechanisms of heart and renal allograft injury, but satisfactory models of chronic AMR remain more elusive. Nevertheless, these new studies have begun to reveal many insights into the molecular and pathological sequelae of antibody binding to the allograft endothelium. In addition, complement-independent and –dependent effects of antibodies on endothelial cells have been identified in vitro. As small animals models become better defined, it is anticipated that they will be more widely used to answer further questions concerning mechanisms of antibody-mediated tissue injury as well as to design therapeutic interventions.
Baldwin, William M.; Valujskikh, Anna; Fairchild, Robert L.
This study sought to develop a correlate model of 3-year scholarly performance of 296 clinical pharmacy faculty. Participants were surveyed concerning refereed research, grants/books research, and nonresearch scholarship. Eight correlates, including two related to the departmental workplace, emerged as significant factors in scholarly performance.…
Jungnickel, Paul W.; Creswell, John W.
Prostate tumors are among the most heterogeneous of cancers, both histologically and clinically. Microarray expression analysis was used to determine whether global biological differences underlie common pathological features of prostate cancer and to identify genes that might anticipate the clinical behavior of this disease. While no expression correlates of age, serum prostate specific antigen (PSA), and measures of local invasion
Dinesh Singh; Phillip G. Febbo; Kenneth Ross; Donald G. Jackson; Judith Manola; Christine Ladd; Pablo Tamayo; Andrew A. Renshaw; Anthony V. D'Amico; Jerome P. Richie; Eric S. Lander; Massimo Loda; Philip W. Kantoff; Todd R. Golub; William R. Sellers
Objective: The paper compares the speed, validity, and applicability of two different protocols for searching the primary medical literature. Design: A randomized trial involving medicine residents was performed. Setting: An inpatient general medicine rotation was used. Participants: Thirty-two internal medicine residents were block randomized into four groups of eight. Main Outcome Measures: Success rate of each search protocol was measured by perceived search time, number of questions answered, and proportion of articles that were applicable and valid. Results: Residents randomized to the MEDLINE-first (protocol A) group searched 120 questions, and residents randomized to the MEDLINE-last (protocol B) searched 133 questions. In protocol A, 104 answers (86.7%) and, in protocol B, 117 answers (88%) were found to clinical questions. In protocol A, residents reported that 26 (25.2%) of the answers were obtained quickly or rated as “fast” (<5 minutes) as opposed to 55 (51.9%) in protocol B, (P = 0.0004). A subset of questions and articles (n = 79) were reviewed by faculty who found that both protocols identified similar numbers of answer articles that addressed the questions and were felt to be valid using critical appraisal criteria. Conclusion: For resident-generated clinical questions, both protocols produced a similarly high percentage of applicable and valid articles. The MEDLINE-last search protocol was perceived to be faster. However, in the MEDLINE-last protocol, a significant portion of questions (23%) still required searching MEDLINE to find an answer.
Patel, Manesh R.; Schardt, Connie M.; Sanders, Linda L.; Keitz, Sheri A.
The provocative questions initiative has assembled a list of 24 important questions from the research community to stimulate the NCI’s research communities to use laboratory, clinical and populations sciences in especially effective and imaginative ways to answer the questions. The questions are not simple restatements of long-term goals of the National Cancer Program, which are to improve the prevention, detection, diagnosis, and treatment of all forms of cancer.
Objectives: To characterize the clinical and genetic features of spinal bulbar muscular atrophy (SBMA), a rare neurodegenerative disorder caused by the expansion of a CAG repeat in the first exon of the androgen receptor gene, in the United Kingdom. Methods: We created a national register for SBMA in the United Kingdom and recruited 61 patients between 2005 and 2013. In our cross-sectional study, we assessed, by direct questioning, impairment of activities of daily living (ADL) milestones, functional rating, and subjective disease impact, and performed correlations with both CAG repeat size and degree of somatic mosaicism. Ten patients were deceased, 46 patients participated in the study, and 5 declined. Results: Subjects had an average age at onset of 43.4 years, and weakness onset most frequently occurred in the lower limbs (87%). Impaired mobility was the most frequently reported problem by patients, followed by bulbar dysfunction. Age distribution of the impairment of ADL milestones showed remarkable overlap with a Japanese study. We have identified a significant correlation between the number of CAG repeats and both age at onset and ADL milestones. Somatic mosaicism also showed a correlation with CAG expansion size and age at onset. Conclusions: Clinical features in SBMA show a substantial overlap when comparing populations with different genetic backgrounds. This finding has major implications, because multicenter trials will be necessary to obtain sufficient power in future clinical trials. Clinical-genetic correlations are strong in SBMA and should inform any clinical research strategy in this condition.
Nirmalananthan, Niranjanan; Masset, Luc; Skorupinska, Iwona; Collins, Toby; Cortese, Andrea; Pemble, Sally; Malaspina, Andrea; Fisher, Elizabeth M.C.; Greensmith, Linda; Hanna, Michael G.
Extensively correlated ab initio potential energy and dipole moment curves are calculated for the X 1? +, a 3?, A 1? +, and 3? + states of CaO over the range 3.0 au ? R ? 6.0 au. The calculations are the first which correctly predict that X 1? + is the ground state of CaO. Vertical spectra, adiabatic spectra, spectroscopic constants, curve crossings, and dipole moments are determined. The 3? + results are apparently the first accurate values available. The dipole moment function is a linear function of bondlength for the ? states and 3? +. Two extrema occur in the dipole moment function of X 1? +. Combined with experimental results, this suggests that ?(X 1? +) exhibits a maximum near Re in the heavy alkaline earth monoxides. The ?(A 1? +) increases sharply near Re. The X 1? + calculations require special attention near Re: Localized ionic entities are involved which have different MO configurations and different correlation requirements. A second-order theory which correctly describes atomic correlation is necessary. The ab initio bondlengths are systematically larger than the experimental bondlengths by amounts that are greater than the expected accuracy limits of the calculations. This overestimation is also observed in KF, KCl and KOH, but ab initio bondlengths of the lighter metal alkali halides and alkaline earth monoxides agree closely with experiment. It appears that the core electrons must be responsible, possibly because of explicit core correlation requirements and/or relativistic corrections.
England, Walter B.
We have correlated the in vitro results of testing the susceptibility of Cryptococcus neoformans to fluconazole with the clinical outcome after fluconazole maintenance therapy in patients with AIDS-associated cryptococcal disease. A total of 28 isolates of C. neoformans from 25 patients (24 AIDS patients) were tested. The MICs were determined by the broth microdilution technique by following the modified guidelines
A. I. Aller; E. Martin-Mazuelos; F. Lozano; J. Gomez-Mateos; L. Steele-Moore; W. J. Holloway; M. J. Gutierrez; F. J. Recio; A. Espinel-Ingroff
The aim of this study was to correlate clinical and functional evaluations with kinematic variables of upper limp reach-to-grasp movement in patients with tetraplegia. Twenty chronic patients were selected to perform reach-to-grasp kinematic assessment using a target placed at a distance equal to the arm's length. Kinematic variables (hand peak…
Cacho, Enio Walker Azevedo; de Oliveira, Roberta; Ortolan, Rodrigo L.; Varoto, Renato; Cliquet, Alberto
Objectives. This study sought to correlate angiographically detected complex lesions and intracoronary thrombus with the severity of clinical presentation in unstable angina (UA).Background. Unstable angina is usually related to acute thrombosis superimposed on a disrupted plaque. Complex and thrombotic lesions are more prevalent in UA and have been associated with a worse prognosis. The highest levels of the Braunwald classification
George Dangas; Roxana Mehran; Sylvan Wallenstein; Nikolaos A Courcoutsakis; Venu Kakarala; Jacqueline Hollywood; John A Ambrose
PURPOSE. The validity of clinical perimetry for evaluation of the pathology of glaucoma is based on correlated losses in retinal ganglion cells and visual sensitivity, but procedures to quantify neural losses from visual field defects have not been devel- oped. The purpose of the present study was to investigate the neural and sensitivity losses from experimental glaucoma to establish the
Ronald S. Harwerth; Louvenia Carter-Dawson; Earl L. Smith III; George Barnes; William F. Holt; Morris L. J. Crawford
This review summarizes the published studies on suicide and suicide attempts in individuals with eating disorders, highlighting rates of occurrence, clinical correlates, and implications for practitioners. Multiple studies find high rates of suicide in patients with anorexia nervosa (AN) [Standardized Mortality Ratio (SMR) for suicide range from 1.0 to 5.3], whereas suicide rates do not appear to be elevated in
Debra L. Franko; Pamela K. Keel
The purpose of the present research was to investigate the extent to which performance on a criterion-referenced, written proficiency examination in clinical laboratory technology (CLT) correlates with measures of laboratory practice. The following assess...
C. G. Schoon M. Kaley I. Stern
Background This study was designed to investigate the prevalence and correlates of depression in Myotonic dystrophy type 1 (DM1). Methods Thirty-one patients with DM1 and 47 subjects in a clinical contrast group, consisting of other neuromuscular disorders, including Spinal muscular atrophy, Limb girdle muscle atrophy and Facioscapulohumeral dystrophy, completed Beck Depression Inventory (BDI). We aimed to establish whether different factors associated with DM1 correlated with ratings in the BDI. Results Signs of a clinical depression were prevalent in 32% of the patients with DM1, which was comparable with ratings in the clinical contrast group. The depressive condition was mild to moderate in both groups. In DM1, a longer duration of clinical symptoms was associated with lower scores on the BDI and higher educational levels were correlated with higher scores on depression. We also found a negative association with brain white matter lesions. Conclusions Findings indicate significantly more DM1 patients than normative collectives showing signs of a clinical depression. The depressive condition is however mild to moderate and data indicate that the need for intervention is at hand preferentially early during the disease process.
Severe acute respiratory syndrome (SARS) poses a major threat to the health of people worldwide. We performed a retrospective case series analysis to assess clinical outcome and identify pretreatment prognostic correlates of SARS, managed under a standardized treatment protocol. We studied 127 male and 196 female patients with a mean age of 41±14 (range 18–83). All patients, except two, received ribavirin and steroid combination therapy. In 115 (36%) patients, the course of disease was limited. Pneumonitis progressed rapidly in the remaining patients. Sixty-seven (21%) patients required intensive care, and 42 (13%) required ventilator support. Advanced age, high admission neutrophil count, and high initial lactate dehydrogenase level were independent correlates of an adverse clinical outcome. SARS-associated coronavirus caused severe illnesses in most patients, despite early treatment with ribavirin and steroid. This study has identified three independent pretreatment prognostic correlates.
Kwok, Man Leung; Yuen, Hon; Lai, Sik To
This paper examines the usefulness of question prompt lists (QPLs) in aiding doctor-patient communication during discussions of clinical trials. The QPL presents patients with a menu of potential issues to discuss with a physician. Focus groups were conducted to assess the perceived utility of QPLs with trial-experienced and trial-naïve patients. All patients viewed the QPL as a valuable tool to support their decision-making regarding clinical trials.
This is an outstanding and intellectually-stimulating question which introduces a new way to translate more effectively metastasis research to the clinic. It is certainly worth exploring and badly needed. because, if positive, drugs could be immediately useful to help defined populations of patients. Per points, we agree that these are limited metastasis groups; however, results could at minimum justify moving forward to full adjuvant trials. Worthy cause given the "bottleneck" we experience nowadays since drugs are mostly not tested in metastasis prevention.
Molecular deletion screening with cDNA probes from the dystrophin gene was undertaken in patients with Becker muscular dystrophy from 58 separate families. Deletions were found in 41 (71%) of these families. Thirty-four (83%) of the deletions started in the same intron near the centre of the gene, and although there was no precise correlation between clinical severity and deletion pattern, the commonest deletion pattern, which was present in 49% of all deletion families, is associated with a mild phenotype.
Norman, A M; Thomas, N S; Kingston, H M; Harper, P S
The purpose of this study was to evaluate non-contrast magnetic resonance imaging (MRI) findings of adhesive capsulitis and\\u000a correlate them with clinical stages of adhesive capsulitis. This will hopefully define a role for shoulder MR imaging in the\\u000a diagnosis of adhesive capsulitis as well as in potentially directing appropriate treatment. Forty-seven consecutive non-contrast\\u000a magnetic resonance imaging examinations of 46 patients
Carolyn M. Sofka; Gina A. Ciavarra; Jo A. Hannafin; Frank A. Cordasco; Hollis G. Potter
Background: The goal of this study was to examine serotonergic functioning and concomitant clinical and familial correlates in depressed abused children.Methods: L-5-Hydroxytryptophan ( L-5-HTP) (0.8 mg\\/kg) was administered intravenously to 10 depressed abused (MDD-AB), 10 depressed nonabused (MDD-NA), and 10 normal control nonabused (NC-NA) children. The children in the two nonabused cohorts represent a small matched subset of children from
Joan Kaufman; Boris Birmaher; James Perel; Ronald E Dahl; Stacy Stull; David Brent; Laura Trubnick; Mayadah Al-Shabbout; Neal D Ryan
Numerous imaging studies have shown structural brain abnormalities in schizophrenia. Recently, voxel-based morphometry enabled whole brain analysis beyond the regions of interest (ROI). Regional gray matter concentrations of magnetic resonance (MR) images from 35 patients with paranoid schizophrenia were compared with those from 35 age- and sex-matched controls, and their clinical correlations were explored using voxel-based morphometry. Gray matter concentrations
Tae Hyon Ha; Tak Youn; Kyoo Seob Ha; Kyu Sik Rho; Jong Min Lee; In Young Kim; Sun I. Kim; Jun Soo Kwon
The Medical Home Portal is a web site aimed at supporting physicians and families in improving the care and outcomes for children with special health care needs (CSHCN) in the Medical Home model. To optimize access to its information and resources, the content has been structured using XML schemas that incorporate relevant clinical questions. This approach guides authors as they develop content and informs the organization of the site, aimed at assuring that users can readily locate needed information and resources. It will also enable direct access to relevant content via “infobuttons” or a questions-based interface, and extraction of content for use in electronic health records or other electronic media.
Norlin, Chuck; Kerr, Lynne M.; Rocha, Roberto A.
Various clinical tests and balance scales have been used to assess postural stability and the risk of falling in patients with idiopathic Parkinson's disease (IPD). Quantitative posturography allows a more objective assessment but the findings in previous studies have been inconsistent and few studies have investigated which posturographic measures correlate best with a history of falling. The purpose of this study was to determine the efficacy of clinical tests, balance scales, and stable-platform posturography in detecting postural instability and discriminating between fallers and non-fallers in a home-dwelling PD cohort. Forty-eight PD subjects (Hoehn & Yahr stage 1-3) and 17 age-matched controls had the following assessments: Activities-specific Balance Confidence scale, Berg Balance Scale, Unified Parkinson's Disease Rating Scale (UPDRS) (motor), pull-test, timed up-and-go, static posturography, and dynamic posturography to assess multidirectional leaning balance. Of the clinical assessments, all but the pull-test were closely correlated with a history of falling. Static posturography discriminated between PD fallers and controls but not between PD fallers and non-fallers, whereas dynamic posturography (reaction time, velocity, and target hit-time) also discriminated between fallers and non-fallers. Our findings suggest that this combination of clinical and posturographic measures would be useful in the prospective assessment of falls risk in PD patients. A further prospective study is now required to assess their predictive value. © 2013 Movement Disorder Society. PMID:23609352
Johnson, Liam; James, Ian; Rodrigues, Julian; Stell, Rick; Thickbroom, Gary; Mastaglia, Frank
Historical accounts of questioning used in the education process trace back to Socrates. One of the best examples of his use of questioning is found in Plato's "The Republic." Socrates used a series of strategic questions to help his student Glaucon come to understand the concept of justice. Socrates purposefully posed a series of questions to…
Tienken, Christopher H.; Goldberg, Stephanie; DiRocco, Dominic
Cytotoxic chemotherapy targets elements common to all nucleated human cells, such as DNA and microtubules, yet it selectively kills tumor cells. Here we show that clinical response to these drugs correlates with, and may be partially governed by, the pre-treatment proximity of tumor cell mitochondria to the apoptotic threshold, a property called mitochondrial priming. We used BH3 profiling to measure priming in tumor cells from patients with multiple myeloma, acute myelogenous and lymphoblastic leukemia, and ovarian cancer. This assay measures mitochondrial response to peptides derived from pro-apoptotic BH3 domains of proteins critical for death signaling to mitochondria. Patients with highly primed cancers exhibited superior clinical response to chemotherapy. In contrast, chemoresistant cancers and normal tissues were poorly primed. Manipulation of mitochondrial priming might enhance the efficacy of cytotoxic agents.
Chonghaile, Triona Ni; Sarosiek, Kristopher A.; Vo, Thanh-Trang; Ryan, Jeremy A.; Tammareddi, Anupama; Moore, Victoria Del Gaizo; Deng, Jing; Anderson, Ken; Richardson, Paul; Tai, Yu-Tzu; Mitsiades, Constantine S.; Matulonis, Ursula A.; Drapkin, Ronny; Stone, Richard; DeAngelo, Daniel J.; McConkey, David J.; Sallan, Stephen E.; Silverman, Lewis; Hirsch, Michelle S.; Carrasco, Daniel Ruben; Letai, Anthony
A literature review of the associations between involvement in bullying and depression is presented. Many studies have demonstrated a concurrent association between involvement in bullying and depression in adolescent population samples. Not only victims but also bullies display increased risk of depression, although not all studies have confirmed this for the bullies. Retrospective studies among adults support the notion that victimization is followed by depression. Prospective follow-up studies have suggested both that victimization from bullying may be a risk factor for depression and that depression may predispose adolescents to bullying. Research among clinically referred adolescents is scarce but suggests that correlations between victimization from bullying and depression are likely to be similar in clinical and population samples. Adolescents who bully present with elevated numbers of psychiatric symptoms and psychiatric and social welfare treatment contacts.
Kaltiala-Heino, Riittakerttu; Frojd, Sari
Childhood ataxia is characterized by impaired balance and coordination primarily due to cerebellar dysfunction. Friedreich ataxia, a form of childhood ataxia, is the most common multisystem autosomal recessive disease. Most of these patients are homozygous for the GAA repeat expansion located on the first intron of the frataxin gene on chromosome 9. Mutations in the frataxin gene impair mitochondrial function, increase reactive oxygen species, and trigger redistribution of iron in the mitochondria and cytosol. Targeted therapies for Friedreich ataxia are undergoing testing. In addition, a centralized database, patient registry, and natural history study have been launched to support clinical trials in Friedreich ataxia. The 2011 Neurobiology of Disease in Children symposium, held in conjunction with the 40th annual Child Neurology Society meeting, aimed to (1) describe clinical features surrounding Friedreich ataxia, including cardiomyopathy and genetics; (2) discuss recent advances in the understanding of the pathogenesis of Friedreich ataxia and developments of clinical trials; (3) review new investigations of characteristic symptoms; (4) establish clinical and biochemical overlaps in neurodegenerative diseases and possible directions for future basic, translational, and clinical studies.
Ashley, Claire N.; Hoang, Kelly D.; Lynch, David R.; Perlman, Susan L.; Maria, Bernard L.
Following their successful implementation for the treatment of metastatic breast cancer, the 'third-generation' aromatase inhibitors (anastrozole, letrozole, and exemestane) have now become standard adjuvant endocrine treatment for postmenopausal estrogen receptor-positive breast cancers. These drugs are characterized by potent aromatase inhibition, causing >98% inhibition of estrogen synthesis in vivo. A recent meta-analysis found no difference in anti-tumor efficacy between these three compounds. As of today, aromatase inhibitor monotherapy and sequential treatment using tamoxifen followed by an aromatase inhibitor for a total of 5 years are considered equipotent treatment options. However, current trials are addressing the potential benefit of extending treatment duration beyond 5 years. Regarding side effects, aromatase inhibitors are not found associated with enhanced risk of cardiovascular disease, and enhanced bone loss is prevented by adding bisphosphonates in concert for those at danger of developing osteoporosis. However, arthralgia and carpal tunnel syndrome preclude drug administration among a few patients. While recent findings have questioned the use of aromatase inhibitors among overweight and, in particular, obese patients, this problem seems to focus on premenopausal patients treated with an aromatase inhibitor and an LH-RH analog in concert, questioning the efficacy of LH-RH analogs rather than aromatase inhibitors among overweight patients. Finally, recent findings revealing a benefit from adding the mTOR inhibitor everolimus to endocrine treatment indicate targeted therapy against defined growth factor pathways to be a way forward, by reversing acquired resistance to endocrine therapy. PMID:23625614
Lønning, Per Eystein; Eikesdal, Hans Petter
Following their successful implementation for the treatment of metastatic breast cancer, the ‘third-generation’ aromatase inhibitors (anastrozole, letrozole, and exemestane) have now become standard adjuvant endocrine treatment for postmenopausal estrogen receptor-positive breast cancers. These drugs are characterized by potent aromatase inhibition, causing >98% inhibition of estrogen synthesis in vivo. A recent meta-analysis found no difference in anti-tumor efficacy between these three compounds. As of today, aromatase inhibitor monotherapy and sequential treatment using tamoxifen followed by an aromatase inhibitor for a total of 5 years are considered equipotent treatment options. However, current trials are addressing the potential benefit of extending treatment duration beyond 5 years. Regarding side effects, aromatase inhibitors are not found associated with enhanced risk of cardiovascular disease, and enhanced bone loss is prevented by adding bisphosphonates in concert for those at danger of developing osteoporosis. However, arthralgia and carpal tunnel syndrome preclude drug administration among a few patients. While recent findings have questioned the use of aromatase inhibitors among overweight and, in particular, obese patients, this problem seems to focus on premenopausal patients treated with an aromatase inhibitor and an LH-RH analog in concert, questioning the efficacy of LH-RH analogs rather than aromatase inhibitors among overweight patients. Finally, recent findings revealing a benefit from adding the mTOR inhibitor everolimus to endocrine treatment indicate targeted therapy against defined growth factor pathways to be a way forward, by reversing acquired resistance to endocrine therapy.
L?nning, Per Eystein; Eikesdal, Hans Petter
In patients with progressive supranuclear palsy (PSP), previous reports have shown a severe white matter (WM) damage involving supra and infratentorial regions including cerebellum. In the present study, we investigated potential correlations between WM integrity loss and clinical-cognitive features of patients with PSP. By using magnetic resonance imaging and diffusion tensor imaging with tract based spatial statistic analysis, we analyzed WM volume in 18 patients with PSP and 18 healthy controls (HCs). All patients and HCs underwent a detailed clinical and neuropsychological evaluation. Relative to HCs, patients with PSP showed WM changes encompassing supra and infratentorial areas such as corpus callosum, fornix, midbrain, inferior fronto-occipital fasciculus, anterior thalamic radiation, superior cerebellar peduncle, superior longitudinal fasciculus, uncinate fasciculus, cingulate gyrus, and cortico-spinal tract bilaterally. Among different correlations between motor-cognitive features and WM structural abnormalities, we detected a significant association between fronto-cerebellar WM loss and executive cognitive impairment in patients with PSP. Our findings, therefore, corroborate the hypothesis that cognitive impairment in PSP may result from both "intrinsic" and "extrinsic" frontal lobe dysfunction, likely related to cerebellar disconnection. PMID:24786632
Tessitore, Alessandro; Giordano, Alfonso; Caiazzo, Giuseppina; Corbo, Daniele; De Micco, Rosa; Russo, Antonio; Liguori, Sara; Cirillo, Mario; Esposito, Fabrizio; Tedeschi, Gioacchino
Skip to content The National Cancer Institute www.cancer.gov The National Institutes of Health AccrualNetTM STRATEGIES, TOOLS AND RESOURCES TO SUPPORT ACCRUAL TO CLINICAL TRIALS User menu Register Sign In Search form Search Main menu Protocol Accrual
The exact mechanism for the occurrence of sickle leg ulcers (SLUs) has not been fully explained, although, popular opinion supports a multifactorial etio-pathogenetic process. Leg ulceration in sickle cell is a chronic and debilitating condition which is difficult to treat and may worsen the psychosocial impact of this illness. This study aims to evaluate the laboratory and clinical correlates of SLUs. One hundred sixty-seven patients who had been diagnosed with sickle cell anemia (homozygous S) had their steady-state hemoglobin concentration (Hb), hematocrit, white cell count, platelet count, serum bilirubin, and aspartate transaminase (AST) as well as frequency of crisis per annum evaluated with respect to their relationship to the occurrence of leg ulcers. They were aged 6-53 years (mean age 24.3 years), and prevalence of leg ulcer was found to be 2.75 per 1000 (2.54 per 1000 in females and 2.83 per 1000 in males). The independent sample t-test showed a significant difference in the serum AST levels in those with SLU (p = 0.029), though a positive correlation did not exist. Other predictors of disease severity found to have positive relationship with each other were the AST and total serum bilirubin 0.207 (p = 0.012); Hb and age 0.130 (p = 0.035); Hb and white cell count -0.159 (p = 0.010), white cell count and age -0.113 (p = 0.018). SLUs do not occur in patients with severe disease in sickle cell. The clinical and laboratory indicators of severe sickle cell disease do not correlate positively with the occurrence of SLU. Serum AST may have a relationship with leg ulceration in these patients. Environmental factors most likely play a major part in the etiopathogenesis of leg ulcer and this may require further studies in different sociocultural settings. PMID:24134724
Madu, Anazoeze Jude; Ubesie, Agozie; Madu, Kenechi Anthony; Okwor, Bismarck; Anigbo, Chukwudi
Depression is one of the most common nonmotor complications of Parkinson's disease (PD) and has a major impact on quality of life. Although several clinical factors have been associated with depression in PD, the relationship between depression and stage of illness as well as between depression and degree of disability remains controversial. We have collected clinical data on 1,378 PD cases from 632 families, using the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II (activities of daily living) & III (motor), the Mini-Mental State Exam, the Geriatric Depression Scale (GDS), and the Blessed Functional Activity Scale (Blessed). Analyses were performed using the 840 individuals with verified PD and without evidence of cognitive decline. Logistic regression was used to identify study variables that individually and collectively best predicted the presence of depressive symptoms (GDS >or= 10). After correcting for multiple tests, depressive symptoms were significantly associated with Hoehn and Yahr stage and other clinical measures but not with any genetic variant (parkin, LRRK2, APOE). The Blessed score, education, presence of a first degree relative with signs of depression, and UPDRS Part II were found to best predict depressive symptomatology (R(2) = 0.33; P = 4 x 10(-48)). Contrary to several reports, the results from this large study indicate that stage of illness, motor impairment, and functional disability are strongly correlated with depressive symptoms. PMID:18785635
Pankratz, Nathan; Marder, Karen S; Halter, Cheryl A; Rudolph, Alice; Shults, Cliff W; Nichols, William C; Foroud, Tatiana
Depression is one of the most common nonmotor complications of Parkinson's disease (PD) and has a major impact on quality of life. Although several clinical factors have been associated with depression in PD, the relationship between depression and stage of illness as well as between depression and degree of disability remains controversial. We have collected clinical data on 1,378 PD cases from 632 families, using the Unified Parkinson's Disease Rating Scale (UPDRS) Parts II (activities of daily living) & III (motor), the Mini-Mental State Exam, the Geriatric Depression Scale (GDS), and the Blessed Functional Activity Scale (Blessed). Analyses were performed using the 840 individuals with verified PD and without evidence of cognitive decline. Logistic regression was used to identify study variables that individually and collectively best predicted the presence of depressive symptoms (GDS ? 10). After correcting for multiple tests, depressive symptoms were significantly associated with Hoehn and Yahr stage and other clinical measures but not with any genetic variant (parkin, LRRK2, APOE). The Blessed score, education, presence of a first degree relative with signs of depression, and UPDRS Part II were found to best predict depressive symptomatology (R2 = 0.33; P = 4 × 10?48). Contrary to several reports, the results from this large study indicate that stage of illness, motor impairment, and functional disability are strongly correlated with depressive symptoms.
Pankratz, Nathan; Marder, Karen S.; Halter, Cheryl A.; Rudolph, Alice; Shults, Cliff W.; Nichols, William C.; Foroud, Tatiana
Aims: To report the histopathology of two specimens of polypoidal choroidal vasculopathy (PCV) obtained from two eyes of Japanese patients. Methods: Specimens were obtained under direct visualisation during macular translocation surgery with 360 degree retinotomy. The clinical findings were correlated with the light microscopic findings of the two specimens. Results: One specimen from a 77 year old man was the central portion of the lesion that lay under the sensory retina on the retinal pigment epithelium (RPE). The specimen was made up mainly of fibrous tissue with small, thin walled vessels. Indocyanine green angiography after surgery revealed that active leaking polypoidal element remained under the RPE. Another specimen obtained from a 62 year old man was made up of a fibrovascular membrane situated within Bruch's membrane. The part of this specimen inferior to the foveal region included a collection of dilated, thin walled blood vessels without pericytes, surrounded by macrophages that stained positive for CD68. The dilated vessels appeared to be correlated with the orange coloured polyps observed by ophthalmoscopy, the polypoidal structure seen in indocyanine green angiograms, and the pyramidal elevation with intermediate reflectivity by optical coherence tomography. Conclusion: Polypoidal structures are located within Bruch's space. They are composed of clusters of dilated, thin walled blood vessels surrounded by macrophages and fibrin material. The positive immunohistochemical staining for vascular endothelial growth factor in the RPE and the vascular endothelial cells suggests that this fibrovascular complex is a subretinal choroidal neovascularisation.
Terasaki, H; Miyake, Y; Suzuki, T; Nakamura, M; Nagasaka, T
Central nervous system tumors are the most common solid tumors in children. Many histological subtypes and biological variants exist. The 2007 Neurobiology of Disease in Children Symposium, held in conjunction with the 36th annual meeting of the Child Neurology Society, aimed to define current knowledge in the field and to develop specific aims for future clinical, translational, and fundamental science. Because of advances in structural and metabolic imaging, surgical technique, and combination therapies, the life expectancy of children with some of the most common tumors, such as cerebellar astrocytomas and medulloblastomas, has improved. Other common tumor types, including diffuse pontine gliomas and malignant embryonal tumors, still have a dismal prognosis. As novel therapies are identified for pediatric central nervous system tumors, long-term survival may be associated with considerable disability. A cooperative effort is crucial to early diagnosis and to translating basic research findings into safe, effective new treatments.
Babcock, Michael A.; Kostova, Felina V.; Fountain, Jane; Guha, Abhijit; Packer, Roger J.; Pollack, Ian F.; Maria, Bernard L.
Aim To assess the clinical characteristic of CD as well as correlation of symptoms and the degrees of intestinal mucosal lesions in Iranian children. Background Microscopic Enteritis (Marsh 0-II) is associated with malabsorption. Patients and methods From August 2005 to September 2009, 111 cases with malabsorption and classical gastrointestinal symptoms were evaluated. Results The mean (±SD) age of children with CD was 4.9±3.5 years (range, 6 month - 16 years) and the mean duration of symptoms was 8 ± 20.5 months. 50 cases (45%) were female and 61 cases (55%) were male. The most common clinical presentation was failure to thrive in 72%, chronic diarrhea in 65.8% and Iron deficiency anemia in 59.5%. Sensitivity of EMA was 100% in patients with Marsh IIIb and Marsh IIIc. EMA was also positive in 77% of cases with Marsh 0, 18% in Marsh I, 44% in Marsh II and 81.8% in patients with Marsh IIIa. Conclusion Histopathology did not reflect the severity of gluten sensitivity. This would suggest that the degree of intestinal mucosal damage might not be a reliable prognostic factor. Significant symptoms can be present with minor histological change on biopsy.
Shahraki, Touran; Shahraki, Mansour; Bold, Justine; Danciu, Mihai; Al Dulaimi, David; Villanacci, Vincenzo; Bassotti, Gabrio
In the six decades that have followed the work of Hodgkin and Huxley, multiple generations of neuroscientists and biophysicists have built upon their pivotal contributions. It is now clear that, in mammals, nine genes encode nine distinct voltage-gated sodium channels with different amino acid sequences and different physiological and pharmacological properties. The different sodium channel isoforms produce a multiplicity of distinct sodium currents with different time-dependent characteristics and voltage dependencies, which interact with each other and with the currents produced by other channels (including calcium and potassium channels) to shape neuronal firing patterns. Expression of these sodium channel isoforms is highly dynamic, both in the normal nervous system, and in the injured nervous system. Recent research has shed light on the roles of sodium channels in human disease, a development that may open up new therapeutic strategies. This article examines the pain-signalling system as an example of a neuronal network where multiple sodium channel isoforms play complementary roles in electrogenesis and a strong link with human disease has been established. Recent research suggests that it may be possible to target specific sodium channel isoforms that drive hyperexcitability in pain-signalling neurons, thereby providing new therapeutic strategies for chronic pain, and providing an illustration of the impact of the Hodgkin–Huxley legacy in the clinical domain.
Waxman, Stephen G
While the causal mechanisms that link excess body weight to increased risk for certain cancers are largely unknown (as noted in other questions), we pose an associated question -- what are the causal mechanisms that link excess body weight to decreased risk of certain other cancers?
Background Despite the increasing interest in using non-physician clinicians in many low-income countries, little is known about the roles they play in typical health system settings. Prior research has concentrated on evaluating their technical competencies compared to those of doctors. This work explored perceptions of the roles of Kenyan non-physician clinicians (Clinical Officers (COs). Methods Qualitative methods including in-depth interviews (with COs, nurses, doctors, hospital management, and policymakers, among others), participant observation and document analysis were used. A nomothetic-idiographic framework was used to examine tensions between institutions and individuals within them. A comparative approach was used to examine institutional versus individual notions of CO roles, how these roles play out in government and faith-based hospital (FBH) settings as well as differences arising from three specific work settings for COs within hospitals. Results The main finding was the discrepancy between policy documents that outline a broad role for COs that covers both technical and managerial roles, while respondents articulated a narrow technical role that focused on patient care and management. Respondents described a variety of images of COs, ranging from ‘filter’ to ‘primary healthcare physician’, when asked about CO roles. COs argued for a defined role associated with primary healthcare, feeling constrained by their technical role. FBH settings were found to additionally clarify CO roles when compared with public hospitals. Tensions between formal prescriptions of CO roles and actual practice were reported and coalesced around lack of recognition over COs work, role conflict among specialist COs, and role ambiguity. Conclusions Even though COs are important service providers their role is not clearly understood, which has resulted in role conflict. It is suggested that their role be redefined, moving from that of ‘substitute clinician’ to professional ‘primary care clinician’, with this being supported by the health system.
A QPL is a proven intervention to aid patients to be active participants in consultations with their physicians by asking questions. This study tested the efficacy of a targeted QPL for clinical trials.
Provocative Questions Skip to content. | Skip to navigation Personal tools Sign Up Log in Sections Home Home Current RFAs and PQs Cancer Prevention and Risk Mechanisms of Tumor Development or Recurrence Tumor Detection, Diagnosis, and Prognosis Cancer
Provocative Questions Skip to content. | Skip to navigation Personal tools Sign Up Log in Sections Home Home Current RFAs and PQs Cancer Prevention and Risk Mechanisms of Tumor Development or Recurrence Tumor Detection, Diagnosis, and Prognosis Cancer
Provocative Questions Skip to content. | Skip to navigation Personal tools Sign Up Log in Sections Home Home Current RFAs and PQs Cancer Prevention and Risk Mechanisms of Tumor Development or Recurrence Tumor Detection, Diagnosis, and Prognosis Cancer
Background Schwannomas are slow-growing typically encapsulated tumors composed of differentiated Schwann cells, the primary class of peripheral glial cells.?Complete excision is the treatment of choice for orbital schwannomas that cause pain, disfigurement, diplopia, or optic neuropathy.?The presence of multiple schwannomas in a single patient suggests possible association with neurofibromatosis type 2 (NF2) or schwannomatosis. Case presentation We present 2 patients who experienced recurrent orbital schwannoma without evidence for neurofibromatosis. The recurrence in one patient, a 59-year old man, occurred 6 years after complete excision of the initial tumor. This recurrence consisted of 2 independent tumors in the same orbit. The recurrence in the second patient, a 5 year-old girl, occurred multiple times within days to weeks of partial excisions until eventually a complete excision was performed. Conclusion The clinical history, histopathologic features and particularly the intraoperative findings suggest that the 59 year old man suffers from orbital schwannomatosis, while the rapid recurrence in the second patient correlated with the cellular features of her plexiform schwannoma. Hence, the recurrence in each patient is linked to a different etiology, with implications for treatment and patient counseling given the difficulty in treating orbital schwannomatosis. To our knowledge, this is the first description of isolated orbital schwannomatosis.
This study sought to examine the prevalence of insomnia and its association with depression, anxiety, and medical comorbidities in patients after an acute coronary syndrome (ACS). Insomnia increases risk of recurrent cardiac events in ACS patients, but little is known about the prevalence and clinical correlates of insomnia in this setting. Patients (n = 102, 58.3 ± 10.6 years-old) admitted for ACS to a cardiology service at an urban academic medical center completed the Insomnia Severity Index, Epworth Sleepiness Scale, and measures of depression and anxiety. A subset (n = 20) completed ambulatory polysomnography (PSG) in their homes several weeks after discharge. Moderate or severe insomnia was reported by 37% of patients during hospitalization and was associated with 76 minutes more wake after sleep onset measured by home PSG. Although depression and insomnia were strongly associated, about 1 in 4 patients with insomnia did not report significant depressive symptoms. Sleep apnea was documented in 80% of patients on PSG, but insomnia was not associated with sleep apnea, periodic limb movements, demographic factors, or medical conditions other than liver disease. Insomnia is present in over one-third of ACS patients during hospitalization, but at-risk patients could not be readily identified by demographic or medical factors or by depression symptoms. PMID:24097213
Coryell, Virginia T; Ziegelstein, Roy C; Hirt, Kellie; Quain, Angela; Marine, Joseph E; Smith, Michael T
A prospective clinical and radiological correlation study was performed to determine the frequency, and the clinical and radiological features of callosal infarction. From 1 January 1993 to the end of December 1993 282 cases of cerebral infarction seen in the Neurology service of the University Hospital of Dijon were studied prospectively. Eight cases with callosal ischaemic lesions were identified by CT and MRI. A callosal disconnection syndrome occurred in only five of eight patients, related to a single, large infarct or several infarctions in the anterior part of the corpus callosum. Clinical features were characterised by left ideomotor apraxia, construction apraxia, and left agraphia in all five cases. Alien hand was noted in only two cases. There were gait disorders in three cases with MRI features of multiple lacunes in a large part of the corpus callosum, and also the subcortical areas of both hemispheres. It is emphasised that callosal infarctions are not rare and that they contribute to the clinical features of strokes. As well as the classic incomplete callosal disconnection syndrome, these callosal ischaemic lesions may induce non-specific gait disorders. Images
Giroud, M; Dumas, R
To assess the clinical and radiologic correlates of frontal intermittent rhythmic delta activity (FIRDA), the authors reviewed the hospital charts of patients whose EEGs depicted this EEG finding, and recorded their past medical and neurologic history, the reason for hospital admission, and their neurologic status both on admission and during EEG recordings. Laboratory results on admission and concomitant to the EEG recording, computed tomography, or MRI findings during hospital admission were also reviewed. Sixty-eight patients were assessed. The gender ratio was 1:1; mean age was 56 years. Chronic disease occurred in 78% of patients, including hypertension (34%), diabetes (32%), and renal failure (18%). On admission, renal failure (n = 34) and hyperglycemia (n = 22) were most prominent. The majority of patients had at least one abnormal laboratory result. Thirty-eight of 51 patients in whom the level of consciousness was stated during EEG were described as awake. More than half of 58 patients whose EEG background activity was stipulated demonstrated diffuse slowing, mostly in the theta range. MRI was abnormal in 15 of 17 patients. Intrahemispheric lesions, particularly ischemic and hemorrhagic, were most common (n = 10), followed by basal ganglia lacunae (n = 4). Computed tomography was abnormal in 29 of 44 patients. Hemispheric pathology, diffuse or localized, occurred in 22 patients. Frontal intermittent rhythmic delta activity is associated with mild to moderate encephalopathy and is detected principally in awake patients. Most patients in this series had chronic systemic illness. Old ischemic structural brain lesions may predispose some patients to develop FIRDA during acute metabolic derangement, such as uremia and hyperglycemia. Frontal intermittent rhythmic delta activity was not associated with EEG epileptiform activity. Deep midline lesions, posterior fossa tumors, and hydrocephalus were not detected in this series of patients with FIRDA. PMID:12488784
Watemberg, Nathan; Alehan, Fusun; Dabby, Ron; Lerman-Sagie, Tally; Pavot, Pierre; Towne, Alan
Current clinical evaluations often rely on static anatomic imaging modalities for diagnosis of mechanical low back pain, which provide anatomic snapshots and a surrogate analysis of a functional disease. Three dimensional in vivo motion is available with the use of digital fluoroscopy, which was used to capture kinematic data of the lumbar spine in order to identify coefficients of motion that may assist the physician in differentiating patient pathology. 40 patients distributed among 4 classes of lumbar degeneration, from healthy to degenerative, underwent CT, MRI, and digital x-ray fluoroscopy. Each patient underwent diagnosis by a neurosurgeon. Fluoroscopy was taken as the patient performed lateral bending (LB), axial rotation (AR) and flexion-extension (FE). Patient specific models were registered with the fluoroscopy images to obtain in vivo kinematic data. Motion coefficients, CLB, CAR, CFE, were calculated as the ratio of in-plane motion to total out-of-plane motion. Range of motion (ROM) was calculated about the axis of motion for each exercise. Inter- and Intra- group statistics were examined for each coefficient and a flexible Bayesian classifier was used to differentiate patients with degeneration. The motion coefficients CLB and CFE were significantly different (p < 0.05) in 4 of 6 group comparisons. In plane motion, ROMLB, was significantly different in only 1 of 6 group comparisons. The classifier achieved 95% sensitivity and specificity using (CFE, CLB, ROMLB) as input features, and 40% specificity and 80% sensitivity using ROM variables. The new coefficients were better correlated with patient pathology than ROM measures. The coefficients suggest a relationship between pathology and measured motion which has not been reported previously.
Johnson, J. Michael; Mahfouz, Mohamed; Battaglia, Nicholas V.; Sharma, Adrija; Cheng, Joseph S.; Komistek, Richard D.
This cross-sectional study was done to assess the association of obesity with multiple conditions in an inner-city adult medicine clinic. Data were gathered to assess the relationship of obesity to multiple variables. Logistic regression was used to adjust for age, gender, ethnicity and tobacco use. Of 2,081 patients, 62% were minorities; 41% lacked insurance, and 38% had Medicaid. Forty-two percent were obese, with 9% morbidly obese. Out of 25 conditions, 20 had statistically significant correlations with obesity (two-sided P < 0.05): four cardiovascular, two pulmonary, three musculoskeletal, three metabolic syndrome conditions (metabolic syndrome is defined by the presence of three or more of the following: Fasting glucose > 110 mg/dL, BP > 130/85, Waist circumference in men > 40 inches or in women > 35 inches, HDL < 40 mg/dL in men or < 50 mg/dL in women, triglycerides > 150 mg/dL), four other clinical conditions, multiple ED visits, multiple clinic visits, unemployment, and disability. Body mass index (BMI) predicted coronary artery disease (P < 0.001), stroke (P = 0.011) and peripheral arterial disease (P = 0.013), but these associations were no longer statistically significant after adjustment for hypertension, diabetes and dyslipidemia. In conclusion, obesity was associated with many diseases, as well as with healthcare utilization, unemployment and disability in this predominantly minority inner-city population. PMID:23691735
Yassir, Shahla; Chopra, Ravi; Roush, George
The authors reanalyzed previously published data from a prospectively randomized, placebo-controlled, double-blind phase-III study of 130 inpatients with dementia syndrome. The patients in the study had been diagnosed as having suffered from organic brain syndrome (ICD 290), which is the core syndrome of dementia (so-called dementia syndrome) for at least two years. They were treated with piracetam for three months at a dose level of 4,800 mg/d. These data were reexamined in order both to survey the extent of drug-related improvement and response rates when assessed at different levels and to investigate the comparability of efficacy in subgroups suffering from either senile dementia of the Alzheimer type or multi-infarct dementia. Three scales were used for the assessment of efficacy. They were the CGI, or Clinical Global Impression, completed by the physicians; the SCAG, or Sandoz Clinical Assessment Geriatric, used by clinical psychologists; and the BGP, or Beurteilungsskala für Geriatrische Patienten (Evaluation Scale for Geriatric Patients), employed by the nursing staff. The Syndrome-Kurztest (SKT) and Benton tests served to measure performance. The items and subscores of the SCAG and the SKT were highly intercorrelated at baseline, forming a common factor fairly independent of the information gained by BGP. This suggests that merely using different kinds of information-gathering methods, i.e., clinical scales and performance tests, completed by different groups of observers, does not automatically result in nonredundant comprehensive information. When using the most conservative response criterion of individual improvement, i.e., at least one baseline standard deviation, treatment with piracetam showed statistically significant (pe less than .001) explorative response rates of 50% and above in three out of four target variables, as compared to the 0 to 6% obtained with placebo. CGI was used as descriptive variable. Again, using this response criterion from a separate analysis of diagnostic subgroups, as matched by the median of the patients' Hachinski Ischemic Scale scores, it does not appear that piracetam's efficacy for patients with senile dementia of the Alzheimer type (SDAT) varies with its efficacy for patients with multi-infarct dementia (MID). PMID:1391670
Herrmann, W M; Stephan, K
Sequencing of natural human tumors is teaching us invaluable lessons. It is becoming clear that the new dogmas created in the post genome era are being questioned. The previously suspected genetic heterogeneity of tumors is now proven on the sequence level. The extreme genetic heterogeneity of individual tumors and the existence of multiple tumors (not metastases) pose fundamental doubt on the prevailing dogma of targeted drug(s) and personalized treatments.
Objective: To correlate the histopathology of adenomyosis particularly the depth and spread of adenomyosis and symptomatology. Study Design: Medical records of 94 patients who had undergone a hysterectomy and who were found to have adenomyosis on histopathologic examination were reviewed and histopathologic slides were reexamined. The symptoms were correlated with the presence of adenomyosis, the depth of penetration, and the
Aref Sammour; Imran Pirwany; Alp Usubutun; Jocelyne Arseneau; Togas Tulandi
Multiple sclerosis (MS) is a chronic inflammatory demyelinating disease of the central nervous system, in which movement disorders (MD) have been reported very rarely. Anatomopathological studies of MS indicate two main processes: inflammation and neurodegeneration. The occurrence of the movement disorders symptoms in MS revises the question of aetiology of these two diseases. During the 10 years of observation in our out-patient clinic and MS units we examined about 2500 patients with clinically definite MS diagnosed according to the revised McDonald's criteria. Only in 10 cases we found coexistence of MS and MD signs. Below we present rare cases of patients with coexistence of MS and chorea, pseudoathetosis, dystonia and parkinsonism. Searching for the strategic focal lesion in our case series showed demyelinating plaques placed in the thalamus most often. Detailed analysis of the clinical, pharmacological and neuroimaging correlations may help to explain the character of movement disorders in MS. PMID:24729346
Potulska-Chromik, A; Rudzinska, M; Nojszewska, M; Podlecka-Pi?towska, A; Szczudlik, A; Zakrzewska-Pniewska, B; Go??biowski, M
The present study documents the correlation between gait analysis data and clinical measurements and evaluates the combined predictive value of static and dynamic clinical measurements on gait data of children with cerebral palsy. Two hundred patients were evaluated using a set of measurements of range of motion (ROM), alignment, spasticity, strength and selectivity, and by three-dimensional gait analysis. Fair to moderate correlations were found between clinical measurements and gait data, the overall highest correlation being 0.60. Clinical data of strength and selectivity had the highest degree of significant correlations with gait data, compared to the ROM and spasticity. ROM, spasticity and strength measurements for the hip in the coronal plane and spasticity of rectus femoris most frequently showed fair to moderate correlations to gait data. Time and distance and EMG parameters mainly correlated with strength and selectivity parameters. Unexpectedly, alignment parameters only fairly correlated with hip rotation in stance. Multiple regression analysis revealed that adding dynamic clinical measurements (spasticity, strength and selectivity) to a static model (ROM) enhanced the link between clinical measurements and gait data. The variance of gait parameters was better explained by a combined model of static and dynamic clinical measurements, compared to a purely static model. However, R(2)-values were low. Gait analysis data cannot be sufficiently predicted by a combination of clinical measurements. The independence of the measurements supports the notion that both, clinical examination and gait analysis data provide important information for delineating the problems of children with CP. PMID:16303305
Desloovere, Kaat; Molenaers, Guy; Feys, Hilde; Huenaerts, Catherine; Callewaert, Barbara; Van de Walle, Patricia
Females who are affected by fragile X syndrome (FXS) can have significant physical, neuropsychological and emotional involvement. This study was designed to explore the relationships between these three domains and to learn how the degree of involvement in each of these phenotypic areas relates to molecular parameters including CGG repeat length and activation ratio (the proportion of normal FMR1 alleles on the active X chromosome). Three groups of females were studied: 35 women who grew up in a fragile X family but do not carry an FMR1 mutation, 92 women with a premutation, and 29 women with a full mutation. Correlations between neurocognitive, physical and emotional traits were calculated for each of the three groups. Within the full mutation group significant correlations were seen between schizotypal traits and full scale IQ. The Lie scale was significantly correlated with the physical findings index. The activation ratio correlated significantly with the measure of executive function (r = .50, P = .01). There was a trend toward correlations of activation ratio with the physical index score, outer ear prominence and IQ. CGG repeat number significantly correlated only with the physical index (r = .44, P = .0 1). Thus, activation ratio may be the more pertinent molecular parameter in full mutation women in determining the degree of cognitive and physical phenotypic involvement. 29 refs., 2 tabs.
Sobesky, W.E.; Riddle, J.; Hagerman, R.J. [Children`s Hospital, Denver, CO (United States)] [and others] [Children`s Hospital, Denver, CO (United States); and others
Duchenne muscular dystrophy is caused by mutations in the DMD gene that disrupt the open reading frame and prevent the full translation of its protein product, dystrophin. Restoration of the open reading frame and dystrophin production can be achieved by exon skipping using antisense oligonucleotides targeted to splicing elements. This approach aims to transform the Duchenne muscular dystrophy phenotype to that of the milder disorder, Becker muscular dystrophy, typically caused by in-frame dystrophin deletions that allow the production of an internally deleted but partially functional dystrophin. There is ongoing debate regarding the functional properties of the different internally deleted dystrophins produced by exon skipping for different mutations; more insight would be valuable to improve and better predict the outcome of exon skipping clinical trials. To this end, we have characterized the clinical phenotype of 17 patients with Becker muscular dystrophy harbouring in-frame deletions relevant to on-going or planned exon skipping clinical trials for Duchenne muscular dystrophy and correlated it to the levels of dystrophin, and dystrophin-associated protein expression. The cohort of 17 patients, selected exclusively on the basis of their genotype, included 4 asymptomatic, 12 mild and 1 severe patient. All patients had dystrophin levels of >40% of control and significantly higher dystrophin (P?=?0.013), ?-dystroglycan (P?=?0.025) and neuronal nitric oxide synthase (P?=?0.034) expression was observed in asymptomatic individuals versus symptomatic patients with Becker muscular dystrophy. Furthermore, grouping the patients by deletion, patients with Becker muscular dystrophy with deletions with an end-point of exon 51 (the skipping of which could rescue the largest group of Duchenne muscular dystrophy deletions) showed significantly higher dystrophin levels (P?=?0.034) than those with deletions ending with exon 53. This is the first quantitative study on both dystrophin and dystrophin-associated protein expression in patients with Becker muscular dystrophy with deletions relevant for on-going exon skipping trials in Duchenne muscular dystrophy. Taken together, our results indicate that all varieties of internally deleted dystrophin assessed in this study have the functional capability to provide a substantial clinical benefit to patients with Duchenne muscular dystrophy.
Anthony, Karen; Cirak, Sebahattin; Torelli, Silvia; Tasca, Giorgio; Feng, Lucy; Arechavala-Gomeza, Virginia; Armaroli, Annarita; Guglieri, Michela; Straathof, Chiara S.; Verschuuren, Jan J.; Aartsma-Rus, Annemieke; Helderman-van den Enden, Paula; Bushby, Katherine; Straub, Volker; Sewry, Caroline; Ferlini, Alessandra; Ricci, Enzo; Morgan, Jennifer E.
Objectives There is a paucity of studies on psychosocial disorders in a clinic population in Jamaica. Therefore, we sought to determine the prevalence and correlates of symptoms of depression and anxiety in a clinic population in western Jamaica. Methods A total of 338 participants from four outpatient clinics of the Western Regional Health Authority (WRHA) were screened for symptoms of depression and anxiety using questions from the Beck Depression Inventory-II and the Beck Anxiety Inventory. The chi-square test was used to examine differences in symptoms of anxiety and depression by gender. Multivariate linear and logistic regression were used to examine the associations between symptoms and socio-demographic variables with significance set at p<0.05. Results Approximately 30% of participants had moderate or severe depression symptoms while 18.6% had moderate or severe anxiety symptoms. Participants aged 30–39 years were more likely than older participants to have moderate or severe anxiety symptoms (odds ratio [OR]: 2.0, 95% confidence interval [CI]:1.39–5.56). Women reported a statistically significant higher prevalence of anxiety symptoms (10.0% vs. 7.1%, p=0.003). There was also a statistically significant difference between anxiety means by gender. Furthermore, income was found to be a significant predictor of anxiety for women only (p=0.0113). Married persons were more likely than those who had never married to have moderate or severe anxiety symptoms (OR: 2.57, 95% CI: 1.14–5.76). Conclusions Our findings suggest that the prevalence of depression may be higher than global estimates in similar outpatient settings. Screening and intervention efforts may need to focus on younger persons, women, and married persons.
Monroe, Cara E.; Affuso, Olivia; Martin, Michelle Y.; Aung, Maung; Crossman, Lisbeth; Jolly, Pauline E.
Initial weight-loss success was correlated with two severity variables. Persons reporting frequent binge eating and histories of previous dieting weight loss lost the most weight. Persons who were successful at maintenance used frequent exercise. Those who relapsed reported high levels of stress during follow-up. (Author)
And Others; Gormally, Jim
Neurological signs and computed tomographic morphology were compared in 60 patients. The primary neurological deficit was most commonly located in the sacral (n = 31) or lumbar plexus (n = 23) and was most commonly caused by a neoplasm (n = 40). In 78% of the patients it correlated with the lesions detected by computed tomography (CT). CT reliably demonstrates
P Vock; H Mattle; M Studer; M Mumenthaler
BACKGROUND AND PURPOSE: Segmental spinal dysgenesis (SSD) is a rare congenital abnormality in which a segment of the spine and spinal cord fails to develop properly. Our goal was to investigate the neuroradiologic features of this condition in order to correlate our findings with the degree of residual spinal cord function, and to provide insight into the em- bryologic origin
Paolo Tortori-Donati; Maria Paola Fondelli; Andrea Rossi; Charles A. Raybaud; Armando Cama; Valeria Capra
Basic factual information about disease is the cornerstone of health promotion and disease prevention interventions. Previous studies have shown that content analysis of the questions asked of service providers can elucidate the information needs of service consumers. Questions asked by individuals at known high risk for HIV infection have not…
Kalichman, Seth C.; Cain, Demetria; Knecht, Joanna; Hill, Justin
Although stealing among adolescents appears to be fairly common, an assessment of adolescent stealing and its relationship to other behaviors and health issues is incompletely understood. A large sample of high school students (n=3999) was examined using a self-report survey with 153 questions concerning demographic characteristics, stealing behaviors, other health behaviors including substance use, and functioning variables such as grades and violent behavior. The overall prevalence of stealing was 15.2% (95%CI: 14.8–17.0). Twenty-nine (0.72%) students endorsed symptoms consistent with a diagnosis of DSM-IV kleptomania. Poor grades, alcohol and drug use, regular smoking, sadness and hopelessness, and other antisocial behaviors were all significantly (p<.05) associated with any stealing behavior. Stealing appears fairly common among high school students and is associated with a range of potentially addictive and antisocial behaviors. Significant distress and loss of control over this behavior suggests that stealing often has significant associated morbidity.
Grant, Jon E.; Potenza, Marc N.; Krishnan-Sarin, Suchitra; Cavallo, Dana A.; Desai, Rani A.
Argyrophilic grains (AGs) are a pathologic feature found in association with neurodegenerative disease. Some have suggested that these features may occur as a distinctive condition. We reviewed 80 subjects from our tissue bank with pathologically confirmed AGs and identified their clinical features. We compared these subjects' features to the features of subjects with matched clinical diagnoses but without AGs. Subjects with AGs represented 21.7% of the entire autopsy sample from 1999 through 2005 (80/367). Of AD subjects, 43 /233 had AGs (18.4% of AD subjects); 11 /42 PD-D subjects had AGs (26.1% of PDD subjects); 2 / 9 DLB subjects had AGs (22.2% of DLB subjects); 4 /15 MCI subjects had AGs (26.7% of MCI subjects); and 20 /68 cognitively normal subjects had AGs (29.4% of NC). Subjects with AGs tended to be older but only significantly so in AD. Many co-morbid non-neurological health conditions were seen in cases of AGs without any single predilection emerging. AGs occur in approximately 22% of the entire autopsy cohort and likely are associated with advanced age. No distinctive antemortem clinical features were overrepresented in the AG cases. AGs can occur with or without neurodegenerative conditions and can occur in the absence of significant cognitive decline. AGs are not clearly associated with any single co-morbid health condition.
Sabbagh, Marwan N.; Sandhu, Sonny S.; Farlow, Martin R.; Vedders, Linda; Shill, Holly A.; Caviness, John N.; Connor, Donald J; Sue, Lucia; Adler, Charles H.; Beach, Thomas G.
Evidence-based practice (EBP) requires practitioners to identify and formulate questions in response to patient encounters, and to seek, select, and appraise applicable clinical research. A standardized workshop format serves as the model for training of medical educators in these skills. We developed an evaluation exercise to assess the ability…
Wyer, Peter C,; Naqvi, Zoon; Dayan, Peter S.; Celentano, James J.; Eskin, Barnet; Graham, Mark J.
We identified empirical correlates of the MMPI-2 Restructured Clinical (RC) scales in 1,872 male and 498 female psychiatric inpatients drawn from 2 large tertiary care medical centers. We generated clinical criteria from a systematic review of the patients' intake and discharge medical records. We report zero order correlations between RC scales and clinical criteria and relative risk ratios for dichotomous variables. We found the RC scales to be correlated with conceptually relevant criteria such that for each scale, we identified significant increases in the risk for a variety of emotional, cognitive, and behavioral problems among individuals whose T score exceed 64. PMID:18444105
Arbisi, Paul A; Sellbom, Martin; Ben-Porath, Yossef S
Objectives This study aimed to investigate the effect of clinical clerkship-associated achievements, such as performance of procedures at the student clinic, observation, and attitude towards a clerkship, on the objective structured clinical examination (OSCE) scores of dental students graduating in restorative dentistry. Materials and Methods The OSCEs consisted of two stations designed to assess students' clinical skills regarding cavity preparation for a class II gold inlay and a class IV composite restoration. The clerkship achievements, consisting of the number of student clinical procedures performed, observation-related OSCE, and scores of their attitudes towards a conservative dentistry clerkship, were assessed. Correlation and multiple regression analyses were conducted. Results The correlation coefficient between the OSCE scores for cavity preparation for a class II gold restoration and clerkship attitude scores was 0.241 (p < 0.05). Regarding a class IV composite restoration, OSCE scores showed statistically significant correlations with the observation (r = 0.344, p < 0.01) and attitude (r = 0.303, p < 0.01) scores. In a multiple regression analysis, attitudes towards a clerkship (p = 0.033) was associated with the cavity preparation for a class II gold inlay OSCE scores, while the number of procedure observations (p = 0.002) was associated with the class IV composite restoration OSCE scores. Conclusions The number of clinical procedures performed by students, which is an important requirement for graduation, showed no correlation with either of the OSCEs scores.
The goal of the Cognitive Neuroscience Test Reliability and Clinical Applications for Schizophrenia (CNTRACS) Consortium was to develop measures of discrete cognitive processes, allowing for the interpretation of specific deficits that could be linked to specific neural systems. Here we report on the intertask, clinical, and functional correlates of the 4 tasks that were investigated in large groups of patients with schizophrenia (>100) and healthy controls (>73) at 5 sites across the United States. In both healthy and patient groups, the key dependent measures from the CNTRACS tasks were minimally intercorrelated, suggesting that they are measuring discrete abilities. Correlations were examined between CNTRACS tasks and measures of functional capacity, premorbid IQ, symptom severity, and level of community functioning. Performance on tasks measuring relational memory encoding, goal maintenance, and visual gain control were correlated with premorbid IQ and the former 2 tasks with the functional capacity. Goal maintenance task performance was negatively correlated with negative symptom severity and informant reports of community function. These correlations reflect the relationship of specific abilities with functional outcome. They are somewhat lower than functional outcome correlations observed with conventional neuropsychological tests that confound multiple cognitive and motivational deficits. The measures of visual integration and gain control were not significantly correlated with clinical symptoms or function. These results suggest that the CNTRACS tasks measure discrete cognitive abilities, some of which relate to aspects of functional capacity/outcome in schizophrenia.
Gold, James M.; Barch, Deanna M.; Carter, Cameron S.; Dakin, Steven; Luck, Steven J.; MacDonald, Angus W.; Ragland, J. Daniel; Ranganath, Charan; Kovacs, Ilona; Silverstein, Steven M.; Strauss, Milton
Although stealing among adolescents appears to be fairly common, an assessment of adolescent stealing and its relationship to other behaviors and health problems is incompletely understood. A large sample of high school students (n = 3,999) was examined by self-report survey with 153 questions concerning demographic characteristics, stealing behaviors, other health behaviors including substance use, and functioning variables, such as grades and violent behavior. The overall prevalence of stealing was 15.2 percent (95% confidence interval (CI), 14.8-17.0). Twenty-nine (0.72%) students endorsed symptoms consistent with a diagnosis of DSM-IV-TR kleptomania. Poor grades, alcohol and drug use, regular smoking, sadness and hopelessness, and other antisocial behaviors were all significantly (p < .05) associated with any stealing behavior. Stealing appears to be fairly common among high school students and is associated with a range of potentially addictive and antisocial behaviors. Significant distress and loss of control over this behavior suggest that stealing often has significant associated morbidity. PMID:21389165
Grant, Jon E; Potenza, Marc N; Krishnan-Sarin, Suchitra; Cavallo, Dana A; Desai, Rani A
Increased frequency of cavum septum pellucidum (CSP) has been inconsistently observed in schizophrenia, and little is known about its functional implications. We investigated whether patients with schizophrenia were more likely than healthy controls to have CSP, and among patients assessed the relationship between CSP, psychiatric symptoms, and selected neuropsychological functions. Seventy-seven patients with diagnoses of DSM-IV schizophrenia spectrum disorders and 55 healthy controls were studied and completed a 1.5 T MRI scan. Two raters, blind to group membership, determined the presence, length and grade of the CSP. A subset of participants also underwent neuropsychological testing. A CSP of at least 1 mm in length was present in 68.8% of patients and 76.4% of controls, and the groups did not differ significantly with respect to presence or absence, length, overall size, or percent with an abnormally large CSP (> or =6 mm). Patients with an abnormally large CSP demonstrated poorer performance on measures of verbal learning and memory than patients with smaller CSP. Among patients, CSP length was significantly correlated with negative symptoms, verbal learning, and sentence comprehension. Among patients with abnormally large CSP, CSP length was correlated with reaction time on two conditions of a Continuous Performance Test. CSP, while prevalent, was not more frequent in our sample of patients with schizophrenia, and had few associations with symptom severity or neuropsychological deficits. PMID:17291728
Flashman, Laura A; Roth, Robert M; Pixley, Heather S; Cleavinger, Howard B; McAllister, Thomas W; Vidaver, Robert; Saykin, Andrew J
Establishing hematopoietic mixed chimerism can lead to donor-specific tolerance to transplanted organs and may eliminate the need for long-term immunosuppressive therapy, while also preventing chronic rejection. In this review, we discuss central and peripheral mechanisms of chimerism induced tolerance. However, even in the long-lasting presence of a donor organ or donor hematopoietic cells, some allogeneic tissues from the same donor can be rejected; a phenomenon known as split tolerance. With the current goal of creating mixed chimeras using clinically feasible amounts of donor bone marrow and with minimal conditioning, split tolerance may become more prevalent and its mechanisms need to be explored. Some predisposing factors that may increase the likelihood of split tolerance are immunogenicity of the graft, certain donor-recipient combinations, prior sensitization, location and type of graft and minimal conditioning chimerism induction protocols. Additionally, split tolerance may occur due to a differential susceptibility of various types of tissues to rejection. The mechanisms involved in a tissue's differential susceptibility to rejection include the presence of polymorphic tissue-specific antigens and variable sensitivity to indirect pathway effector mechanisms. Finally, we review the clinical attempts at allograft tolerance through the induction of chimerism; studies that are revealing the complex relationship between chimerism and tolerance. This relationship often displays split tolerance, and further research into its mechanisms is warranted. PMID:22509425
Al-Adra, David P; Anderson, Colin C
Objectives: To determine (1) the proportion of responses to an open-ended question related to patient satisfaction that could be categorized into 1 or more of 9 previously developed domains of out- patient care and (2) whether any other important aspects of care could be identified by adding the open-ended question to a satisfaction questionnaire. Study Design: A 3-month observational study
Bruce D. Bialor; Joseph L. Musial; Graciela E. Rojas; Mark J. Fagan
The chronology of Plio-Pleistocene sediment-cores from Central Arctic Ocean retrieved during the Healy-Oden Transarctic expedition in 2005 is attempted constructed using paleomagnetic reversal/excursion stratigraphies and relative paleointensity records combined with stratigraphic variations of mineral magnetic properties. Shipboard whole core magnetic susceptibility measurements revealed surprisingly similar records in cores retrieved between the Mendeleev Ridge and Alpha Ridge; 7 cores can be tied together by more than 15 characteristic susceptibility features, enabling a very detailed and precise correlation. This result suggests lateral uniformity of sediment-composition and only minor variation in deposition rates across this part of the Arctic. Paleomagnetic directions and relative paleointensity-data have so far been obtained from two cores; one from the Alpha Ridge-area, and one collected within the conspicuous depression (gap) across the Lomonosov Ridge. The two cores reveal a large number of short-duration polarity reversals (i.e. excursions), as is a characteristic feature of Arctic Ocean sediment cores. The highly varying lengths of the reversed `polarity' intervals may reflect local variations in accumulation/erosion rates. Relative paleointensity (RPI) curves may be correlated with SINT-800. However, most `excursions' are not associated with intensity-lows, questioning the reality of these excursions as well as the reliability of using SINT-800 as a dating tool. A previously investigated core from the Lomonosov Ridge (AO96-12pc1) also carries a large number of `excursions' with varying lengths. Although the RPI-curve resembles the Alpha Ridge RPI-records, any correlation with SINT-800 to obtain a chronology is presently questionable. We address the following questions: A) Are all - or some of - the inferred excursions artifacts due to undisclosed post-depositional processes? B) May RPI-variations be invariant to geomagnetic field-directions? C) May the geomagnetic field produce `excursions' confined to polar (i.e. high-latitudes) regions only?
Lovlie, R.; Jakobsson, M.; Wang, Y.; Wallin, A.; Sellén, E.; Polyak, L.
The aim of this study was to explore the association between pathological gambling (PG) and anger by assessing whether psychopathology and personality are related to PG and to evaluate gender differences. The sample comprised 71 PGs and 37 healthy controls. Anger, psychopathology and personality were assessed with the STAXI-2, SCL-90-R and TCI-R respectively. Gender did not affect anger expression after stratifying by diagnostic condition (p > .05). Among PG patients, anger, psychopathology and personality measures were correlated with good effect-size (r > .30). Scores in the Anger Temperament (B = 0.21, p = .038) and Anger External-Expression (B = 0.27, p = .029) scales were positively associated with PG severity scores. Anger expression in PG should be considered in future treatment programs. PMID:25011386
Aymamí, Neus; Granero, Roser; Penelo, Eva; Fernández-Aranda, Fernando; Krug, Isabel; Gunnard, Katarina; Santamaría, Juan José; Bueno, Blanca; Jaurrieta, Nuria; Gómez-Peña, Mónica; Alvarez-Moya, Eva; Claes, Laurence; Fagundo, Ana Beatriz; Menchón, José Manuel; Jiménez-Murcia, Susana
A retrospective study over 26 female patients with chronic active hepatitis was made. The mean age was 39 years old, the mean length of illness of 8 months; 5 patients had positive markers for hepatitis B. Patients were selected with the grade of histological activity: 8 patients had a mild form from disease (2A) and 16 with a severe one (2B). The predominant group was 2B. Severe inflammatory infiltration was the hallmark and multiobulillar necrosis, bridging, eosinophils and hiperplasia of kuppfer cells were found only in this group. Clinical features range from hepatic manifestations to systemic ones. Chronic active hepatitis may present with cholestasis, but the latter is not always related with the grade of activity. Group 2B had elevated aminotransferases and a low concentration for protrobine. PMID:2491700
Subauste, M C
Introduction The precise evaluation of Crohn’s disease (CD) activity is difficult mainly due to the complex symptoms of the disease. Establishing correlations between the most widely used scales of CD clinical, endoscopic and histopathological activity might help to identify the most accurate scale in the assessment of the course of CD. Aim Comparison of the results of clinical, endoscopic and histological scales of CD activity, i.e. (Crohn’s Disease Activity Index (CDAI) score, Montreal Classification, Crohn’s Disease Endoscopic Index of Severity (CDEIS) and D’Haens classification). Material and methods A group of 62 patients with CD was examined. All individuals underwent medical interview and physical examination. All patients had colonoscopy, at which the extent of the disease was analysed according to Montreal Classification and intensity of mucosal lesion described by CDEIS scale. Biopsy samples were taken during colonoscopy. Crohn’s disease activity was evaluated by clinical scales (Montreal Classification – A and B, CDAI), endoscopic scales (Montreal Classification – L, CDEIS) and histopathological classification by D’Haens. Results The results of histopathological activity scale of CD by D’Haens correlated only with the results of endoscopic classification CDEIS. The results of CDEIS correlated also with parameter B of Montreal Classification. The analysis of Montreal Classification parameters showed correlations between the age of disease onset (A) and localization of the disease (L). Additionally, correlation of parameter A (age of onset) and B (behaviour of the disease) of Montreal Classification was observed. The values of clinical CDAI scale correlated only with parameter B of Montreal Classification (behaviour of the disease). Conclusions There was a significant correlation between the histological (D’Haens) classification and endoscopic scale (CDEIS), but their results did not correlate with clinical scales. There was no consistent correlation between the clinical scales themselves however the correlations concerned only some parameters assessed, which may be the result of subjective clinicians evaluation of CD activity.
Stasikowska-Kanicka, Olga A.; Wagrowska-Danilewicz, Malgorzata; Danilewicz, Marian; Malecka-Panas, Ewa I.
Summary Subclavian ‘steal’ phenomenon is a function of the proximal subclavian artery (SA) steno-occlusive disease, with subsequent retrograde blood flow in the ipsilateral vertebral artery (VA). The symptoms from the compromised vertebrobasilar and brachial blood flows constitute the subclavian steal syndrome (SSS), and include paroxysmal vertigo, drop attacks and/or arm claudication. Once thought to be rare, the emergence of new imaging techniques has drastically improved its diagnosis and prevalence. The syndrome, however, remains characteristically asymptomatic and solely poses no serious danger to the brain. Recent studies have shown a linear correlation between increasing arm blood pressure difference with the occurrence of symptoms. Atherosclerosis of the SA remains the most common cause. Doppler ultrasound is a useful screening tool, but the diagnosis must be confirmed by CT or MR angiography. Conservative treatment is the initial best therapy for this syndrome, with surgery reserved for refractory symptomatic cases. Percutaneous angioplasty and stenting, rather than bypass grafts of the subclavian artery, is the widely favored surgical approach. Nevertheless, large, prospective, randomized, controlled trials are needed to compare the long-term patency rates between the endovascular and open surgical techniques.
Osiro, Stephen; Zurada, Anna; Gielecki, Jerzy; Shoja, Mohammadali M.; Tubbs, R. Shane; Loukas, Marios
The peroneus quartus (PQ) is an accessory muscle of the peroneal/lateral compartment of the leg. The muscle has often been implicated as a cause of pain in the lateral ankle region, and subluxation or attrition of the peroneal tendons. The present study was aimed at observing the prevalence and morphology of this muscle in human cadavers. Ninety-two embalmed lower limbs were dissected for this study. The PQ muscle was found in 21% of the limbs. In all these limbs it originated from the lower part of the lateral surface of the fibula, the undersurface of peroneus brevis and the posterior intermuscular septum. In the majority of limbs, insertion was on the retrotrochlear eminence of the calcaneus. Taking into account the possibility of this muscle being a cause of lateral ankle pathology, the present study attempts to correlate the findings with the anatomy of the surrounding region. The frequent occurrence of this muscle in humans is suggestive of a progressive evolutionary change to evert the foot in order to assume a bipedal gait. PMID:22252433
Athavale, Sunita Arvind; Gupta, Vanita; Kotgirwar, Sheetal; Singh, Vikrant
Anhedonia is a condition in which the capacity of experiencing pleasure is totally or partially lost, and it refers to both a state symptom in various psychiatric disorders and a personality trait. It has a putative neural substrate, originating in the dopaminergic mesolimbic and mesocortical reward circuit. Anhedonia frequently occurs in mood disorders, as a negative symptom in schizophrenia, and in substance use disorders. In particular, we focus our attention on the relationships occurring between anhedonia and substance use disorders, as highlighted by many studies. Several authors suggested that anhedonia is an important factor involved in relapse as well as in the transition from recreational use to excessive drug intake. In particular, anhedonia has been found to be a frequent feature in alcoholics and addicted patients during acute and chronic withdrawal as well as in cocaine, stimulant, and cannabis abusers. Furthermore, in subjects with a substance dependence disorder, there is a significant correlation between anhedonia, craving, intensity of withdrawal symptoms, and psychosocial and personality characteristics. Therefore treating anhedonia in detoxified alcohol-dependent subjects could be critical in terms of relapse prevention strategies, given its strong relationship with craving.
Hatzigiakoumis, Daniele Stavros; Martinotti, Giovanni; Giannantonio, Massimo Di; Janiri, Luigi
Our group has recently obtained data based upon whole- mounted step-sectioned radical prostatectomy specimens using a 3D computer assisted prostate biopsy simulator that suggests an increased detection rate is possible using laterally placed biopsies. A new 10-core biopsy pattern was demonstrated to be superior to the traditional sextant biopsy. This patter includes the traditional sextant biopsy cores and four laterally placed biopsies in the right and left apex and mid portion of the prostate gland. The objective of this study is to confirm the higher prostate cancer defection rate obtained using our simulated 10-core biopsy pattern in a small clinical trial. We retrospectively reviewed 35 consecutive patients with a pathologic diagnosis of prostate cancer biopsied by a single urologist using the 10-core prostate biopsy patterns were compared with respect to prostate cancer detection rate. Of the 35 patients diagnosed with prostate cancer, 54.3 percent were diagnosed when reviewing the sextant biopsy data only. Review of the 10-core pattern revealed that an additional 45.7 percent were diagnosed when reviewing the sextant biopsy data only. Review of the 10-core pattern revealed that an additional 45.7 percent of patients were diagnosed solely with the laterally placed biopsies. Our results suggest that biopsy protocols that use laterally placed biopsies based upon a five region anatomical model are superior to the routinely used sextant prostate biopsy pattern.
Bauer, John J.; Zeng, Jianchao; Zhang, Wei; Sesterhenn, Isabell A.; Dean, Robert; Moul, Judd W.; Mun, Seong K.
Background Primary hyperparathyroidism (PHPT) is an endocrine disorder most commonly affecting women, suggesting a role for female hormones and/or their receptors in parathyroid adenomas. We here investigated the prolactin receptor (PRLr) which is associated with tumours of the breast and other organs. Methodology/Principal Findings PRLr expression was investigated in a panel of 37 patients with sporadic parathyroid tumours and its functionality in cultured parathyroid tumour cells. In comparison with other tissues and breast cancer cells, high levels of prolactin receptor gene (PRLR) transcripts were demonstrated in parathyroid tissues. PRLr products of 60/70 kDa were highly expressed in all parathyroid tumours. In addition varying levels of the 80 kDa PRLr isoform, with known proliferative activity, were demonstrated. In parathyroid tumours, PRLr immunoreactivity was observed in the cytoplasm (in all cases, n?=?36), cytoplasmic granulae (n?=?16), the plasma membrane (n?=?12) or enlarged lysosomes (n?=?4). In normal parathyroid rim (n?=?28), PRLr was uniformly expressed in the cytoplasm and granulae. In in vitro studies of short-term cultured human parathyroid tumour cells, prolactin stimulation was associated with significant transcriptional changes in JAK/STAT, RIG-I like receptor and type II interferon signalling pathways as documented by gene expression profiling. Moreover, PRLR gene expression in parathyroid tumours was inversely correlated with the patients’ plasma calcium levels. Conclusions We demonstrate that the prolactin receptor is highly abundant in human parathyroid tissues and that PRLr isoforms expression and PRLr subcellular localisation are altered in parathyroid tumours. Responsiveness of PRLr to physiological levels of prolactin was observed in the form of increased PTH secretion and altered gene transcription with significant increase of RIG-I like receptor, JAK-STAT and Type II interferon signalling pathways. These data suggest a role of the prolactin receptor in parathyroid adenomas.
Vukojevic, Vladana; Nilsson, Inga-Lena; Andreasson, Adam; Dzabic, Mensur; Branstrom, Robert; Hoog, Anders; Juhlin, C. Christofer; Larsson, Catharina
Various statistical methods can be used to analyze correlated data from a clinical study. At baseline of the EXPLORE study, a multi-site HIV prevention clinical trial conducted in the U.S., data from the most recent sexual episode with up to three of the most recent partners were collected. We were interested in the relationship between substance use and risky sexual
Marla Husnik; Eugene Huang; Grant Colfax
Purpose: To describe the clinical, imaging, and pathologic characteristics and diagnostic methods of telangiectatic osteosarcoma (TOS) for improving the diagnostic level. Materials and methods: The authors retrospectively reviewed patient demographics, serum alkaline phosphatase (AKP) levels, preoperative biopsy pathologic reports, pathologic materials, imaging findings, and treatment outcomes from 26 patients with TOS. Patient images from radiography (26 cases) and magnetic resonance (MR) imaging (22 cases) were evaluated by 3 authors in consensus for intrinsic characteristics. There were 15 male and 11 female patients in the study, with an age of 9-32 years (mean age 15.9 years). Results: Eighteen of 26 patients died of lung metastases within 5 years of follow-up. The distal femur was affected more commonly (14 cases, 53.8%). Regarding serum AKP, normal (8 cases) or mildly elevated (18 cases) levels were found before preoperative chemotherapy. Radiographs showed geographic bone lysis without sclerotic margin (26 cases), cortical destruction (26 cases), periosteal new bone formation (24 cases), soft-tissue mass (23 cases), and matrix mineralization (4 cases). The aggressive radiographic features of TOS simulated the appearance of conventional high-grade intramedullary osteosarcoma, though different from aneurysmal bone cyst. MR images demonstrated multiple big (16 cases) or small (6 cases) cystic spaces, fluid-fluid levels (14 cases), soft-tissue mass (22 cases), and thick peripheral and septal enhancement (22 cases). Nine of 26 cases were misdiagnosed as aneurysmal bone cysts by preoperative core-needle biopsy, owing to the absence of viable high-grade sarcomatous cells in the small tissue samples. Conclusion: The aggressive growth pattern with occasional matrix mineralization, and multiple big or small fluid-filled cavities with thick peripheral, septal, and nodular tissue surrounding the fluid-filled cavities are characteristic imaging features of TOS, and these features are helpful in making the correct preoperative diagnosis of TOS. PMID:24334494
Gao, Zhen-Hua; Yin, Jun-Qiang; Liu, Da-Wei; Meng, Quan-Fei; Li, Jia-Ping
On April 28, 2008, the Food and Drug Administration (FDA or Agency) amended its regulations on the acceptance of foreign clinical studies not conducted under an investigational new drug application (IND) (non-IND foreign clinical studies) as support for a...
The author is pleased to introduce a new section in "TAJ," Four Questions. The structure is simple: four questions are asked to teaching artists working in various media and locations. The questions are always the same, but because each teaching artist's approach is unique, their answers will provide an insight into particular methodologies that…
Hark-Weber, Amara G., Ed.
Smaller expansions (41–54?CGG repeats) in the fragile X mental retardation 1 (FMR1) gene are termed “gray zone” alleles. Only recently has interest in these expansions increased due to reporting of phenotypes unique to gray zone carriers or similar to those seen in individuals with larger expansions. As minimal research has focused on gray zone expansions, this paper asks several questions related to this topic. These include the following: What is the definition of the gray zone? Is there a risk of developing neurological signs in these carriers? Are there secondary gene effects that impact gray zone alleles or a biologic advantage to carrying these repeats? How do we counsel patients with gray zone expansions? The answers to these questions will help to determine the significance of these expansions and provide needed information to the research community and clinicians.
Hall, Deborah A.
Background: Lumbar disc prolapse is one of the common causes of low back pain seen in the working population. There are contradictorty reports regarding the clinical significance of various magnetic resonance imaging (MRI) findings observed in these patients. The study was conducted to correlate the abnormalities observed on MRI and clinical features of lumbar disc prolapse. Materials and Methods: 119 clinically diagnosed patients with lumbar disc prolapse were included in the study. Clinical evaluation included pain distribution, neurological symptoms and signs. MR evaluation included grades of disc degeneration, type of herniation, neural foramen compromise, nerve root compression, and miscellaneous findings. These MRI findings were tested for inter- and intraobserver variability. The MRI findings were then correlated with clinical symptoms and the level of disc prolapse as well as neurological signs and symptoms. Statistical analysis included the Kappa coefficient, Odd’s ratio, and logistic regression analysis. Results: There were no significant inter- or intraobserver variations for most of MRI findings (Kappa value more than 0.5) except for type of disc herniation which showed a interobserver variation of 0.46 (Kappa value). The clinical level of pain distribution correlated well with the MRI level (Kappa 0.8), but not all disc bulges produced symptoms. Central bulges and disc protrusions with thecal sac compression were mostly asymptomatic, while centrolateral protrusions and extrusions with neural foramen compromise correlated well with the dermatomal distribution of pain. Root compression observed in MRI did not produce neurological symptoms or deficits in all patients but when deficits were present, they correlated well with the presence of root compression in MRI. Multiple level disc herniations with foramen compromise were strongly associated with the presence of neurological signs. Conclusions: The presence of centrolateral protrusion or extrusion with gross foramen compromise correlates with clinical signs and symptoms very well, while central bulges and disc protrusions correlate poorly with clinical signs and symptoms. The presence of neural foramen compromise is more important in determining the clinical signs and symptoms while type of disc herniation (bulge, protrusion, or extrusion) correlates poorly with clinical signs and symptoms.
Janardhana, Aithala P; Rajagopal; Rao, Sharath; Kamath, Asha
Social cognitive impairments are common, detectable across a wide range of tasks, and appear to play a key role in explaining poor outcome in schizophrenia and related psychotic disorders. However, little is known about the underlying factor structure of social cognition in people with psychotic disorders due to a lack of exploratory factor analyses using a relatively comprehensive social cognitive assessment battery. In a sample of 85 outpatients with psychosis, we examined the factor structure and clinical/functional correlates of eight indexes derived from five social cognition tasks that span the domains of emotional processing, social perception, attributional style, and Theory of Mind. Exploratory factor analysis revealed three factors with relatively low inter-correlations that explained a total of 54% of the variance: (1) Hostile attributional style, (2) Lower-level social cue detection, and (3) Higher-level inferential and regulatory processes. None of the factors showed significant correlations with negative symptoms. Factor 1 significantly correlated with clinical symptoms (positive, depression-anxiety, agitation) but not functional outcome, whereas Factors 2 and 3 significantly correlated with functional outcome (functional capacity and real-world social and work functioning) but not clinical symptoms. Furthermore, Factor 2 accounted for unique incremental variance in functional capacity, above and beyond non-social neurocognition (measured with MATRICS Consensus Cognitive Battery) and negative symptoms. Results suggest that multiple separable dimensions of social cognition can be identified in psychosis, and these factors show distinct patterns of correlation with clinical features and functional outcome.
Mancuso, Francesco; Horan, William P.; Kern, Robert S.; Green, Michael F.
The present investigation was performed in a population of patients with temporomandibular disorders (TMD), and it was designed to assess the correlation between self-reported questionnaire-based bruxism diagnosis and a diagnosis based on history taking plus clinical examination. One-hundred-fifty-nine patients with TMD underwent an assessment including a questionnaire investigating five bruxism-related items (i.e. sleep grinding, sleep grinding referral by bed partner, sleep clenching, awake clenching, awake grinding) and an interview (i.e. oral history taking with specific focus on bruxism habits) plus a clinical examination to evaluate bruxism signs and symptoms. The correlation between findings of the questionnaire, viz., patients' report, and findings of the interview/oral history taking plus clinical examination, viz., clinicians' diagnosis, was assessed by means of ? coefficient. The highest correlations were achieved for the sleep grinding referral item (? = 0·932) and for the awake clenching item (? = 0·811), whilst lower correlation values were found for the other items (? values ranging from 0·363 to 0·641). The percentage of disagreement between the two diagnostic approaches ranged between 1·8% and 18·2%. Within the limits of the present investigation, it can be suggested that a strong positive correlation between a self-reported and a clinically based approach to bruxism diagnosis can be achieved as for awake clenching, whilst lower levels of correlation were detected for sleep-time activities. PMID:24112029
Paesani, D A; Lobbezoo, F; Gelos, C; Guarda-Nardini, L; Ahlberg, J; Manfredini, D
View all of the questions that have been submitted and see how they have been evaluated by peers. Submit your own evaluation of a submitted question, or leave a comment about a question (commenting requires log in or creation of your own PQ account).
Chlamydia trachomatis is among the most prevalent genital infections and is an important cause of tubal factor infertility. The majority of infected females are asymptomatic. Evidence on the reliability of signs of inflammation used to predict chlamydia in female patients is inconsistent. This study examined associations between criteria routinely used in many Scandinavian sexually transmitted infection (STI) clinics and a positive chlamydia test in a high-prevalence population. Clinical and microscopic signs of cervicitis and urethritis were recorded in 99 women attending due to chlamydia infection in a sexual partner. Mucopurulent cervical discharge, easily induced bleeding from the cervix, and more polymorpho-nuclear cells than epithelial cells in vaginal wet smear all correlated significantly with a positive Chlamydia trachomatis test (odds ratios: 3.4, 4.0 and 4.8, respectively). Increased numbers of polymorphonuclear leucocytes (>30 and ? 5 respectively) in stained cervical and urethral smears were not significantly correlated with chlamydia infection. Hence, routine collection of cervical and urethral smears in female STI patients is questionable. PMID:23460336
Berntsson, Matilda; Tunbäck, Petra
The most common clinical features of tempero-mandibular joint internal derangement are correlated with the MRI findings of shape of the disc in an attempt to find the etiology of tempero-mandibular joint internal derangement. In this study, the clinical parameters of pain, muscle tenderness, clicking with in the joint (like early, middle and late) are correlated with the MRI findings of disc shapes. (like biconcave, thick, lengthened, folded, adhesion). The study reveals any trauma that leads to muscle tenderness results in internal derangement of tempero-mandibular joint. PMID:16900891
Chowdary, U V; Rajesh, P; Neelakandan, R S; Nandagopal, C M
Susceptibility testing of fungi by flow cytometry (also called fluorescence-activated cell sorting (FACS)) using vital staining with FUN-1 showed a good correlation with the standard M27-A procedure for assessing MICs. In this study we determined MICs for blood culture isolates from patients with candidemia by NCCLS M27-A and FACS methods and correlated the clinical outcome of these patients with in
CHRISTOPH WENISCH; CAROLINE B. MOORE; ROBERT KRAUSE; ELISABETH PRESTERL; PETER PICHNA; DAVID W. DENNING
Susceptibility testing of fungi by flow cytometry (also called fluorescence-activated cell sorting (FACS)) using vital staining with FUN-1 showed a good correlation with the standard M27-A procedure for assessing MICs. In this study we determined MICs for blood culture isolates from patients with candidemia by NCCLS M27-A and FACS methods and correlated the clinical outcome of these patients with in
CHRISTOPH WENISCH; CAROLINE B. MOORE; ROBERT KRAUSE; ELISABETH PRESTERL; PETER PICHNA; DAVID W. DENNING
Objective. This prospective study was designed to determine the MRI features, clinical significance, and correlation to histopathologic\\u000a findings of secondary vascularized degenerative intervertebral disks. Materials and methods. Fifty-three patients with localized painful spine syndrome were investigated prospectively by contrast-enhanced MRI. Pain\\u000a was not predominantly radiating and there was no clinical evidence of spinal infection. In all patients sagittal SE T1-weighted,
A. Stäbler; M. Weiss; Jürgen Scheidler; Andreas Krödel; Manfred Seiderer; Maximilian Reiser
The aim of this study was to investigate HFE gene mutations, blood iron indices, and their clinical correlates in a Korean population. In 484 prospectively enrolled health-check\\u000a examinees, HFE gene mutations and iron indices with clinical and laboratory variables were analyzed. Although neither the C282Y nor S65C\\u000a gene mutation were found, the H63D heterozygote was detected in 41 subjects (8.5%).
Sang Hyub Lee; Jin-Wook Kim; So Hyun Shin; Kyoung Phil Kang; Hyun Cheol Choi; Sung Hee Choi; Kyoung Un Park; Hyun Young Kim; Weechang Kang; Sook-Hyang Jeong
Dr. Connie Ulrich, is an Associate Professor of Bioethics and Nursing at the University of Pennsylvania School of Nursing. Connie's research is all about clinical trial participation. I hope you find her insights as useful as we have. Please review her comments below and let us know your thoughts.
Objective Cervical myelopathy is a spinal cord dysfunction related to degeneration typical of aging. Its primary pathology is related to ischemia and spinal cord compression. Patients with myelopathy present many clinical problems; more severe cases may lead to quadriplegia if not treated in a timely manner. Because the primary pathology of this disease is caused by compression, thus generating spinal cord ischemia, we believed there must be a correlation between the degree of compression and the clinical assessment of patients with cervical myelopathy, but we did not find any study in the literature that made this correlation. Because there is doubt the literature we aimed, in our study, to analyze the correlation between the degree of clinical impairment of patients with cervical myelopathy and the Torg index. Methods A prospective, descriptive study, evaluating 46 patients, in which radiographic measurements of the Torg index were performed, with clinical analysis through the Nurick and JOA scale. Results Of the 46 study patients included in the study, 100% presented a Torg score <0.8. The decrease in Torg values was directly proportional to clinical worsening on the Nurick and JOA scale. Conclusions The degree of clinical impairment in patients with cervical myelopathy is directly related to the degree of spinal canal stenosis. Level of Evidence I, Prognostic Studies - Investigating the effect of the characteristics of a patient on the outcome of the disease.
Lozorio, Agnaldo Rogerio; Borges, Mateus; Batista Junior, Jose Lucas; Chacob Junior, Charbel; Machado, Igor Cardoso; Rezende, Rodrigo
The lower-extremity anatomy is complex and normal function is dependent on intact osteochondral, musculotendinous, and ligamentous structures. Injury may result in pain and functional limitation. Specific clinical tests are used to help isolate and define the pathoanatomy; however, their terminology may be confusing to the radiologist and the diagnostic value of these tests may not be well understood. This article presents an algorithmic approach to evaluation of the hip, knee, and ankle to improve the radiologist's understanding of lower-extremity physical examination. Knowledge of test terminology, clinical utility, and diagnostic accuracy will improve clinical and radiologic correlation. The article reviews the common clinical tests used to evaluate the lower extremity and provides an algorithm to establish a clinical examination road map and rapidly review the clinical utility and study hierarchy of a particular test. The sensitivity and specificity of the clinical tests and magnetic resonance (MR) imaging are reviewed because these parameters vary, and an understanding of the diagnostic utility of both the clinical and imaging tests is important in accurately formulating a definitive diagnosis. The structured algorithmic approach to lower-extremity examination described here, knowledge of test jargon, and familiarity with the diagnostic accuracy of the clinical and MR imaging examinations may help the radiologist focus image search patterns and provide detailed and clinically relevant reports. Online supplemental material is available for this article. PMID:24617699
Slaughter, Aubrey J; Reynolds, Kirk A; Jambhekar, Kedar; David, Ryan M; Hasan, S Ashfaq; Pandey, Tarun
Cerebral palsy will affect nearly 10% of the 60,000 very-low-birth-weight infants born in the United States in the next year, and an even greater percentage will display some form of permanent neurological impairment resulting from injury to the preterm brain. The 2008 Neurobiology of Disease in Children Symposium, held in conjunction with the 37th annual meeting of the Child Neurology Society, aimed to define current knowledge and to develop specific aims for future clinical, translational, and fundamental science. A complex interplay of both destructive and developmental forces is responsible for injury to the preterm brain. Advances in imaging and histology have implicated a variety of cell types, though pre-oligodendrocyte injury remains the focus. Research into different mechanisms of injury is facilitating new neuroprotective and rehabilitative interventions. A cooperative effort is necessary to translate basic research findings into clinically effective therapies and better care for these children.
Babcock, Michael A.; Kostova, Felina V.; Ferriero, Donna M.; Johnston, Michael V.; Brunstrom, Jan E.; Hagberg, Henrik; Maria, Bernard L.
Arthroscopic, clinical, and imaging observations were compared in 80 temporomandibular joints with suspected internal derangements. Rating scales were developed for assessment of the key arthroscopic findings of "roofing," vascularity, redundancy, articular surface condition, adhesions, and disc function. Clinical and imaging findings were correlated with the rated arthroscopic findings. The degree of roofing was found to have a significant relationship to disc quality and function. Arthroscopy completed the diagnostic picture in these cases and provided detailed information on the joints that was not elicited from clinical findings or imaging studies. PMID:2760727
McCain, J P; de la Rua, H; Le Blanc, W G
We present a case of clinically relevant and probable interaction between warfarin and scuppernongs in a 73-year-old woman where ingestion of scuppernongs, a variety of quercetin-containing muscadine grapes, over a period of 2?months was associated with elevations in the International Normalised Ratio to supratherapeutic levels. While muscadine grapes and specifically scuppernongs are found primarily in Southeastern USA, the flavonoid in questionand quercetin is found worldwide as a dietary supplement. PMID:24966255
Woodward, Christopher J; Deyo, Zachariah M; Donahue, Katrina E; Deal, Allison M; Hawes, Emily M
Have you ever found yourself lecturing a child, with the best of intentions, in an attempt to help him or her learn a lesson or process a situation in a manner that you feel will be productive? Curiosity questions, which the authors also call What and How questions, help children process an experience, event, or natural consequence so that they…
Nelsen, Jane; DeLorenzo, Chip
PURPOSE: To assess correlations between muscle edema on magnetic resonance (MR) images and clinical indexes of muscle injury in delayed-onset muscle soreness (DOMS) produced by submaximal exercise protocols. MATERIALS AND METHODS: Sixteen subjects performed 36 elbow flexions ("biceps curls") at one of two submaximal workloads that emphasized eccentric contractions. Changes in MR imaging findings, plasma levels of creatine kinase, and pain scores were correlated. RESULTS: Both exercise protocols produced DOMS in all subjects. The best correlation was between change in creatine kinase level and volume of muscle edema on MR images, regardless of the workload. Correlations tended to be better with the easier exercise protocol. CONCLUSION: Whereas many previous studies of DOMS focused on intense exercise protocols to ensure positive results, the present investigation showed that submaximal workloads are adequate to produce DOMS and that correlations between conventionally measured indexes of injury may be enhanced at lighter exercise intensities.
Evans, G. F.; Haller, R. G.; Wyrick, P. S.; Parkey, R. W.; Fleckenstein, J. L.; Blomqvist, C. G. (Principal Investigator)
The purpose of this study was (1) to examine the association of race/ethnicity on clinical trial awareness, controlling for several sociodemographic, attitudinal, and knowledge variables, and (2) to inform future communication campaigns to increase clinical trial awareness and participation. Secondary analysis was conducted among 6,754 Hispanic, Black, and White adult respondents to the National Cancer Institute’s 2007 Health Information National Trends Survey (HINTS). The dependent variable was awareness of clinical trials. Logistic regression was used to examine possible correlates of clinical trial awareness including sociodemographics, trust of sources of health information, beliefs about safety of health information, family/personal history of cancer, health seeking information, and awareness of three health agencies. Compared with Whites, Blacks and Hispanics were significantly less likely to have heard of a clinical trial. Other significant correlates of clinical trial awareness included education, income, belief that health information is safely guarded, family history of cancer, awareness of the Centers for Disease control, trust of health information from the Internet and charitable organizations, and distrust of health information from religious institutions. Blacks and Hispanics are significantly less aware of clinical trials. Campaigns that exploit unique beliefs and delivery channels for racial/ethnic subgroups should be considered.
LANGFORD, AISHA; RESNICOW, KEN; AN, LAWRENCE
Background. The frequency and clinical, neuropsychological and neuroimaging correlates of apathy in patients who have had a stroke are inadequately defined. Method. A total of 167 consecutive patients admitted to the stroke units of two university hospitals after an ischaemic stroke and 109 controls received extensive medical, psychiatric and neuro- psychological assessments ; a subset received a magnetic resonance imaging
HENRY BRODATY; PERMINDER S. SACHDEV; ADRIENNE WITHALL; ANNETTE ALTENDORF; MICHAEL J. VALENZUELA; LISA LORENTZ
The validity of an examination of knowledge in the medical sciences was assessed. Scores in clinical medicine categories and total score of the Quarterly Profile Examination were correlated with corresponding scores on the Part II examination of the National Board of Medical Examiners for three different examination dates. (Author/CTM)
Willoughby, T. Lee
This study was designed to investigate whether the neuropsychological correlates of the symptom dimensions of schizophrenia vary with the clinical state in patients followed from the acute to stable the phase of the illness. Fifteen patients were assessed for symptoms (SAPS-SANS) and undergone a complete neuropsychological assessment at two…
Guillem, F.; Ganeva, E.; Pampoulova, T.; Stip, E.; Lalonde, P.; Sasseville, M.
Cancer vaccine trials have failed to yield robust immune- correlated clinical improvements as observed in animal models, fueling controversy over the utility of human cancer vaccines. Therapeutic vaccination represents an intriguing additional therapy for glioblastoma multiforme (GBM; grade 4 glioma), which has a dismal prognosis and treatment response, but only early phase I vaccine trial results have been reported. Immune
Christopher J. Wheeler; Gentao Liu; Xiao-xue Zhang; Samuel Pepkowitz; Dennis Goldfinger; Dwain Irvin
Objective: Rage attacks have been documented in youth with varied psychiatric disorders, but few data have been reported on the clinical characteristics and correlates of rage attacks among children with obsessive-compulsive disorder (OCD). Method: Participants were 86 children (ages 6-16 years) with a primary diagnosis of OCD. Patients and their…
Storch, Eric A.; Jones, Anna M.; Lack, Caleb W.; Ale, Chelsea M.; Sulkowski, Michael L.; Lewin, Adam B.; De Nadai, Alessandro S.; Murphy, Tanya K.
Objective: To determine correlates of clinical outcomes in patients with short bowel syndrome (SBS). Methods: Retrospective medical record review of neonates treated between 1986 and 1998 who met our criteria for SBS: dependence on parenteral nutrition (PN) for at least 90 days after surgical therapy for congenital or acquired intestinal diseases. Results: Thirty subjects with complete data were identified; 13
David J. Andorsky; Dennis P. Lund; Craig W. Lillehei; Tom Jaksic; James DiCanzio; Denise S. Richardson; Sharon B. Collier; Clifford Lo; Christopher Duggan
This study investigated self-harming behaviors in 149 female adolescent victims of sexual abuse, first, by determining the rates of nine types of self-mutilating behavior at intake and nine months later and, second, by investigating comorbidity of clinical correlates associated with these behaviors. The adolescents were divided into three groups…
Cyr, Mireille; McDuff, Pierre; Wright, John; Theriault, Chantal; Cinq-Mars, Caroline
Sixty-five patients undergoing cardiac valve replacement were followed for one year by electroencephalography (EEG). Occurrence of delta or sharp wave disturbances of low frequency of dominant activity before operation was found to have prognostic significance. The degree of EEG change after operation correlated with clinical signs of cerebral involvement, and predicted the later course.
Sotaniemi, K A
A significant skewing of the peripheral T cell repertoire has been shown in relapsing–remitting multiple sclerosis (MS). Most of the studies already performed in this field are cross-sectional and therefore, little is known of the T cell repertoire evolution over time in MS and the correlation of T cell repertoire variation with clinical and MRI parameters. This study was performed
David-Axel Laplaud; Laureline Berthelot; Patrick Miqueu; Kasia Bourcier; Julien Moynard; Yannick Oudinet; Marina Guillet; Catherine Ruiz; Neal Oden; Sophie Brouard; Charles R. G. Guttmann; Howard L. Weiner; Samia J. Khoury; Jean-Paul Soulillou
In this paper, we analyze the correlations between four clinical measures (Fugl-Meyer upper extremity scale, Motor Activity Log, Action Research Arm Test, and Jebsen-Taylor Hand Function Test) and four robotic measures (smoothness of movement, trajectory error, average number of target hits per minute, and mean tangential speed), used to assess motor recovery. Data were gathered as part of a hybrid
Ozkan Celik; Marcia K. O'Malley; Corwin Boake; Harvey S. Levin; Nuray Yozbatiran; Timothy A. Reistetter
Demographic and clinical factors may influence assessment of autism symptoms. This study evaluated these correlates and also examined whether social communication and interaction and restricted/repetitive behavior provided unique prediction of autism spectrum disorder diagnosis. We analyzed data from 7352 siblings included in the Interactive…
Frazier, Thomas W.; Youngstrom, Eric A.; Embacher, Rebecca; Hardan, Antonio Y.; Constantino, John N.; Law, Paul; Findling, Robert L.; Eng, Charis
BackgroundAlthough craniopharyngiomas have a histologically benign nature, their treatment can be difficult. The correlation among clinical, proliferative, and immunohistologic features of female sex hormone receptors was determined in craniopharyngiomas to analyze whether they influence the growth of the tumor.
Shuichi Izumoto; Tsuyosi Suzuki; Manabu Kinoshita; Tetsuo Hashiba; Naoki Kagawa; Kouichi Wada; Yasunori Fujimoto; Naoya Hashimoto; Youichi Saitoh; Motohiko Maruno; Toshiki Yoshimine
We designed this study to identify empirical correlates on the MMPI-2 (Butcher et al., 2001) restructured clinical (RC) scales in a college counseling setting with a sample of 228 men and 522 women from a university-based psychological clinic. Participants were administered the MMPI-2 at intake and were rated by their therapists on a variety of variables including a 192-item Client Description Form. The findings indicate that the RC scales were generally most strongly correlated with conceptually relevant criteria and generally uncorrelated with conceptually nonrelevant criteria, which replicated findings of convergent and discriminant validity from previous studies. Follow-up analyses indicate that the RC scales have improved discriminant validity in comparison to the clinical scales and stronger convergent validity than a set of alternative MMPI-2 measures. PMID:16436023
Sellbom, Martin; Ben-Porath, Yossef S; Graham, John R
In clinical pathologic correlations, including the potential effect of the virus on the liver, the morphologic features of the various stages of viral hepatitis are the firm information available today. With acute hepatitis being an inflammatory reaction to cell injury and necrosis, and chronic hepatitis being sustained inflammation, correlation with clinical features and functional defects is good in acute hepatitis and less so in the chronic stages. The pathogenesis of the diseases-including cell necrosis, inflammation, fibrosis, and cirrhosis formation-is reasonably well understood, and this knowledge assists both in prognosis and in monitoring of therapy. The localization of the components of the hepatitis B antigen and their effects, including the nature of the immune response, is the most exciting aspect of the clinical pathologic problem. Today's interpretations offer, at best, a working hypothesis promising further understanding of the evolution of the disease. Images Figure 1 Figure 2
Photodynamic therapy (PDT) has been applied in a variety of oncological fields with good results. In neurosurgery, the clinical series are limited and the number of treated patients is not statistically significant. This work examines the results of PDT performed in our clinic and discusses some difficulties and causes of failure of this method in neurosurgical patients. Eight patients with malignant brain tumors underwent PDT. All had been treated previously by operation and radiation therapy and one patient had also received chemotherapy. At 24 hours after the i.v. injection of hematoporphyrin (5 mg/kg body weight), the tumor was removed as radically as possible and the residual tumor bed was exposed to either 630-nm light from an argon-dye laser or 600- to 680-nm light isolated from the emission of a quartz-halogen lamp. The type of sensitizer, the irradiation methods, and the peculiarities of glial tumors are examined as possible causes of failure. The longer survivals of some patients with glial tumors treated by PDT may make this treatment suitable when traditional therapies fail. PMID:2849067
Perria, C; Carai, M; Falzoi, A; Orunesu, G; Rocca, A; Massarelli, G; Francaviglia, N; Jori, G
Introduction Achieving participant comprehension has proven to be one of the most difficult, practical, and ethical challenges of HIV prevention clinical trials. It becomes even more challenging when local languages do not have equivalent scientific and technical vocabularies, rendering communication of scientific concepts in translated documents extremely difficult. Even when bilingual lexicons are developed, there is no guarantee that participants understand the terminology as translated. Methods We conducted twelve focus groups with women of reproductive age in Mwanza, Tanzania to explore the effectiveness of four questioning techniques for: (1) assessing participants' familiarity with existing technical terms and concepts, (2) generating a list of acceptable technical and non-technical terms, (3) testing our definitions of technical terms, and (4) verifying participants' preferences for terms. Focus groups were transcribed, translated, and qualitatively analyzed. Results and Discussion A translation process that uses all four questioning techniques in a step-wise approach is an effective way to establish a baseline understanding of participants' familiarity with research terms, to develop and test translatable definitions, and to identify participants' preferred terminology for international HIV clinical research. This may help to ensure that important concepts are not “lost in translation.” The results emphasize the importance of using a variety of techniques depending on the level of participant familiarity with research concepts, the existence of colloquial or technical terms in the target language, and the inherent complexity of the terms.
Mack, Natasha; Ramirez, Catalina B.; Friedland, Barbara; Nnko, Soori
Purpose Clinical grammar markers are needed for children with SLI older than 8 years. This study followed children studied earlier on sentences with omitted finiteness to determine if affected children continue to perform at low levels and to examine possible predictors of low performance. This is the first longitudinal report of grammaticality judgments of questions. Method Three groups of children participated: 20 SLI, 20 age controls and 18 language-matched controls, followed from ages 6–15 years. An experimental grammaticality judgment task was administered with BE copula/auxiliary and DO auxiliary in Wh- and Yes/No questions for 9 times of measurement. Predictors were indices of vocabulary, nonverbal intelligence, and maternal education. Results Growth curve analyses show that the affected group performed below the younger controls at each time of measurement, for each variable. Growth analyses show linear and quadratic effects for both groups across variables, with the exception of BE acquisition which was flat for both groups. The control children reached ceiling levels; the affected children reached a lower asymptote. Conclusions The results suggest an on-going maturational lag in finiteness marking for affected children with promise as a clinical marker for language impairment in school-aged and adolescent children and probably adults as well.
Rice, Mabel L; Hoffman, Lesa; Wexler, Ken
The Ski-interacting protein (SKIP) is a transcriptional cofactor distinct from other cofactors and is involved in regulation of many cancer-related proteins. However, its distribution and clinical significances in bladder cancer remains poorly understood. In this study, Quantitative real-time PCR and immunohistochemistry were performed to detect the expression of SKIP in clinical bladder cancer samples. In addition, the correlation of SKIP expression and clinicopathological features and clinical outcomes were analyzed. The expression levels of SKIP in clinical bladder cancer were much higher than that in paired adjacent noncancerous tissues. High expression of SKIP was closely related with histological grades and the poor prognosis of bladder cancer. Based on our data, we speculated that SKIP may be a potential prognostic marker in bladder cancer. PMID:24817966
Wang, Longwang; Zhang, Mei; Wu, Yong; Cheng, Cheng; Huang, Yawei; Shi, Zimin; Huang, Hongwei
The Ski-interacting protein (SKIP) is a transcriptional cofactor distinct from other cofactors and is involved in regulation of many cancer-related proteins. However, its distribution and clinical significances in bladder cancer remains poorly understood. In this study, Quantitative real-time PCR and immunohistochemistry were performed to detect the expression of SKIP in clinical bladder cancer samples. In addition, the correlation of SKIP expression and clinicopathological features and clinical outcomes were analyzed. The expression levels of SKIP in clinical bladder cancer were much higher than that in paired adjacent noncancerous tissues. High expression of SKIP was closely related with histological grades and the poor prognosis of bladder cancer. Based on our data, we speculated that SKIP may be a potential prognostic marker in bladder cancer.
Wang, Longwang; Zhang, Mei; Wu, Yong; Cheng, Cheng; Huang, Yawei; Shi, Zimin; Huang, Hongwei
OBJECTIVE: To determine whether air trapping (expressed as the percentage of air trapping relative to total lung volume [AT%]) correlates with clinical and functional parameters in children with obliterative bronchiolitis (OB). METHODS: CT scans of 19 children with OB were post-processed for AT% quantification with the use of a fixed threshold of ?950 HU (AT%950) and of thresholds selected with the aid of density masks (AT%DM). Patients were divided into three groups by AT% severity. We examined AT% correlations with oxygen saturation (SO2) at rest, six-minute walk distance (6MWD), minimum SO2 during the six-minute walk test (6MWT_SO2), FVC, FEV1, FEV1/FVC, and clinical parameters. RESULTS: The 6MWD was longer in the patients with larger normal lung volumes (r = 0.53). We found that AT%950 showed significant correlations (before and after the exclusion of outliers, respectively) with the clinical score (r = 0.72; 0.80), FVC (r = 0.24; 0.59), FEV1 (r = ?0.58; ?0.67), and FEV1/FVC (r = ?0.53; r = ?0.62), as did AT%DM with the clinical score (r = 0.58; r = 0.63), SO2 at rest (r = ?0.40; r = ?0.61), 6MWT_SO2 (r = ?0.24; r = ?0.55), FVC (r = ?0.44; r = ?0.80), FEV1 (r = ?0.65; r = ?0.71), and FEV1/FVC (r = ?0.41; r = ?0.52). CONCLUSIONS: Our results show that AT% correlates significantly with clinical scores and pulmonary function test results in children with OB.
Mocelin, Helena; Bueno, Gilberto; Irion, Klaus; Marchiori, Edson; Sarria, Edgar; Watte, Guilherme; Hochhegger, Bruno
Aims A growing literature has documented the substantial prevalence of and putative mechanisms underlying co-occurring (i.e., concurrent or simultaneous) cannabis and tobacco use. Greater understanding of the clinical correlates of co-occurring cannabis and tobacco use may suggest how intervention strategies may be refined to improve cessation outcomes and decrease the public health burden associated with cannabis and tobacco use. Methods A systematic review of the literature on clinical diagnoses, psychosocial problems, and outcomes associated with co-occurring cannabis and tobacco use. Twenty-eight studies compared clinical correlates in co-occurring cannabis and tobacco users vs. cannabis or tobacco only users. These included studies of treatment-seekers in clinical trials and non-treatment-seekers in cross-sectional or longitudinal epidemiological or non-population-based surveys. Results Sixteen studies examined clinical diagnoses, four studies examined psychosocial problems, and 11 studies examined cessation outcomes in co-occurring cannabis and tobacco users (several studies examined multiple clinical correlates). Relative to cannabis use only, co-occurring cannabis and tobacco use was associated with a greater likelihood of cannabis use disorders, more psychosocial problems, and poorer cannabis cessation outcomes. Relative to tobacco use only, co-occurring use did not appear to be consistently associated with a greater likelihood of tobacco use disorders, more psychosocial problems, nor poorer tobacco cessation outcomes. Conclusions Cannabis users who also smoke tobacco are more dependent on cannabis, have more psychosocial problems, and have poorer cessation outcomes than those who use cannabis but not tobacco. The converse does not appear to be the case.
Peters, Erica N.; Budney, Alan J.; Carroll, Kathleen M.
Soluble CD30 (sCD30) has been proposed as a promising noninvasive biomarker for clinical renal allograft rejection, but its diagnostic characteristics regarding detection of subclinical rejection have not been assessed. We investigated sCD30 in 146 consecutive kidney allograft recipients under tacrolimus-mycophenolate-based immunosuppression having 250 surveillance biopsies at 3 and 6 months as well as 52 indication biopsies within the first year post-transplant. Allograft histology results were classified as (i) acute Banff score zero or interstitial infiltrates only, (ii) tubulitis t1, (iii) tubulitis t2-3 and (iv) isolated vascular compartment inflammation. sCD30 correlated well with the extent of clinical (P < 0.0001), but not subclinical tubulointerstitial rejection (P = 0.06). To determine diagnostic characteristics of sCD30, histological groups were assigned to two categories: no relevant inflammation (i.e. acute Banff score zero and interstitial infiltrates only) versus all other pathologies (tubulitis t1-3 and isolated vascular compartment inflammation). For clinical allograft inflammation, AUC was 0.87 (sensitivity 89%, specificity 79%; P = 0.0006); however, for subclinical inflammation, AUC was only 0.59 (sensitivity 50%, specificity 69%; P = 0.47). In conclusion, sCD30 correlated with clinical, but not subclinical renal allograft rejection limiting its clinical utility as a noninvasive rejection screening biomarker in patients with stable allograft function receiving tacrolimus-mycophenolate-based immunosuppression. PMID:23137306
Hirt-Minkowski, Patricia; Roth, Michèle; Hönger, Gideon; Amico, Patrizia; Hopfer, Helmut; Schaub, Stefan
We examined the empirical correlates of the MMPI-2 Restructured Clinical (RC; Tellegen et al., 2003) scales in a nonclinical setting. We administered 12 criterion measures assessing variables expected to be associated differentially with the RC Scales along with the MMPI-2 to a sample of 1,038 college students (Men, N = 407; Women, N = 631). Criteria included measures of somatization, depression, Machiavellian negativism, drug and alcohol abuse, anger, anxiety, social phobias, obsessive-compulsive tendencies, magical ideation, perceptual aberration, lability, and impulsivity. Results demonstrate good convergent and discriminant validity for the RC scales and add to a growing body of empirical correlates of these scales. PMID:18444107
Forbey, Johnathan D; Ben-Porath, Yossef S
This is a prospective study to evaluate the accuracy of clinical predictions related to surgical results in subjects who underwent maxillary superior repositioning without anterior-posterior movement. Surgeons' predictions according to clinical (tooth show at rest and at the maximum smile) and cephalometric evaluation were documented for the amount of maxillary superior repositioning. Overcorrection or undercorrection was documented for every subject 1 year after the operations. Receiver operating characteristic curve test was used to find a cutoff point in prediction errors and to determine positive predictive value (PPV) and negative predictive value. Forty subjects (14 males and 26 females) were studied. Results showed a significant difference between changes in the tooth show at rest and at the maximum smile line before and after surgery. Analysis of the data demonstrated no correlation between the predictive data and the surgical results. The incidence of undercorrection (25%) was more common than overcorrection (7.5%). The cutoff point for errors in predictions was 5 mm for tooth show at rest and 15 mm at the maximum smile. When the amount of the presurgical tooth show at rest was more than 5 mm, 50.5% of clinical predictions did not match the clinical results (PPV), and 75% of clinical predictions showed the same results when the tooth show was less than 5 mm (negative predictive value). When the amount of presurgical tooth shown in the maximum smile line was more than 15 mm, 75% of clinical predictions did not match with clinical results (PPV), and 25% of the predictions had the same results because the tooth show at the maximum smile was lower than 15 mm. Clinical predictions according to the tooth show at rest and at the maximum smile have a poor correlation with clinical results in maxillary superior repositioning for vertical maxillary excess. The risk of errors in predictions increased when the amount of superior repositioning of the maxilla increased. Generally, surgeons have a tendency to undercorrect rather than overcorrect, although clinical prediction is an original guideline for surgeons, and it may be associated with variable clinical results. PMID:24769611
Tabrizi, Reza; Zamiri, Barbad; Kazemi, Hamidreza
Introduction: This study aims to examine the socio-demographic and clinical correlates of the duration of untreated psychosis (DUP) in first-episode psychosis patients in an Asian country. Material and Methods: Three hundred thirty-four patients from the Early Psychosis Interven- tion Programme (EPIP) of Singapore were recruited for the study. Socio-demographic data were collected and patients were diagnosed using SCID I (Structural
E Pek; S Mythily
This study aimed to identify the incidence and clinical correlates of aggression and violence in first episode psychosis. We prospectively recruited subjects with a first episode of DSM-psychosis presenting from a geographically defined catchment area to a secondary referral psychiatric service over a four-year period (n=157). We used the Modified Overt Aggression Scale to retrospectively assess aggression (a hostile or
Sharon R. Foley; Brendan D. Kelly; Mary Clarke; Orfhlaith McTigue; Maurice Gervin; Moyyad Kamali; Conall Larkin; Eadbhard O'Callaghan; Stephen Browne
The aim of our study was to identify relationships between epigenetic parameters correlating with a relaxed chromatin state of the DUX4 promoter region and clinical severity as measured by a clinical severity score or muscle pathologic changes in D4Z4 contraction-dependent (FSHD1) and -independent (FSHD2) facioscapulohumeral muscular dystrophy patients. Twenty primary fibroblast (5 control, 10 FSHD1 and 5 FSHD2) and 26 primary myoblast (9 control, 12 FSHD1 and 5 FSHD2) cultures originating from patients with FSHD and controls were analyzed. Histone modification levels were determined by chromatin immunoprecipitation. We examined correlations between the chromatin compaction score (ChCS) defined by the H3K9me3:H3K4me2 ratio and an age corrected clinical severity score (CSS) or muscle pathology score (MPS). Possible relationships were investigated using linear regression analysis and significance was tested by Pearson's product-moment coefficient. We found a significant difference of the ChCS between controls and patients with FSHD1 and between controls and patients with FSHD2. Tissue specific differences in ChCS were also observed. We also found a near-significant relationship between ChCS and the age corrected CSS in fibroblasts but not in myoblasts. Surprisingly, we found a strong correlation between the MPS of the vastus lateralis and the CSS. Our results confirm the D4Z4 chromatin relaxation previously shown to be associated with FSHD in a small number of samples. A possible relationship between clinical and epigenetic parameters could be established in patient fibroblasts, but not in myoblasts. The strong correlation between the MPS of the vastus lateralis and the CSS suggests that this muscle can be used to study for surrogate markers of overall disease severity. PMID:22522912
Balog, Judit; Thijssen, Peter E; de Greef, Jessica C; Shah, Bharati; van Engelen, Baziel G M; Yokomori, Kyoko; Tapscott, Stephen J; Tawil, Rabi; van der Maarel, Silvère M
Review, analysis and correlation (clinical, radiologic and pathologic) of 29 consecutive adults (16 drug addicts and\\/or homosexuals) with DLU on Ga-67 scintigraph were made. Diffuse increased uptake of at least 75% of both lungs was considered as DLU. WFOF cameras were used to obtain 24 to 96 hr. scintigraphs after IV injection of 3-5 mCi of Ga-67 citrate. In 26,
W. M. Sy; I. S. Seo; J. Vieira; M. Zaman
Sjögren’s syndrome (SS) is a chronic inflammatory systemic autoimmune disease. The disease spectrum extends from sicca syndrome to systemic involvement and extraglandular manifestations, and SS may be associated with malignancies, especially non-Hodgkin’s lymphoma. Patients with SS present a broad spectrum of serologic features. Certain serological findings are highly correlated with specific clinical features, and can be used as prognostic markers.
Garcia-Carrasco, Mario; Mendoza-Pinto, Claudia; Jimenez-Hernandez, Cesar; Jimenez-Hernandez, Mario; Nava-Zavala, Arnulfo; Riebeling, Carlos
The usage of laser correlation spectroscopy for verification of preclinical and clinical states is substantiated. Developed "semiotic" classifier for solving the problems of preclinical and clinical states is presented. The substantiation of biological algorithms as well as the mathematical support and software for the proposed classifier for the data of laser correlation spectroscopy of blood plasma are presented. PMID:9848161
Ternovo?, K S; Kryzhanovski?, G N; Musi?chuk, Iu I; Noskin, L A; Klopov, N V; Noskin, V A; Starodub, N F
Awareness in dementia is increasingly recognized not only as multifactorial, but also as domain specific. We demonstrate differential clinical correlates for awareness of daily function, awareness of memory, and the novel exploration of awareness of balance. Awareness of function was higher for participants with mild cognitive impairment (aMCI and non-aMCI) than for those with dementia (due to Alzheimer disease; AD and non-AD), whereas awareness of memory was higher for both non-aMCI and non-AD dementia patients than for those with aMCI or AD. Balance awareness did not differ based on diagnostic subgroup. Awareness of function was associated with instrumental activities of daily living and caregiver burden. In contrast, awareness of balance was associated with fall history, balance confidence, and instrumental activities of daily living. Clinical correlates of awareness of memory depended on diagnostic group: associations held with neuropsychological variables for non-AD dementia, but for patients with AD dementia, depression and instrumental activities of daily living were clinical correlates of memory awareness. Together, these data provide support for the hypothesis that awareness and dementia are not unitary and are, instead, modality specific. PMID:24551452
O'Connell, Megan E; Dal Bello-Haas, Vanina; Crossley, Margaret; Morgan, Debra
In Graves' ophthalmopathy (GO) it is important to distinguish acute inflammation at an early stage, responsive to immunosuppressive treatment, from inactive fibrotic end stage disease, unresponsive to the same treatment. The purpose of this study was to identify the most relevant signal intensities on orbital MR imaging with contrast administration both to classify patients according to their clinical activity score (defined by a cut-off value of 3) and to make a prediction of patient's CAS. Such threshold was considered as widely used in literature. Sixteen consecutive patients with a diagnosis of GO in different phases of thyroid disease based on clinical and orbital MR imaging signs, and six normal volunteers were examined. Orbital MR imaging was performed on a 1.5 Tesla MR Unit. MR scans were assessed by an experienced neuroradiologist, blinded to the clinical examinations. We found a statistical correlation between CAS and both STIR and contrast enhanced T1-weighted sequences. There was also a statistically significant correlation between STIR and contrast-enhanced T1 images disclosing the possibility of avoiding the injection of contrast medium. Our study proved that signal intensity values on STIR sequence increase in the inflammatory oedematous phase of disease. We confirmed the correlation between signal intensities on this sequence and CAS, showing an increase in signal intensity proportional to the CAS value. So we validated MRI use to establish the activity phase of disease more sensitively than CAS alone. PMID:24199816
Tortora, Fabio; Cirillo, Mario; Ferrara, Marco; Belfiore, Maria Paola; Carella, Carlo; Caranci, Ferdinando; Cirillo, Sossio
A study examined whether the technique of having students ask "active questions" (in the form of "I understand that...but I don't understand...") enhanced critical thinking and overall performance in the classroom. Subjects, 164 students in six tenth-grade biology sections and four junior-senior astronomy/geology sections, responded to a…
Williams, Steven F.
In this article, the author discusses a project involving the observation of 12 teachers in different schools, teaching pupils at Key Stage 3 of differing ages and abilities, noting both questioning techniques used and pupils' responses. The teachers involved were volunteers, chosen to give a range of experience, styles, and school, and included a…
Questor is a curious little bird whose four broad questions are helpful to anyone interested in making art or understanding the art of others. He was designed as a character in an online video for children, "Building on a River: Questor's Tale." The video is narrated by Questor, who relates the 2000 year history of architecture along the Salt…
Erickson, Mary; Dock, Michelle Nichols; Eldridge, Laurie
Objective: This study aimed at exploring the psychosocial and clinical correlates of substance use disorder in an adolescent inpatient psychiatric population. Method: During the period from 2006–2007, all subjects were systematically screened for substance use disorder (SUD) and were assessed for SUD characteristics by an independent support team using the RECAP (Joint Report on Drug Addiction and Treatment). Each SUD case was matched for age, gender, unit, and admission week, so as to compare a consumer sample (cases) with a non-consumer sample (controls). We retrospectively extracted data (socio-demographic and clinical characteristics) from charts to realize a case-control comparison. To assess Axis II borderline psychopathology, the child retro-DIB (Diagnosis Interview for Borderline) was used. Results: The sample included 30 cases and 30 controls between 14 and 17 years of age. SUD was significantly associated with maltreatment (p=0.038), loss of a first-degree relative (p=0.039), school absenteeism (p=0.035) and suicide attempts (p=0.02). Regarding psychopathology, significant co-occurrence was observed between SUD and conduct disorder (p=0.019), all personality disorders (p=0.003) and borderline personality disorder specifically (p=0.021). Conclusion: Adolescent inpatients with SUD possess differential psychosocial and clinical characteristics and particular correlates that justify adopting a specific multidisciplinary approach to this high-risk clinical subgroup.
Daudin, Marianne; Cohen, David; Edel, Yves; Bonnet, Nicolas; Bodeau, Nicolas; Consoli, Angele; Deniau, Emmanuelle; Guile, Jean-Marc
The aim of this study was to investigate the presence of premorbid Personality Disorder (PD) and its relationship with clinical correlates in patients with Delusional Disorder (DD). Eighty-six outpatients with DD whose diagnoses were confirmed using the Structured Clinical Interview for DSM-IV Axis I (SCID-I) Disorders (psychosis module) were evaluated for premorbid PD utilizing the Standardized Assessment of Personality (SAP). Psychopathology was assessed using Module B of SCID-I and the Positive and Negative Syndrome Scale (PANSS); psychosocial functioning was evaluated with the Global Assessment of Functioning scale. Premorbid intelligence was assessed using the Wechsler Adult Intelligence Scale-Third Edition, vocabulary subtest. A sociodemographic-clinical questionnaire was completed. Sixty-four percent of the patients had at least one premorbid PD, the most common being paranoid PD (38.4%), followed by schizoid PD (12.8%). The presence of at least one premorbid PD was significantly associated with higher scores for psychopathology, in particular, on the affective dimension of DD symptoms. However, the presence of premorbid PD was not associated with psychosocial functioning. Each of the premorbid PD was associated with different psychopathological profiles. Premorbid PD is a relevant phenomenon in DD, given its high prevalence and comorbidity, its influence on clinical correlates and its potential ability to predict specific sub-syndromes. PMID:23993136
de Portugal, Enrique; Díaz-Caneja, Covadonga M; González-Molinier, Manuel; de Castro, María Jesús; del Amo, Victoria; Arango, Celso; Cervilla, Jorge A
Eleven Acanthamoeba isolates, obtained from Acanthamoeba keratitis patients, from contact lens cases of non-Acanthamoeba keratitis patients, from asymptomatic individuals, from necrotic tissue, and from tap water and two reference strains were investigated by morphological, molecular biological, and physiological means in order to discriminate clinically relevant and nonrelevant isolates. All clinically relevant isolates showed Acanthamoeba sp. group II morphology. 18S ribosomal DNA sequencing revealed sequence type T4 to be the most prevalent group among the isolates and also the group recruiting most of the pathogenic strains. Interestingly, within T4 the strains of no clinical relevance clustered together. Moreover, physiological properties appeared to be highly consistent with initial pathogenicity and with sequence clustering. Altogether, the results of our study indicate a correlation between the phylogenetic relationship and pathogenicity.
Walochnik, Julia; Obwaller, Andreas; Aspock, Horst
This study evaluates spelling errors in the three subtypes of primary progressive aphasia (PPA): agrammatic (PPA-G), logopenic (PPA-L), and semantic (PPA-S). Forty one PPA-patients and 36 age-matched healthy controls were administered a test of spelling. The total number of errors and types of errors in spelling to dictation of regular words, exception words and nonwords, were recorded. Error types were classified based on phonetic plausibility. In the first analysis, scores were evaluated by clinical diagnosis. Errors in spelling exception words and phonetically plausible errors were seen in PPA-S. Conversely, PPA-G was associated with errors in nonword spelling and phonetically implausible errors. In the next analysis, spelling scores were correlated to other neuropsychological language test scores. Significant correlations were found between exception word spelling and measures of naming and single word comprehension. Nonword spelling correlated with tests of grammar and repetition. Global language measures did not correlate significantly with spelling scores, however. Cortical thickness analysis based on MRI showed that atrophy in several language regions of interest were correlated with spelling errors. Atrophy in the left supramarginal gyrus and inferior frontal gyrus (IFG) pars orbitalis correlated with errors in nonword spelling, while thinning in the left temporal pole and fusiform gyrus correlated with errors in exception word spelling. Additionally, phonetically implausible errors in regular word spelling correlated with thinning in the left IFG pars triangularis and pars opercularis. Together, these findings suggest two independent systems for spelling to dictation, one phonetic (phoneme to grapheme conversion), and one lexical (whole word retrieval).
Shim, HyungSub; Hurley, Robert S.; Rogalski, Emily; Mesulam, M.-Marsel
Whereas metacognition is of great interest for neuropsychological practice, little is known about the impact of metacognitive questions during a neuropsychological assessment. This study explored the impact of measuring "on-line" metacognitive processes on neuropsychological performances in a non-clinical population. Participants were randomly assigned to a "standard" or a "metacognitive" neuropsychological test procedure. The "standard" procedure assessed executive functions (Modified Card Sorting Test), episodic memory ("Rappel libre Rappel indicé" 16), working memory (digit span test Wechsler Adult Intelligence Scale III) and social cognition (Faces Test). In the "metacognitive" procedure, two questions were added after each item of these tests to evaluate "on-line" metacognitive monitoring and control. Working memory performances were better and episodic memory performances lower in the "metacognitive" versus the "standard" procedure. No significant difference was found concerning executive functioning or social cognition. The assessment of "on-line" metacognition might improve working memory performances by enhancing concentration, and might impair episodic memory performances by acting as a distractor. These findings may have implications for the development of cognitive remediation programs. (JINS, 2014, 20, 547-554). PMID:24867441
Quiles, C; Verdoux, H; Prouteau, A
Introduction Sepsis is still a leading cause of morbidity and mortality, even in modern times, and thrombocytopenia has been closely associated with unfavorable disease outcome. Decreases in mitochondrial membrane potential (depolarization) were found in different tissues during sepsis. Previous work suggests that mitochondrial dysfunction of platelets correlates with clinical disease activity in sepsis. However, platelet mitochondrial membrane potential (Mmp) has not been investigated in a clinical follow-up design and not with regard to disease outcome. Methods In this study, platelet mitochondrial membrane depolarization was assessed by means of a fluorescent Mmp-Index with flow cytometry in 26 patients with sepsis compared with control patients. Platelet Mmp-Index on admission was correlated with the clinical disease scores Acute Physiology and Chronic Health Evaluation Score II (APACHE II), Sequential Organ Failure Score (SOFA), and Simplified Acute Physiology Score II (SAPS II). Finally, platelet Mmp-Index on admission and follow-up were compared in the group of sepsis survivors and nonsurvivors. Expression of the prosurvival protein Bcl-xL in platelets was quantified by immunoblotting. Results Platelet mitochondrial membrane depolarization correlated significantly with the simultaneously assessed clinical disease severity by APACHE II (r?=?-0.867; P?0.0001), SOFA (r?=?-0.857; P <0.0001), and SAPS II score (r?=?-0.839; P?0.0001). Patients with severe sepsis showed a significant reduction in platelet Mmp-Index compared with sepsis without organ failure (0.18 (0.12 to 0.25) versus 0.79 (0.49 to 0.85), P?0.0006) or with the control group (0.18 (0.12 to 0.25) versus 0.89 (0.68 to 1.00), P?0.0001). Platelet Mmp-Index remained persistently low in sepsis nonsurvivors (0.269 (0.230 to 0.305)), whereas we observed recovery of platelet Mmp-Index in the survivor group (0.9 (0.713 to 1.017)). Furthermore, the level of prosurvival protein Bcl-xL decreased in platelets during severe sepsis. Conclusion In this study, we demonstrated that mitochondrial membrane depolarization in platelets correlates with clinical disease severity in patients with sepsis during the disease course and may be a valuable adjunct parameter to aid in the assessment of disease severity, risk stratification, and clinical outcome.
Diffusion tensor imaging (DTI) and MR spectroscopic imaging (MRSI) provide greater sensitivity than conventional MRI to detect diffuse alterations in normal appearing white matter (NAWM) of Multiple Sclerosis (MS) patients with different clinical forms. Therefore, the goal of this study is to combine DTI and MRSI measurements to analyze the relation between diffusion and metabolic markers, T2-weighted lesion load (T2-LL) and the patients clinical status. The sensitivity and specificity of both methods were then compared in terms of MS clinical forms differentiation. MR examination was performed on 71 MS patients (27 relapsing remitting (RR), 26 secondary progressive (SP) and 18 primary progressive (PP)) and 24 control subjects. DTI and MRSI measurements were obtained from two identical regions of interest selected in left and right centrum semioval (CSO) WM. DTI metrics and metabolic contents were significantly altered in MS patients with the exception of N-acetyl-aspartate (NAA) and NAA/Choline (Cho) ratio in RR patients. Significant correlations were observed between diffusion and metabolic measures to various degrees in every MS patients group. Most DTI metrics were significantly correlated with the T2-LL while only NAA/Cr ratio was correlated in RR patients. A comparison analysis of MR methods efficiency demonstrated a better sensitivity/specificity of DTI over MRSI. Nevertheless, NAA/Cr ratio could distinguish all MS and SP patients groups from controls, while NAA/Cho ratio differentiated PP patients from controls. This study demonstrated that diffusivity changes related to microstructural alterations were correlated with metabolic changes and provided a better sensitivity to detect early changes, particularly in RR patients who are more subject to inflammatory processes. In contrast, the better specificity of metabolic ratios to detect axonal damage and demyelination may provide a better index for identification of PP patients. PMID:22479330
Hannoun, Salem; Bagory, Matthieu; Durand-Dubief, Francoise; Ibarrola, Danielle; Comte, Jean-Christophe; Confavreux, Christian; Cotton, Francois; Sappey-Marinier, Dominique
This website, created by math educator Dan Meyer, randomly displays photos and brief videos contributed by Meyer or visitors to the site. The photos and videos are in intended to be "perplexing" and to promote wondering. Visitors to the site are encouraged to post questions inspired by the images. Many of these can be used in the classroom to spark inquiry and initiate mathematics investigations. The page links to a related blog.
Objective Little is known about apathy in the early stages of Parkinson's disease (PD). We determined the clinical correlates of apathy in a large representative sample of patients recently diagnosed with PD (ANIMO study). Methods PD patients, diagnosed within 2 years of inclusion, were recruited in 102 outpatient clinics situated in 82 populations throughout Spain. Apathy was quantified using the Lille Apathy Rating Scale (LARS). Clinical comparisons and correlations were performed using nonparametric tests. Regression analyses were used to test the association of clinical variables with apathy. Results We recruited 557 PD patients (60.3% men) with a mean age of 68.8 ± 9.7 years, and UPDRS motor score of 21.1 ± 10.8. Apathy only was diagnosed in 186 (33.4%), and apathy and depression in 215 patients (38.6%). Patients with higher comorbidity (OR = 1.10, 95% CI 1.01?1.20, p = 0.001), motor impairment (OR = 1.07, 95% CI 1.03?1.10, p < 0.0001), and lower education (OR = 2.16, 95% CI 1.21?;3.85, p = 0.009) had higher odds of having apathy, in contrast to patients living in a rural environment (OR = 0.35, 95% CI 0.32–0.85, p = 0.01), and left predominant PD motor laterality (OR = 0.34, 95% CI 0.13–0.88, p = 0.01). LARS scores were significantly correlated with UPDRS motor scores (rs = 0.44, p < 0.001), predominantly with axial score (rs = 0.43, p < 0.001). Conclusions In PD, apathy is a very common and disabling nonmotor symptom separable from depression. Patients living in a rural environment, with lower comorbidity and motor impairment, higher education background, and left predominant PD motor laterality are at lower risk of suffering from apathy.
Cubo, Esther; Benito-Leon, Julian; Coronell, Carlos; Armesto, Diana
Objective To assess the role of polymerase chain reaction (PCR) in serum samples, in the diagnosis of osteoarticular tuberculosis (OTB) in a setting where only clinical and imaging diagnoses determine the treatment. Methods A total of 44 consecutive serum specimens were collected from clinically suspected OTB patients, based on clinical and radiological [X-ray or magnetic resonance imaging/computed tomography] features. They were screened by in-house nested PCR. In addition, a few specimens were examined by Gram stain, acid-fast bacilli stain, histopathology and routine bacterial culture. A total of 39 specimens were collected from patients suffering from other bone diseases of nontuberculous origin and included as negative controls. Results Of the 44 clinically suspected OTB patients, in-house nested PCR was positive in 40 (91%) cases; PCR was negative in 38 (97%) negative controls. Sensitivity and specificity of our in-house nested PCR was 90.9% and 97.4%, respectively. The PCR report was available within 48 h. It was possible to standardize serum PCR technique and in positive cases, a good correlation was observed in terms of an adequate treatment response. Conclusions Nested PCR in serum samples is a rapid, highly sensitive and specific modality for OTB detection. PCR should be performed in addition to clinical evaluation, imaging studies, acid-fast bacilli staining, culture and histopathology diagnosis, if possible.
Garcia-Elorriaga, Guadalupe; Martinez-Elizondo, Olga; del Rey-Pineda, Guillermo; Gonzalez-Bonilla, Cesar
To assess the rate of sexual distress, sexual dysfunction and relationship quality and their association with clinical variables in women with systemic sclerosis (SSc), 102 sexually active women with SSc were recruited. Sexual distress, sexual dysfunction and dissatisfaction with relationship quality were investigated by Female Sexual Distress Scale Revised (FSDS-R), Female Sexual Function Index (FSFI) and Dyadic Adjustment Scale (DAS), respectively. The patients underwent medical examinations and nailfold videocapillaroscopy (NVC). Of the 102 patients, 37 (36%) reported sexual distress with FSDS-R score >11, 45 (44%) had sexual dysfunction with FSFI score <19 and 49 (48%) were not satisfied with relationship quality with DAS score <100. There was a negative correlation (p<0.001, R= -0.30) between FSDS-R and FSFI. No correlation was found between FSDS-R and DAS. FSFI showed a positive correlation with DAS (p<0.0001, R= 0.36). Age correlated negatively (p<0.05, R= -0.26) with FSFI, while FSDS-R and DAS did not correlate (p>0.05) with age. SSc women with digital ulcers (DU) had a reduction of FSFI and DAS compared with women without DU. In patients with late capillaroscopic pattern, mean value of FSFI was significantly lower than the other two capillaroscopic patterns. DAS decreased with progression of capillaroscopic damage. In a high percentage of women with SSc FSDS-R was increased, while FSFI and DAS were reduced. Age correlated negatively with FSFI, while skin score showed a negative correlation with DAS. Digital vascular damage negatively influenced FSFI and DAS. PMID:25004840
Rosato, E; Rossi, C; Molinaro, I; Di Giulio, M A; Trombetta, A C; Marra, A M; Gigante, A; Barbano, B; Quarta, S; Pisarri, S; Afeltra, A; Salsano, F
We examined correlates of antinuclear antibody (ANA) positivity (ANA+) in individuals with chronic hepatitis C virus (HCV) infection and the effect of positivity on clinical outcome of HCV. Pretreatment sera from 645 patients from three centres in Sweden (n = 225), the UK (n = 207) and Italy (n = 213) were evaluated by indirect immunofluorescence on Hep-2 cells for ANA pattern and titre by a single laboratory. Liver biopsies were all scored by one pathologist. A total of 258 patients were subsequently treated with interferon monotherapy. There was a significant difference in the prevalence of ANA (1:40) by geographic location: Lund 4.4%, London 8.7%, Padova 10.3% [odds ratio (OR) = 0.66; 95% CI: 0.46-0.94; P = 0.023]. Duration of HCV infection, age at infection, current age, route of infection, viral genotype, alcohol consumption, fibrosis stage and inflammatory score were not correlated with ANA+ or ANA pattern. Female gender was correlated with ANA+ and this association persisted in multivariable analyses (OR = 3.0; P = 0.002). Increased plasma cells were observed in the liver biopsies of ANA-positive individuals compared with ANA-negative individuals, while a trend towards decreased lymphoid aggregates was observed [hazard ratio (HR) = 9.0, P = 0.037; HR = 0.291, P = 0.118, respectively]. No correlations were observed between ANA positivity and nonresponse to therapy (OR = 1.4; P = 0.513), although ANA+ was correlated with faster rates of liver fibrosis, this was not statistically significant (OR = 1.8; P = 0.1452). Low titre ANA+ should not be a contraindication for interferon treatment. Our observation of increased plasma cells in ANA+ biopsies might suggest B-cell polyclonal activity with a secondary clinical manifestation of increased serum immunoglobulins. PMID:15357653
Yee, L J; Kelleher, P; Goldin, R D; Marshall, S; Thomas, H C; Alberti, A; Chiaramonte, M; Braconier, J-H; Hall, A J; Thursz, M R
Body dysmorphic disorder (BDD) is characterized by an often-delusional preoccupation with misperceived defects of appearance, causing significant distress and disability. Although previous studies have found functional abnormalities in visual processing, frontostriatal, and limbic systems, no study to date has investigated the microstructure of white matter connecting these systems in BDD. Participants comprised 14 medication-free individuals with BDD and 16 healthy controls who were scanned using diffusion-weighted magnetic resonance imaging (MRI). We utilized probabilistic tractography to reconstruct tracts of interest, and tract-based spatial statistics to investigate whole brain white matter. To estimate white matter microstructure, we used fractional anisotropy (FA), mean diffusivity (MD), and linear and planar anisotropy (c(l) and c(p)). We correlated diffusion measures with clinical measures of symptom severity and poor insight/delusionality. Poor insight negatively correlated with FA and c(l) and positively correlated with MD in the inferior longitudinal fasciculus (ILF) and the forceps major (FM). FA and c(l) were lower in the ILF and the inferior fronto-occipital fasciculus and higher in the FM in the BDD group, but differences were nonsignificant. This is the first diffusion-weighted MR investigation of white matter in BDD. Results suggest a relationship between impairments in insight, a clinically important phenotype, and fiber disorganization in tracts connecting visual with emotion/memory processing systems. PMID:23375265
Feusner, Jamie D; Arienzo, Donatello; Li, Wei; Zhan, Liang; Gadelkarim, Johnson; Thompson, Paul M; Leow, Alex D
Background & Aims Chronic visceral pain is frequent, extremely debilitating, and generally resistant to pharmacological treatment. It has been shown that chronic visceral inflammation, through altered afferent visceral sensory input, leads to plastic changes in the central nervous system that ultimately sustain pain. Therefore approaches aiming at modulation of brain activity are attractive candidates to control visceral pain. Methods Here we report findings of a phase II, sham-controlled clinical trial assessing the clinical and neurophysiological effects of a 10-day course of daily sessions of slow frequency, repetitive transcranial magnetic stimulation (rTMS) targeting the right secondary somatosensory cortex (SII) in patients with chronic pancreatitis and severe visceral pain. Results Our results show a significant reduction in pain after real rTMS that lasted for at least 3 weeks following treatment. These clinical changes were correlated with increases in glutamate and N-acetyl aspartate (NAA) levels - neurometabolites associated with cortical activity and brain damage - as measured by in vivo single-voxel proton magnetic resonance spectroscopy (1H-MRS). Adverse effects in the real rTMS group were mild and short-lasting. Conclusions Our results support preliminary findings showing that modulation of right SII with rTMS is associated with a significant analgesic effect and that this effect is correlated with an increase in excitatory neurotransmitter levels such as glutamate and NAA.
Fregni, Felipe; Potvin, Kimberly; DaSilva, Deborah; Wang, Xiaoen; Lenkinski, Robert; Freedman, Steven D.; Pascual-Leone, Alvaro
In the present study, we examined clinical and laser-evoked potentials (LEP) features in a group of chronic tension-type headache (CTTH) patients, in order to perform a topographic analysis of Laser evoked potentials (LEPs) and a correlation with clinical features. Eighteen patients suffering from CTTH [Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders 2nd ed. Cephalalgia 2004; 24 Suppl 1, 1-159.] participated in the study. Twelve age- and sex-matched controls were also examined. We performed a basal evaluation of clinical features, Total Tenderness Score (TTS) and a topographic analysis of LEPs obtained by the hand and the pericranial points stimulation in all patients vs healthy subjects. The later LEPs, especially the P2 component, were significantly increased in amplitude in the CTTH group, specially when the pericranial points were stimulated. The P2 wave amplitude was correlated with TTS levels and anxiety scores. The results of this study confirm that pericranial tenderness is a phenomenon initiating a self-sustaining circuit, involving central sensitization at the level of the cortical nociceptive areas devoted to attentional and emotional components of pain. PMID:16503063
de Tommaso, Marina; Shevel, Elliott; Pecoraro, Carla; Sardaro, Michele; Losito, Luciana; Lamberti, Paolo; Livrea, Paolo
Infections with hemorrhagic fever viruses are characterized by increased permeability leading to capillary leakage. Hantavirus infection is associated with endothelial dysfunction, and the clinical course is related to the degree of vascular injury. Circulating endothelial progenitor cells (cEPCs) play a pivotal role in the repair of the damaged endothelium. Therefore, we analyzed the number of cEPCs and their mobilizing growth factors in patients suffering from hantavirus disease induced by infection with Puumala virus. The numbers of EPCs of 36 hantavirus-infected patients and age- and gender-matched healthy controls were analyzed by flow cytometry. Concentrations of cEPC-mobilizing growth factors in plasma were determined by enzyme-linked immunosorbent assay. Laboratory parameters were correlated with the number of cEPCs. In patients infected with hantavirus, the number of cEPCs was significantly higher than that in healthy controls. Levels of mobilizing cytokines were upregulated in patients, and the mobilization of cEPCs is paralleled with the normalization of clinical parameters. Moreover, higher levels of cEPCs correlated with higher serum albumin levels and platelet concentrations. Our data indicate that cEPCs may play a role in the repair of hantavirus-induced endothelial damage, thereby influencing the clinical course and the severity of symptoms.
Grouls, Stephan; Hettwer, David; Rafat, Neysan; Tonshoff, Burkhard; Zeier, Martin
Background: Managing dental caries in young children is demanding due to the elusions present on the right diagnostic criteria for treatment. The present study evaluated the histological status of pulp tissues extracted from primary second molar with caries involvement. Histological findings are correlated with clinical and radiographic assessment. Materials and Methods: Simple experimental study was conducted on upper or lower second primary molars with occlusal (22 teeth) or proximal (22 teeth) dental caries. Selected children were below 6 years of age. Percentage of caries involvement, residual dentin thickness (RDT), radiographic assessment of interradicular and periapical areas, clinical caries depth and signs and symptoms are the parameters considered for comparing with the histological findings. The specimens were grouped based on the nature of the inflammatory process as acute or chronic. The data were analyzed by Student t-test to compare histological types of inflammation with clinical parameters. P value < 0.05 was considered as significant. Results: Four cases revealed severe acute inflammation in coronal and relatively mild acute inflammation in radicular pulp. In the rest of the specimen coronal and radicular pulp had similar acute or chronic inflammatory changes. Histological evidence of pulpitis correlated with dental caries depth of ?80%, RDT of ?1 mm, radiographic rarefactions in the interradicular regions and symptoms of pain. Conclusion: Primary second molars with more than two-third caries involvement with symptoms of pain histologically showed inflammation of both coronal and radicular pulp tissues in all cases.
Gopinath, Vellore Kannan; Anwar, Khurshid
Background Giardia duodenalis is one of the most important human enteric parasites throughout the world. Clinical symptoms of this parasite vary from asymptomatic infection to chronic diarrhea. Still it is not clear, whether different types of pathogenesis are due to different strains of organism or to variable host factors. The purpose of this study was to investigate possible correlation of clinical symptoms with assemblages among symptomatic and asymptomatic cases collected from southwest of Iran. Methods Fecal samples were collected from 100 symptomatic and asymptomatic cases, which were positive for G. duodenalis. The samples were subjected to semi-nested PCR and RFLP for gdh gene. Results Among symptomatic patients, 54% had mixed genotypes AII and BIII, 28% and 18% of samples indicated assemblages BIII and AII, respectively. In contrast, among asymptomatic cases, 64%, 26% and 10%samples had mixed genotypes, BIII and AII assemblages, respectively. Statistical analysis using Chi- Square test showed that there was no significant correlation between assemblage and clinical symptoms in current study. Conclusion High prevalence of mixed infection in both groups may affect this conclusion, therefore further study in more details are necessary to clarify these finding. Additionally, it is important to carry out investigations regarding human host factors as well.
RAFIEI, Abdollah; ROOINTAN, Elham Sadat; SAMARBAFZADEH, Ali Reza; SHAYESTEH, Ali Akbar; SHAMSIZADEH, Ahmad; POURMAHDI BORUJENI, Mahdi
Background: Hashimoto's thyroiditis (HT) is an autoimmune disease and it is more prevalent in Asians. The incidence of HT seems to be increasing in the recent times. It is one of the most common cause of hypothyroidism. The purpose of this study is to review the cytomorphologic spectrum of HT and correlate it with clinical findings including thyroid function and antibody profile. Materials and Methods: We retrospectively analyzed the fine-needle aspiration (FNA) features of 52 HT patients. Based on cytomorphologic features patients were categorized into three groups. Clinical findings including thyroid function and thyroid peroxidase (TPO) antibody profile were correlated with cytomorphologic features in all three groups. Results: Majority of the patients were females and in 2nd, 3rd and 4th decades. Diffuse goiter and thyroid hypofunction were the common findings. Significant number of patients had thyroid hyperfunction. Increased lymphocytes on the background and lymphocytic infiltration of thyroid follicular cell clusters in cytology smears were diagnostic of HT. The 32 patients showed elevated titers of TPO antibodies. In the early stages and mild form of the disease, results of thyroid function and anti TPO antibodies are quite variable. Conclusions: HT is a disease of young and middle age and mostly occur in females. Clinical findings alone may not be adequate for definitive diagnosis. FNA is the gold standard for diagnosis. In the presence of abundant colloid, follicular hyperplasia or co-existing neoplasm, careful interpretation of cytology smears should be done. Aspiration from more than one site minimizes the diagnostic pitfalls.
Chandanwale, Shirish S.; Gore, Charusheela R.; Bamanikar, Sunita A.; Gupta, Nidhi; Gupta, Kanika
This chapter will discuss the concept of correlation , which is used in later chapters that will explain the concepts of validity and reliability. Here, the authors introduce the Pearson correlation coefficient, a statistic that is used with ratio
Christmann, Edwin P.; Badgett, John L.
Sequencing of natural human tumors is teaching us invaluable lessons. It is becoming clear that the new dogmas created in the post genome era are being questioned. The previously suspected genetic heterogeneity of tumors is now proven on the sequence level. The extreme genetic heterogeneity of individual tumors and the existence of multiple tumors (not metastases) pose fundamental doubt on the prevailing dogma of targeted drug(s) and personalized treatments.
Purpose To investigate the in vitro in vivo correlation of a sustained release formulation for human growth hormone (hGH) based on hydroxyethyl methacrylated dextran (dex-HEMA) microspheres in Pit-1 deficient Snell dwarf mice and in healthy human volunteers. Materials and Methods A hGH-loaded microsphere formulation was developed and tested in Snell dwarf mice (pharmacodynamic study) and in healthy human volunteers (pharmacokinetic study). Results Single subcutaneous administration of the microspheres in mice resulted in a good correlation between hGH released in vitro and in vivo effects for the hGH-loaded microsphere formulation similar to daily injected hGH indicating a retained bioactivity. Testing the microspheres in healthy volunteers showed an increase (over 7–8 days) in hGH serum concentrations (peak concentrations: 1–2.5 ng/ml). A good in vitro in vivo correlation was obtained between the measured and calculated (from in vitro release data) hGH serum concentrations. Moreover, an increased serum concentration of biomarkers (insulin-like growth factor-I (IGF-I), IGF binding protein-3 (IGFBP-3) was found again indicating that bioactive hGH was released from the microspheres. Conclusions Good in vitro in vivo correlations were obtained for hGH-loaded dex-HEMA microspheres, which is an important advantage in predicting the effect of the controlled drug delivery product in a clinical situations.
de Vrueh, R.; Gresnigt, M. G.; Hoogerbrugge, C. M.; van Buul-Offers, S. C.; de Leede, L. G. J.; Sterkman, L. G. W.; Crommelin, D. J. A.; Hennink, W. E.; Verrijk, R.
A study was carried out in the Kingdom of Tonga, an area of hyperendemic Bancroftian filariasis, to determine whether correlations could be made between microfilaraemia, as diagnosed by membrane filter concentration, and immunological (skin test, immunoglobulin levels) or clinical findings. There was no relationship between the presence or degree of microfilaraemia and any clinical manifestation or skin test reaction. The skin test positivity rate for microfilaraemic and amicrofilaraemic individuals was approximately the same for all age groups. Among those aged 0 to 4 years, 48% of microfilaria positives were negative in the skin test. The highest average IgG and IgE levels were found in the groups with the highest microfilarial densities, i.e., in children with a history of fever and in adults with a history of lymphangitis/lymphadenitis. Over a period of a year, the microfilarial density changed significantly in 18 (34%) of 53 adults.
Desowitz, Robert S.; Berman, Steven J.; Puloka, Tili
Hopelessness is a widely observed barrier to recovery from schizophrenia spectrum disorders. Yet little is known about how clinical, social, and psychological factors independently affect hope. Additionally, the relationships that exist between these factors and different kinds of hope are unclear. To explore both issues, we correlated two aspects of hope, expectations of the future and agency, with stigma, clinical symptoms, anxiety, and coping preferences in 143 persons with a schizophrenia spectrum disorder. Multiple regressions revealed that hope for the future was predicted by lesser alienation, lesser preference for ignoring stressors, and lesser emotional discomfort and negative symptoms, accounting for 43% of the variance. A greater sense of agency was linked to lesser endorsement of mental illness stereotypes, fewer negative symptoms, lesser social phobia, and lesser preference for ignoring stressors, accounting for 44% of the variance. Implications for research and interventions are discussed. PMID:19009477
Lysaker, Paul H; Salyers, Michelle P; Tsai, Jack; Spurrier, Linda Yorkman; Davis, Louanne W
DNA hybridization data and aminoglycoside resistance profiles (AGRPs) were determined for 4,088 clinical isolates from three studies (United States, Belgium, and Argentina). The correlation between susceptibility profiles and hybridization results was determined with nine DNA probes. For each of the seven aminoglycoside resistance profiles which we were able to test, the data suggested at least two distinct genes could encode enzymes which lead to identical resistance profiles. Furthermore, the DNA hybridization data showed that individual strains carried up to six unique aminoglycoside resistance genes. DNA hybridization revealed interesting differences in the frequencies of these genes by organism and by country.
Shaw, K J; Hare, R S; Sabatelli, F J; Rizzo, M; Cramer, C A; Naples, L; Kocsi, S; Munayyer, H; Mann, P; Miller, G H
The authors conducted a flow cytometry immunophenotyping study in patients with acute lymphoblastic leukemia (ALL) from Natal, Rio Grande do Norte, Brazil. The patients (n = 126) were newly diagnosed using a panel of monoclonal antibodies: CD1a, CD2, CD3, CD4, CD7, CD8, CD10, CD13, CD33, CD14, CD19, CD22, CD79a, CD117, CD34, anti-IgM, anti-TdT, anti-HLA-Dr, and anti-human kappa and lambda light chains. Additional data, such as patients' age and gender, clinical and laboratory findings such as presence of tumor masses, lymphadenopathy, hepatomegaly, splenomegaly, leukemic infiltration in the central nervous system (CNS) were also investigated. Results showed that 56.7% of the cases were B-lineage ALL and 55% were T-cell ALL. Also, we found that males were more affected by the disease, regardless of immunological classification. The correlation between age and immunological subtypes showed that the B-lineage ALL occurred more frequently in patients aged under 15 while the T-cell ALL subtype was more frequent in adults. Immunophenotypic profiles and morphological subtypes showed a direct correlation between L3 subtype and B-lineage ALL, while L1 and L2 subtypes correlated more often with B-cell lineage and T-cell ALL, respectively. Correlation analysis between immunophenotypic and clinical profiles showed that T-cell ALL was more associated with a higher incidence of lymphadenopathy, hepatomegaly, splenomegaly and CNS leukemic infiltration, also showing a greater blast cell count in peripheral blood than the other subgroups. The presented data suggest that immunophenotyping is an important method in the diagnosis, monitoring and prognostic assessment in determining the pathological mechanisms of evolution of ALL. PMID:23143625
Alves, Gabriela Vasconcelos de Andrade; Fernandes, Andrea Luciana Araújo da Cunha; Freire, Juliana Mendonça; Paiva, Aldair de Souza; Vasconcelos, Roberto Chaves de; Sales, Valéria Soraya de Farias; Lemos, Telma Maria de Araújo Moura; Gil, Erica Aires; Freire, Flávio Henrique Miranda de Araújo; Cavalcanti e Silva, Dany Geraldo Kramer; Maciel, James Farley Rafael; Farkatt, Irian Guedes; Cavalcanti Júnior, Geraldo Barroso
Background: Polycystic ovary syndrome (PCOS) is a common disorder. PCOS women are at a high risk for insulin resistance and metabolic syndrome (MS). Adiponectin is positively related to insulin sensitivity. It has a preventive role in atherogenesis and MS. The present work was conducted to study the correlation between serum adiponectin levels and clinical characteristics and biochemical parameters in PCOS patients. Materials and Methods: A prospective study in 49 newly diagnosed (as per Rotterdam criteria) Indian PCOS women was conducted. PCOS women were clinically examined and investigated for biochemical parameters. Results: The mean serum adiponectin was 12 ± 9.4 ?g/mL (range 0.47-45). Hypoadiponectinemia (serum adiponectin <4 ?g/mL) was present in 22% patients. Age and adiponectin correlated significantly and inversely (r = ?0.42, P = 0.027). Overweight/obese patients had lower mean adiponectin levels than normal weight (11.62 ± 9.5 vs 13.58 ± 9.5, P = 0.56). It was significantly lower in patients with acanthosis nigricans (AN) as compared with those without AN (8.4 ± 5.9 vs 15 ± 11, P = 0.038). Hirsute patients showed lower mean adiponectin levels than nonhirsute (10 ± 7.3 vs 13 ± 10, P = 0.57). A positive, insignificant correlation was observed between serum adiponectin and cholesterol, low-density lipoprotein, follicle stimulating hormone (FSH), thyroid stimulating hormone, levels. A negative insignificant correlation existed between serum adiponectin and luteinizing hormone (LH), LH: FSH ratio, prolactin, dehydroepiandrosterone, testosterone, triglyceride, high-density lipoprotein, fasting blood glucose, fasting insulin, and Homeostasis Model Assessment. Conclusion: Hypoadiponectinemia is present in one-fifth of women with PCOS. Adiponectin levels decrease as age advances. Low levels of adiponectin possibly contributes to the development of dermal manifestation (AN) of insulin resistance.
Ramanand, Sunita J.; Ramanand, Jaiprakash B.; Ghongane, Balasaheb B.; Patwardhan, Milind H.; Patwardhan, Varsha M.; Ghanghas, Ravi; Halasawadekar, Nimish R.; Patil, Praveenkumar
Azithromycin when used in combination with faster-acting antimalarials has proven efficacious in treating Plasmodium falciparum malaria in phase 2 clinical trials. The aim of this study was to establish optimal combination ratios for azithromycin in combination with either dihydroartemisinin or quinine, to determine the clinical correlates of in vitro drug sensitivity for these compounds, and to assess the cross-sensitivity patterns. Seventy-three fresh P. falciparum isolates originating from patients from the western border regions of Thailand were successfully tested for their drug susceptibility in a histidine-rich protein 2 (HRP2) assay. With overall mean fractional inhibitory concentrations of 0.84 (95% confidence interval [CI] = 0.77 to 1.08) and 0.78 (95% CI = 0.72 to 0.98), the interactions between azithromycin and dihydroartemisinin, as well as quinine, were classified as additive, with a tendency toward synergism. The strongest tendency toward synergy was seen with a combination ratio of 1:547 for the combination with dihydroartemisinin and 1:44 with quinine. The geometric mean 50% inhibitory concentration (IC50) of azithromycin was 2,570.3 (95% CI = 2,175.58 to 3,036.58) ng/ml. The IC50s for mefloquine, quinine, and chloroquine were 11.42, 64.4, and 54.4 ng/ml, respectively, suggesting a relatively high level of background resistance in this patient population. Distinct correlations (R = 0.53; P = 0.001) between quinine in vitro results and parasite clearance may indicate a compromised sensitivity to this drug. The correlation with dihydroartemisinin data was weaker (R = 0.34; P = 0.038), and no such correlation was observed for azithromycin. Our in vitro data confirm that azithromycin in combination with artemisinin derivatives or quinine exerts additive to synergistic interactions, shows no cross-sensitivity with traditional antimalarials, and has substantial antimalarial activity on its own.
Noedl, Harald; Krudsood, Srivicha; Leowattana, Wattana; Tangpukdee, Noppadon; Thanachartwet, Wipa; Looareesuwan, Sornchai; Miller, Robert Scott; Fukuda, Mark; Jongsakul, Krisada; Yingyuen, Kritsanai; Sriwichai, Sabaithip; Ohrt, Colin; Knirsch, Charles
INTRODUCTION Spinocerebellar ataxia type 7 is a neurodegenerative polyglutamine disease characterized by ataxia and retinal degeneration. The longitudinal course is unknown, and relationships between repeat expansion, clinical manifestations, and neuropathology remain uncertain. METHODS We followed 16 affected individuals of a 61-member kindred over 27 years with electroretinograms, neurological examinations including the Brief Ataxia Rating Scale, neuroimaging in 5, and autopsy in 4 cases. RESULTS We identified 4 stages of the illness. Stage 0; gene positive but phenotypically silent. Stage 1; no symptoms, but hyperreflexia and/or abnormal electroretinograms. Stage 2; symptoms and signs progress modestly. Stage 3; rapid clinical progression. CAG repeat length correlated inversely with age of onset of visual or motor signs (r=-0.74, p=0.002). Stage 3 rate of progression did not differ between cases (p=0.18). Electroretinograms correlated with Brief Ataxia Rating Scale score and were a biomarker of disease onset and progression. All symptomatic patients developed gait ataxia, extremity dysmetria, dysarthria, dysrhythmia, and oculomotor abnormalities. Funduscopy revealed pale optic discs and pigmentary disturbances. Visual acuity declined to blindness in those with longer CAG expansions. Hyperreflexia was present from Stage 1 onwards. Restless legs syndrome and sensory impairment were common. Neuropathological hallmarks were neuronal loss in cerebellar cortex, deep cerebellar nuclei, inferior olive, and anterior horns of the spinal cord, and axonal loss in spinocerebellar tracts, dorsal nerve roots and posterior columns. Retinal pathology included photoreceptor degeneration and disruption of retinal pigment epithelium. DISCUSSION Spinocerebellar ataxia type 7 evolves through 4 clinical stages; neuropathological findings underlie the clinical presentation; electroretinograms are a potential biomarker of disease progression.
Horton, Laura C.; Frosch, Matthew P.; Vangel, Mark G.; Weigel-DiFranco, Carol; Berson, Eliot L.; Schmahmann, Jeremy D.
Elevated cerebrospinal fluid (CSF) concentrations of asymmetric dimethylarginine (ADMA), an endogenous inhibitor of nitric oxide synthase, have been found in patients with subarachnoid hemorrhage (SAH). In addition, CSF levels of ADMA are associated with the severity of vasospasm. However, the relation between CSF ADMA levels and the clinical outcome of SAH patients is still unclear. We hypothesized that elevated ADMA levels in CSF might be related to the clinical outcome of SAH patients. CSF ADMA levels were measured in 20 SAH patients at days 3-5, days 7-9 and days 12-14 after SAH onset using high-performance liquid chromatography. Cerebral vasospasm was assessed by transcranial Doppler ultra sonography. Clinical outcome at 2year follow-up was evaluated using the Karnofsky Performance Status scale (KPS). CSF ADMA concentrations in all SAH patients were significantly increased at days 3-5 (p=0.002) after SAH, peaked on days 7-9 (p<0.001) and remained elevated until days 12-14 (p<0.001). In subgroup analysis, significant increases of CSF ADMA levels were found in patients both with and without vasospasm. The KPS scores significantly correlated with CSF levels of ADMA at days 7-9 (correlation coefficient=-0.55, p=0.012; 95% confidence interval -0.80 to -0.14). Binary logistic regression analysis indicated that higher ADMA level at days 7-9 predicted a poor clinical outcome at 2year follow-up after SAH (odds ratio=1.722, p=0.039, 95% confidence interval 1.029 to 2.882). ADMA may be directly involved in the pathological process and future adverse prognosis of SAH. PMID:24814854
Li, Hua; Wu, Wei; Liu, Ming; Zhang, Xin; Zhang, Qing-Rong; Ni, Li; Hang, Chun-Hua
Review, analysis and correlation (clinical, radiologic and pathologic) of 29 consecutive adults (16 drug addicts and/or homosexuals) with DLU on Ga-67 scintigraph were made. Diffuse increased uptake of at least 75% of both lungs was considered as DLU. WFOF cameras were used to obtain 24 to 96 hr. scintigraphs after IV injection of 3-5 mCi of Ga-67 citrate. In 26, tissue diagnosis established: pneumocystis carinii (PC) 15, miliary tuberculosis (TB) 3, sarcoidosis (SR) 3, drug-induced toxicity 2, and toxoplasmosis (TX), primary hyperparathyroidism and nonspecific lymphocytic pneumonia-one each. In two with breast and one with esophageal carcinomas, no lung tissue diagnosis was sought. Concurrent chest x-rays were negative in 16, but in 7/16, lung infiltrate was later documented. An average of 31 days elapsed before x-rays became positive in four with PC, 7 days in two with TB, and 22 days in one with TX. In 13, concurrent x-rays showed lung infiltrate, but in 6, only subtle, localized rather than diffuse infiltrate was noted. Fourteen of 29 had at least two Ga-67 studies. In 12 (7 PC, 2 TB, 3 SR) of 14 whose repeat studies showed significant to total disappearance of DLU, all did well clinically. In two whose initial studies were negative or equivocal, they became clinically worse when the repeat study showed DLU. In three others (2 PC, 1 TX) who died, their single studies recorded intense DLU. DLU on gallium scintigraph indicated a variety of pathology. In 55.2%, gallium scintigraph predated x-ray findings by a few days to weeks. In 20.3%, x-ray findings were only subtle or localized. Scintigraphic changes correlated well with the clinical courses in various diseases.
Sy, W.M.; Seo, I.S.; Vieira, J.; Zaman, M.
Spinocerebellar ataxia type 7 is a neurodegenerative polyglutamine disease characterized by ataxia and retinal degeneration. The longitudinal course is unknown, and relationships between repeat expansion, clinical manifestations, and neuropathology remain uncertain. We followed 16 affected individuals of a 61-member kindred over 27 years with electroretinograms, neurological examinations including the Brief Ataxia Rating Scale, neuroimaging in five, and autopsy in four cases. We identified four stages of the illness: Stage 0, gene-positive but phenotypically silent; Stage 1, no symptoms, but hyperreflexia and/or abnormal electroretinograms; Stage 2, symptoms and signs progress modestly; and Stage 3, rapid clinical progression. CAG repeat length correlated inversely with age of onset of visual or motor signs (r = -0.74, p = 0.002). Stage 3 rate of progression did not differ between cases (p = 0.18). Electroretinograms correlated with Brief Ataxia Rating Scale score and were a biomarker of disease onset and progression. All symptomatic patients developed gait ataxia, extremity dysmetria, dysarthria, dysrhythmia, and oculomotor abnormalities. Funduscopy revealed pale optic discs and pigmentary disturbances. Visual acuity declined to blindness in those with longer CAG expansions. Hyperreflexia was present from Stage 1 onwards. Restless legs syndrome and sensory impairment were common. Neuropathological hallmarks were neuronal loss in cerebellar cortex, deep cerebellar nuclei, inferior olive, and anterior horns of the spinal cord, and axonal loss in spinocerebellar tracts, dorsal nerve roots, and posterior columns. Retinal pathology included photoreceptor degeneration and disruption of retinal pigment epithelium. Spinocerebellar ataxia type 7 evolves through four clinical stages; neuropathological findings underlie the clinical presentation; electroretinograms are a potential biomarker of disease progression. PMID:22915085
Horton, Laura C; Frosch, Matthew P; Vangel, Mark G; Weigel-DiFranco, Carol; Berson, Eliot L; Schmahmann, Jeremy D
Background Fibromyalgia (FM) is a chronic pain syndrome with unknown etiology and a wide spectrum of symptoms such as allodynia, debilitating fatigue, joint stiffness and migraine. Recent studies have shown some evidences demonstrating that oxidative stress is associated to clinical symptoms in FM of fibromyalgia. We examined oxidative stress and bioenergetic status in blood mononuclear cells (BMCs) and its association to headache symptoms in FM patients. The effects of oral coenzyme Q10 (CoQ10) supplementation on biochemical markers and clinical improvement were also evaluated. Methods We studied 20 FM patients and 15 healthy controls. Clinical parameters were evaluated using the Fibromyalgia Impact Questionnaire (FIQ), visual analogues scales (VAS), and the Headache Impact Test (HIT-6). Oxidative stress was determined by measuring CoQ10, catalase and lipid peroxidation (LPO) levels in BMCs. Bioenergetic status was assessed by measuring ATP levels in BMCs. Results We found decreased CoQ10, catalase and ATP levels in BMCs from FM patients as compared to normal control (P<0.05 and P<0.001, respectively) We also found increased level of LPO in BMCs from FM patients as compared to normal control (P<0.001). Significant negative correlations between CoQ10 or catalase levels in BMCs and headache parameters were observed (r?=??0.59, P<0.05; r?=??0.68, P<0.05, respectively). Furthermore, LPO levels showed a significant positive correlation with HIT-6 (r?=?0.33, P<0.05). Oral CoQ10 supplementation restored biochemical parameters and induced a significant improvement in clinical and headache symptoms (P<0.001). Discussion The results of this study suggest a role for mitochondrial dysfunction and oxidative stress in the headache symptoms associated with FM. CoQ10 supplementation should be examined in a larger placebo controlled trial as a possible treatment in FM.
Cordero, Mario D.; Cano-Garcia, Francisco Javier; Alcocer-Gomez, Elisabet; De Miguel, Manuel; Sanchez-Alcazar, Jose Antonio
Background: In hospital settings, depression is an underdetected, undertreated, but prevalent and interfering illness that is associated with significant disability, morbidity, and mortality. A general hospital emergency department (ED) setting may be well suited to identify individuals with clinically significant depressive symptoms, facilitating their referral and treatment. Method: Cross-sectional data of adult ED patients in a general hospital enrolling in a human immunodeficiency virus (HIV) screening study between February 2007 and March 2008 were analyzed. Data included demographic factors, the Center for Epidemiologic Studies Depression Scale (CES-D), alcohol and substance use history, sexual risk taking, and brief medical history. The primary outcome was a dichotomous measure of self-reported clinically significant depressive symptoms. Patients who scored ? 16 on the CES-D were considered to screen positive for depressive symptoms. Results: Of the 3,262 patients enrolled in the screening trial, 2,588 (79%) completed the survey between February 2007 and March 2008. Among these, 1,945 (75%) completed the psychosocial assessment battery; 596 (31%) survey completers screened positive for clinically significant depressive symptoms. In a multivariable model, female sex (RR = 1.36; 95% CI, 1.16–1.57), being unemployed (RR = 1.61; 95% CI, 1.32–1.93), and lower annual income (RR from 1.73 to 2.24) were associated with increased rates of clinically significant depressive symptoms (CES-D score ? 16). Clinically significant depressive symptoms were more often present in patients who screened positive for alcohol dependence (RR = 1.48; 95% CI, 1.19–1.78), individuals reporting current smoking (RR = 1.39; 95% CI, 1.17–1.62), those with a prior psychiatric disorder diagnosis (RR = 2.20; 95% CI, 1.80–2.57) or history of hypertension (RR = 1.47; 95% CI, 1.18–1.79), and those who reported ever having sex with an HIV-infected partner (RR = 1.58; 95% CI, 1.08–2.09). Conclusions: This study identified a high frequency of undiagnosed clinically significant depressive symptoms among ED patients and highlights several new demographic and clinical correlates of such symptoms. Screening for and diagnosis of clinical depression in the ED setting introduces important opportunities for acute care providers and for the health care system as a whole.
Reichmann, William M.; Safren, Steven A.; Losina, Elena; Arbelaez, Christian; Walensky, Rochelle P.
Carnitine metabolism and the therapeutic use of carnitine has been a major area of interest in dialysis patients. The purpose of this study was to determine whether any correlations exist between carnitine status and selected clinical parameters in hemodialysis (HD) patients. This study was an observational study of data from patients receiving HD at a Midwest dialysis center. The subjects (n=49) were 60+/-16 (mean+/-SD) years of age and 48% male. Fifteen percent of the subjects had type 1 diabetes mellitus (DM), 29% had type 2 DM, and 25% had left ventricular hypertrophy (LVH). The serum-free and total carnitine, and acylcarnitine concentrations were: 40.3+11.8 microm/l, 22.8+/-7.3, and 17.5+/-5.9 microm/l, respectively. The serum acylcarnitine to free carnitine ratio (A/F) was 0.80+/-0.27. Blood urea nitrogen (BUN), parathyroid hormone and ejection fraction were positively correlated and age and left atrial dilation (cm) were negatively correlated with serum total carnitine (P<0.05). BUN and hematocrit were positively correlated (P<0.05) and age was negatively correlated with free carnitine. Subjects who used mannitol or were male had significantly higher concentrations of both free and total carnitine, respectively (P<0.05). Subjects using aspirin had lower concentrations of serum total carnitine (P<0.10). These results suggest certain subgroups of patients may need to be targeted for further studies with carnitine replacement therapy, i.e. long-term patients, older patients, patients with left verticular hypertrophy and left atrial enlargement, females and patients on aspirin therapy. PMID:14757390
Steiber, A L; Weatherspoon, L J; Spry, L; Davis, A T
Regional hypoxia caused by accelerated cell proliferation and overgrowth is an important characteristic of neoplasm. Hypoxia can cause a series of changes in gene transcription and protein expression, thereby not only inducing tumor cell resistance to radiotherapy and chemotherapy but also promoting tumor invasion and metastasis. This study aimed to investigate the relationship between HIF-1? expression and cellular apoptosis, angiogenesis and clinical prognosis in rectal carcinoma. In 113 rectal carcinoma cases, cellular apoptosis was analyzed by the in situ terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling (TUNEL) assay, whereas the levels of HIF-1? expression, VEGF expression, microvessel density (MVD) and lymphatic vessel density(LVD) were examined by immunohistochemical staining. HIF-1 expression was detected in 67 of 113 rectal carcinoma cases (59.3 %). A positive correlation was found among HIF-1? expression, cellular apoptosis and angiogenesis. The 5-year survival rate in the HIF-1?-negative group was significantly higher than that in the HIF-1?-positive group (81.34 % versus 50 %, P?0.05). According to the Cox regression analysis, HIF-1? expression, VEGF expression and cellular apoptosis index were independent risk factors for clinical prognosis in rectal carcinoma. Aberrant HIF-1? expression correlates with apoptosis inhibition, angiogenesis and poor prognosis in rectal carcinoma. PMID:24374863
Feng, Liu; Tao, Lin; Dawei, He; Xuliang, Li; Xiaodong, Luo
Purpose: This retrospective study measured correlation of student performance between 2 objective structured clinical examinations (OSCEs) and an introductory integrated clinical skills course that preceded the OSCEs. The hypothesis was that there would be a strong, positive correlation between the earlier level examinations and the upper level OSCE, high enough that earlier examinations could be viewed as predictors of upper level OSCE performance. Methods: Using student scores for 5 academic terms of upper level OSCEs for 2008–2009 (n = 208) and respective earlier scores, correlation coefficients were calculated for the upper level OSCE and Clinical Skills course, and upper and lower level OSCEs. Multiple linear regression analysis was used to evaluate how well the lower level OSCE and clinical skills scores, both as lone and combined independent variables, predicted the upper level OSCE scores. Results: There was at least a moderate correlation between both sets of scores: r = .51 (p < .001) between upper level OSCE and clinical skills course, r = .54 (p < .001) between the upper and lower level OSCEs. A combination of clinical skills and lower level OSCE scores suggested a moderate prediction of upper level OSCE scores (R2 = .38.) Conclusions: Correlations were found to be of at least a moderate level. According to linear regression analysis, a combination of the earlier scores was moderately predictive for the upper level OSCE. More research could be done to determine additional components of student performance.
Russell, Brent S.; Hoiriis, Kathryn T.; Guagliardo, Joseph
Background Disease caused by the dengue virus (DENV) is a significant cause of morbidity throughout the world. Although prior research has focused on the association of specific DENV serotypes (DENV-1, DENV-2, DENV-3, and DENV-4) with the development of severe outcomes such as dengue hemorrhagic fever and dengue shock syndrome, relatively little work has correlated other clinical manifestations with a particular DENV serotype. The goal of this study was to estimate and compare the prevalence of non-hemorrhagic clinical manifestations of DENV infection by serotype. Methodology and Principal Findings Between the years 2005–2010, individuals with febrile disease from Peru, Bolivia, Ecuador, and Paraguay were enrolled in an outpatient passive surveillance study. Detailed information regarding clinical signs and symptoms, as well as demographic information, was collected. DENV infection was confirmed in patient sera with polyclonal antibodies in a culture-based immunofluorescence assay, and the infecting serotype was determined by serotype-specific monoclonal antibodies. Differences in the prevalence of individual and organ-system manifestations were compared across DENV serotypes. One thousand seven hundred and sixteen individuals were identified as being infected with DENV-1 (39.8%), DENV-2 (4.3%), DENV-3 (41.5%), or DENV-4 (14.4%). When all four DENV serotypes were compared with each other, individuals infected with DENV-3 had a higher prevalence of musculoskeletal and gastrointestinal manifestations, and individuals infected with DENV-4 had a higher prevalence of respiratory and cutaneous manifestations. Conclusions/Significance Specific clinical manifestations, as well as groups of clinical manifestations, are often overrepresented by an individual DENV serotype.
Halsey, Eric S.; Marks, Morgan A.; Gotuzzo, Eduardo; Fiestas, Victor; Suarez, Luis; Vargas, Jorge; Aguayo, Nicolas; Madrid, Cesar; Vimos, Carlos; Kochel, Tadeusz J.; Laguna-Torres, V. Alberto
Quantitative assessment of atherosclerosis from arteriograms was applied in clinical follow-up trials for the evaluation of lipid-modulating treatment or risk factors. Computer-estimated lumen volume and arterial edge roughness in the femoral artery and in the aorta, visual scoring of aorto-femoral arteriograms and manual measuring of coronary artery stenosis were used. In each of 276 hypercholesterolaemic patients two femoral arteriograms were made, with a 10-minute interval. The reproducibility of the computer analysis method was found to be constant over the years, with slightly better reproducibility for lumen volume than for edge roughness. A small but significant drift in the radiological equipment was confirmed by the use of phantoms. In 290 patients, atherosclerosis assessments from the femoral artery (lumen volume and roughness) and visual scoring of the aorto-femoral arteriogram were correlated with clinical symptoms of coronary artery disease or previous myocardial infarction to test whether femoral atherosclerosis estimates can replace coronary studies in clinical trials. Both men and women with coronary artery disease had lower values for femoral lumen volume and more edge roughness than patients without these symptoms. Men with previous myocardial infarction had higher mean visual scores than those without. Thus, femoral atherosclerosis is an expression of a more generalized disease associated with clinical symptoms of coronary heart disease. The 290 patients were tested for correlation between degree of peripheral atherosclerosis and various metabolic risk factors. In women, high serum triglyceride values were associated with more extensive atherosclerosis. High fasting glucose values were associated with more extensive atherosclerosis in men. In men and women, high uric acid values were associated with greater roughness in the femoral artery. The effects of smoking, hypertension, poor physical fitness and body mass index on the development of peripheral atherosclerosis in hypercholesterolaemia were also investigated. The results indicated that the hypercholesterolaemic patients most likely to develop peripheral atherosclerosis are male and female smokers who do not take any physical exercise, and who have increased values of systolic blood pressure, uric acid and fasting glucose concentrations. Aortograms from 293 subjects were digitized and circular lumen volume and edge roughness were computer-estimated in a 7.35-cm segment of the distal aorta. A correlation between atherosclerosis in the aorta and in the femoral arteries indicated that aortic atherosclerosis is a manifestation of a more general disease.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8184697
Purpose To investigate an association between the levels of serum thyroid-stimulating hormone (TSH)-receptor autoantibodies (TRAbs) and Graves' orbitopathy (GO) activity/severity scores, and compare the performance of three different TRAb assays in assessing the clinical manifestations of GO. Materials and Methods Cross-sectional study. Medical records of 155 patients diagnosed with GO between January 2008 and December 2010 were reviewed. GO activity was assessed by clinical activity score (CAS) and severity graded with the modified NOSPECS score by a single observer. Serum TRAb was measured by three different methods: 1st generation thyrotropin-binding inhibitor immunoglobulin (TBII) assay (TRAb1st); 3rd generation TBII assay (TRAb3rd); and biological quantitative assay of thyroid-stimulating immunoglobulin (TSI) using Mc4-CHO cells (Mc4-CHO TSI assay). Results were correlated with scores of activity/severity of thyroid eye disease. Results All three assays (TRAb1st, TRAb3rd, and Mc4-CHO TSI) yielded results that were significantly positively correlated with CAS (?=0.21, 0.21, and 0.46, respectively; p<0.05) and proptosis (?=0.38, 0.34, and 0.33, respectively; p<0.05). Mc4-CHO TSI bioassay results were significantly positively correlated with all GO severity indices (soft tissue involvement, proptosis, extraocular muscle involvement, and total eye score; ?=0.31, 0.33, 0.25, and 0.39, respectively; p<0.05). Conclusion Mc4-CHO TSI bioassay was superior over the two TBIIs in assessing active inflammation and muscle restriction due to GO, whereas TBII assay would be sufficient for evaluation of patients with proptosis.
Jang, Sun Young; Shin, Dong Yeob; Lee, Eun Jig; Choi, Young Joon; Lee, Sang Yeul
Introduction Sarcoidosis is an incurable, chronic granulomatous disease primarily involving the lungs and lymph nodes of unknown aetiology, treated with non-specific anti-inflammatory/immunosuppressive drugs. Persistently symptomatic patients worsen with a disabling, potentially fatal clinical course. To determine a possible infectious cause, we correlated in a case-control study the clinical information with the presence of bacterial DNA in sarcoidosis mediastinal lymph nodes compared with control lymph nodes resected during cancer surgery. Methods We retrospectively studied formalin-fixed, paraffin-embedded, mediastinal lymph nodes from 30 patients with sarcoidosis and 30 control patients with lung cancer. Nucleic acids were extracted from nodes, evaluated by ribosomal RNA PCR for bacterial 16S ribosomal DNA and the results were sequenced and compared with a bacterial sequence library. Clinical information was correlated. Results 11/30 (36.7%) of lymph nodes from patients with sarcoidosis had detectable bacterial DNA, significantly more than control patient lymph nodes (2/30, 6.7%), p=0.00516. At presentation, 19/30 (63.3%) patients with sarcoidosis were symptomatic including all patients with detectable bacterial DNA. Radiographically, there were 18 stage I and 12 stage II patients. All stage II patients were symptomatic and 75% had PCR-detectable bacteria. After a mean follow-up of 52.8±32.8?months, all patients with PCR-detectable bacteria in this series were persistently symptomatic requiring treatment. Discussion 36.6% of patients with sarcoidosis had detectable bacterial DNA on presentation, all of these patients were quite symptomatic and most were radiographically advanced stage II. These findings suggest that bacterial DNA-positive, symptomatic patients have more aggressive sarcoidosis that persists long term and might benefit from antimicrobial treatment directed against this presumed chronic granulomatous infection.
Robinson, Lary A; Smith, Prudence; SenGupta, Dhruba J; Prentice, Jennifer L; Sandin, Ramon L
Abstract Purpose: To evaluate the imaging features of anorectal gastrointestinal stromal tumors (GISTs) with clinical and histopathologic correlation. Materials and methods: In this Institutional Review Board-approved, Health Insurance Portability and Accountability Act-compliant retrospective study, 16 patients (12 men; mean age 66 years (30–89 years)) with pathologically proven anorectal GISTs seen at our institution from January 2001 to July 2011 were identified. Electronic medical records were reviewed to obtain clinical data. Pretreatment imaging studies (computed tomography (CT) in 16 patients, magnetic resonance imaging (MRI) in 9 patients and fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT in 8 patients) were evaluated by 2 radiologists until consensus. The location, size and imaging features of the primary tumor and metastases at presentation, if any, were recorded, and correlated with clinical data and pathologic features (histologic type, presence of necrosis, mitotic activity, risk category, immunohistochemical profile). Results: The mean tumor size was 6.9?×?6.0?cm. Of the 16 tumors, 11 (68.7%) were infralevator, 4 (25%) supra and infralevator and 1 (6.3%) supralevator; 9 (56.2%) were exophytic, 6 (37.5%) both exophytic and intraluminal, and 1 (6.3%) was intraluminal. The tumors were iso- to minimally hypoattenuating to muscle on CT, iso- to minimally hypointense on T1-weighted images, hyperintense on T2-weighted images and showed variable enhancement. Necrosis was seen in 4 (25%), and hemorrhage and calcification in 2 (12.5%) patients each. The tumors were FDG avid with a mean maximum standardized uptake value of 11 (8.4–16.8). All tumors were positive for KIT and CD34. Distant metastasis to liver was seen in 1 patient (6.3%) at presentation. Conclusion: Anorectal GISTs are well-circumscribed, non-circumferential, predominantly infralevator, intramural or exophytic, FDG-avid, hypoattenuating masses, and present without lymphadenopathy or intestinal obstruction.
Koch, M.R.; Jagannathan, J.P.; Krajewski, K.M.; Raut, C.P.; Hornick, J.L.; Ramaiya, N.H.
Background/Aims We evaluated clinicopathological correlates of upper motor neuron (UMN) damage in amyotrophic lateral sclerosis (ALS), and analyzed if the presence of the C9ORF72 repeat expansion was associated with alterations in microglial inflammatory activity. Methods Microglial pathology was assessed by IHC with 2 different antibodies (CD68, Iba1), myelin loss by Kluver-Barrera staining and myelin basic protein (MBP) IHC, and axonal loss by neurofilament protein (TA51) IHC, performed on 59 autopsy cases of ALS including 9 cases with C9ORF72 repeat expansion. Results Microglial pathology as depicted by CD68 and Iba1 was significantly more extensive in the corticospinal tract (CST) of ALS cases with a rapid progression of disease. Cases with C9ORF72 repeat expansion showed more extensive microglial pathology in the medulla and motor cortex which persisted after adjusting for disease duration in a logistic regression model. Higher scores on the clinical UMN scale correlated with increasing microglial pathology in the cervical CST. TDP-43 pathology was more extensive in the motor cortex of cases with rapid progression of disease. Conclusions This study demonstrates that microglial pathology in the CST of ALS correlates with disease progression and is linked to severity of UMN deficits.
Brettschneider, Johannes; Toledo, Jon B.; Van Deerlin, Vivianna M.; Elman, Lauren; McCluskey, Leo; Lee, Virginia M.-Y.; Trojanowski, John Q.
Since the imbalance of the nasal cavities due to nasal septal deviation (NSD) is a commonly observed anatomic variation in healthy adults, clinicians must often decide whether or not it is clinically relevant to the symptoms of nasal airway obstruction (NAO). Main reason for this is a lack of data correlating the symptoms of NAO with objective findings. The aim of our study is to find the correlation between fluid dynamic parameters and the anatomy of nasal cavity with NSD by numerical simulation. We generated 6 computational models of nasal cavities with NSD were created from computed tomographic images: 3 symptomatic patients with NAO and 3 asymptomatic patients. Computational fluid dynamics (CFD) was used to simulate steady inspiratory airflows in each nasal cavity model and compare the fluid dynamic properties of each. In the symptomatic cases, the pressure drop from the naris to the end of the septum was larger, and more uneven flow partitioning was observed. Local maximum velocity and wall shear stress were higher in the symptomatic group than in the asymptomatic group. The symptoms of NAO seem to be related more to the nasal resistance from the naris to the end of the septum than to the total nasal resistance from naris to nasopharynx. Factors correlated with NAO by CFD can be used as elements in patient-specific objective diagnostic tools for NAO in the presence of NSD. PMID:24361464
Kim, Sung Kyun; Heo, Go Eun; Seo, Anna; Na, Yang; Chung, Seung-Kyu
Motor asymmetries were investigated in 28 unmedicated schizophrenic in-patients and 32 healthy controls. Of the patients, who were assessed as right-handers by a handedness questionnaire, 46.4% changed their motor laterality in at least one part of the tapping test series, probably because of a decrease of functional hemispheric asymmetry. These patients were characterized by more pronounced psychotic symptoms than those who did not change motor laterality. According to the tapping frequency, two groups of patients could be distinguished: the high- and the low-frequency group. In both groups certain tapping data could be correlated with characteristic clinical features. While the findings in the high-frequency group point to an enhanced activation level of the right hemisphere and appear to be correlated with the onset of positive symptoms and better prognosis, the findings in the low-frequency group may be a reflection of a disturbed function of the left frontal region and seem to be correlated with a gradual chronic development of predominant negative symptoms with worse prognostic implications. PMID:1390954
Gorynia, I; Uebelhack, R
In 39 patients with a proven subarachnoid hemorrhage (SAH), the clinical status, the amount of subarachnoid blood on a computerized tomography scan obtained within 5 days after SAH, and the flow velocities (FV's) in both middle cerebral arteries (MCA's) measured by transcranial Doppler sonography were recorded daily and correlated. All patients had pathological FV's over 80 cm/sec between Day 4 and Day 10 after SAH. The side of the ruptured aneurysm showed higher FV's than did the unaffected side in cases of laterally localized aneurysms. Increase in FV preceded clinical manifestation of ischemia. A step early increase of FV's portended severe ischemia and impending infarction. Maximum FV's in the range of 120 to 140 cm/sec were not critical and in no case led to brain infarction. Maximum FV's over 200 cm/sec were associated with a tendency for ischemia, but the patients may remain clinically asymptomatic. In cases of no or only a little blood in the basal cisterns, mean FV's in both MCA's increased only moderately whereas, with thick clots of subarachnoid blood, there was a steeper and higher increase of mean FV's. PMID:3512799
Seiler, R W; Grolimund, P; Aaslid, R; Huber, P; Nornes, H
In 92 patients with spinal cord lesion, out of spinal shock, the data from a clinical neurological examination of the lumbosacral area are compared with the data from a full urodynamic investigation, including evaluation of sensation in the lower urinary tract. A significant correlation can be found between different levels of spinal cord lesion, the function of bladder neck and sphincter and the anal bulbocavernosus reflexes. Higher lesions correspond more with a reflexic lower urinary tract and somatic motor activity, lower lesions more with areflexia. With a lesion between thoracic 10 and lumbar 2 as many reflexic as areflexic lower urinary tract dysfunctions were found. The presence or absence of perineal sensation of light touch corresponded significantly with the presence or absence of sensation in the lower urinary tract. Detrusor and striated sphincter reflexia/areflexia corresponded significantly with the presence/absence of bulbocavernosus and anal reflexes. Clinical neurological examination gives useful information which acceptably corresponds with the LUT function. However to decide on a detailed individual diagnosis, clinical examination is in our opinion insufficient. Urodynamic tests are needed for a profound evaluation of the function of different parts of the lower urinary tract and their interaction. PMID:9143082
Wyndaele, J J
Objective. Adenoid hypertrophy is a common condition in childhood, which may be associated with recurring acute otitis media (RAOM), otitis media with effusion (OME), and obstructive sleep apnea syndrome (OSAS). These different clinical characteristics have some clinical overlap; however, they might be explained by distinct immunologic and infectious profiles and result in various histopathologic findings of adenoid specimens. Methods. A total of 59 children with adenoid hypertrophy undergoing adenoidectomy were studied. Three series of identical adenoid specimens were processed to hematoxylin-eosin (H.E.) and Gram staining and to respiratory virus specific real-time PCR, respectively. Results. According to the clinical characteristics, patients were recruited into three groups: RAOM (n = 25), OME (n = 19), and OSAS (n = 15). Bacterial biofilms were detected in 21 cases, while at least one of the studied respiratory viruses was detected in 52 specimens. RAOM cases were significantly associated with biofilm existence (n = 20, P < 0.001). In contrast, OME group was characterized by the absence of bacterial biofilm and by normal mucosa. Showing a statistically significant correlation, all OME cases were positive for human bocavirus (HBoV, P < 0.001). Conclusions. Bacterial biofilms might contribute to the damage of respiratory epithelium and recurring acute infections resulting in RAOM. In OME cases persisting respiratory viruses, mainly HBoV, can cause subsequent lymphoid hyperplasia leading to ventilation disorders and impaired immunoreactivity of the middle ear cleft.
Szalmas, Anita; Csomor, Peter; Konya, Jozsef; Sziklai, Istvan; Szekanecz, Zoltan; Karosi, Tamas
AIM: To correlate the ease or difficulty of embryo transfer and blood at catheter tip with pregnancy rate when embryo transfer (ET) was performed by the same operator using soft catheter. MATERIALS AND METHODS: A retrospective analysis of 342 patients who underwent in vitro fertilization or ICSI cycle from January 2008 to December 2010 in a single centre was done. The type of transfer was divided into two groups: ‘easy’ or ‘difficult’. Transfer was considered difficult when additional instrumentation was required or firmer catheter was used or required changing of catheter. Patients undergoing cryo-preserved ET were excluded from the study. RESULTS: On the day of transfer in 284 (83%) patients, ET was easy and difficulty was encountered in 58 (17%) patients. Blood at catheter was seen in 101 (29.53%) patients. In the group of 58 difficult transfers, 10 pregnancies resulted with a clinical pregnancy rate of 17.2%, while 67 pregnancies resulted in 284 cycles of easy transfer with clinical pregnancy rate of 23.6% (P value = 0.045). While no significant difference was seen in pregnancies with blood on outer catheter and blood less transfer, there was significant reduction in pregnancy rate when blood was present on catheter tip compared to bloodless transfer (13.3% v/s 24.1; P value = 0.032). CONCLUSION: Reduction in clinical pregnancy rate is seen with difficult ETs, more when blood is present at the catheter tip.
Singh, Neeta; Gupta, Prerna; Mittal, Suneeta; Malhotra, Neena
Cloned cDNA sequences representing exons from the Duchenne/Becker muscular dystrophy (DMD/BMD) gene were used for deletion screening in a population of 287 males males affected with DMD or BMD. The clinical phenotypes of affected boys were classified into three clinical severity groups based on the age at which ambulation was lost. Boys in group 1 had DMD, losing ambulation before their 13th birthday; those in group 2 had disease of intermediate severity, losing ambulation between the ages of 13 and 16 years; and boys in group 3 had BMD, being ambulant beyond 16 years. A fourth group consisted of patients too young to be classified. Clinical group allocation was made without previous knowledge of the DNA results. A gene deletion was found in 124 cases where the clinical severity group of the affected boy was known. The extent of the deletions was delineated using cDNA probes. There were 74 different deletions. Fifty-five of these were unique to individual patients, but the other 19 were found in at least two unrelated patients. The different clinical groups showed generally similar distributions of deletions, and the number of exon bands deleted (that is, deletion size) was independent of phenotype. Some specific deletion types, however, correlated with the clinical severity of the disease. Deletion of exons containing HindIII fragments 33 and 34 and 33 to 35 were associated with BMD and were not found in patients with DMD. Deletions 3 to 7 occurred in four patients with the intermediate phenotype and one patient with BMD. Other shared deletions were associated with DMD, although in four cases patients with disease of intermediate severity apparently shared the same deletion with boys with DMD. The range of phenotypes observed, and the overlap at the genetic level between severe and intermediate and mild and intermediate forms of dystrophy, emphasizes the essential continuity of the clinical spectrum of DMD/BMD. There were no characteristic deletions found in boys with mental retardation or short stature which differed from deletions in affected boys without these features. Images
Hodgson, S; Hart, K; Abbs, S; Heckmatt, J; Rodillo, E; Bobrow, M; Dubowitz, V
Cloned cDNA sequences representing exons from the Duchenne/Becker muscular dystrophy (DMD/BMD) gene were used for deletion screening in a population of 287 males males affected with DMD or BMD. The clinical phenotypes of affected boys were classified into three clinical severity groups based on the age at which ambulation was lost. Boys in group 1 had DMD, losing ambulation before their 13th birthday; those in group 2 had disease of intermediate severity, losing ambulation between the ages of 13 and 16 years; and boys in group 3 had BMD, being ambulant beyond 16 years. A fourth group consisted of patients too young to be classified. Clinical group allocation was made without previous knowledge of the DNA results. A gene deletion was found in 124 cases where the clinical severity group of the affected boy was known. The extent of the deletions was delineated using cDNA probes. There were 74 different deletions. Fifty-five of these were unique to individual patients, but the other 19 were found in at least two unrelated patients. The different clinical groups showed generally similar distributions of deletions, and the number of exon bands deleted (that is, deletion size) was independent of phenotype. Some specific deletion types, however, correlated with the clinical severity of the disease. Deletion of exons containing HindIII fragments 33 and 34 and 33 to 35 were associated with BMD and were not found in patients with DMD. Deletions 3 to 7 occurred in four patients with the intermediate phenotype and one patient with BMD. Other shared deletions were associated with DMD, although in four cases patients with disease of intermediate severity apparently shared the same deletion with boys with DMD. The range of phenotypes observed, and the overlap at the genetic level between severe and intermediate and mild and intermediate forms of dystrophy, emphasizes the essential continuity of the clinical spectrum of DMD/BMD. There were no characteristic deletions found in boys with mental retardation or short stature which differed from deletions in affected boys without these features. PMID:2585468
Hodgson, S; Hart, K; Abbs, S; Heckmatt, J; Rodillo, E; Bobrow, M; Dubowitz, V
Objectives. In vulvar carcinoma, the expression of Ki-67 has been previously found to correlate with patient outcome. The objective of the study was to determine whether a specific pattern of expression was associated with occult vulvar cancer in patients with vulvar intraepithelial neoplasia (VIN) III and whether patterns of Ki-67 expression correlated with other clinical prognostic factors.Methods. 19 women with
Susan C. Modesitt; Pamela A. Groben; Leslie A. Walton; Wesley C. Fowler; Linda Van Le
BACKGROUND AND PURPOSE: The role of diffusion tensor imaging (DTI) in neurosurgical planning and follow-up is currently being defined and needs clinical validation. To that end, we sought correlations between preoperative and postoperative DTI and clinical motor deficits in patients with space-occupying lesions involving the corticospinal tract (CST). METHODS: DTI findings in four patients with masses near the CST and
Bryan J. Laundre; Brian J. Jellison; Behnam Badie; Andrew L. Alexander; Aaron S. Field
Introduction Prior studies have demonstrated an increased frequency of antibodies to Porphyromonas gingivalis (Pg), a leading agent of periodontal disease, in rheumatoid arthritis (RA) patients. However, these patients generally had long-standing disease, and clinical associations with these antibodies were inconsistent. Our goal was to examine Pg antibody responses and their clinical associations in patients with early RA prior to and after disease-modifying antirheumatic drug (DMARD) therapy. Methods Serum samples from 50 DMARD-naïve RA patients were tested using an enzyme-linked immunosorbent assay with whole-Pg sonicate. For comparison, serum samples were tested from patients with late RA, patients with other connective tissue diseases (CTDs), age-similar healthy hospital personnel and blood bank donors. Pg antibody responses in early RA patients were correlated with standard RA biomarkers, measures of disease activity and function. Results At the time of enrollment, 17 (34%) of the 50 patients with early RA had positive immunoglobulin G (IgG) antibody responses to Pg, as did 13 (30%) of the 43 patients with late RA. RA patients had significantly higher Pg antibody responses than healthy hospital personnel and blood bank donors (P < 0.0001). Additionally, RA patients tended to have higher Pg antibody reactivity than patients with other CTDs (P = 0.1), and CTD patients tended to have higher Pg responses than healthy participants (P = 0.07). Compared with Pg antibody-negative patients, early RA patients with positive Pg responses more often had anti-cyclic citrullinated peptide (anti-CCP) antibody reactivity, their anti-CCP levels were significantly higher (P = 0.03) and the levels of anti-Pg antibodies correlated directly with anti-CCP levels (P < 0.01). Furthermore, at the time of study entry, the Pg-positive antibody group had greater rheumatoid factor values (P = 0.04) and higher inflammatory markers (erythrocyte sedimentation rate, or ESR) (P = 0.05), and they tended to have higher disease activity scores (Disease Activity Score based on 28-joint count (DAS28)-ESR and Clinical Disease Activity Index) and more functional impairment (Health Assessment Questionnaire). In Pg-positive patients, greater disease activity was still apparent after 12 months of DMARD therapy. Conclusions A subset of early RA patients had positive Pg antibody responses. The responses correlated with anti-CCP antibody reactivity and to a lesser degree with ESR values. There was a trend toward greater disease activity in Pg-positive patients, and this trend remained after 12 months of DMARD therapy. These findings are consistent with a role for Pg in disease pathogenesis in a subset of RA patients.
Background: Primary intracerebral hemorrhage (PICH) remains the deadliest and most disabling form of stroke. The aim of our study was to determine the potential predictors for survival and neurological recovery in PICH patients by clinical-computed tomographic (CT) correlation. Materials and Methods: A prospective study conducted among PICH patients at a tertiary care hospital. The clinical and CT scan findings were correlated with the functional outcome using modified Rankin scores (mRS) of 0-5 at discharge and during six months follow-up. Results: The clinical and CT findings in 160 (93 male and 67 female) eligible adult patients with age range from 25 to 85 years (mean age 58.30 ± 11.44 years) were analyzed. The mean Glasgow Coma Scale [GCS] score was significantly higher among survivors. (12.8 ± 0.4 vs. 8.5 ± 0.5, P < 0.001) Based upon the pattern of the CT findings, the best outcome in terms of survival was for the patients with ICH in basal ganglia/internal capsule region (86.7 %), followed by lobar hemorrhage (67.1%). Good functional outcome was associated with a hematoma volume of less than 30 ml. At discharge majority of the survivors were functionally dependent 76 (70.4%) and only 32 (29.6%) achieved functional independence. The significant independent predictors of in- hospital survival were GCS score > 9 (OR 10.8; 95% CI 4.061 to 28.719), basal ganglia/internal capsule bleed (OR 9.750; 95% CI 2.122 to 45.004), hematoma volume <30 ml (OR 11.476; 95% CI 4. 810 to 27.434), no mid line shift (OR 4.901; 95% CI 2.405 to 9.987) and no intraventricular extension of hemorrhage (OR 7.040; 95% CI 3.358 to 14.458). Conclusion: Outcome and functional status at discharge were well correlated with the initial CT scan findings and GCS score.
Rathor, Mohammad Yousuf; Rani, Mohammad Fauzi Abdul; Jamalludin, A. R.; Amran, M.; Shahrin, T. C. A.; Shah, A.
Fifty episodes of oropharyngeal candidiasis in HIV-infected patients were analyzed prospectively in order to evaluate the clinical response to fluconazole. The minimum inhibitory concentrations (MICs) of fluconazole for theCandida strains isolated from the pharynx were correlated with the clinical response. Treatment with fluconazole (100 mg\\/day) was successful in 86% of the cases. A good clinical outcome followed in 97% of
C. Quereda; A. M. Polanco; C. Giner; A. Sánchez-Sousa; E. Pereira; E. Navas; J. Fortún; A. Guerrero; F. Baquero
Carcinoma of the parathyroid is a rare malignancy that can be cured surgically if the proper diagnosis and treatment is given initially. Arriving to the clinical suspicion of a malignancy preoperatively is by far the most important step for a good prognosis. Our goal is to review the correlation between clinical and final histopathological findings that can arouse the suspicion of such malignancy and their true predictive value in the diagnosis. All patients that underwent surgical removal of the parathyroid mass between March of 1992 and March of 2003 were reviewed retrospectively at Providence Hospital and Medical Centers. Among 168 patients who underwent parathyroid excision, 14 (8.3%) had hyperplasia of the parathyroid, 121 (72%) had benign adenoma, 25 (14.8%) had other benign lesions, and 8 (4.7%) patients had primary carcinoma of the parathyroid confirmed by pathology. Our mean serum calcium level was 11.57 mg/dL, which was lower than the mean level (12 mg/dL) for benign hyperparathyroidism. The mean tumor size was 2.18 cm, smaller than the proposed for malignant criteria, and none of the eight patients (0%) had any symptoms of hypercalcemia at the time of diagnosis. Seven of eight patients (87.5%) had frank signs of invasion together with other histological features, and two patients had associated papillary carcinoma of the thyroid. Five patients from our series did not meet clinical criteria for malignancy (tumor size > 3 cm, palpable mass, and serum calcium > 14 mg/dL), but had undisputable histological findings (high mitotic pattern, fibrous trabeculae, capsular invasion, vascular invasion, and nodular involvement). On the other hand, 17 patients with benign histology had tumors greater than 3 cm, and an additional 18 had palpable masses on physical examination. We believe that these patients need to be followed closely. The patients with diagnosis of parathyroid carcinoma, their kindred, and those with large adenomas may benefit from genetic screening for HRTP2 gene mutations in search of early detection of tumors suspicious for malignancy. This is based on the fact that we did not find correlation between the clinical presentation and the histological features in our patients with proven malignancy. PMID:16719197
Chang, Yeon-Jeen; Mittal, Vijay; Remine, Stephen; Manyam, Harish; Sabir, Mubashir; Richardson, Todd; Young, Shun
Amygdala dysfunction has been proposed as a critical contributor to social impairment in autism spectrum disorders (ASD). The current study investigated biochemical abnormalities in the amygdala in 20 high functioning adults with autistic disorder or Asperger’s disorder and 19 typically developing adults matched on age and IQ. Magnetic resonance spectroscopy was used to measure n-acetyl aspartate (NAA), creatine/phosphocreatine (Cre), choline/choline containing compounds (Cho), and Myoinositol (mI) in the right and left amygdala. There were no significant between-group differences in any of the metabolites. However, NAA and Cre levels were significantly correlated to clinical ratings on the Autism Diagnostic Interview-Revised. This suggests that altered metabolite levels in the amygdala may be associated with a more severe early developmental course in ASD.
Kleinhans, Natalia M.; Richards, Todd; Weaver, Kurt E.; Liang, Olivia; Dawson, Geraldine; Aylward, Elizabeth
This study investigated the phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with ASD (N = 102; range 7-16 years). The presence of suicidal thoughts and behavior was assessed through the Anxiety Disorders Interview Schedule-Child and Parent Versions. Children and parents completed measures of anxiety severity, functional impairment, and behavioral and emotional problems. Approximately 11 % of youth displayed suicidal thoughts and behaviors. Children with autism were more likely to have suicidal thoughts and behaviors whereas children with Asperger's disorder were less likely. Suicidal thoughts and behaviors were associated with the presence of depression and post-traumatic stress disorder. Overall, results suggest that suicidal thoughts and behaviors are common in youth with ASD, and may be related to depression and trauma. PMID:23446993
Storch, Eric A; Sulkowski, Michael L; Nadeau, Josh; Lewin, Adam B; Arnold, Elysse B; Mutch, P Jane; Jones, Anna M; Murphy, Tanya K
Contrast laryngograms performed on 50 patients referred to the radiology department of University Hospital between 1967 and 1973 were correlated with the direct laryngoscopic and pathological findings. Not a single malignancy in this series was missed radiologically, but in three out of 32 cases, the radiological extent of these lesions was considered more advanced than the pathology results. All patients with proven chronic inflammations, had symptoms of carcinomas of the larynx. No false positive carcinomas were diagnosed laryngographically in this group. In a patient with the nasopharyngeal carcinoma and in a case of myasthenia laryngis the radiological diagnosis would probably not have been misinterpreted if clinical histories were obtained prior to laryngography. PMID:933250
Bachynski, J E; Vyas, U S
At present it is difficult to distinguish those human chorioretinal diseases in which the retinal pigment epithelium (RPE) is the primary site of dysfunction. This difficulty is caused by several factors such as scarcity of biochemical and histological information and a lack of correlation of basic science information available with the clinical body of knowledge. In the present study we examined 134 eyes at early or late stages of hereditary diseases involving the RPE. We tried to distinguish primary RPE involvement by using standard ERG (a- and b-wave) and EOG testing. We conclude that in general primary RPE damage can be better assessed by current electrophysiology in those diseases which seem to remain localized at the RPE level for a long time. PMID:3956360
Ponte, F; Anastasi, M; Cillino, S
The importance of clinical assessment and its contribution to the diagnosis of neck masses was investigated in patients presenting with a neck mass. In our study, we collected the medical history of a total of 127 patients, including 66 males and 61 females, who presented with a neck mass. Physical exams, endoscopic examinations, laboratory tests, a variety of imaging studies, and fine-needle aspiration biopsies were performed. The relationship between age, duration and location of the neck mass, FNAB results, and definitive histopathological diagnosis were investigated as well as the correlation between the consensus diagnosis reached after the evaluation of the medical history, physical examination and imaging studies, and definitive histopathological diagnosis. A strong and positive relationship (p < 0.01) was found between patients' ages and the definitive diagnosis established by histopathological examination. There was no statistically significant relationship (p > 0.05) between the duration and location of the neck mass and definitive diagnosis established by histopathological examination. And no statistically significant relationship (p > 0.05) was found between FNAB results and definitive histopathological diagnosis. Although no statistically significant relationship was found between the characteristics of neck masses and age, duration and location of masses and FNAB results, there was a statistically significant correlation between the pre-diagnosis estimated by ENT specialists and definitive diagnosis established by histopathological examination. A strong and positive relationship (p < 0.01) was found between clinical pre-diagnosis and definitive diagnosis established by histopathological examination. In patients presenting with a neck mass, the diagnosis should be made based on the medical history, physical examination, radiologic imaging and FNAB results, treatment decisions should be based on those findings. PMID:25032107
Ozdas, Talih; Ozcan, Kursat Murat; Ozdogan, Fatih; Cetin, Mehmet Ali; Dere, Huseyin
The aim of the present study was to evaluate the frequency and type of oncogenic v-raf murine sarcoma viral oncogene homolog B1 (BRAF)/neuroblastoma RAS viral (v-ras) oncogene homolog (NRAS) mutations in cutaneous melanoma with clinically detected nodal metastases (stage IIIB and C) in relation to clinicopathological features and outcome. The clinicopathological data of 250 patients following therapeutic lymphadenectomy (LND) between 1995 and 2010, as well as BRAF/NRAS mutational status in corresponding nodal metastases, were analyzed. The median follow-up time was 53 months. BRAF mutations were detected in 154 (62%) cases (141 p.V600E, nine p.V600K and four others) and mutually exclusive NRAS mutations were detected in 42 (17%) cases. The presence of a BRAF mutation was found to correlate with patients of a younger age. The five-year overall survival (OS) rate was 33 and 43% for LND and primary tumor excision, respectively, and the five-year disease-free survival (DFS) rate for LND was 25%. No correlation was identified between BRAF/NRAS mutational status and RFS or OS (calculated from the date of the LND and primary tumor excision); for BRAF- and NRAS-mutated melanoma, the prognosis was the same for patients with wild-type (WT) melanoma. The important factors which had a negative impact on OS and DFS were as follows: Male gender, >1 metastatic lymph node and extracapsular extension of nodal metastases. The interval between the diagnosis of the initial melanoma to regional nodal metastasis (median, 10 months) was not significantly different between BRAF-mutant and -WT patients. Our largest comprehensive molecular analysis of clinical stage III melanoma revealed that BRAF and NRAS mutational status is not a prognostic marker in stage III melanoma patients with macroscopic nodal involvement, but may have implications for potential adjuvant therapy.
RUTKOWSKI, PIOTR; GOS, ALEKSANDRA; JURKOWSKA, MONIKA; SWITAJ, TOMASZ; DZIEWIRSKI, WIRGINIUSZ; ZDZIENICKI, MARCIN; PTASZYNSKI, KONRAD; MICHEJ, WANDA; TYSAROWSKI, ANDRZEJ; SIEDLECKI, JANUSZ A.
OBJECTIVES: This study aimed to investigate the clinical correlation between angiographic coronary atherosclerosis and N-terminal pro-B-type natriuretic peptide along with other known correlated factors. METHODS: In total, 153 patients with a diagnostic hypothesis of stable angina, unstable angina or acute myocardial infarction were classified as group A (patients with angiographically normal coronary arteries) or group B (patients with angiographic coronary atherosclerosis). The two groups were analyzed with respect to the following factors: gender, age, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, early family history of atherosclerosis, statin use, the presence of metabolic syndrome, clinical presentation and biochemical factors, including cholesterol, creatinine and fibrinogen plasma concentrations, monocyte counts and N-terminal pro-B-type natriuretic peptide. RESULTS: Univariate analyses comparing the two groups revealed that group B patients more frequently had diabetes, used statins and had systolic dysfunction, N-terminal pro-B-type natriuretic peptide levels ?250 pg/mL, fibrinogen levels >500 mg/dL and ?501 monocytes/mm3 compared with group A patients (p<0.05). Nevertheless, multivariate logistic regression analysis demonstrated that the independent predictors of angiographic coronary atherosclerosis were an N-terminal pro-B-type natriuretic peptide level ?250 pg/mL, diabetes mellitus and increased monocyte numbers and fibrinogen plasma concentration, regardless of the creatinine level or the presence of systolic dysfunction. CONCLUSIONS: An N-terminal pro-B-type natriuretic peptide plasma concentration of ?250 pg/mL is an independent predictor of angiographic coronary atherosclerosis.
Ribeiro, Demostenes G. L.; Silva, Ricardo P.; Barboza, Daniella R. M. M.; Lima-Junior, Roberto C. P.; Ribeiro, Ronaldo A.
Diffusion tensor imaging (DTI) is rarely applied in spinal cord injury (SCI). The aim of this study was to correlate diffusion properties after SCI with electrophysiological and neurological measures. Nineteen traumatic cervical SCI subjects and 28 age-matched healthy subjects participated in this study. DTI data of the spinal cord were acquired with a Philips Achieva 3 T MR scanner using an outer volume suppressed, reduced field of view (FOV) acquisition with oblique slice excitation and a single-shot EPI readout. Neurological and electrophysiological measures, American Spinal Injury Association (ASIA) impairment scale scores, and motor (MEP) and somatosensory evoked potentials (SSEP) were assessed in SCI subjects. Fractional anisotropy (FA) values were decreased in the SCI subjects compared to the healthy subjects. In upper cervical segments, the decrease in FA was significant for the evaluation of the entire cross-sectional area of the spinal cord, and for corticospinal and sensory tracts. A decreasing trend was also found at the thoracic level for the corticospinal tracts. The decrease of DTI values correlated with the clinical completeness of SCI, and with SSEP amplitudes. The reduced DTI values seen in the SCI subjects are likely due to demyelination and axonal degeneration of spinal tracts, which are related to clinical and electrophysiological measures. A reduction in DTI values in regions remote from the injury site suggests their involvement with wallerian axonal degeneration. DTI can be used for the quantitative evaluation of the extent of spinal cord damage, and eventually to monitor the effects of future regeneration-inducing treatments. PMID:22150011
Petersen, Jens A; Wilm, Bertram J; von Meyenburg, Jan; Schubert, Martin; Seifert, Burkhardt; Najafi, Yousef; Dietz, Volker; Kollias, Spyridon
Processing speed deficit, ascertained by digit-symbol substitution test (DSST), is considered as a fundamental impairment in schizophrenia. Clinical correlates of processing speed abnormalities, especially using the parametric version of DSST is yet to be evaluated comprehensively. In this study, we examined schizophrenia patients (N=66) and demographically matched healthy controls (N=72) using computer-administered parametric DSST (pDSST) with fixed (pDSSTF) as well as random (pDSSTR) conditions and analysed the relationship between pDSST performance and clinical symptoms. Psychopathology was assessed using Scale for Assessment of Positive Symptoms (SAPS)/Negative Symptoms (SANS) with good inter-rater reliability. In comparison with healthy controls, patients demonstrated significantly lesser number of correct responses (CN) in pDSSTF (t=8.0; p<0.001) and pDSSTR (t=7.8; p<0.001) as well as significantly prolonged reaction time in pDSSTF (t=7.1; p<0.001) and pDSSTR (t=7.0; p<0.001). The difference in CN between pDSSTF and pDSSTR [?CN] was significantly lesser in patients than healthy controls (t=2.61; p=0.01). The pDSST reaction time had significant positive correlation with negative syndrome scores as well as bizarre behaviour score. Significantly greater processing speed deficits in pDSST suggest potential relational memory/visual scanning abnormalities in schizophrenia. Furthermore, pDSST deficits demonstrated a significant association with the psychopathology, especially with the various negative symptoms and bizarre behaviour. PMID:25042951
Amaresha, Anekal C; Danivas, Vijay; Shivakumar, Venkataram; Agarwal, Sri Mahavir; Kalmady, Sunil V; Narayanaswamy, Janardhanan C; Venkatasubramanian, Ganesan
Summary Background and objectives Incidence of AKI in hospitalized patients with cancer is increasing, but reports are scant. The objective of this study was to determine incidence rate, clinical correlates, and outcomes of AKI in patients admitted to a cancer center. Design, setting, participants, & measurements Cross-sectional analysis of prospectively collected data on 3558 patients admitted to the University of Texas M.D. Anderson Cancer Center over 3 months in 2006. Results Using modified RIFLE (Risk, Injury, Failure, Loss, ESRD) criteria, 12% of patients admitted to the hospital had AKI, with severity in the Risk, Injury, and Failure categories of 68%, 21%, and 11%, respectively. AKI occurred in 45% of patients during the first 2 days and in 55% thereafter. Dialysis was required in 4% of patients and nephrology consultation in 10%. In the multivariate model, the odds ratio (OR) for developing AKI was significantly higher for diabetes (OR, 1.89; 95% confidence interval [CI], 1.51–2.36), chemotherapy (OR, 1.61; 95% CI, 1.26–2.05), intravenous contrast (OR, 4.55; 95% CI, 3.51–5.89), hyponatremia (OR, 1.97; 95% CI, 1.57–2.47), and antibiotics (OR, 1.52; 95% CI, 1.15–2.02). In patients with AKI, length of stay (100%), cost (106%), and odds for mortality (4.7-fold) were significantly greater. Conclusion The rate of AKI in patients admitted to a comprehensive cancer center was higher than the rate in most noncancer settings; was correlated significantly with diabetes, hyponatremia, intravenous contrast, chemotherapy, and antibiotics; and was associated with poorer clinical outcomes. AKI developed in many patients after admission. Studies are warranted to determine whether proactive measures may limit AKI and improve outcomes.
Doshi, Simit M.; Pawar, Tushar; Nowshad, Gul; Lahoti, Amit; Shah, Pankaj
Chronic kidney disease (CKD) occurs frequently after liver transplantation (LT) and is associated with significant morbidity and mortality. Thus, there is a pressing need to identify characteristics and biomarkers diagnostic of CKD to enable early diagnosis allowing preemptive interventions, as well as mechanistic insights into the progression from kidney injury to irreversible kidney failure. We analyzed 342 patients who had baseline GFR>60 at time of LT and are now >3 years post-LT. Risk factors for post-LT CKD were compared between 3 different groups defined by current GFR: >90 (n=40), 60–90 (n=146) and <60 (n=156) ml/min. Age, cyclosporine use, and pre-LT GFR were independently associated with new onset CKD. A subset (n=64) without viral/immune disease or graft dysfunction underwent multi-analyte plasma proteomic evaluations for correlation with CKD. Plasma proteomic analysis of two independent cohorts, test (n=22) and validation (n=42), identified 10 proteins highly associated with new onset CKD. In conclusion, we have identified clinical characteristics and a unique plasma proteomic signature correlating with new onset CKD after LT. These preliminary results are currently being validated in a prospective, multi-center study to determine if this signature precedes the onset of CKD and resolves with early interventions aimed at preserving kidney function.
Levitsky, Josh; Salomon, Daniel R.; Abecassis, Michael; Langfelder, Peter; Horvath, Stephen; Friedewald, John; Wang, Ed; Kurian, Sunil M.; Mondala, Tony; Gil, Sorelly; McDade, Ralph; Ballard, Karri; Gallon, Lorenzo
A prospective study was undertaken of 129 children with spastic cerebral palsy to clarify the relationship between magnetic resonance imaging (MRI) findings and clinical features of cerebral palsy. Low birth weight, asphyxia, prematurity, seizures, mental development, Gross Motor Function Classification System, and MRI findings were analyzed. Significant abnormalities relevant to the cerebral palsy were evident on imaging in 123 (95.3%). A similar percentage of MRI abnormalities were detected in the groups, 45 (100%) in patients with tetraplegic cerebral palsy, 37 (92.5%) in children with diplegic cerebral palsy, and 42 (95.4%) with hemiplegic cerebral palsy. Periventricular leukomalacia was detected more frequently in the children with spastic diplegia than in the patients with tetraplegia or hemiplegia. Cerebral atrophy was found more often in the tetraplegic group compared to the diplegic patients. Porencephalic cysts were detected more frequently in children with spastic hemiplegia. Congenital brain anomalies were found in a higher proportion in tetraplegic children. Significant correlations between the MRI findings and Gross Motor Function Classification System in the diplegic and tetraplegic patients were found. No correlations between the MRI results and risk factors for cerebral palsy in the tetraplegic patients were noted. Early detection of brain abnormalities in children with cerebral palsy may help in the prognosis and in the initiation of appropriate therapy PMID:17608298
Ku?ak, Wojciech; Sobaniec, Wojciech; Kubas, Bozena; Walecki, Jerzy; Smigielska-Kuzia, Joanna; Bockowski, Leszek; Artemowicz, Barbara; Sendrowski, Krzysztof
Corneal confocal microscopy is a growing technique for the study of the cornea at the cellular level, providing images comparable to ex vivo histochemical methods. In vivo confocal microscopy (IVCM) has an enormous potential, being a noninvasive procedure that images the living cornea, to study both its physiological and pathological states. Corneal nerves are of great interest to clinicians and scientists due to their important roles in regulating corneal sensation, epithelial integrity, proliferation, wound healing, and for their protective functions. IVCM enables the noninvasive examination of corneal nerves, allowing the study of nerve alterations in different ocular diseases, after corneal surgery, and in systemic diseases. To date, the correlation of sub-basal corneal nerves and their function has been studied in normal eyes, keratoconus, dry eye, contact lens wearers, and in neurotrophic keratopathy, among others. Further, the effect of corneal surgery on nerves has been studied, demonstrating the regenerative capacity of corneal nerves and the recovery of sensation. Moreover, IVCM has been applied in the diagnosis of peripheral diabetic neuropathy and the assessment of progression in this systemic disease. The purpose of this review is to describe the principles, applications, and clinical correlation of IVCM in the study of corneal nerves in different ocular and systemic diseases.
Cruzat, Andrea; Pavan-Langston, Deborah; Hamrah, Pedram
This study examined correlates of preschoolers' anxiety disorders using a comprehensive, multimethod design. Participants included a community sample of 541 three-year-old children, of whom 106 (19.6%) met criteria for at least 1 anxiety disorder. Child and parental psychopathology and life stress were assessed with clinical interviews. Child temperament and parenting behavior were assessed with laboratory observations. Mothers and fathers reported on their parenting styles. Compared to preschoolers with no anxiety disorder, preschoolers with an anxiety disorder were more likely to meet criteria for comorbid depressive and oppositional defiant disorders and to exhibit greater temperamental behavioral inhibition and lower positive affectivity, and more sleep problems. Children with anxiety disorders also experienced more stressful life events in the previous 6 months, and their mothers had a higher rate of current anxiety disorders. Compared to children with other anxiety disorders, children with only specific phobia exhibited a somewhat different pattern of associations than children with other anxiety disorders. Overall, the findings suggest that many of the correlates observed in older youth with anxiety disorders are also observed in preschoolers. PMID:23368788
Dougherty, Lea R; Tolep, Marissa R; Bufferd, Sara J; Olino, Thomas M; Dyson, Margaret; Traditi, Jennifer; Rose, Suzanne; Carlson, Gabrielle A; Klein, Daniel N
OBJECTIVE—To explore functional corticocortical connections in multiple sclerosis by means of coherence of the EEG, and to evaluate their correlations with the degree of cognitive impairment and with brain lesion load assessed by MRI.?METHODS—EEG coherence was studied from 28 patients with clinically definite multiple sclerosis. Ten minutes of resting EEG were recorded with 20 scalp electrodes, with binaural reference. FFT power and coherence were calculated in artifact free epochs of 1 second and compared with values from 22 control subjects of comparable age and sex distribution. Patients also underwent MRI (n=27) and neuropsychological examination (n=21).?RESULTS—Compared with controls, patients with multiple sclerosis showed increased ? power in the frontotemporal-central regions (p<0.005). ? Band coherence was decreased between homologous areas (p<0.02). ? Band coherence was decreased both in the local and long distance connections (p<0.0005). These findings were most striking both in patients with high MRI subcortical lesion load and in patients with cognitive involvement. A significant correlation was found between interhemispheric ? (p=0.02) and ? (p=0.017) and anteroposterior ? (p=0.013) coherence and subcortical MRI lesion load, but not with exclusively periventricular lesion load.?CONCLUSIONS—These findings support the hypothesis that cognitive impairment in multiple sclerosis is mostly dependent on involvement of corticocortical connections related to demyelination and/or axonal loss within the white matter immediately underlying the cortex.??
Leocani, L.; Locatelli, T.; Martinelli, V.; Rovaris, M.; Falautano, M.; Filippi, M.; Magnani, G.; Comi, G.
Background The results of a small number of studies of autonomic function in patients with advanced cancer suggest that autonomic dysfunction (AD) is common. In other disease-specific groups this is associated with decreased survival, falls and symptoms such as postural hypotension, nausea, early satiety and fatigue. The contribution of AD to symptoms in advanced cancer is unknown. Methods We conducted a prospective cohort study designed to identify the risk factors for falls in patients with advanced cancer. Ambulant adult patients admitted consecutively to palliative care services were invited to participate. Participants underwent an assessment at baseline which included standard clinical tests of autonomic function, assessment of symptom severity, muscle strength, anthropometric measurements, walking speed, medication use, comorbidities and demographics. Information regarding survival was recorded ten months following cessation of recruitment. The clinical correlates of AD, defined as definite or severe dysfunction using Ewing's classification, were examined by univariate and multivariate logistic regression analysis. Survival analysis was conducted using Kaplan-Meier plots and the log rank test. Results Of 185 patients recruited, 45% were unable to complete all of the clinical tests of autonomic function. Non-completion was associated with scoring high on clinical indicators of frailty. It was possible to accurately classify 138/185 (74.6%) of participants as having either definite or severe versus normal, early or atypical AD: 110 (80%) had definite/severe AD. In logistic regression analysis, age (OR = 1.07 [95% CI; 1.03-1.1] P = 0.001) and increased severity of fatigue (OR = 1.26 [95% CI; 1.05-1.5] p = 0.016) were associated with having definite/severe AD. In analysis adjusted for age, median survival of participants with definite/severe AD was shorter than in those with normal/early/atypical classification (?2 = 4.3, p = 0.038). Conclusions Autonomic dysfunction is highly prevalent in patients with advanced cancer and is associated with increased severity of fatigue and reduced survival. Due to frailty, up to 45% of participants were unable to complete standard clinical tests of autonomic function. In order to further investigate the impact of AD and the therapeutic potential of treatment of AD in patients with advanced cancer, the validity of alternative novel methods of assessing autonomic function must be appraised.
Varicella-zoster virus (VZV) encodes a thymidine kinase (EC 126.96.36.199) which phosphorylates several antiviral nucleoside analogs, including acyclovir (ACV). A mutation in the VZV thymidine kinase coding sequence, resulting in an arginine-to-glutamine substitution at amino acid residue 130 (R130Q), is associated with clinical resistance to ACV. We have expressed the wild-type and the mutant enzymes in bacteria and have studied the kinetic characteristics of the purified enzymes. The arginine-to-glutamine substitution resulted in decreased catalytic activity and altered substrate specificity. The most striking effect was a decrease in the rates of nucleoside phosphorylation to less than 2% of the rates with the wild-type enzyme. This was accompanied by increased apparent Km values for thymidine and deoxycytidine. ACV was not detectably phosphorylated by the R130Q enzyme but still competed with thymidine for the enzyme. The inability of the R130Q enzyme to catalyze the phosphorylation of ACV correlates with resistance to ACV noted with a clinical isolate of VZV. Images
Roberts, G B; Fyfe, J A; Gaillard, R K; Short, S A
We aimed to assess prevalence and correlates of hazardous use of tobacco, alcohol and other drugs in a primary care population in Cape Town, South Africa. Stratified random sampling was used to select 14 of the 49 clinics in the public health sector in Cape Town, and every “nth” patient, with those ages 18–25 oversampled (N = 2,618). Data were collected from December 2003 through 2004, using the World Health Organization Alcohol, Smoking, and Substance Involvement Screening Test. Hazardous use of tobacco was most common, followed by alcohol and then other drugs. Hazardous tobacco use was associated with the 18–25 years age group, no religious involvement, high school completion, and higher stress. Hazardous alcohol use was associated with male gender, younger men, no religious involvement, employment, some high school education, and higher stress. Hazardous use of other drugs was associated with Colored (mixed) race (particularly among men), no religious involvement, employment, and stress. For all substances, women, particularly Black women, had the lowest rates of hazardous use. Although the study is cross-sectional, it does identify groups that may be at high risk of substance misuse and for whom intervention is urgent. Because prevalence of substance use is high in this population, routine screening should be introduced in primary care clinics.
WARD, CATHERINE L.; MERTENS, JENNIFER R.; FLISHER, ALAN J.; BRESICK, GRAHAM F.; STERLING, STACY A.; LITTLE, FRANCESCA; WEISNER, CONSTANCE M.
Objectives Indications for cochlear implantation have expanded today to include very young children and those with syndromes/multiple handicaps. Programming the implant based on behavioural responses may be tedious for audiologists in such cases, wherein matching an effective Measurable Auditory Percept (MAP) and appropriate MAP becomes the key issue in the habilitation program. In 'Difficult to MAP' scenarios, objective measures become paramount to predict optimal current levels to be set in the MAP. We aimed to (a) study the trends in multi-modal electrophysiological tests and behavioural responses sequentially over the first year of implant use; (b) generate normative data from the above; (c) correlate the multi-modal electrophysiological thresholds levels with behavioural comfort levels; and (d) create predictive formulae for deriving optimal comfort levels (if unknown), using linear and multiple regression analysis. Methods This prospective study included 10 profoundly hearing impaired children aged between 2 and 7 years with normal inner ear anatomy and no additional handicaps. They received the Advanced Bionics HiRes 90 K Implant with Harmony Speech processor and used HiRes-P with Fidelity 120 strategy. They underwent, impedance telemetry, neural response imaging, electrically evoked stapedial response telemetry (ESRT), and electrically evoked auditory brainstem response (EABR) tests at 1, 4, 8, and 12 months of implant use, in conjunction with behavioural mapping. Trends in electrophysiological and behavioural responses were analyzed using paired t-test. By Karl Pearson's correlation method, electrode-wise correlations were derived for neural response imaging (NRI) thresholds versus most comfortable level (M-levels) and offset based (apical, mid-array, and basal array) correlations for EABR and ESRT thresholds versus M-levels were calculated over time. These were used to derive predictive formulae by linear and multiple regression analysis. Such statistically predicted M-levels were compared with the behaviourally recorded M-levels among the cohort, using Cronbach's alpha reliability test method for confirming the efficacy of this method. Results NRI, ESRT, and EABR thresholds showed statistically significant positive correlations with behavioural M-levels, which improved with implant use over time. These correlations were used to derive predicted M-levels using regression analysis. On an average, predicted M-levels were found to be statistically reliable and they were a fair match to the actual behavioural M-levels. When applied in clinical practice, the predicted values were found to be useful for programming members of the study group. However, individuals showed considerable deviations in behavioural M-levels, above and below the electrophysiologically predicted values, due to various factors. While the current method appears helpful as a reference to predict initial maps in 'difficult to Map' subjects, it is recommended that behavioural measures are mandatory to further optimize the maps for these individuals. Conclusion The study explores the trends, correlations and individual variabilities that occur between electrophysiological tests and behavioural responses, recorded over time among a cohort of cochlear implantees. The statistical method shown may be used as a guideline to predict optimal behavioural levels in difficult situations among future implantees, bearing in mind that optimal M-levels for individuals can vary from predicted values. In 'Difficult to MAP' scenarios, following a protocol of sequential behavioural programming, in conjunction with electrophysiological correlates will provide the best outcomes. PMID:24606544
Raghunandhan, S; Ravikumar, A; Kameswaran, Mohan; Mandke, Kalyani; Ranjith, R
Study Objectives: Recent studies have suggested that nonrestorative sleep (NRS) symptoms may be distinct from nocturnal insomnia symptoms (NIS). However, there is limited information on the demographic, medical, and biologic correlates of NRS independent from NIS in the general population. This report presents the sociodemographic correlates, patterns of comorbidity with other sleep and physical disorders, C-reactive protein (CRP) levels, and general productivity associated with NIS and NRS in a nationally representative sample of US adults. Design: National Health and Nutrition Examination Survey (NHANES). Setting: The 2005-2008 surveys of the general population in the United States. Participants: There were 10,908 individuals (20 years or older) Interventions: N/A. Measurements and Results: Respondents were classified by the presence or absence of NIS and NRS. Compared with those without insomnia symptoms, respondents with NIS were older and had lower family income and educational levels than those with NRS. In addition, there was a significant association between NIS and cardiovascular disease, whereas NRS was associated with other primary sleep disorders (including habitual snoring, sleep apnea, and restless legs syndrome), respiratory diseases (emphysema and chronic bronchitis), thyroid disease, and cancer as well as increased CRP levels. In addition, the study participants with NRS only reported poorer scores on the Functional Outcomes of Sleep Questionnaire (FOSQ) than those without insomnia symptoms or those with NIS only. Conclusions: These findings suggest that there are substantial differences between NIS and NRS in terms of sociodemographic factors, comorbidity with other sleep and physical disorders, increased CRP level, and functional impairment. An inflammatory response might play a unique role in the pathogenesis of NRS. Citation: Zhang J; Lamers F; Hickie IB; He JP; Feig E; Merikangas KR. Differentiating nonrestorative sleep from nocturnal insomnia symptoms: demographic, clinical, inflammatory, and functional correlates. SLEEP 2013;36(5):671-679.
Zhang, Jihui; Lamers, Femke; Hickie, Ian B.; He, Jian-Ping; Feig, Emily; Merikangas, Kathleen R.
Mutations in the gene-encoding filaggrin (FLG), a key molecule involved in skin barrier function, have been shown to be a major predisposing factor for atopic dermatitis (AD; eczema). To elucidate the pathomechanisms underlying filaggrin-related AD, we investigated stratum corneum (SC) hydration and transepidermal water loss (TEWL) as parameters of barrier function in AD patients harboring FLG mutations compared to AD patients without any FLG mutation. In filaggrin-related AD, SC hydration was both significantly reduced (P<0.01-0.05) and thicker (P<0.01-0.05) than that in healthy controls. TEWL was demonstrably increased in non-filaggrin AD compared to healthy controls (P<0.01-0.05). The objective score of atopic dermatitis (OSCORAD), a disease clinical severity index, significantly correlated with TEWL (r=0.81, P<0.005), SC hydration (r=-0.65, P<0.05), and SC thickness (r=0.59, P<0.05) in filaggrin-related AD. On the contrary, there was no correlation between these parameters and the OSCORAD in non-filaggrin AD. Furthermore, a significant correlation was obtained between the OSCORAD and specific IgE for house dust (r=0.66, P<0.05), mite allergen (r=0.53, P<0.05), and cat dander (r=0.64, P<0.05) in filaggrin-related AD, but not in non-filaggrin AD. All these data suggest that experimentally demonstrable skin barrier defects due to FLG mutations may play a crucial role in the pathogenesis of AD. PMID:18818676
Nemoto-Hasebe, Ikue; Akiyama, Masashi; Nomura, Toshifumi; Sandilands, Aileen; McLean, W H Irwin; Shimizu, Hiroshi
The prevalence and clinical correlates of left ventricular (LV) wall motion abnormalities (WMAs), associated with morbidity and mortality, have not been well-characterized in the population. Framingham Heart Study Offspring Cohort participants (n = 1,794, 844 men, age 65 ± 9 years) underwent cine cardiovascular magnetic resonance for evaluation of LV function. A subset (n = 1,009, 460 men) underwent cardiac multidetector computed tomography for analysis of coronary artery calcium. The presence of coronary heart disease and heart failure (CHD-HF) were assessed in relation to the presence of WMAs. WMAs were present in 117 participants (6.5%) and were associated with male gender, elevated hemoglobin A1c, LV mass, LV end-diastolic volume, and lower LV ejection fraction. Of the 1,637 participants without CHD-HF, 68 (4.2%) had WMAs. In this group, WMAs were associated with obesity, hypertension, and Framingham coronary heart disease risk score in the age- and gender-adjusted analyses and were associated with male gender and hypertension on multivariate analysis. Most subjects with WMAs were in the greatest coronary artery calcium groups. The presence of coronary artery calcium greater than the seventy-fifth percentile and Agatston score >100 were associated with a greater than twofold risk of WMAs in the age- and gender-adjusted analysis but were no longer significant when additionally adjusted for CHD-HF. Previous Q-wave myocardial infarction was present in 29% of the 117 participants with WMAs. In conclusion, in the present longitudinally followed free-living population, 4.2% of the participants without CHD-HF had WMAs. WMAs were associated with the clinical parameters associated with cardiovascular disease risk. Aggressive risk factor modification may be prudent for subjects with WMAs, particularly those free of clinical CHD-HF. PMID:21247548
Tsao, Connie W; Gona, Philimon; Salton, Carol; Danias, Peter G; Blease, Susan; Hoffmann, Udo; Fox, Caroline S; Albert, Mark; Levy, Daniel; O'Donnell, Christopher J; Manning, Warren J; Yeon, Susan B
O6-methylguanine DNA-methyltransferase (MGMT) promoter methylation has been identified as a potential prognostic marker for glioblastoma patients. The relationship between the exact site of promoter methylation and its effect on gene silencing, and the patient's subsequent response to therapy, is still being defined. The aim of this study was to comprehensively characterize cytosine-guanine (CpG) dinucleotide methylation across the entire MGMT promoter and to correlate individual CpG site methylation patterns to mRNA expression, protein expression, and progression-free survival. To best identify the specific MGMT promoter region most predictive of gene silencing and response to therapy, we determined the methylation status of all 97 CpG sites in the MGMT promoter in tumor samples from 70 GBM patients using quantitative bisulfite sequencing. We next identified the CpG site specific and regional methylation patterns most predictive of gene silencing and improved progression-free survival. Using this data, we propose a new classification scheme utilizing methylation data from across the entire promoter and show that an analysis based on this approach, which we call 3R classification, is predictive of progression-free survival (HR ?=?5.23, 95% CI [2.089–13.097], p<0.0001). To adapt this approach to the clinical setting, we used a methylation-specific multiplex ligation-dependent probe amplification (MS-MLPA) test based on the 3R classification and show that this test is both feasible in the clinical setting and predictive of progression free survival (HR ?=?3.076, 95% CI [1.301–7.27], p?=?0.007). We discuss the potential advantages of a test based on this promoter-wide analysis and compare it to the commonly used methylation-specific PCR test. Further prospective validation of these two methods in a large independent patient cohort will be needed to confirm the added value of promoter wide analysis of MGMT methylation in the clinical setting.
Shah, Nameeta; Lin, Biaoyang; Sibenaller, Zita; Ryken, Timothy; Lee, Hwahyung; Yoon, Jae-Geun; Rostad, Steven; Foltz, Greg
Objectives To describe the echocardiographic characteristics and investigate the clinical correlates and prognostic significance of left ventricular false tendons (LVFTs). Background Although LVFTs are generally considered as anatomic variants, they have been associated with innocent precordial murmurs and electrocardiographic abnormalities in small case series. The correlates of LVFTs in the community are unknown. Methods We compared 101 Framingham Study participants with LVFTs (mean age 56 years, 45% women) on routine two-dimensional echocardiograms with 151 referents without LVFTs (mean age 57 years, 44% women). We examined the cross-sectional clinical, electrocardiographic (rest and ambulatory), and echocardiographic correlates of LVFTs using logistic regression models, and evaluated the prospective association between LVFTs and all-cause mortality using Cox proportional hazards regression models. Results A total of 107 LVFTs (94 simple with two points of attachment, and 13 complex/branching type with three or more points of attachment) were identified in 101 participants. LVFTs were most commonly visualized in the apical four chamber view (81%) and were predominantly localized to apical-third of the LV cavity (78%). LVFTs were associated with the presence of innocent precordial murmurs (multivariable adjusted odds ratio [OR] 5.55, 95% confidence interval [CI] 1.40-21.94), and electrocardiographic LV hypertrophy (OR 4.43, 95% CI 1.08-18.25). Body mass index (BMI) was inversely related to the presence of LVFTs (per kg/m2 increment, OR 0.94, 95% CI 0.88-0.99). LVFTs were not associated with QRS axis deviation, ventricular premature beats or repolarization abnormalities (all p-values >0.20). During a mean (±SD) follow-up of 7.7 (±1.6) years, 15 participants with and 19 without LVFTs died. In multivariable analyses, presence of LVFTs was not associated with the risk of death (p=0.92). Conclusions In our community-based sample of middle-aged to elderly white women and men, LVFTs were more likely to be identified in individuals with lower BMI, were cross-sectionally associated with the presence of innocent precordial murmurs and electrocardiographic LV hypertrophy, but were not associated with the risk of mortality.
Kenchaiah, Satish; Benjamin, Emelia J.; Evans, Jane C.; Aragam, Jayashri; Vasan, Ramachandran S.
Background Although rosacea is a chronic cutaneous inflammatory disorder that's commonly seen in adults, the etiology and pathogenesis of the illness remain unclear. A well established diagnostic classification and grading system may play a critical role in performing research and it would serve as a diagnostic reference in the clinical field. Objective We sought to classify the patients with the new standard classification and grading system and we wanted determine the peculiar features and relationships of each subtype. We also analyzed the relationships between the degree of sun exposure and each subtype. Methods We reviewed the medical records and clinical photos of 168 patients who were diagnosed with rosacea from 2002 to 2007 at our hospital. The standard classification and grading system suggested by the National Rosacea Society (NRS) Expert Committee was adopted to evaluate each patient's subtype and the severity. Results The male:female ratio was 1:2.29. The mean age at the time of diagnosis was 47.8 years. The mean duration of disease was 3.5 years. Sun exposure and hot baths/exercise were the two most common precipitating factors, while the majority of patients did not have any specific factor that relieved their symptoms. According to the NRS classification and grading system, the patients were classified into four subtypes. One hundred sixty two (96.4%) patients were diagnosed with the erythematotelangiectatic subtype irrespective of severity. Eighty five (50.6%) patients had the papulopustular subtype and 24 (14.3%) patients had ocular rosacea. Eight (4.8%) patients displayed mild phymatous change. The degree of sun exposure had significant correlation with the development and severity of the erythematotelangiectatic subtype (p<0.05), while it had no correlation with the papulopustular, ocular and phymatous subtypes. Conclusion Although the erythematotelangiectatic subtype was the most common subtype of rosacea, many patients also had other subtypes of rosacea simultaneously. Based on our results, we proved that ocular rosacea is an extension of the clinical spectrum of erythematotelangiectatic rosacea. In addition, the results of our study particularly suggest that sun exposure has a different influence on each subtype of rosacea.
Bae, You In; Yun, Sook-Jung; Lee, Jee-Bum; Kim, Seong-Jin; Won, Young Ho
Background The brain develops in concert and in coordination with the developing facial tissues, with each influencing the development of the other and sharing genetic signaling pathways. Autism spectrum disorders (ASDs) result from alterations in the embryological brain, suggesting that the development of the faces of children with ASD may result in subtle facial differences compared to typically developing children. In this study, we tested two hypotheses. First, we asked whether children with ASD display a subtle but distinct facial phenotype compared to typically developing children. Second, we sought to determine whether there are subgroups of facial phenotypes within the population of children with ASD that denote biologically discrete subgroups. Methods The 3dMD cranial System was used to acquire three-dimensional stereophotogrammetric images for our study sample of 8- to 12-year-old boys diagnosed with essential ASD (n = 65) and typically developing boys (n = 41) following approved Institutional Review Board protocols. Three-dimensional coordinates were recorded for 17 facial anthropometric landmarks using the 3dMD Patient software. Statistical comparisons of facial phenotypes were completed using Euclidean Distance Matrix Analysis and Principal Coordinates Analysis. Data representing clinical and behavioral traits were statistically compared among groups by using ?2 tests, Fisher's exact tests, Kolmogorov-Smirnov tests and Student's t-tests where appropriate. Results First, we found that there are significant differences in facial morphology in boys with ASD compared to typically developing boys. Second, we also found two subgroups of boys with ASD with facial morphology that differed from the majority of the boys with ASD and the typically developing boys. Furthermore, membership in each of these distinct subgroups was correlated with particular clinical and behavioral traits. Conclusions Boys with ASD display a facial phenotype distinct from that of typically developing boys, which may reflect alterations in the prenatal development of the brain. Subgroups of boys with ASD defined by distinct facial morphologies correlated with clinical and behavioral traits, suggesting potentially different etiologies and genetic differences compared to the larger group of boys with ASD. Further investigations into genes involved in neurodevelopment and craniofacial development of these subgroups will help to elucidate the causes and significance of these subtle facial differences.
Abstract There is no consensus on a gold standard for monitoring adherence to antiretroviral therapy (ART). We compared different adherence monitoring tools in predicting virologic failure as part of a clinical trial. HIV-infected Thai and Cambodian children aged 1-12 years (N=207) were randomized to immediate-ART or deferred-ART until CD4% <15%. Virologic failure (VF) was defined as HIV-RNA >1000 copies/mL after ?6 months of ART. Adherence monitoring tools were: (1) announced pill count, (2) PACTG adherence questionnaire (form completed by caregivers), and (3) child self-report (self-reporting from children or caregivers to direct questioning by investigators during the clinic visit) of any missed doses in the last 3 days and in the period since the last visit. The Kappa statistic was used to describe agreement between each tool. The median age at ART initiation was 7 years with median CD4% 17% and HIV-RNA 5.0?log10copies/mL and 92% received zidovudine/lamivudine/nevirapine. Over 144 weeks, 13% had VF. Mean adherence by announced pill count before VF in VF children was 92% compared to 98% in children without VF (p=0.03). Kappa statistics indicated slight to fair agreement between tools. In multivariate analysis adjusting for gender, treatment arm ethnicity and caregiver education, significant predictors of VF were poor adherence by announced pill count (OR 4.56; 95%CI 1.78-11.69), reporting any barrier to adherence in the PACTG adherence questionnaire (OR 7.08; 95%CI 2.42-20.73), and reporting a missed dose in the 24 weeks since the last HIV-RNA assessment (OR 8.64; 95%CI 1.96-38.04). In conclusion, we recommend the child self-report of any missed doses since last visit for use in HIV research and in routine care settings, because it is easy and quick to administer and a strong association with development of VF. PMID:24901463
Intasan, Jintana; Bunupuradah, Torsak; Vonthanak, Saphonn; Kosalaraksa, Pope; Hansudewechakul, Rawiwan; Kanjanavanit, Suparat; Ngampiyaskul, Chaiwat; Wongsawat, Jurai; Luesomboon, Wicharn; Apornpong, Tanakorn; Kerr, Stephen; Ananworanich, Jintanat; Puthanakit, Thanyawee
Background Optimizing treatment through microarray-based molecular subtyping is a promising method to address the problem of heterogeneity in breast cancer; however, current application is restricted to prediction of distant recurrence risk. This study investigated whether breast cancer molecular subtyping according to its global intrinsic biology could be used for treatment customization. Methods Gene expression profiling was conducted on fresh frozen breast cancer tissue collected from 327 patients in conjunction with thoroughly documented clinical data. A method of molecular subtyping based on 783 probe-sets was established and validated. Statistical analysis was performed to correlate molecular subtypes with survival outcome and adjuvant chemotherapy regimens. Heterogeneity of molecular subtypes within groups sharing the same distant recurrence risk predicted by genes of the Oncotype and MammaPrint predictors was studied. Results We identified six molecular subtypes of breast cancer demonstrating distinctive molecular and clinical characteristics. These six subtypes showed similarities and significant differences from the Perou-Sørlie intrinsic types. Subtype I breast cancer was in concordance with chemosensitive basal-like intrinsic type. Adjuvant chemotherapy of lower intensity with CMF yielded survival outcome similar to those of CAF in this subtype. Subtype IV breast cancer was positive for ER with a full-range expression of HER2, responding poorly to CMF; however, this subtype showed excellent survival when treated with CAF. Reduced expression of a gene associated with methotrexate sensitivity in subtype IV was the likely reason for poor response to methotrexate. All subtype V breast cancer was positive for ER and had excellent long-term survival with hormonal therapy alone following surgery and/or radiation therapy. Adjuvant chemotherapy did not provide any survival benefit in early stages of subtype V patients. Subtype V was consistent with a unique subset of luminal A intrinsic type. When molecular subtypes were correlated with recurrence risk predicted by genes of Oncotype and MammaPrint predictors, a significant degree of heterogeneity within the same risk group was noted. This heterogeneity was distributed over several subtypes, suggesting that patients in the same risk groups require different treatment approaches. Conclusions Our results indicate that the molecular subtypes established in this study can be utilized for customization of breast cancer treatment.
Background Snail1 is a transcription regulator of E-cadherin. The loss of E-cadherin seems to be a crucial step in the process of Epithelial-mesenchymal transition (EMT). EMT initiates invasion and proliferation in many tumours. Overexpression of Snail1 is known to be associated with poor outcome in several solid tumours. The aim of this study was to analyse its expression profile and prognostic significance in colorectal cancer. Methods Tissue microarrays (TMA) containing paraffin-embedded primary colorectal cancer (CRC) tissue samples from 251 patients were used in this study. The expression of Snail1 and E-cadherin was assessed by immunohistochemistry in different tumour compartments, corresponding lymph node metastases and normal colonic mucosa. Intensity of staining was classified according to the Remmele score (standardized scoring system) as well as the semiquantitative score established by Blechschmidt et al. Results Snail1 expression was observed in 76% of the CRC. Loss of E-cadherin was noted in 87% of the CRC. Snail1 positive tumours were significantly correlated with Snail1 positive lymph node metastases (p=0.03). There was no significant correlation between loss of E-cadherin and Snail1 expression, or between N-stage or grading and Snail1 expression. Kaplan-Meier survival analysis identified no prognostic impact of Snail1 expression on overall survival. Conclusion Snail1 expression was detectable in most of the CRC but showed no significant association with E-cadherin loss, clinical pathological characteristics or overall survival. The observed loss of E-cadherin could be explained by effects of other important EMT pathways, such as the Wnt-signalling cascade.
Intradialytic hypotension (IH) is a frequent complication of hemodialysis (HD) and is associated with increased patient mortality and cardiovascular events. We studied IH to determine its variability, correlates, and clinical impact in 13 outpatient HD facilities. Blood pressure was captured by machine download. IH was defined as >30 mmHg decrease in systolic blood pressure to <90 mmHg. Risk factors were assessed by logistic regression and hospitalization by Poisson regression. Time to death and first hospitalization were assessed using Kaplan-Meier analysis in patients completing >20 HD treatments. We studied IH in 44,801 treatments (Tx) in 1137 patients. IH was frequent (17.2% of treatments) and highly variable by patient (0-100% Tx) and dialysis facility (11.1-25.8% Tx). 25.1% of patients had no IH (0% Tx) and 16.2% had IH on >35% Tx. Increased IH frequency was associated with age, female gender, diabetes, Hispanic origin, longer end stage renal disease vintage, higher body mass index, higher ultrafiltration volume, the second and third weekly Tx, lower pre-HD systolic blood pressure, higher difference between prescribed and achieved post-HD weight, and higher dialysate temperature. Dialysis facility was an independent predictor of IH frequency. Patients with >35% IH treatments had poorer survival (P = 0.036), and more frequent and longer hospitalization (P = 0.04, P = 0.002, respectively) than patients without IH. In conclusion, IH frequency was highly variable, associated with individual facilities, patient and treatment characteristics, and correlated with mortality and hospitalization. Identifying practice patterns associated with IH coupled with routine reporting of IH will facilitate medical management and may result in the prevention of IH, decreased mortality, and decreased hospitalization. PMID:24467830
Sands, Jeffrey J; Usvyat, Len A; Sullivan, Terry; Segal, Jonathan H; Zabetakis, Paul; Kotanko, Peter; Maddux, Franklin W; Diaz-Buxo, Jose A
Rationale There is a need for a readily available, non-invasive source of biomarkers that predict poor asthma control. Objectives We sought to determine if there is an association between the salivary inflammatory profile and disease control in children and adults with asthma. Methods In this cross-sectional study, we collected demographic and clinical information from two independent populations at different sites, resulting in convenience samples of 58 pediatric and 122 adult urban asthmatics. Control was assessed by symptom questionnaire (children) and by Asthma Control Questionnaire and current exacerbation (adults). Saliva was collected in all subjects. We applied principal component analysis to a 10-plex panel of relevant inflammatory markers to characterize marker profiles and determined if profiles were associated with asthma control. Results There were similar, strong correlations amongst biologically related markers in both populations: eosinophil-related: eotaxin-1/CCL11, RANTES/CCL5, and IL-5 (p<.001); myeloid/innate: IL-1?, IL-6, MCP-1/CCL2, and IL-8/CXCL8 (p<.001). The first three principal components captured ?74% of variability across all ten analytes in both populations. In adults, the Principal Component 1 score, broadly reflective of all markers, but with greater weight given to myeloid/innate markers, was associated with Asthma Control Questionnaire score and exacerbation. The Principal Component 3 score, reflective of IP-10/CXCL10, was associated with current exacerbation. In children, the Principal Component 1, 2, and 3 scores were associated with recent asthma symptoms. The Principal Component 2 score, reflective of higher eosinophil markers, was inversely correlated with symptoms. The Principal Component 3 score was positively associated with all symptom outcomes. Conclusion The salivary inflammatory profile is associated with disease control in children and adults with asthma.
Delgado, Diana M.; Wexler, Philip J.; Oppenheim, Frank G.; Mitchell, Patricia; Feldman, James A.; Walt, David R.; Peng, Roger D.
Primary ciliary dyskinesia (PCD) is a genetic disease characterized by abnormalities in ciliary function, leading to compromised airway clearance and chronic bacterial infection of the upper and lower airways. The compositions of these infections and the relationships between their characteristics and disease presentation are poorly defined. We describe here the first systematic culture-independent evaluation of lower airway bacteriology in PCD. Thirty-three airway samples (26 from sputum, 7 from bronchoalveolar lavage [BAL] fluid) were collected from 24 PCD patients aged 4 to 73 years. 16S rRNA quantitative PCR and pyrosequencing were used to determine the bacterial loads and community compositions of the samples. Bacterial loads, which ranged from 1.3 × 104 to 5.2 × 109 CFU/ml, were positively correlated with age (P = 0.002) but not lung function. An analysis of ?7,000 16S rRNA sequences per sample identified bacterial species belonging to 128 genera. The concurrently collected paired samples showed high bacterial community similarity. The mean relative abundance of the dominant genera was 64.5% (standard deviation [SD], 24.5), including taxa reported through standard diagnostic microbiology (members of the genera Pseudomonas, Haemophilus, and Streptococcus) and those requiring specific ex vivo growth conditions (members of the genera Prevotella and Porphyromonas). The significant correlations observed included a positive relationship between Pseudomonas aeruginosa relative abundance and age and a negative relationship between P. aeruginosa relative abundance and lung function. Members of the genus Ralstonia were also found to contribute substantially to the bacterial communities in a number of patients. Follow-up samples from a subset of patients revealed high levels of bacterial community temporal stability. The detailed microbiological characterization presented here provides a basis for the reassessment of the clinical management of PCD airway infections.
Carroll, Mary P.; Zain, Nur Masirah M.; Bruce, Kenneth D.; Lock, Karen; Walker, Woolf; Jones, Graeme; Daniels, Thomas W. V.; Lucas, Jane S.
Background Although the studies published so far have found an affectation in the Health Related Quality of Life (HRQOL) in both psychiatric and substance use dependence disorders, very few studies have applied HRQOL as an assessment measure in patients suffering both comorbid conditions, or Dual Diagnosis. The aim of the current study was to assess HRQOL in a group of patients with Dual Diagnosis compared to two other non-comorbid groups and to determine what clinical factors are related to HRQOL. Methods Cross-sectional assessment of three experimental groups was made through the Short Form – 36 Item Health Survey (SF-36). The sample consisted of a group with Dual Diagnosis (DD; N?=?35), one with Severe Mental Illness alone (SMI; N?=?35) and another one with Substance Use Dependence alone (SUD; N?=?35). The sample was composed only by males. To assess the clinical correlates of SF-36 HRQOL, lineal regression analyses were carried out. Results The DD group showed lower scores in most of the subscales, and in the mental health domain. The group with SUD showed in general a better state in the HRQOL while the group with SMI held an intermediate position with respect to the other two groups. Daily medication, suicidal attempts and daily number of coffees were significantly associated to HRQOL, especially in the DD group. Conclusions The DD group showed lower self-reported mental health quality of life. Assessment of HRQOL in dual patients allows to identify specific needs in this population, and may help to establish therapeutic goals to improve interventions.
Current treatment protocols for Wilms tumor achieve 90% cure rates, but relapse risk and side effects from therapy remain challenging. Over the last decade, numerous markers have been proposed for classification and/or prediction of outcome. However, cohort sizes were quite variable and often small. We now provide a large-scale reassessment by real-time RT-PCR of 40 markers in 102 Wilms tumors followed by validation of potentially relevant markers in an independent set of 74 tumors. In the first data set, individual comparison with clinical data combined with adjustment for multiple testing and multivariate analysis revealed potentially relevant alteration of CA9, DKK1, EGR1, HEY2, MYC, MYCN, TERT, TOP2A, TRIM22, and VEGF expression in association with CTNNB1 mutation status, histological risk, response to chemotherapy, metastasis, relapse, or mortality. To further validate these data, potentially relevant genes for specific outcomes were reanalyzed in a second, independent tumor set. Here, univariate analysis confirmed the association of HEY2 with high-risk tumors and of TRIM22 with mortality. Even where significance levels could not be reached, the direction and extent of differential expression were generally reproducible. Multivariate analysis verified a weak correlation of TOP2A expression with metastasis and of TRIM22 with fatal outcome. Although we could corroborate only some of the previously reported associations of expression changes with clinical parameters, our results indicate that real-time RT-PCR analysis can facilitate further classification of Wilms tumor and prediction of outcome to adjust treatment accordingly. This article contains Supplementary Material available at http://www.interscience.wiley.com/jpages/1045-2257/suppmat. PMID:18260125
Wittmann, Stefanie; Wunder, Christina; Zirn, Birgit; Furtwängler, Rhoikos; Wegert, Jenny; Graf, Norbert; Gessler, Manfred
Prevalence of left atrial enlargement (LAE) in hypertension has been mostly assessed in population-based samples and selected hypertensive groups. A few data are available in clinical practice. We examined LAE prevalence and severity in a cohort of hypertensive patients referred by general practitioners to a routine echocardiographic examination. A total of 2170 hypertensive individuals (mean age 62 years, 53% men) referred by practitioners to 17 outpatient echocardiographic laboratories across Italy for detection of hypertensive cardiac disease were included in the study. LAE was defined as: A) absolute LA diameter >4.0 cm in men and >3.8 cm in women; B) LA diameter normalized to body surface area (BSA) >2.3 cm/m(2) in both sexes. Left atrial enlargement was graded as mild, moderate, and severe according to Lang's report. Patients with LAE were 38% by criterion A, and 20% by criterion B. A moderate/severe increase in LA size was present in 34% (A) and 32% (B) of patients with LAE. Severe LAE was 3.3-fold (A) and 2.6-fold (B) more frequent in women than in men. Left ventricular mass was the strongest correlate of absolute LA diameter as well as of normalized LA diameter, after age. Left atrial enlargement defined either by absolute or normalized LA diameter is a frequent cardiac phenotype in hypertensive patients referred to echo-labs in clinical practice. This cardiac parameter is closely related to LV mass and its severity is highly prevalent in women. PMID:21649531
Cuspidi, Cesare; Negri, Francesca; Lonati, Laura; Muiesan, Maria Lorenza; Capra, Anna; Milan, Alberto; Sala, Carla; Danzi, Gian Battista; Longo, Marcella; Morganti, Alberto
Background The natural course of Sturge-Weber syndrome (SWS) is poorly understood, although neurological symptoms are often progressive. Aims To track longitudinal changes in brain glucose metabolism measured with positron emission tomography (PET) and their relation to clinical changes during the early course of SWS. Methods Fourteen children (age 3 months to 3.9 years at enrollment) with SWS and unilateral leptomeningeal angioma underwent two consecutive glucose metabolism PET scans with a mean follow-up time of 1.2 years. Longitudinal changes of the extent of cortical glucose hypometabolism on the angioma side were measured and correlated with age, clinical seizure frequency and hemiparesis. Result An increase in the size of the hypometabolic cortex was seen in 6 children, coinciding with an age-related increase in cortical glucose metabolism measured in unaffected contralateral cortex. These 6 patients were younger both at the initial (mean age 0.75 vs. 2.8 years; p<0.001) and the second scan (mean age 1.8 vs. 4.2 years; p=0.001) than those with no change in the extent of hypometabolic cortex (N=6). The area of cortical hypometabolism decreased in the two remaining children, and this was associated with resolution of an initial hemiparesis in one of them. Seizure frequency between the two scans was higher in children who showed progressive enlargement of cortical hypometabolism, as compared to those with no progression (p = 0.008). Conclusions In SWS, detrimental metabolic changes occur before 3 years of age coinciding with a sharp increase of developmentally regulated cerebral metabolic demand. Progressive hypometabolism is associated with high seizure frequency in these children. However, metabolic abnormalities may remain limited or even partially recover later in some children with well-controlled seizures. Metabolic recovery accompanied by neurological improvement suggests a window for therapeutic intervention in children with unilateral SWS.
Juhasz, C.; Batista, C.E.A.; Chugani, D.C.; Muzik, O.; Chugani, H.T.
Background Clinical evaluation to differentiate the characteristic features of pulmonary fibrosis and emphysema is often difficult in patients with combined pulmonary fibrosis and emphysema (CPFE), but diagnosis of pulmonary fibrosis is important for evaluating treatment options and the risk of acute exacerbation of interstitial pneumonia of such patients. As far as we know, it is the first report describing a correlation among clinical, radiological, and whole-lung pathological features in an autopsy cases of CPFE patients. Methods Experts retrospectively reviewed the clinical charts and examined chest computed tomography (CT) images and pathological findings of an autopsy series of 22 CPFE patients, and compared these with findings from 8 idiopathic pulmonary fibrosis (IPF) patients and 17 emphysema-alone patients. Results All patients had a history of heavy smoking. Forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC%) was significantly lower in the emphysema-alone group than the CPFE and IPF-alone groups. The percent predicted diffusing capacity of the lung for carbon monoxide (DLCO%) was significantly lower in the CPFE group than the IPF- and emphysema-alone groups. Usual interstitial pneumonia (UIP) pattern was observed radiologically in 15 (68.2%) CPFE and 8 (100%) IPF-alone patients and was pathologically observed in all patients from both groups. Pathologically thick-cystic lesions involving one or more acini with dense wall fibrosis and occasional fibroblastic foci surrounded by honeycombing and normal alveoli were confirmed by post-mortem observation as thick-walled cystic lesions (TWCLs). Emphysematous destruction and enlargement of membranous and respiratory bronchioles with fibrosis were observed in the TWCLs. The cystic lesions were always larger than the cysts of honeycombing. The prevalence of both radiological and pathological TWCLs was 72.7% among CPFE patients, but no such lesions were observed in patients with IPF or emphysema alone (p?=?0.001). The extent of emphysema in CPFE patients with TWCLs was greater than that in patients without such lesions. Honeycombing with emphysema was also observed in 11 CPFE patients. Conclusions TWCLs were only observed in the CPFE patients. They were classified as lesions with coexistent fibrosing interstitial pneumonia and emphysema, and should be considered an important pathological and radiological feature of CPFE.
Fragile X syndrome is caused by an expansion of a CGG repeat in the FMR1 gene. The CGG repeat number of the FMR1 mutation and the percentage of cells with methylation of the gene were studied in 218 male patients. Physical and cognitive measurements were also performed. Patients were divided into three groups; those with full mutation and complete methylation (n = 160), those with full mutation and partial methylation (n = 12), and those with a mosaic pattern (n = 46). Statistical comparisons were made between males with the fully methylated full mutation and those with a mosaic pattern. Males having full mutation with complete methylation had the lowest IQ scores and greatest physical involvement. These significant differences were seen only in ages after puberty. CGG repeat length did not correlate with IQ or the physical index score in any group. These findings suggest that a partial production of FMR1 protein may predict milder clinical involvement in some males with fragile X syndrome. PMID:8844089
Merenstein, S A; Sobesky, W E; Taylor, A K; Riddle, J E; Tran, H X; Hagerman, R J
The vagus nerve stimulation (VNS) represents a diffuse non-pharmacological low-risk surgical option for epilepsy treatment. The aim of this study is to investigate the correlation between variations of global EEG synchronization and the clinical outcome in pharmacoresistant epileptic subjects implanted with VNS. Ten subjects affected by pharmacoresistant epilepsy were recruited on the basis of a clear-cut successful or unsuccessful outcome of the VNS add-on treatment. After five years from VNS surgery we examined the EEG in five subjects in each group. The investigation was led with the method of the phase lag index (PLI), which allows for the study of the global rate of synchronicity among the EEG signals before and after VNS implantation. The results of this study show that after five years from VNS surgery, in subjects whose seizures show a significant reduction, the desynchronization in the gamma frequency band is statistically decreased in comparison with patients who failed to show variations in the frequency and characteristics of their seizures. The other frequency bands are unaffected. This finding suggests that long lasting variations in gamma band desynchronization can be a new tool in assessing the efficacy of VNS. The possibility that GABA-mediated VNS-induced effects can also play a role in this result is discussed. PMID:23333601
Fraschini, Matteo; Puligheddu, Monica; Demuru, Matteo; Polizzi, Lorenzo; Maleci, Alberto; Tamburini, Giorgio; Congia, Socrate; Bortolato, Marco; Marrosu, Francesco
The contingent negative variation (CNV) is a neurophysiological pattern related to planning of external - paced, voluntary movements. The aim of the study, was to examine the CNV in a cohort of mild demented and non-medicated HD patients, evaluating the CNV amplitude modifications in the light of clinical features and performing Low Resolution Brain Electromagnetic Tomography (LORETA) analysis in order to show the CNV multiple generators. Fourteen HD patients and 25 sex and age-matched controls were studied. All subjects were evaluated by the motor section of UHDRS, MMSE and WAIS. The CNV was recorded by 19 scalp electrodes, with a red light flash as visual warning stimulus (S1), followed by a blue light flash (S2) after a fixed interval of 3 s. The amplitude of early CNV was significantly reduced in HD, compared to controls: the amplitude reduction was significantly correlated with the bradikinesia score. LORETA analysis of early CNV significantly discriminated patients from controls, for a prevalent activation of the posterior part of anterior cingulate cortex in HD. An abnormal activation of the associative cortex devoted to the processing of attention preceding voluntary movement may be supposed in HD, probably mediated by the altered basal ganglia modulation. PMID:17300807
de Tommaso, Marina; Difruscolo, Olimpia; Sciruicchio, Vittorio; Specchio, Nicola; Livrea, Paolo
Tumor growth factor-? (TGF-?) signaling in cancer has been implicated in growth suppression of early lesions and enhancing tumor cell invasion and metastasis. However, the cellular mechanisms that determine this signaling output in individual tumors are still largely unknown. In endothelial cells, TGF-? signaling is modulated by the TGF-? co-receptor endoglin (CD105). Here we demonstrate that endoglin is expressed in a subset of invasive breast cancers and cell lines and is subject to epigenetic silencing by gene methylation. Endoglin downregulation in non-tumorigenic MCF10A breast cells leads to the formation of abnormal acini in 3D culture, but does not promote cell migration or transformation. In contrast, in the presence of activated ErbB2, endoglin downregulation in MCF10A cells leads to enhanced invasion into a 3D matrix. Consistent with these data, ectopic expression of endoglin in MDA-MB-231 cells blocks TGF-?-enhanced cell motility and invasion and reduces lung colonization in an in vivo metastasis model. Unlike endothelial cells, endoglin does not modulate Smad-mediated TGF-? signaling in breast cells but attenuates the cytoskeletal remodeling to impair cell migration and invasion. Importantly, in a large cohort of invasive breast cancers, lack of endoglin expression in the tumor cell compartment correlates with ENG gene methylation and poor clinical outcome. PMID:21042283
Henry, L A; Johnson, D A; Sarrió, D; Lee, S; Quinlan, P R; Crook, T; Thompson, A M; Reis-Filho, J S; Isacke, C M
Our study was aimed to assess the clinical correlates of different degrees of renal dysfunction in a wide group of non-diabetic hypertensive patients, free from cardiovascular (CV) complications and known renal diseases, participating to the REDHY (REnal Dysfunction in HYpertension) study. A total of 1856 hypertensive subjects (mean age: 47±14 years), attending our hypertension centre, were evaluated. The glomerular filtration rate (GFR) was estimated by the simplified Modification of Diet in Renal Disease Study prediction equation. A 24-h urine sample was collected to determine albumin excretion rate (AER). Albuminuria was defined as an AER greater than 20??g?min?1. We used the classification proposed by the US National Kidney Foundation's guidelines for chronic kidney disease (CKD) to define the stages of renal function impairment. In multiple logistic regression analysis, the probability of having stage 1 and stage 2 CKD was significantly higher in subjects with greater values of systolic blood pressure (SBP) and with larger waist circumference. SBP was also positively related to stage 3 CKD. Stage 3 and stages 4–5 CKD were inversely associated with waist circumference and directly associated with serum uric acid. Age was inversely related to stage 1 CKD and directly related to stage 3 CKD. The factors associated with milder forms of kidney dysfunction are, in part, different from those associated with more advanced stages of renal function impairment.
Cerasola, G; Mule, G; Nardi, E; Cusimano, P; Palermo, A; Arsena, R; Guarneri, M; Geraci, C; Cottone, S
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the aberrant production of a broad and heterogenous group of autoantibodies. Even though the presence of autoantibodies in SLE has been known, for more than 60 years, still nowadays a great effort is being made to understand the pathogenetic, diagnostic, and prognostic meaning of such autoantibodies. Antibodies to ds-DNA are useful for the diagnosis of SLE, to monitor the disease activity, and correlate with renal and central nervous involvements. Anti-Sm antibodies are highly specific for SLE. Anti-nucleosome antibodies are an excellent marker for SLE and good predictors of flares in quiescent lupus. Anti-histone antibodies characterize drug-induced lupus, while anti-SSA/Ro and anti-SSB/La antibodies are associated with neonatal lupus erythematosus and photosensitivity. Anti-ribosomal P antibodies play a role in neuropsychiatric lupus, but their association with clinical manifestations is still unclear. Anti-phospholipid antibodies are associated with the anti-phospholipid syndrome, cerebral vascular disease, and neuropsychiatric lupus. Anti-C1q antibodies amplify glomerular injury, and the elevation of their titers may predict renal flares. Anti-RNP antibodies are a marker of Sharp's syndrome but can be found in SLE as well. Anti-PCNA antibodies are present in 5–10% of SLE patients especially those with arthritis and hypocomplementemia.
Cozzani, Emanuele; Drosera, Massimo; Parodi, Aurora
The presence of mitochondrial DNA (mtDNA) mutations in human cancer has long been recognized, but their functional significance has remained obscure. Debate persists as to whether the mutations help drive the tumor, or are bystander events. Here, we analyze next-generation mtDNA sequence data from 99 breast cancer patients. High depth coverage enables detection of even low-level heteroplasmic variants, and data from matched normal tissue allow us to distinguish between shifts in heteroplasmy and acquired mutations. Somatic mtDNA mutations are found in 73 (73.7%) of patient tumors, and dramatic shifts from the initial germline allele proportions are observed for many heteroplasmies. Clustering of somatic mutations in promoter and replication regions, and also in genes coding for electron transport chain complex I, suggest selection for mutations affecting critical mitochondrial processes. Furthermore, statistical tests for Darwinian selection reveal evidence for positive and relaxed negative selection for somatic missense mutations. We also observe a dramatic decrease in per-cell mtDNA content in tumor tissues, as well as a surprising positive correlation between somatic mtDNA mutational burden and patient survival. Taken together, our results support the view that somatic mtDNA mutations are not solely bystander events, but have significance in cancer from both biological and clinical perspectives. We also anticipate that the catalog of heteroplasmies and somatic mutations presented here will serve as a reference for future studies of cancer mitochondrial genomes. PMID:24442641
McMahon, Sarah; LaFramboise, Thomas
This study examined lifetime exposure to traumatic events as reported by 581 homeless female veterans enrolled in a Homeless Women Veterans Program across 11 sites to characterize the types of trauma they experienced; their correlation with baseline characteristics; and their association with housing, clinical outcomes, and psychosocial functioning over a 1-year treatment period. Almost all participants endorsed multiple types and episodes of traumatic events. Among the most common were having someone close experience a serious or life-threatening illness (82%) and rape (67%). Exploratory factor analysis revealed 6 potential trauma categories: being robbed, experiencing accident or disasters, illness or death of others, combat, sexual assault, and physical assault. At baseline, trauma from sexual assault was associated with more days homeless (? = .18, p < .001), trauma from accidents or disasters was associated with poorer physical health (? = -.23, p < .001), and trauma from being robbed was related to greater use of drugs (? = .22, p < .001). Trauma reported at baseline, however, was not predictive of 1-year outcomes, suggesting type and frequency of trauma does not negatively affect the housing gains homeless women veterans can achieve through homeless services. PMID:23225030
Tsai, Jack; Rosenheck, Robert A; Decker, Suzanne E; Desai, Rani A; Harpaz-Rotem, Ilan
This study examined lifetime exposure to traumatic events as reported by 581 homeless female veterans enrolled in a Homeless Women Veterans Program across 11 sites to characterize the types of trauma they experienced; their correlation with baseline characteristics; and their association with housing, clinical outcomes, and psychosocial functioning over a 1-year treatment period. Almost all participants endorsed multiple types and episodes of traumatic events. Among the most common were having someone close experience a serious or life-threatening illness (82%) and rape (67%). Exploratory factor analysis revealed 6 potential trauma categories: being robbed, experiencing accident or disasters, illness or death of others, combat, sexual assault, and physical assault. At baseline, trauma from sexual assault was associated with more days homeless (? = .18, p < .001), trauma from accidents or disasters was associated with poorer physical health (? = -.23, p < .001), and trauma from being robbed was related to greater use of drugs (? = .22, p < .001). Trauma reported at baseline, however, was not predictive of 1-year outcomes, suggesting type and frequency of trauma does not negatively affect the housing gains homeless women veterans can achieve through homeless services. PMID:23138863
Tsai, Jack; Rosenheck, Robert A; Decker, Suzanne E; Desai, Rani A; Harpaz-Rotem, Ilan
Fragile X syndrome is caused by an expansion of a CGG repeat in the FMR1 gene. The CGG repeat number of the FMR1 mutation and the percentage of cells with methylation of the gene were studied in 218 male patients. Physical and cognitive measurements were also performed. Patients were divided into three groups; those with full mutation and complete methylation (n = 160), those with full mutation and partial methylation (n = 12), and those with a mosaic pattern (n = 46). Statistical comparisons were made between males with the fully methylated full mutation and those with a mosaic pattern. Males having full mutation with complete methylation had the lowest IQ scores and greatest physical involvement. These significant differences were seen only in ages after puberty. CGG repeat length did not correlate with IQ or the physical index score in any group. These findings suggest that a partial production of FMR1 protein may predict milder clinical involvement in some males with fragile X syndrome. 39 refs., 4 tabs.
Merenstein, S.A.; Sobesky, W.E.; Tran, H.X. [Children`s Hospital, Denver, CO (United States)] [and others] [Children`s Hospital, Denver, CO (United States); and others
Clinically nonfunctioning pituitary adenomas (CNFPAs) consist of several histological subtypes, including null cell adenoma (NCA), silent gonadotroph cell adenoma (SGA), silent corticotroph adenoma (SCA), and other silent adenomas (OSA) (i.e., GH, TSH, and prolactin adenomas). To detect possible correlations between MRI findings and the subtypes, we retrospectively studied 390 consecutive patients with CNFPA who underwent surgery between 2008 and 2010. They were classified into three groups: NCA/SGA (313 cases), SCA (39 cases), and OSA (36 cases); in addition there were two unusual cases of plurihormonal adenoma. Three MRI findings were less common in NCA/SGA than in the other groups (P < 0.0001): giant adenoma (>40 mm), marked cavernous sinus invasion (Knosp grade 4), and lobulated configuration of the suprasellar tumor. When these MRI findings were negative in patients older than 40 years old, 91.0% (212/233) were NCA/SGA. These MRI findings were frequently noted despite a low MIB-1 index in SCA. OSA showed a high MIB-1 index and a preponderance in younger patients. In conclusion, although SCA and OSA consisted of only 20% of CNFPAs, their frequency significantly increased when the tumor was large, invasive, and lobulated, and the patient was younger than 40 years old. PMID:22569896
Nishioka, Hiroshi; Inoshita, Naoko; Sano, Toshiaki; Fukuhara, Noriaki; Yamada, Shozo
Background Prospective measures of high knee abduction moment during landing identify female athletes at high risk for non-contact anterior cruciate ligament injury. Biomechanical laboratory measurements predict high knee abduction moment landing mechanics with high sensitivity (85%) and specificity (93%). The purpose of this study was to identify correlates to laboratory-based predictors of high knee abduction moment for use in a clinic-based anterior cruciate ligament injury risk prediction algorithm. The hypothesis was that clinically obtainable correlates derived from the highly predictive laboratory-based models would demonstrate high accuracy to determine high knee abduction moment status. Methods Female basketball and soccer players (N=744) were tested for anthropometrics, strength and landing biomechanics. Pearson correlation was used to identify clinically feasible correlates and logistic regression to obtain optimal models for high knee abduction moment prediction. Findings Clinical correlates to laboratory-based measures were identified and predicted high knee abduction moment status with 73% sensitivity and 70% specificity. The clinic-based prediction algorithm, including (Odds Ratio: 95% confidence interval) knee valgus motion (1.43:1.30–1.59 cm), knee flexion range of motion (.98:0.96–1.01 deg), body mass (1.04:1.02–1.06 kg), tibia length (1.38:1.25–1.52 cm) and quadriceps to hamstring ratio (1.70:1.06–2.70) predicted high knee abduction moment status with C statistic 0.81. Interpretation The combined correlates of increased knee valgus motion, knee flexion range of motion, body mass, tibia length and quadriceps to hamstrings ratio predict high knee abduction moment status in female athletes with high sensitivity and specificity.
Myer, Gregory D.; Ford, Kevin R.; Khoury, Jane; Succop, Paul; Hewett, Timothy E.
Objective: The purpose of this study was to examine the correlation between the quality of visually graded patient (clinical) chest images and a quantitative assessment of chest phantom (physical) images acquired with a computed radiography (CR) imaging system. Methods: The results of a previously published study, in which four experienced image evaluators graded computer-simulated postero-anterior chest images using a visual grading analysis scoring (VGAS) scheme, were used for the clinical image quality measurement. Contrast-to-noise ratio (CNR) and effective dose efficiency (eDE) were used as physical image quality metrics measured in a uniform chest phantom. Although optimal values of these physical metrics for chest radiography were not derived in this work, their correlation with VGAS in images acquired without an antiscatter grid across the diagnostic range of X-ray tube voltages was determined using Pearson’s correlation coefficient. Results: Clinical and physical image quality metrics increased with decreasing tube voltage. Statistically significant correlations between VGAS and CNR (R=0.87, p<0.033) and eDE (R=0.77, p<0.008) were observed. Conclusion: Medical physics experts may use the physical image quality metrics described here in quality assurance programmes and optimisation studies with a degree of confidence that they reflect the clinical image quality in chest CR images acquired without an antiscatter grid. Advances in knowledge: A statistically significant correlation has been found between the clinical and physical image quality in CR chest imaging. The results support the value of using CNR and eDE in the evaluation of quality in clinical thorax radiography.
Wood, T J; Beavis, A W; Saunderson, J R
Wilson's disease, a rare autosomal recessive disorder of hepatic copper transport, is characterized by a varying pattern of hepatic, neurologic and psychiatric symptoms. Currently, about 250 causative mutations of the ATP 7B gene are known. However, a correlation between genotype and phenotype according to these mutations is not yet clear. To elucidate a possible correlation in this study 39 patients with Wilson's disease were subdivided into three groups according to the underlying mutation in group I for homocygote respectively group II for compound heterocygote mutation in H1069Q and group III for other mutations. Clinical subtype and extent of neurologic disturbance as well as epidemiologic aspects, presence of psychiatric symptoms, results of acustically evoked potentials (Wave III, interpeak latency III-V) and findings of cranial MRI were considered. While psychopathological symptoms, the results of acustically evoked potentials and cranial MRI show a correlation to the clinical subtype of Wilson's disease there was no genotype-phenotype correlation on the basis of the mutation in H1069Q. The qualitative and quantitative pattern of results do not show any significant differences in the three groups of genotype. Thus, the time of treatment onset still has most influence on the extent of clinical manifestation and reversibility of the toxic copper accumulation. PMID:16586257
Hermann, W; Günther, P; Schneider, J P; Villmann, T; Kühn, H J; Eichelkraut, S
Several microRNAs (miRNAs) were shown to be deregulated in adrenocortical carcinoma (ACC) as compared with adenoma, but a detailed assessment of their expression in its histologic variants and correlation with clinicopathologic characteristics has not been performed, so far. Our aim was to assess the expression of 5 selected miRNAs (IGF2 gene-related miR-483-3p and 5p and hypoxia-induced miR-210, miR-195, and miR-1974) in a series of 51 ACCs (35 classical, 6 myxoid, and 10 oncocytic) as compared with clinical and pathologic features and immunohistochemical expression of prognostic markers, including steroidogenic factor 1, p53, ?-catenin, and glucose transporter 1. Oncocytic carcinomas had a reduced expression of miR-483-3p (P = .0325), miR-483-5p (P = .0175), and miR-210 (P = .0366), as compared with other histotypes. Overexpression of miR-210 was associated with the presence of necrosis (P = .0035), high Ki-67 index (P = .0013), and high glucose transporter 1 expression (P = .0043), whereas an inverse correlation with mitotic rate was observed in cases with high miR-493-3p (P = .0191) and miR-1974 (P = .0017) expression. High miR-1974 was also associated with low Ki-67 (P = .0312) and European Network for the Study of Adrenal Tumors stage (P = .0082) and negative p53 (P = .0013). At univariate analysis myxoid/classic histotype (P = .026), high miR-210 (P = .0465), high steroidogenic factor 1 protein (P = .0017), high Ki-67 (P = .0066), and high mitotic index (P = .0006) were significantly associated the shorter overall survival, the latter being the sole independent prognostic factor at multivariate analysis (P = .017). In conclusion, (a) miR-483-3p, miR-483-5p, and miR-210 are differentially expressed in ACC variants, and (b) high miR-210 is associated with clinicopathologic parameters of aggressiveness and a poor prognosis. PMID:24890943
Duregon, Eleonora; Rapa, Ida; Votta, Arianna; Giorcelli, Jessica; Daffara, Fulvia; Terzolo, Massimo; Scagliotti, Giorgio V; Volante, Marco; Papotti, Mauro
The present study was undertaken to investigate the involvement of oxidative damage in lead-induced toxicity in humans and to enlighten whether oxidative stress indicators are correlated with the known indices of lead toxicity. For these purposes, selected oxidative stress parameters along with some clinical indices of lead poisoning were determined in blood of battery plant workers and control subjects. Workers
Hande Gurer-Orhan; Handan U Sab?r; Hilal Özgüne?
Background: The goal of this study was to investigate the occurrence, severity and clinical correlates of emotional lability (EL) in children with attention deficit/hyperactivity disorder (ADHD), and to examine factors contributing to EL and familiality of EL in youth with ADHD. Methods: One thousand, one hundred and eighty-six children with ADHD…
Sobanski, Esther; Banaschewski, Tobias; Asherson, Philip; Buitelaar, Jan; Chen, Wai; Franke, Barbara; Holtmann, Martin; Krumm, Bertram; Sergeant, Joseph; Sonuga-Barke, Edmund; Stringaris, Argyris; Taylor, Eric; Anney, Richard; Ebstein, Richard P.; Gill, Michael; Miranda, Ana; Mulas, Fernando; Oades, Robert D.; Roeyers, Herbert; Rothenberger, Aribert; Steinhausen, Hans-Christoph; Faraone, Stephen V.
BACKGROUND: There are few published data on the correlation between the clinical findings in subjects with chronic sputum production and the appearances on high resolution computed tomographic (HRCT) scans of the chest. METHODS: HRCT scanning of the chest was performed on 40 subjects with chronic sputum production. Three readers independently reported the scans for the presence or absence of bronchiectasis and the extent of bronchiectasis on the basis of the percentage of involved bronchi in each lobe. Relationships were sought between these findings and the clinical history, physical examination, and laboratory investigations. RESULTS: HRCT scanning showed that 27 subjects had bronchiectasis. Of the clinical features only the continual production of purulent sputum and childhood pertussis were associated with bronchiectasis. There was a positive correlation between the extent of bronchiectasis and dyspnoea, and a negative correlation with forced expiratory volume in one second but not with forced vital capacity. CONCLUSIONS: These results indicate that, in subjects with chronic sputum production, only a few clinical features show any correlation with the presence or extent of bronchiectasis as visualised on HRCT scans.
Smith, I. E.; Jurriaans, E.; Diederich, S.; Ali, N.; Shneerson, J. M.; Flower, C. D.
ObjectiveThe scientific literature about attention-deficit hyperactivity disorder (ADHD) is based almost exclusively on male subjects, and girls with ADHD may be underidentified and undertreated. The aim of this study was to examine clinical correlates of ADHD in females using comprehensive assessments in multiple domains of functioning.
JOSEPH BIEDERMAN; STEPHEN V. FARAONE; ERIC MICK; SARAH WILLIAMSON; TIMOTHY E. WILENS; THOMAS J. SPENCER; WENDY WEBER; JENNIFER JETTON; ILANA KRAUS; JIM PERT; BARRY ZALLEN
The goal of this study was to analyze antibody responses to Plasmodium falciparum glutamate-rich protein (GLURP) using clinical data and plasma samples obtained from villagers of Dielmo, Senegal. This molecule was chosen because it is targeted by human antibodies which induce parasite growth inhibition in antibody- dependent cellular inhibition (ADCI) assays. The results showed a strong correlation between protection against
CLAUDE OEUVRAY; MICHAEL THEISEN; CHRISTOPHE ROGIER; JEAN-FRANCOIS TRAPE; SØREN JEPSEN; PIERRE DRUILHE
OBJECTIVES: To describe the metabolic syndrome and its demographic and clinical correlates in native African type-2 diabetic patients. METHODS: Cross-sectional analysis of 254 type-2 diabetic indigenous Nigerians consecutively recruited in a teaching hospital. The main outcome measure was metabolic syndrome. Variables of interest included family history/duration of diabetes mellitus and hypertension, gender, socioeconomic class, occupation and place of domicile (urban or rural). Intergroup comparisons were made with Chi-squared tests or t-tests. RESULTS: Patients were aged 35-80 years (mean: 52.0 +/- 11.7 years) and made of 154 (60.6%) males and 100 (39.4%) females. Full-blown metabolic syndrome was noted in 52 patients (20.5%). Metabolic syndrome, as defined by the WHO, was noted in 150 patients (59.1%). About 72.4% of patients were dyslipidemic, 54.3% were hypertensive, 42.5% were obese, 44.9% were microalbuminuric and 32.3% were hyperuricemic. Ischemic heart disease (myocardial infarction) occurred in only 2.4% of patients. Concurrent hypertension and dyslipidemia; obesity and dyslipidemia; and hypertension and obesity occurred in 44.4%, 42.5% and 33.1% of type-2 diabetics, respectively. Compared to the diabetics without metabolic syndrome, those with the syndrome had a significantly higher proportion of patients with a family history of hypertension and diabetes (44% versus 25%; p = 0.003); among the upper/middle socioeconomic class: 52.0% versus 30.8% (p = 0.001); and among the urban dwelling: 68.0% versus 49.0% (p = 0.004). Metabolic syndrome was inversely proportional to the physical activity of an individual (chi2 = 21.69, df = 5, p = 0.001). Blood pressure was significantly higher among patients with metabolic syndrome than those without it (140.6 +/- 22.9/85.2 +/- 12.9 mmHg versus 126.9 +/- 15.4 mmHg; P < 0.01). CONCLUSIONS: The development of metabolic syndrome in African type-2 diabetic patients is influenced by demographic and clinical factors. Vigilant dietary habit and physical exercise may reduce the chance of metabolic syndrome in urban Nigerian type-2 diabetics.
Isezuo, S. A.; Ezunu, E.
Patients with anginal symptoms and normal coronary arteries have been found to present with high levels of neuroticism i.e. anxiety, depression and somatic concerns. Whether neuroticism plays a role in precipitating coronary hypoperfusion and symptoms is still a matter of investigation. The present study was undertaken to assess the relation between psychological status and clinical symptoms in 22 patients with syndrome X (angina and ST depression with angiographically normal coronary arteries and reversible myocardial perfusion abnormalities). Neuroticism was evaluated by Beck Depression Inventory, Hamilton Anxiety Rating Scale (HAM-A), State-Trait Anxiety Inventory, Sheehan Patient Rated Anxiety Scale, State-Trait Anger Expression Inventory (STAXI), Brief Psychiatric Rating Scale and Clinical Global Impression. Data were compared with those obtained in 30 patients with stable angina as well as coronary artery disease. All patients underwent an exercise stress testing and a 24-hour ambulatory Holter monitoring. Patients with syndrome X scored significantly higher than stable angina (p < 0.05 each) on all psychological tests but STAXI. No significant differences, between syndrome X and stable angina were found in exercise stress testing parameters and during Holter monitoring. Twelve out of 22 syndrome X patients had a score > 28 in HAM-A (Group 1, with frank psychiatric abnormalities). The remaining 10 patients were labelled as Group 2. No significant differences between Group 1 and Group 2 were found in exercise capacity (time to 0.1 m V ST depression: 397 +/- 73 and 419 +/- 137 s, respectively; NS) or in the number of anginal episodes per day (0.9 +/- 1.3/24 hours and 0.6 +/- 0.8/24 hours respectively; NS). In contrast, Holter monitoring showed a significantly higher number of ischemic episodes in Group 1 than in Group 2 (1.6 +/- 1.7 vs 0.1 +/- 0.3/24 hours; p < 0.02) and a greater duration of ischemia (23.8 +/- 32 vs 0.3 +/- 1 min/24 hours; p < 0.03). We conclude that: patients with syndrome X evidence elevated neuroticism scores; a high degree of anxiety correlates with increased transient myocardial ischemia during daily life; neuroticism may itself cause changes in coronary microvascular function in syndrome X. Alternatively it may simply modulate the threshold for ischemia in the presence of underlying dysfunction. PMID:8766418
Ruggeri, A; Taruschio, G; Loricchio, M L; Samory, G; Borghi, A; Bugiardini, R
Questions and question-formulating strategies are central to science. In many ways the formulation of a question forms the basis for high-quality instruction in science. Effective questioning has a strong connection to cognitive theory. The sentence start
Klentschy, Michael P.
This is an outstanding and intellectually-stimulating question which introduces a new way to translate more effectively metastasis research to the clinic. It is certainly worth exploring and badly needed. because, if positive, drugs could be immediately useful to help defined populations of patients. Per points, we agree that these are limited metastasis groups; however, results could at minimum justify moving forward to full adjuvant trials. Worthy cause given the "bottleneck" we experience nowadays since drugs are mostly not tested in metastasis prevention.
The incidence and clinical correlates of acute in-hospital mortality of takotsubo cardiomyopathy (TTC) are not clear. We performed a systematic review and meta-analysis to consolidate the current evidence on acute mortality in TTC. We then assessed the impact of "secondary" TTC, male gender, advancing age, and catecholamine use on mortality. A comprehensive search of 4 major databases (EMBASE, Ovid MEDLINE, PubMed, and Google Scholar) was performed from their inception to the first week of July 2013. We included original research studies, recruiting ?10 participants, published in English language, and those that reported data on mortality and cause of death in patients with TTC. Of 382 citations, 37 studies (2,120 patients with TTC) from 11 different countries were included in the analyses. The mean age of the cohort was 68 years (95% confidence interval [CI] 67 to 69) with female predominance (87%). The in-hospital mortality rate among patients with TTC was 4.5% (95% CI 3.1 to 6.2, I2=60.8%). Among all deaths, 38% were directly related to TTC complications and rest to underlying noncardiac conditions. Male gender was associated with higher TTC mortality rate (odds ratio 2.6, 95% CI 1.5 to 4.6, p=0.0008, I2=0%) so was "secondary" TTC (risk difference -0.11, 95% CI -0.18 to -0.04, p=0.003, I2=84%). The mean age of patients dying tended to be greater than that in the whole cohort (72±7 vs 65±7 years). In conclusion, TTC is not as benign as once thought. To reduce the mortality rate, greater efforts need to be directed to the diagnosis, treatment, and ultimately prevention of "secondary" TTC. PMID:24685327
Singh, Kuljit; Carson, Kristin; Shah, Ranjit; Sawhney, Gagandeep; Singh, Balwinder; Parsaik, Ajay; Gilutz, Harel; Usmani, Zafar; Horowitz, John
Left atrial (LA) size is related to cardiovascular morbidity and mortality. The relative role of multiple determinants of LA morphology in healthy subjects remains incompletely defined. The aim of this study is to define normal ranges for LA diameters and volume index (LAVi), and to investigate clinical and echocardiographic correlates. A total of 1480 healthy individuals (mean age 36.1 ± 15.5 years, range 20-80; 61% males) underwent a comprehensive transthoracic echocardiography exam including assessment of LAVi calculated using the biplane area-length method at the apical four-chamber and two-chamber views at ventricular end systole (maximum LA size) and indexed for body surface area (BSA). Mean LAVi in the overall population was 29.5 ± 10.8 mL/m(2) (range: 26.1-41.8 mL/m(2) ). Distinct higher values were found in subjects ?50 years as compared with those <50 years of age (33.4 ± 12.5 vs. 29.1 ± 13.5; P < 0.001). On univariate analysis, LA volume was significantly associated with age (r = 0.48, P < 0.0001), male gender (r = 0.28, P < 0.05), BSA (r = 0.51, P < 0.0001), mitral E/E' (r = 0.47, P < 0.0001), LV end-diastolic volume (r = 0.52, P < 0.0001), and LV mass index (r = 0.31, P < 0.05). Multivariable analysis identified age, BSA, LV end-diastolic volume, and mitral E/E' ratio as the only independent determinants of LA volume (model R(2) = 0.54, P < 0.0001). Gender was an independent predictor of most absolute LA volume, but following normalization to BSA, some associations became nonsignificant. In healthy individuals LAVi vary significantly by age, BSA, diastolic function, and LV dimensions, with lesser effects of gender. PMID:23594028
D'Andrea, Antonello; Riegler, Lucia; Rucco, Maria Antonietta; Cocchia, Rosangela; Scarafile, Raffaella; Salerno, Gemma; Martone, Francesca; Vriz, Olga; Caso, Pio; Calabrò, Raffaele; Bossone, Eduardo; Russo, Maria Giovanna
Background In psychotic disorders, early intervention with antipsychotic medications increases the likelihood of favourable long-term course. However, the pharmacologic management especially with conventional antipsychotic medications is complicated by a high rate of adverse effects including sexual dysfunction. This study aims to determine the demographic and clinical factors associated with sexual dysfunction among male psychiatric outpatients on conventional antipsychotic medications in South-western Nigeria. Methods Two hundred and seventy five consecutive male outpatients with psychotic disorders on conventional antipsychotic medications were interviewed. Data was collected on demographic characteristics, illness-related and medication-related variables. Illness severity was assessed with the Brief psychiatric rating scale. The International Index of Erectile Function questionnaire was used to assess for sexual dysfunctions. Results A total of 111 (40.4%) respondents had one or more forms of sexual dysfunction. Sexual desire dysfunction was present in 47 (17.1%) of respondents, erectile dysfunction in 95 (34.5%), orgasmic dysfunctions in 51 (18.5%), intercourse dissatisfaction in 72 (26.2%) and overall dissatisfaction in 64 (23.3%). Sexual dysfunction was significantly associated with employment status, age, marital status, haloperidol use, medication dosage, and presence of psychopathology. Unemployment was the only significant independent correlate of sexual dysfunction, with unemployed respondents twice more likely to have sexual dysfunction compared with those employed (Wald?=?3.865, Odds Ratio?=?2.033, 95% confidence interval?=?1.002 - 4.124, p?=?0.049). Conclusions The high prevalence of sexual dysfunction found in this study suggests a need among clinicians for increased awareness and recognition of the sexual side effects in patients taking conventional antipsychotic medications. This knowledge should guide conventional antipsychotic medication prescription in the at-risk population to improve treatment adherence.
In a serological laboratory with a routine service for determining autoantibodies to human neutrophils, antibodies giving a selective or preferential reaction with the nucleus or perinuclear area of neutrophils are not uncommon. The aim of this study was to look for clinical correlates with the presence of such neutrophil-reactive autoantibodies. The specificity of such antibodies for nuclear or cytoplasmic antigens was studied in 65 consecutive sera displaying nuclear/perinuclear reactivity at a titre of at least 80 using the indirect immunofluorescence technique (IIF) on ethanol-fixed leucocytes. The sera were also investigated by IIF on formalin-acetone fixed leucocytes and on HEp-2 cells. ELISA techniques were used to measure antibodies to azurophil granule constituents (ANCA), purified myeloperoxidase (MPO-ANCA), and lactoferrin (LF-ANCA). Furthermore a qualitative spot immunoassay was used for the detection of antibodies to alpha, beta, and gamma fractions, and the nuclear fraction of neutrophils, purified proteinase 3 (PR3), MPO, enolase, lysozyme, elastase, lactoferrin, and cathepsin G. The diagnoses linked to such GS-ANA/pANCA positivity were arthritides, vasculitides, inflammatory bowel disease and chronic hepatic conditions. MPO was the main antigen recognized in the vasculitis group, but apart from that, rather limited antigen reactivity was demonstrable by these techniques, lysozyme being the most frequently recognized autoantigen in patients with arthritides. Human lymphocytes served as a suitable control substrate when distinguishing between GS-ANA/pANCA and ANA, whereas HEp-2 cells usually could not be used if both classes of antibodies were present in a sample. Furthermore, formalin-acetone fixation is not recommended for routine use. PMID:7499888
Bang la Cour, B; Wiik, A; Høier-Madsen, M; Baslund, B
Introduction Osteopontin (OPN) is a malignancy-associated glycoprotein that contributes functionally to tumor aggressiveness. In metastatic breast cancer, we previously demonstrated that elevated OPN in primary tumor and blood was associated with poor prognosis. Methods We measured OPN in plasma by ELISA, and in tumors by immunohistochemistry, in 624 (94%) and 462 (69%), respectively, of 667 postmenopausal women with hormone responsive early breast cancer treated by surgery followed by adjuvant treatment with tamoxifen +/? octreotide in a randomized trial (NCIC CTG MA.14; National Cancer Institute of Canada Clinical Trials Group Mammary.14). Results Plasma OPN was measured in 2,540 samples; 688 at baseline and 1,852 collected during follow-up. Mean baseline plasma OPN was 46 ng/ml (range 22.6 to 290) which did not differ from normal levels. Mean percentage OPN tumor cell positivity was 33.9 (95% CI: 30.2 to 37.9). There was no correlation between plasma and tumor OPN values. In multivariate analysis, neither was associated with event-free survival (EFS), relapse-free survival (RFS), overall survival (OS), bone RFS or non-bone RFS. An exploratory analysis in patients with recurrence showed higher mean OPN plasma levels 60.7 ng/ml (23.9 to 543) in the recurrence period compared with baseline levels. Conclusions The hypothesis that OPN tumor expression would have independent prognostic value in early breast cancer was not supported by multivariate analysis of this study population. Plasma OPN levels in women with hormone responsive early breast cancer in the MA.14 trial were not elevated and there was no evidence for prognostic value of plasma OPN in this defined group of patients. However, our finding of elevated mean OPN plasma level around the time of recurrence warrants further study. Trial registration NCT00002864, http://clinicaltrials.gov/show/NCT00002864
Background Severe hypoxemia is a major complication of chronic obstructive pulmonary disease (COPD). Long term oxygen therapy is beneficial in hypoxemic COPD patients. However, the clinical and radiographic predictors of hypoxemia and the use of oxygen therapy are not well described. This study aimed to find the correlates of resting hypoxemia and the pattern of oxygen use in moderate to severe COPD patients. Methods Subjects with GOLD stage II or higher COPD from the first 2500 COPDGene subjects were included in this analysis. All subjects were current or ex-smokers between ages 45 and 80. Severe resting hypoxemia was defined as room air oxygen saturation (SpO2) ? 88%. Use of supplemental oxygen therapy was determined by questionnaire. Results Eighty-two of 1060 COPD subjects (7.7%) had severe resting hypoxemia. Twenty-one of the 82 (25.6%) were not using continuous supplemental oxygen. Female sex, higher BMI, lower FEV1, and enrollment in Denver were independent risk factors for hypoxemia; emphysema severity on quantitative chest CT scan did not predict hypoxemia. 132 of 971(13.6%) subjects without severe resting hypoxemia were using continuous supplemental oxygen. In non-hypoxemic oxygen users, Denver recruitment, higher BMI, lower FEV1, and more severe dyspnea were associated with the use of continuous oxygen. Conclusions A large number of COPD patients without severe hypoxemia were using supplemental oxygen therapy and the pattern of oxygen use was affected by factors other than resting SpO2 and emphysema severity. Longitudinal data will be required to reveal the effects of oxygen therapy in this subgroup.
Kim, Deog Kyeom; Jacobson, Francine L.; Washko, George R.; Casaburi, Richard; Make, Barry J.; Crapo, James D.; Silverman, Edwin K.; Hersh, Craig P.
Primary aldosteronism is the most common form of secondary hypertension. Somatic mutations in KCNJ5, ATP1A1, ATP2B3, and CACNA1D have been described in aldosterone-producing adenomas (APAs). Our aim was to investigate the prevalence of somatic mutations in these genes in unselected patients with APA (n=474), collected through the European Network for the Study of Adrenal Tumors. Correlations with clinical and biochemical parameters were first analyzed in a subset of 199 patients from a single center and then replicated in 2 additional centers. Somatic heterozygous KCNJ5 mutations were present in 38% (180/474) of APAs, whereas ATP1A1 mutations were found in 5.3% (25/474) and ATP2B3 mutations in 1.7% (8/474) of APAs. Previously reported somatic CACNA1D mutations as well as 10 novel CACNA1D mutations were identified in 44 of 474 (9.3%) APAs. There was no difference in the cellular composition of APAs or in CYP11B2, CYP11B1, KCNJ5, CACNA1D, or ATP1A1 gene expression in APAs across genotypes. Patients with KCNJ5 mutations were more frequently female, diagnosed younger, and with higher minimal plasma potassium concentrations compared with CACNA1D mutation carriers or noncarriers. CACNA1D mutations were associated with smaller adenomas. These associations were largely dependent on the population structure of the different centers. In conclusion, recurrent somatic mutations were identified in 54% of APAs. Young women with APAs are more likely to be KCNJ5 mutation carriers; identification of specific characteristics or surrogate biomarkers of mutation status may lead to targeted treatment options. PMID:24866132
Fernandes-Rosa, Fabio Luiz; Williams, Tracy Ann; Riester, Anna; Steichen, Olivier; Beuschlein, Felix; Boulkroun, Sheerazed; Strom, Tim M; Monticone, Silvia; Amar, Laurence; Meatchi, Tchao; Mantero, Franco; Cicala, Maria-Verena; Quinkler, Marcus; Fallo, Francesco; Allolio, Bruno; Bernini, Giampaolo; Maccario, Mauro; Giacchetti, Gilberta; Jeunemaitre, Xavier; Mulatero, Paolo; Reincke, Martin; Zennaro, Maria-Christina
OBJECTIVE. Aggressive angiomyxomas are rare infiltrative mesenchymal neoplasms that commonly recur locally. The purpose of this study was to conduct a retrospective review of imaging findings of aggressive angiomyxomas with clinicopathologic correlation in 16 patients. MATERIALS AND METHODS. CT and MRI studies and clinical data of 16 patients with histopathologic evidence of aggressive angiomyxoma who had been referred to our institutions from January 2002 through January 2012 were retrospectively reviewed. The tumors were evaluated with respect to location, morphology, attenuation or signal intensity, and enhancement characteristics. RESULTS. The most common location was the pelvis and perineum with the mass on either side of the pelvic diaphragm (12/16, 75%). The characteristic "laminated" appearance was seen in 10 of 12 patients on MRI. Aggressive angiomyxomas showed only mild diffusion restriction and mild (18)F-FDG avidity in both of the two patients who underwent DWI and PET/CT, in keeping with histologic low-mitotic activity. Imaging features, such as collateral vessels and fingerlike growth pattern, were seen in seven of 16 (44%) aggressive angiomyxomas. Internal cystic degeneration was seen in three of 16 (19%) aggressive angiomyxomas. CONCLUSION. The finding of a large multicompartmental tumor with a characteristic internal laminated morphology or extension on either side of the pelvic diaphragm should alert the radiologist to the possible diagnosis of aggressive angiomyxoma. Imaging features, such as large peripheral vessels and cystic degeneration are less common, but presence of these features in the background of laminated morphology should not deter the radiologist from suggesting a diagnosis of aggressive angiomyxoma. PMID:24848813
Surabhi, Venkateswar R; Garg, Naveen; Frumovitz, Michael; Bhosale, Priya; Prasad, Srinivasa R; Meis, Jeanne M
Background Patients with inflammatory bowel disease have higher proportions of immunoglobulin G (IgG) antibodies lacking N-galactose, also called agalactosyl IgG, in their serum. Such agalactosyl IgGs have been associated with disease activity and the immunogenicity of biologics. The aim was to describe the relationship between circulating levels of a subset of agalactosyl IgGs (anti-?-Gal) and Crohn’s disease (CD) phenotypes. Methods Prospectively collected serum samples of a well-characterized cohort of patients with inflammatory bowel disease and controls were used. Serum anti-?-Gal levels were measured by a high-affinity enzyme-linked immunosorbent assay and referenced to a standard control. Results Serum samples from 167 subjects were tested; 62 with CD, 76 with ulcerative colitis, and 29 controls. Agalactosyl anti-?-Gal levels were significantly higher in active CD than in active ulcerative colitis (P = 0.0043) or healthy controls (P < 0.0001). Among patients with CD, agalactosyl anti-?-Gal levels were significantly higher in those with a history of arthritis, than those without (P = 0.0002), but lower in those taking immunomodulators (P = 0.03). There was no correlation between agalactosyl anti-?-Gal levels and indices of Crohn’s severity, including C-reactive protein levels or Harvey– Bradshaw index. Patients who were primary or secondary nonresponders to infliximab had similar agalactosyl anti-?-Gal levels to clinical responders. Conclusions Patients with CD have greater amounts of agalactosylated anti-?-Gal antibodies in their serum, particularly in those with associated joint disease. This increase seems to be independent of indices of disease activity, but is influenced by immunomodulator use.
Safaie, Parham; Ham, Maggie; Kuang, Peter; Mehta, Anand S.; Wang, Mengjun; Cheifetz, Adam S.; Robson, Simon; Lau, Daryl; Block, Timothy M.; Moss, Alan C.
Muscular fatigue may result from HIV infection, and may be associated with antiretroviral drug treatment. Clinical features linked to muscle biopsy findings may assist in determining etiology, and guide treatment decisions.This case series examined HIV patients in an ambulatory HIV clinic who received antiretroviral therapy, and complained of unexplained muscular fatigue. Clinical features with measurement of acid-base status, levels of
Steven C. Zell; Surl Nielsen
The prevalence of Body Dysmorphic Disorder (BDD), based on structured and unstructured clinical interviews, was compared in two samples of psychiatric outpatients drawn from the same practice setting. In the first sample, 500 patients were diagnosed according to a routine, unstructured clinical interview. In the second sample, 500 subjects were diagnosed according to information obtained by the Structured Clinical Interview
Mark Zimmerman; Jill I Mattia
BACKGROUND AND PURPOSE: Sarcoidosis is an idiopathic systemic granulomatous dis- ease, recognized in a patient when clinical and radiologic findings are confirmed by histopath- ologic analysis. The objective was to identify a relationship between MR imaging and clinical findings in CNS sarcoidosis. METHODS: The clinical charts of 461 patients with biopsy-proved sarcoidosis were reviewed retrospectively. Criteria for including patients in
Greg A. Christoforidis; Eric M. Spickler; Maria V. Recio; Bharat M. Mehta
Background The treatment of trigger finger so far has heavily relied on clinicians’ evaluations for the severity of patients’ symptoms and the functionality of affected fingers. However, there is still a lack of pathological evidence supporting the criteria of clinical evaluations. This study’s aim was to correlate clinical classification and pathological changes for trigger finger based on the tissue abnormality observed from microscopic images. Methods Tissue samples were acquired, and microscopic images were randomly selected and then graded by three pathologists and two physicians, respectively. Moreover, the acquired images were automatically analyzed to derive two quantitative parameters, the size ratio of the abnormal tissue region and the number ratio of the abnormal nuclei, which can reflect tissue abnormality caused by trigger finger. A self-developed image analysis system was used to avoid human subjectivity during the quantification process. Finally, correlations between the quantitative image parameters, pathological grading, and clinical severity classification were assessed. Results One-way ANOVA tests revealed significant correlations between the image quantification and pathological grading as well as between the image quantification and clinical severity classification. The Cohen’s kappa coefficient test also depicted good consistency between pathological grading and clinical severity classification. Conclusions The criteria of clinical classification were found to be highly associated with the pathological changes of affected tissues. The correlations serve as explicit evidence supporting clinicians in making a treatment strategy of trigger finger. In addition, our proposed computer-aided image analysis system was considered to be a promising and objective approach to determining trigger finger severity at the microscopic level.
Background In instrumented posterolateral fusion reduction of a spondylolisthesis is appealing on theoretical grounds since this may lead to indirect decompression of the entrapped nerve roots. However, there is no consensus in the literature whether a beneficial effect of reduction on outcome can be expected. The objective of the current study was to evaluate whether a correlation between the extent of listhesis reduction and clinical improvement could be established. Methods From two ongoing prospective studies 72 patients with a single-level instrumented posterolateral lumbar fusion for low-grade spondylolisthesis (isthmic/degenerative 51/21) were evaluated. Radiographs and clinical outcome scores were available at baseline, 6 weeks and 1 year after surgery. Changes in neuroforaminal morphology were measured on calibrated radiographs. These changes in radiographic parameters were correlated to clinical outcome (Visual Analogue Score (VAS) leg pain, Oswestry Disability Index (ODI)). Fusion status was assessed on Computed Tomography-scan at one year. Results A mean spondylolisthesis of 25 percent was reduced to 15 percent at 6 weeks with some loss of reduction to 17 percent at one year. The VAS and ODI significantly improved at both time intervals after surgery (p?0.001). No significant correlations could be established between the extent of slip reduction and improvement in VAS or ODI (Pearson’s correlation ?0.2 and 0.07 respectively at one year); this also accounted for the other radiographic parameters. A fusion rate of 64 percent was seen on CT-scan. Conclusions Clinical outcome was not related to the obtained radiographic reduction of the slipped vertebra in patients with a lumbar fusion for low grade spondylolisthesis. Loss of reduction or non-union on CT-scans had no effect on the clinical outcome. Reduction of a low-grade spondylolisthesis in spinal fusion is appealing, however, there is no evidence that it positively affects clinical outcome on the short term. Trial registration ISRCTN43648350
Accurate documentation of disease severity is a prerequisite for clinical research and the practice of evidence-based medicine. The quantification of skin diseases such as psoriasis currently relies heavily on clinical scores. Although these clinical scoring methods are well established and very useful in quantifying disease severity, they require an extensive clinical experience and carry a risk of subjectivity. We explore the opportunity to use in vivo near-infrared (NIR) spectra as an objective and noninvasive method for local disease severity assessment in 31 psoriasis patients in whom selected plaques were scored clinically. A partial least squares (PLS) regression model was used to analyze and predict the severity scores on the NIR spectra of psoriatic and uninvolved skin. The correlation between predicted and clinically assigned scores was R=0.94 (RMSE=0.96), suggesting that in vivo NIR provides accurate clinical quantification of psoriatic plaques. Hence, NIR may be a practical solution to clinical severity assessment of psoriasis, providing a continuous, linear, numerical value of severity. PMID:23508704
Greve, Tanja Maria; Kamp, Søren; Jemec, Gregor B E
Accurate documentation of disease severity is a prerequisite for clinical research and the practice of evidence-based medicine. The quantification of skin diseases such as psoriasis currently relies heavily on clinical scores. Although these clinical scoring methods are well established and very useful in quantifying disease severity, they require an extensive clinical experience and carry a risk of subjectivity. We explore the opportunity to use in vivo near-infrared (NIR) spectra as an objective and noninvasive method for local disease severity assessment in 31 psoriasis patients in whom selected plaques were scored clinically. A partial least squares (PLS) regression model was used to analyze and predict the severity scores on the NIR spectra of psoriatic and uninvolved skin. The correlation between predicted and clinically assigned scores was R=0.94 (RMSE=0.96), suggesting that in vivo NIR provides accurate clinical quantification of psoriatic plaques. Hence, NIR may be a practical solution to clinical severity assessment of psoriasis, providing a continuous, linear, numerical value of severity.
Greve, Tanja Maria; Kamp, Søren; Jemec, Gregor B. E.
The present study was undertaken to investigate the involvement of oxidative damage in lead-induced toxicity in humans and to enlighten whether oxidative stress indicators are correlated with the known indices of lead toxicity. For these purposes, selected oxidative stress parameters along with some clinical indices of lead poisoning were determined in blood of battery plant workers and control subjects. Workers had significantly increased erythrocyte malondialdehyde (MDA) levels, catalase and glucose-6-phosphate dehydrogenase (G6PD) activities, and decreased blood glutathione:glutathione disulfide ratio compared to the controls. Increased blood lead concentrations and zinc protoporphyrin (ZPP) levels, and decreased delta-aminolevulinic acid dehydratase (ALAD) activity were used as clinical indices of lead toxicity. Statistically significant correlation between oxidative stress parameters and clinical indices implies that disrupted prooxidant/antioxidant balance might contribute to lead-induced toxicity in erythrocytes. A significant correlation was found between ALAD activity and blood lead levels in human subjects. Similarly significant correlation between ALAD activity and erythrocyte MDA concentrations was shown. Present data indicates that ALAD can serve as a valuable biomarker of oxidative stress in lead-exposed hematological system as well as being a biochemical indicator of lead exposure. PMID:14751670
Gurer-Orhan, Hande; Sabir, Handan U; Ozgüne?, Hilal
AIM: To investigate computed tomography (CT) and magnetic resonance imaging (MRI) manifestations of rectal gastrointestinal stromal tumors (GISTs) in order to enhance the recognition of these rare tumors. METHODS: Fourteen patients with pathologically proven rectal GISTs were retrospectively reviewed. Patient histories were retrospectively reviewed for patient age, gender, presenting symptoms, endoscopic investigations, operation notes and pathologic slides. All tumors were evaluated for CD117, CD34 expression, and the tumors were stratified according to current criteria of the National Institutes of Health (NIH). In all cases the first pre-operation imaging findings (CT and MRI, n = 3; MRI only, n = 8; CT only, n = 3) were analyzed by two experienced radiologists by consensus, which include: tumor size, shape, CT density (hypodense, isodense and hyperdense), MRI signal intensity (hypointense, isointense and hyperintense), epicenter (intraluminal or extraluminal), margin (well-defined or ill-defined), internal component (presence of calcifications, necrosis, hemorrhage or ulceration), pattern and degree of enhancement, invasion into adjacent structures. After review of the radiologic studies, clinical and pathological findings were correlated with radiological findings. RESULTS: The patients, 13 men and 1 woman, were aged 31-62 years (mean = 51.5 ± 10.7 years). The most common initial presentation was hematochezia (n = 6). The mean tumor diameter was 5.68 ± 2.64 cm (range 1.5-11.2 cm). Eight lesions were round or oval, and 6 lesions were irregular. Eleven lesions were well-defined and 3 had ill-defined margins. Ten tumors were extraluminal and 4 were intraluminal. The density and MR signal intensity of the solid component of the lesions were similar to that of muscle on unenhanced CT (n = 6) and T1-weighted images (n = 11), and hyperintense on T2-weighted MR images. Calcification was detected in 2 tumors. Following intravenous injection of contrast media, 3 lesions had mild enhancement and 11 lesions had moderate enhancement. Enhancement was homogenous in 3 lesions and heterogeneous in 11. In 1 of 11 patients who underwent both CT and MRI, the tumor was homogenous on CT scan and heterogeneous on MRI. Eight patients were classified as high risk according to the modified recurrent risk classification system of NIH. CONCLUSION: Rectal GISTs usually manifest as large, well-circumscribed, exophytic masses with moderate and heterogeneous enhancement on CT and MRI. The invasion of adjacent organs, bowel obstruction and local adenopathy are uncommon.
Jiang, Zhao-Xia; Zhang, Sheng-Jian; Peng, Wei-Jun; Yu, Bao-Hua
Alternative methods to the Draize eye irritation test, such as the hen's egg test-chorioallantoic membrane (HET-CAM) or the bovine corneal opacity and permeability (BCOP) tests, are currently used to evaluate the irritant potential of cosmetic or consumer products. Although, for strong irritants, the results of these tests correlate well with those of the Draize test, they appear to be less suited to identify mild irritants. In order to improve the sensitivity of alternative eye irritation tests, we developed a novel method that uses a human corneal epithelial cell line (CEPI), and the endpoints of cytotoxicity and IL-8 release. Twelve make-up removers were assessed by the HET-CAM, BCOP and CEPI tests, as well as in a clinical in-use test under ophthalmological control after their application to the external eye lid. In addition, we investigated the impact of osmolality and raw material composition on in vitro and clinical results and compared the in vitro results with those of clinical studies. Overall, although HET-CAM results were unrelated to eye discomfort and adverse clinical signs, they correlated mainly with the presence and concentration of surfactants in the test articles. BCOP scores were unrelated to clinical signs, but related mainly to glycol and sodium lactate content and concentration in the test articles. Cytotoxicity in CEPI mainly correlated with presence and concentrations of surfactants, and IL-8 release to clinical signs and/or glycol and sodium lactate concentrations. Overall, IL-8 release appeared to be the most sensitive and reliable endpoint to predict human eye tolerance to mildly irritant products. Although our results suggest that the IL-8 assay appears to be a promising screen for borderline-irritant formulations, further experiments are required to confirm and validate these preliminary results. PMID:15582208
Debbasch, Caroline; Ebenhahn, Catherine; Dami, Nadia; Pericoi, Marc; Van den Berghe, Christine; Cottin, Martine; Nohynek, Gerhard J
Recent advances in neural engineering and mathematical methods influence more and more the way in which brain disorders and symptoms are being diagnosed and treated. In this direction, experimental findings, which emphasize on the correlation between large-scale neural correlates reflected in electroencephalographic data and neuronal mechanisms, have propelled the development of novel brain computer interfaces that represent a step ahead
Carlos Trenado; Lars Haab; Wolfgang Reith; Daniel J. Strauss
Research into correlations of thoughts and feelings was extended by asking psychiatric inpatients and outpatients, hospital paraprofessionals, and college students to complete the Situational Self-Statement and Affective State Inventory, which elicits responses to five classes of self-statements and their matching emotional reactions in the context of imagined frustrations. Correlations between “depressed” and “rational” thoughts with their presumed corresponding and noncorresponding
Geoffrey L. Thorpe; Gary S. Barnes; James E. Hunter; Dwight Hines
Indium-111-labeled antimyosin has been utilized in the diagnosis and localization of acute transmural myocardial infarction. The present report describes a patient who presented with a massive subendocardial infarction. Two days after the injection of antimyosin, the patient's clinical status markedly deteriorated and he expired. Postmortem examination demonstrated severe three-vessel coronary artery disease with extensive myocyte death in the endocardium. Autoradiography and histochemical staining of the prosected heart demonstrated high correlation for myocardial necrosis and corresponded to clinical evidence for diffuse subendocardial infarction.
Hendel, R.C.; McSherry, B.A.; Leppo, J.A. (Univ. of Massachusetts Medical Center, Worcester (USA))
This article describes the addition of a clinical program to a first year medical school curriculum. 25 students were randomly selected to participate in the program. Immediate outcomes measured include:pre-post opinion survey and examination grades. Future outcomes will analyze how this population vs. the traditional track students perform in course exams, clinical surgical rotation scores and residency matches.
Different orthopedic tests are used to evaluate internal derangements of joints. Radiologic examinations like magnetic resonance (MR) imaging are ordered on the basis of results of these tests to narrow the clinical diagnosis and formulate a treatment plan. Although these tests are clinically useful, the test terminology can be confusing and the significance of the tests not clearly understood. This article helps explain the clinical jargon of tests performed for the major joints of the upper extremity and their proper use and diagnostic value in conjunction with MR imaging. The article presents a structured algorithmic approach to explain the tests. For each joint, a hierarchy of clinical tests is performed, starting with general observation and range of motion, followed by more specific tests tailored to evaluate individual or grouped anatomic structures. MR imaging findings and clinical tests complement each other in making a final diagnosis. However, because of the varied sensitivity and specificity of the clinical tests and MR imaging, it is important to be familiar with their diagnostic value before making clinical decisions. Knowledge of clinical jargon and the proper use and diagnostic value of orthopedic tests can aid in interpretation of radiologic images by focusing search patterns, thus allowing comprehensive evaluation and optimized reporting. It also enhances communication with the orthopedist, thereby helping maintain continuity of care. Online supplemental material is available for this article. PMID:24617698
Pandey, Tarun; Slaughter, Aubrey J; Reynolds, Kirk A; Jambhekar, Kedar; David, Ryan M; Hasan, S Ashfaq
Purpose To measure the correlation between subjective symptom score, conventional clinical tests, and Fourier-domain optical coherence tomography (FD-OCT) of lower tear meniscus parameters in patients with dry eye disease. Methods Eighteen patients with dry eye disease requiring medical therapy and/or punctal occlusion were recruited for this prospective, nonrandomized, observational case series. Severity of symptoms of dry eye disease was assessed using the Indiana Dry Eye Questionnaire 2002. Clinical assessments were completed using slit-lamp biomicroscopy, rose bengal dye staining, fluorescein tear break-up time (TBUT), and 5-minute Schirmer’s test with topical anesthesia. The lower tear meniscus was imaged using a FD-OCT system with 5-?m axial resolution and measured manually by a masked grader using computer calipers. Correlation was assessed using Spearman’s correlation coefficient (?). Results The mean scaled symptom score was 58 ± 21 (±SD), with a range of 0 to 100. Vital staining test averaged 1.7 ± 3.4, TBUT averaged 4.4 ± 1.8 seconds, and Schirmer’s tests averaged 10.2 ± 8.1 mm. As determined by OCT, the meniscus height was 228 ± 153 ?m, depth was 127 ± 79 ?m, and cross-sectional area was 0.018 ± 0.021 mm2. OCT meniscus area was negatively correlated with the symptom questionnaire score (P < 0.01) and positively correlated with Schirmer’s test results (P < 0.01). There was no significant correlation between symptom score and rose bengal staining, TBUT, or Schirmer’s test results (P > 0.01). Conclusions Lower tear meniscus measurement with FD-OCT is an objective, noninvasive test that correlates well with symptoms of dry eye disease and the Schirmer’s test.
Nguyen, Pho; Huang, David; Li, Yan; Sadda, Srinivas R.; Ramos, Sylvia; Pappuru, Rajeev R.; Yiu, Samuel C.
This study was aimed at evaluating the association between seminal plasma interleukin-8 (sIL-8) and colour-Doppler ultrasound (CDU) characteristics of the male genital tract in a series of patients fulfilling the criteria of male accessory gland infections (MAGI). Of 250 subjects seeking medical care for couple infertility, 79 (mean age: 36.4 ± 7.5 years) met the criteria of MAGI and scored higher than the rest of the sample on the National Institutes of Health-Chronic Prostatitis Symptom Index score. All patients underwent simultaneous hormone evaluation and seminal analysis (including sIL-8), along with scrotal and transrectal CDU before and after ejaculation. After adjusting for age, sIL-8 in patients with MAGI was significantly related to several abnormal semen and CDU parameters. In particular, leucocytospermia was closely associated with sIL-8. Ejaculate volume, unlike other semen or hormonal parameters, was negatively associated with sIL-8. When scrotal CDU was performed, sIL-8 was positively related to CDU inhomogeneous, hypo-echoic, hyper-echoic epididymis and to epididymal calcifications. In addition, a positive correlation among sIL-8, hyperaemic epididymis and an increased size of epididymal tail was found. When transrectal CDU was performed, an association among sIL-8 and hyper-echoic seminal vesicles, dilated ejaculatory ducts and duct calcifications was also observed. Finally, sIL-8 was positively related to prostate CDU abnormalities such as calcifications, inhomogeneous/hypo-echoic texture, hyperaemia and high arterial blood flow. No association was found with testis parameters. In conclusion, sIL-8 levels in patients with MAGI are associated with several parameters and CDU abnormalities of epididymis, seminal vesicles, ejaculatory ducts and prostate, but not of the testis. Furthermore, sIL-8 positively correlates with CDU signs of ejaculatory duct inflammatory subobstruction. PMID:20969602
Lotti, F; Corona, G; Mancini, M; Filimberti, E; Degli Innocenti, S; Colpi, G M; Baldi, E; Noci, I; Forti, G; Adorini, L; Maggi, M
Wilson’s disease is an autosomal recessive disorder caused by more than 500 mutations in ATP7B gene presenting considerably clinical manifestations heterogeneity even in patients with a particular mutation. Previous findings suggested a potential role of additional genetic modifiers and environment factors on phenotypic expression among the affected patients. We conducted clinical and genetic investigations to perform genotype-phenotype correlation in two large families living in a socio-culturally isolated community with the highest prevalence of Wilson’s disease ever reported of 1?1130. Sequencing of ATP7B gene in seven affected individuals and 43 family members identified a common compound heterozygous genotype, H1069Q/M769H-fs, in five symptomatic and two asymptomatic patients and detected the presence of two out of seven identified single nucleotide polymorphisms in all affected patients. Symptomatic patients had similar clinical phenotype and age at onset (18±1 years) showing dysarthria and dysphagia as common clinical features at the time of diagnosis. Moreover, all symptomatic patients presented Kayser-Fleischer rings and lack of dystonia accompanied by unfavourable clinical outcomes. Our findings add value for understanding of genotype-phenotype correlations in Wilson’s disease based on a multifamily study in an isolated population with high extent of genetic and environmental homogeneity as opposed to majority of reports. We observed an equal influence of presumed other genetic modifiers and environmental factors on clinical presentation and age at onset of Wilson’s disease in patients with a particular genotype. These data provide valuable inferences that could be applied for predicting clinical management in asymptomatic patients in such communities.
Cocos, Relu; Sendroiu, Alina; Schipor, Sorina; Bohiltea, Laurentiu Camil; Sendroiu, Ionut; Raicu, Florina
OBJECTIVE. The purpose of this study was to determine whether each grade in a new system suggested by Park et al. (Park system) to assess cervical neural foraminal stenosis validly correlates with the associated clinical findings and to evaluate the interobserver agreement in grading between two MRI readers. MATERIALS AND METHODS. We evaluated 166 patients (98 men and 68 women; mean age, 46 years) at our institution who underwent oblique sagittal MRI of the cervical spine. Using the new Park grading system, two radiologists evaluated the MRI findings for the presence and grade of cervical neural foraminal stenosis at the most narrow point. A neurosurgeon assessed the associated clinical manifestations. A positive neurologic manifestation of the cervical neural foraminal stenosis was defined as more than one positive neurologic clinical manifestation combined with more than one positive neurologic sign. Interobserver agreements between the two radiologists were analyzed using kappa statistics. Correlation coefficients (R) to assess the relationship between the grade and neurologic manifestations were calculated with nonparametric correlation analysis (Spearman correlation). The relationship between the assigned grade and the clinical manifestations was analyzed several ways: vertebrae level (C4-5, C5-6, or C6-7) and by age group (< 46 years and ? 46 years). RESULTS. Among patients who were evaluated by each reader to be grade 0, only 19 (17%) and 20 patients (18%) showed positive neurologic manifestations, respectively, with most patients showing negative neurologic manifestations. Among the patients who were grade 2 and 3, one reader found all patients and the second reader found all but one patient (100% and 93%, respectively) to have positive neurologic manifestations. According to the correlation coefficients, each Park grade was moderately correlated with the associated neurologic manifestations, such that higher grades were associated with more severe clinical manifestations. If we consider grade 2 or 3 MRI findings positive for identifying positive neurologic manifestations, the sensitivities and specificities were 39.7% and 99.0% (reader 1) and 39.7% and 99.0% (reader 2), respectively. CONCLUSION. The Park system, based on oblique sagittal MRI sections, provides a reliable and reproducible assessment of the severity of cervical neural foraminal stenosis. According to the Park system, grades 2 and 3 are associated with positive neurologic manifestations, and the Park system successfully predicts positive neurologic manifestations at these grades. PMID:25055278
Park, Hee Jin; Kim, Sam Soo; Han, Chul Hee; Lee, So Yeon; Chung, Eun Chul; Kim, Mi Sung; Kwon, Heon Ju
Background: Despite limited clinical efficacy, treatment with dacarbazine or temozolomide (TMZ) remains the standard therapy for metastatic melanoma. In glioblastoma, promoter methylation of the counteracting DNA repair enzyme O6-methylguanine-DNA-methyltransferase (MGMT) correlates with survival of patients exposed to TMZ in combination with radiotherapy. For melanoma, data are limited and controversial. Methods: Biopsy samples from 122 patients with metastatic melanoma being treated with TMZ in two multicenter studies of the Dermatologic Cooperative Oncology Group were investigated for MGMT promoter methylation. We used the COBRA (combined bisulphite restriction analysis) technique to determine aberrant methylation of CpG islands in small amounts of genomic DNA isolated from paraffin-embedded tissue sections. To detect aberrant methylation, bisulphite-treated DNA was amplified by PCR, enzyme restricted, and visualised by gel electrophoresis. Results: Correlation with clinical data from 117 evaluable patients in a best-response evaluation indicated no statistically significant association between MGMT promoter methylation status and response. A methylated MGMT promoter was observed in 34.8% of responders and 23.4% of non-responders (P=0.29). In addition, no survival advantage for patients with a methylated MGMT promoter was detectable (P=0.79). Interestingly, we found a significant correlation between MGMT methylation and tolerance of therapy. Patients with a methylated MGMT promoter had more severe adverse events, requiring more TMZ dose reductions or discontinuations (P=0.007; OR 2.7 (95% CI: 1.32–5.7)). Analysis of MGMT promoter methylation comparing primaries and different metastases over the clinical course revealed no statistical difference (P=0.49). Conclusions: In advanced melanoma MGMT promoter, methylation correlates with tolerance of therapy, but not with clinical outcome.
Hassel, J C; Sucker, A; Edler, L; Kurzen, H; Moll, I; Stresemann, C; Spieth, K; Mauch, C; Rass, K; Dummer, R; Schadendorf, D
Chemokine receptors expressed by normal and neoplastic lymphocytes provide an important mechanism for cells to traffic into the skin and skin-associated lymph nodes. The goal of this study was to correlate chemokine receptor and CD62L expression by circulating neoplastic T cells with the clinical and pathological findings of the leukemic phase of cutaneous T-cell lymphoma, primarily Sézary syndrome (SS). Chemokine
Elisabetta Capriotti; Eric C Vonderheid; Christopher J Thoburn; Emilie C Bright; Allan D Hess
Uptake of radioactivity from 14C-galactose into gangliosides by cultured skin fibroblasts was studied. GM3 was the major ganglioside in control human fibroblasts. An increase of GM1 was demonstrated in GM1-gangliosidosis fibroblasts. The degree of GM1 accumulation was correlated with the clinical types of this disease. The fibroblasts from an infantile-type patient showed a marked increase of GM1. In late-onset types
Yoshiyuki Suzuki; Norimasa Nakamura; Kazuko Fukuoka
Personalized medicine has become essential in the treatment of lung cancer. However, the lung cancer-related gene expression profiles in non-small cell lung cancer (NSCLC) patients have not been elucidated. In this study, the correlation between gene expression profiles and clinicopathological characteristics was investigated in NSCLC patients. A total of 95 patients were enrolled in this study. The mRNA expression levels of 14 genes were assessed by multiplex branched DNA liquidchip (MBL) technology and data on 9 clinicopathological characteristics of patients were collected simultaneously. The correlation between gene expression and clinicopathological characteristics was investigated. Out of the 9 clinicopathological parameters, 6 were associated with several of the 14 genes analyzed. Patient gender was associated with TYMS and TOP2A. Clinical stage was associated with VEGFR2, KIT and HER2. There was weak correlation between primary tumor size of ?3 cm and the expression level of KIT. The mRNA expression levels of VEGFR2 and HER2 correlated with distant metastasis. BRCA1, TYMS, TOP2A and HER2 were associated with histological type. Smoking correlated with higher expression levels of BRCA1, TYMS and TOP2A and lower expression levels of PDGFR?. The results were suggestive of correlation between the clinicopathological parameters of the NSCLC patients and the mRNA expression levels of certain lung cancer-related genes, including BRCA1, TYMS, TOP2A, PDGFR?, VEGFR2, KIT and HER2.
HAN, YI; LI, GUO; SU, CHONGYU; REN, HUA; CHU, XIANGYANG; ZHAO, QIUYUE; ZHU, YANJUN; WANG, ZITONG; HU, BIN; AN, GUANGYU; KANG, JINGBO; WANG, WEI; YU, DAPING; SONG, XIAOYUN; XIAO, NING; LI, YUNSONG; LI, XIA; YANG, HUIYI; YU, GANG; LIU, ZHIDONG
Background The anterior insula cortex is considered to be both the structural and functional link between experience, affect, and behaviour. Magnetic resonance imaging (MRI) studies have shown changes in anterior insula gray matter volume (GMV) in psychosis, bipolar, depression and anxiety disorders in older patients, but few studies have investigated insula GMV changes in young people. This study examined the relationship between anterior insula GMV, clinical symptom severity and neuropsychological performance in a heterogeneous cohort of young people presenting for mental health care. Methods Participants with a primary diagnosis of depression (n?=?43), bipolar disorder (n?=?38), psychosis (n?=?32), anxiety disorder (n?=?12) or healthy controls (n?=?39) underwent structural MRI scanning, and volumetric segmentation of the bilateral anterior insula cortex was performed using the FreeSurfer application. Statistical analysis examined the linear and quadratic correlations between anterior insula GMV and participants’ performance in a battery of clinical and neuropsychological assessments. Results Compared to healthy participants, patients had significantly reduced GMV in the left anterior insula (t?=?2.05, p?=?.042) which correlated with reduced performance on a neuropsychological task of attentional set-shifting (??=?.32, p?=?.016). Changes in right anterior insula GMV was correlated with increased symptom severity (r?=?.29, p?=?.006) and more positive symptoms (r?=?.32, p?=?.002). Conclusions By using the novel approach of examining a heterogeneous cohort of young depression, anxiety, bipolar and psychosis patients together, this study has demonstrated that insula GMV changes are associated with neurocognitive deficits and clinical symptoms in such young patients.
We introduce 3 studies of the empirical correlates of the MMPI-2 Restructured Clinical (RC) Scales: a study by Arbisi, Sellbom, and Ben-Porath (2008/this issue) that expands the range of correlates of the RC scale in mental health settings; an investigation by Sellbom, Ben-Porath, Baum, Erez, and Gregory (2008/this issue) of the empirical correlates of the scales in a forensic setting; and a study by Forbey and Ben-Porath (2008/this issue) examining convergent and discriminant validities of the RC scale in a nonclinical setting. To serve as a general introduction to the 3 new empirical studies presented in this special section, we begin with a review of the existing literature on the RC scales and briefly describe these studies. PMID:18444104
Ben-Porath, Yossef S; Tellegen, Auke
Cloned cDNA sequences representing exons from the Duchenne\\/Becker muscular dystrophy (DMD\\/BMD) gene were used for deletion screening in a population of 287 males males affected with DMD or BMD. The clinical phenotypes of affected boys were classified into three clinical severity groups based on the age at which ambulation was lost. Boys in group 1 had DMD, losing ambulation before
S Hodgson; K Hart; S Abbs; J Heckmatt; E Rodillo; M Bobrow; V Dubowitz
Long-term data on the clinical outcome and the fate of the meniscus allograft after transplantation are scarce. In this study we present the clinical, radiological and MRI outcome of the meniscus graft and the articular cartilage after 42 meniscus allograft transplantations in 41 patients with a minimum follow-up of 10 years. A total of 27 medial and 15 lateral meniscal allografts
Peter C. M. Verdonk; Koenraad L. Verstraete; Karl F. Almqvist; Kristof De Cuyper; Eric M. Veys; Gust Verbruggen; René Verdonk
Background and Objectives: Assessing only the clinical and radiographic parameters for evaluation of dental implants may not be enough as they often reflect extensive inflammatory changes in the periodontal tissues. As peri-implant crevicular fluid (PICF) can give us a more prompt and objective measure of the disease activity, the purpose of this case series is to assess the peri-implant health status of single tooth dental implants not only clinically and radiographically but also biochemically. Materials and Methods: Thirteen patients were subjected to dental implants at single edentulous sites using a conventional surgical approach. At baseline, 6 months, and 12 months after implant placement, the clinical and radiographic parameters were recorded. Additionally, IL-1? in PICF was estimated using the ELISA kit at 6th and 12th month. Results: The clinical and radiographic parameters differed significantly around the implants at different time intervals with IL-1? levels showing highly significant differences between 6 months (31.79 ± 12.26 pg/?l) and 12 months (113.09 ± 51.11 pg/?l). However, Spearman's correlation coefficient showed no correlation with the clinical and radiographic parameters. Interpretation and Conclusion: Assessment of the various parameters confirmed that all the implants had a healthy peri-implant status. Although the levels of IL-1? in PICF were elevated at the 12th month, they were well within the healthy range as observed by previous studies. This indicates that IL-1?, a biochemical marker, can be used as an adjunct to clinical and radiographic parameters in the assessment of EARLY inflammatory changes around implants.
Kajale, Aniruddha M.; Mehta, Dhoom S.
Classroom teachers' engagement in dialogue with their students develops important skills and attitudes. Drawing from a series of inservice teacher education workshops, this paper addresses the following concerns with respect to acquiring and strengthening questioning techniques: (1) "Should all children be asked a variety of question types, or…
Supon, Viola; Wolf, Pat
This study aimed to measure the subjective quality of life (QOL) of Nigerian outpatients with schizophrenia and to examine its socio-demographic as well as clinical determinants. A total of 313 outpatients with schizophrenia participated in the study. Data were collected on socio-demographics, outpatient clinic attendance, perceived social support, perceived satisfaction with hospital care, medication adherence, illness severity and QOL. Multiple linear regression analysis was used to determine the amount of variance in the QOL domain scores explained by socio-demographic and clinical variables. Employment status, perceived social support, satisfaction with outpatient care, antipsychotic medication dose, Brief Psychiatric Rating Scale (BPRS) scores and medication adherence had significant relationships with all the QOL domains. Average monthly allowance and outpatient clinic default were significantly associated with all QOL domains except social relationship. Socio-demographic and clinical factors explained only a modest part (29.4%) of the variance in the QOL scores. It is likely that unmeasured 'internalised' determinants contribute in a much larger sense to the variation in subjective QOL. PMID:23452754
Adelufosi, A O; Ogunwale, A; Abayomi, O; Mosanya, J T
It has been suggested that elevated serum level of YKL-40 could be a marker for asthma and its severity. Along with few published studies, we investigated its correlation with asthma and its severity as well as spirometric indices.114 patients with asthma and 114 healthy controls underwent the assessment of serum level of YKL-40 (by ELISA) and spirometric indices. Pearson's coefficient determined the correlation between the variables and multivariate linear regression analysis was used for adjusting the effect of different probable confounding factors.Serum levels of YKL-40 were significantly higher in the asthmatic patients compared to those in healthy people (p<0.001). We also found a significant correlation between YKL-40 serum level and spirometric indices even after adjusting the effects of other variables.We report for the first time in an Iranian population that YKL-40 may be a good diagnostic marker of asthma in serum. PMID:24659163
Saba, Mohammadali; Sharif, Mohammad Reza; Akbari, Hossein; Nikoueinejad, Hassan; Ramazani Jolfaii, Maryam
Objective To investigate a diagnostic value of ultrasonography in carpal tunnel syndrome (CTS) patients and to evaluate a correlation of sonographic measurements with the degree of electrodiagnostic abnormalities and clinical severity. Methods Two-hundred-forty-six symptomatic hands in 135 patients and 30 asymptomatic hands in 19 healthy individuals as control group were included. In ultrasonographic study, we measured the cross-sectional area (CSA) and flattening ratio (FR) of the median nerve at the pisiform as well as palmar bowing (PB) of the flexor retinaculum. Sensitivity and specificity of ultrasonographic measurements were evaluated and ultrasonographic data from the symptomatic and control hands were compared to the grade of electrodiagnostic and clinical severity. Results The mean CSA was 13.7±4.2 mm2 in symptomatic hands and 7.9±1.3 mm2 in asymptomatic hands. The mean FR was 4.2±1.0 in symptomatic hands and 3.4±0.4 in asymptomatic hands. The mean PB was 3.5±0.5 mm in symptomatic hands and 2.6±0.3 mm in asymptomatic hands. Statistical analysis showed differences of the mean CSA, FR and PB between groups were significant. A cut-off value of 10 mm2 for the mean CSA was found to be the upper limit for normal value. Both the mean CSA and PB are correlated with the grade of electrophysiological abnormalities and clinical severity, respectively. Conclusion Ultrasographic measurement of the CSA and PB is helpful to diagnose CTS as a non-invasive and an alternative modality for the evaluation of CTS. In addition, ultrasonography also provides a reliable correlation with the grade of electrodiagnostic abnormalities and clinical severity.
Kim, Min-Kyu; Jeon, Hong-Jun; Park, Dong-Sik; Nam, Hee-Seung
Examines observations and research on question-answer interaction between client and therapist, and teacher and student. Discusses Patton's six-question instrument which provides categories of question options, with application for the art therapist. Argues that effective formulation of questions provides the clinician, educator, and researcher…
This web page describes the comprehension strategy of Question the Author (QtA), a strategy in which students pose questions while reading nonfiction text. Students pose questions about the author's purpose in including certain phrases or forms of information while reading. Sample questions are provided in a three-step instructional sequence. References are included.
This tool from the National Center for Educational Statistics provides assessment questions used on the NAEP since 1990. Question searches may be limited by subject, grade, year, or type. Questions returned show their assessed difficulty and the percentage of students that answered correctly. Additionally, each question gives its scoring guide, a sample of student responses, and scoring demographics.
Tool, Naep A.
From a very young age, children actively strive to make sense of their world through constant questioning. The ability to ask questions comes naturally for young children, but such natural inclination does not continue because it teachers who ask most of the questions. Sheena Hervey suggests that teaching students how to pose questions is a…
Athletes frequently injure their hips and core muscles. Accurate diagnosis and proper treatment of groin pain in the athlete can be tricky, frequently posing vexing problem for trainers and physicians. Clinical presentations of the various hip problems overlap with respect to history and physical examination. This article reviews clinical presentations and magnetic resonance imaging findings specific to the various causes of groin pain in the athlete. The focus is on the core muscle injuries (athletic pubalgia or "sports hernia"). The goal is to raise awareness about the variety of injuries that occur and therapeutic options. PMID:23773876
Palisch, Andrew; Zoga, Adam C; Meyers, William C
Background: Evaluated trajectories of adolescent depression and their correlates in a longitudinal study of a community sample: early onset (by age 15) with major depression (MDE) recurrence between 15 and 20; early onset with no recurrence; later onset of major depression after age 15 with and without recurrence by 20; and never-depressed.…
Hammen, Constance; Brennan, Patricia A.; Keenan-Miller, Danielle; Herr, Nathaniel R.
Previous studies suggested that sleep apnea is associated with neurocognitive impairments but did not examine populations most likely to have clinically relevant impairments. Cross-sectional, retrospective analyses were performed on 108 patients (65 with mild cognitive impairment, 43 with dementia) seen in an academic medical center. Results indicated that severity of oxygen desaturation was associated with cognitive impairments in attention and
Karim Yamout; Felicia C. Goldstein; James J. Lah; Allan I. Levey; Donald L. Bliwise
The aims were to assess dysautonomia in Alzheimer's Disease (AD), clinically and electrophysiologically, using sympathetic skin response (SSR) test and R-R interval variation (RRIV) test and to analyze the relationship between symptoms of dysautonomia and SSR/RRIV results. A tota of 54 patients with AD and 37 controls were evaluated using Autonomic Symptoms Questionnaire and SSR/RRIV test. Clinical dysautonomia was observed in 66% of patients (eg, orthostatic hypotension in 34.5%, constipation in 17.2%, urinary incontinence in 13.8%). The SSR test was abnormal in 26%, but the RRIV test was abnormal in 97.7% of cases; there was significant difference in RRIV test results between AD and controls (R mean 8.05% and 14.6%, respectively). In AD, clinical dysautonomia occurs at a various degree, and the abnormal SSR and RRIV test results were not always related to the presence of clinical dysautonomia; this observation points that the tests could be used as a useful tool in the assessment of subclinical dysautonomia. PMID:23007287
Zakrzewska-Pniewska, Beata; Gawel, Malgorzata; Szmidt-Salkowska, Elzbieta; Kepczynska, Katarzyna; Nojszewska, Monika
The clinical data, histologic findings, and computed tomographic (CT) abnormalities in eight adult Haitians with toxoplasma encephalitis were analyzed retrospectively. Diagnosis was established by identification of Toxoplasma gondii on autopsy in five and brain biopsy in three specimens and subsequently confirmed by the immunoperoxidase method. All these patiens, six of whom had been in the United States for 24 months
M. J. D. Post; J. C. Chan; G. T. Hensley; T. A. Hoffman; L. B. Moskowitz; S. Lippmann
AIM: To investigate the clinical implications of lipid deposition in the pancreas (fatty pancreas). METHODS: The subjects of this study were 293 patients who had undergone abdominal computed tomography (CT) and sonography. Fatty pancreas was diagnosed by sonographic findings and subdivided into mild, moderate, and severe fatty pancreas groups comparing to the retroperitoneal fat echogenicity. RESULTS: Fatty pancreas was associated
Jun Seok Lee; Sang Heum Kim; Dae Won Jun; Jee Hye Han; Eun Chul Jang; Ji Young Park; Byung Kwan; Seong Hwan Kim; Yoon Ju Jo; Yong Soo Kim
ObjectivesTo analyze the expression levels of Ki-67 and gelsolin in renal cell carcinoma (RCC) and determine their prognostic value in association with other clinicopathologic factors using tissue microarray technology. Histologic nuclear grade, performance status, and clinical stage are important prognostic factors in RCC. Because patients with tumors of similar grade, performance status, and stage may show a wide variation in
Harri Visapää; Matthew Bui; Yunda Huang; David Seligson; Henry Tsai; Allan Pantuck; Robert Figlin; Jian Y. u Rao; Arie Belldegrun; Steve Horvath; Aarno Palotie
In the last few years, new drugs for the treatment of schizophrenia have been introduced in therapy which have noticeably improved the quality of life of many schizophrenic patients. These new "atypical" drugs have chemical, pharmacological and clinical properties which are different from those of the classical neuroleptics. The most used drugs among the "atypical" antipsychotics are clozapine, olanzapine, quetiapine and risperidone. Despite several differences in their pharmacokinetic and pharmacodynamic profiles, they show some common properties: e.g. they don't cause extrapyramidal side effects, and they are active against the negative as well as positive symptoms of schizophrenia. The need for clinical monitoring of patients undergoing therapy is still evident because the onset of side effects is often related to high plasma concentrations of the drug. The clinical monitoring of patients can significantly improve the knowledge of pharmacological interactions among different CNS drugs, as well as enhance the compliance of the patients, thus leading to higher treatment efficacy. In order to carry out efficient clinical monitoring, reliable analytical methods are needed to determine the analytes even at very low concentrations and in the presence of other drugs. For this purpose, analytical techniques such as gas or liquid chromatography are often used coupled with sensitive and selective means of detection, such as fluorimetric, electrochemical or mass spectrometry detectors. The most recent studies on the determination of atypical antipsychotics will be reviewed in addition to the issue of sample pretreatment which is a critical step when the analysis of biological fluids is concerned. PMID:12143799
Raggi, M A
Objectives. This study sought to investigate the clinical characteristics of patients with chronic heart failure and an increased ventilatory response to exercise and to examine the prognostic usefulness of this response.Background. The ventilatory response to exercise is increased in many patients with chronic heart failure and may be characterized by the regression slope relating minute ventilation to carbon dioxide output
Tuan Peng Chua; Piotr Ponikowski; Derek Harrington; Stefan D Anker; Katharine Webb-Peploe; Andrew L Clark; Philip A Poole-Wilson; Andrew J. S Coats
The aetiology of anal squamous cell carcinoma (SCC) has recently been associated with a sexually transmissible agent — human papillomavirus (HPV) type 16. In this study clinical and pathological data from a prospective series of 67 anal SCC collected over a three year period were compared with the HPV type 16 DNA content of these tumours to determine whether any
J. H. Scholefield; J. G. Palmer; N. A. Shepherd; S. Love; K. J. Miller; J. M. A. Northover
BACKGROUND: A definition of disease activity in ulcerative colitis (UC) is difficult. The clinical activity index (CAI) is only an indirect assessment tool of bowel inflammation and the endoscopic activity index (EAI) sometimes cannot reflect the severity of disease to the full extent. Therefore, there is a need for an objective means to quantify inflammatory activity in mucosal biopsies. In
Alexandra Zahn; Thomas Giese; Max Karner; Annika Braun; Ulf Hinz; Wolfgang Stremmel; Robert Ehehalt
In the Sturge-Weber syndrome facial venous and leptomeningeal angiomas are associated. We studied 14 consecutive cases with clinical and radiological evaluations [computed tomography (CT) and magnetic resonance imaging (MRI)]. Radiological studies demonstrated the extent and patency of the leptomeningeal angiomatous malformation, the degree of parenchymal atrophy, the presumed ischemic changes affecting the gray and white matter, the presence and extent
L. Martí-Bonmatí; F. Menor; F. Mulas
In spring, windblown dust storms originating in the deserts of Mongolia and China head toward Taipei city. These occurrences are known as Asian dust storm (ADS) events. The objective of this study was to assess the possible associations of ADS on the daily clinical visits for allergic rhinitis of residents in Taipei, Taiwan, during the period 1997–2001. Forty-nine dust storms
Chih-Ching Chang; I-Ming Lee; Shang-Shyue Tsai; Chun-Yuh Yang
This paper reviews the recent advances in knowledge of brainstem mechanisms related to craniofacial pain. It also draws attention to their clinical implications, and concludes with a brief overview and suggestions for future research directions. It first describes the general organizational features of the trigeminal brainstem sensory nuclear complex (VBSNC), including its input and output properties and intrinsic characteristics that
Barry J. Sessle
Thirty overweight patients with clinically characterized and biopsy proven nonalcoholic steatohepatitis (NASH) were enrolled in a 48-week treatment trial with rosiglitazone, a peroxisome proliferator-activator receptor (PPAR)-? agonist that enhances insulin sensitivity. Improvement in laboratory liver tests, insulin resistance and liver fat content were documented; blinded biopsy review demonstrated decreases in necroinflammatory activity or grade and in individual components of grade,
Elizabeth M. Brunt; Brent A. Neuschwander-Tetri; Dana Oliver; Kent R. Wehmeier; Bruce R. Bacon
Prion diseases are fatal neurodegenerative disorders causing motor dysfunctions, dementia and neuropathological changes such as spongiosis, astroglyosis and neuronal loss. The chain of events leading to the clinical disease and the role of distinct brain areas are still poorly understood. The role of nervous system integrity and axonal properties in prion pathology are still elusive. There is no evidence of
Vladimir Ermolayev; Toni Cathomen; Julia Merk; Mike Friedrich; Wolfgang Härtig; Gregory S. Harms; Michael A. Klein; Eckhard Flechsig
Objectives Traditional clinical risk factors are associated with inflammation cross-sectionally, but associations of longitudinal variation in inflammatory biomarkers with corresponding changes in clinical risk factors are incompletely described. We sought to analyze clinical factors associated with change in inflammation in the community. Methods We studied 3013 Framingham Offspring (n = 2735) and Omni Cohort (n = 278) participants (mean age 59 years, 55% women, 9% ethnic/racial minority) who attended two consecutive examination cycles (mean 6.7 years apart). We selected ten inflammatory biomarkers representing distinctive biological functions: C-reactive protein (CRP), intercellular adhesion molecule-1, interleukin-6, isoprostanes, lipoprotein-associated phospholipase-2 (Lp-PLA2) activity, Lp-PLA2-mass, monocyte chemoattractant protein-1, osteoprotegerin, P-selectin, and tumor necrosis factor receptor II (TNFRII). We constructed multivariable-adjusted regression models to assess the relations of baseline, follow-up and change in clinical risk factors with change in biomarker concentrations over time. Results Baseline, follow-up and change in clinical risk factors explain a moderate amount of the variation in biomarker concentrations across 2 consecutive examinations (ranging from r2 = 0.28 [TNFRII] up to 0.52 [Lp-PLA2-mass]). In multivariable models, increasing body-mass index, smoking initiation, worsening lipid profile, and increasing waist size were associated with increasing concentrations of several biomarkers. Conversely, hypercholesterolemia therapy and hormone replacement cessation were associated with decreasing concentrations of biomarkers such as CRP, Lp-PLA2-mass and activity. Conclusion Cardiovascular risk factors have different patterns of association with longitudinal change in inflammatory biomarkers and explain modest amounts of variability in biomarker concentrations. Nevertheless, a substantial proportion of longitudinal change in inflammatory markers is not explained by traditional risk factors.
Fontes, Joao D.; Yamamoto, Jennifer F.; Larson, Martin G.; Wang, Na; Dallmeier, Dhayana; Rienstra, Michiel; Schnabel, Renate B.; Vasan, Ramachandran S.; Keaney, John F.; Benjamin, Emelia J.
The PET tracer O-(2-[18F]Fluoroethyl)-l-tyrosine (FET) has been shown to be valuable for different roles in the management of brain tumours. The aim of this study was to evaluate several quantitative measures of dynamic FET PET imaging in patients with resected glioblastoma. We evaluated dynamic FET PET in nine patients with histologically confirmed glioblastoma. Following FET PET, all subjects had radiation and chemotherapy. Tumour ROIs were defined by a threshold-based region-growing algorithm. We compared several standard measures of tumour uptake and uptake kinetics: SUV, SUV/background, distribution volume ratio (DVR), weighted frame differences and compartment model parameters. These measures were correlated with disease-free and overall survival, and analysed for statistical significance. We found that several measures allowed robust quantification. SUV and distribution volume did not correlate with clinical outcome. Measures that are based on a background region (SUV/BG, Logan-DVR) highly correlated with disease-free survival (r = -0.95, p < 0.0001), but not overall survival. Some advanced measures also showed a prognostic value but no improvement over the simpler methods. We conclude that FET PET probably has a prognostic value in patients with resected glioblastoma. The ratio of SUV to background may provide a simple and valuable predictive measure of the clinical outcome. Further studies are needed to confirm these explorative results.
Thiele, Frank; Ehmer, Julia; Piroth, Marc D.; Eble, Michael J.; Coenen, Heinz H.; Kaiser, Hans-Juergen; Schaefer, Wolfgang M.; Buell, Ulrich; Boy, Christian
The aim of this study was to evaluate psychometric properties and clinical correlates of the Weight Bias Internalization Scale (WBIS) in a sample of obese adolescents seeking bariatric surgery. Sixty five adolescents enrolled in a bariatric surgery program at a large, urban medical center completed psychiatric evaluations, self-report questionnaires including the WBIS and other measures of psychopathology and physical assessments. The WBIS had high internal consistency (Cronbach’s ? = .92). As in previous research with adults, the one underlying factor structure was replicated and 10 of the original 11 items were retained. The scale had significant partial correlations with depression (r = .519), anxiety (r = .465), social and behavioral problems (r = .364), quality of life (r = ?.480), and eating (r = .579), shape (r = .815), and weight concerns (r = .545), controlling for body mass index. However, WBIS scores did not predict current or past psychiatric diagnosis or treatment or past suicidal ideation. Overall, the WBIS had excellent psychometric properties in a sample of obese treatment-seeking adolescents and correlated significantly with levels of psychopathology. These findings suggest that the WBIS could be a useful tool for healthcare providers to assess internalized weight bias among treatment-seeking obese youth. Assessment of internalized weight bias among this clinical population has the potential to identify adolescents who may benefit from information on coping with weight stigma which in turn can augment weight loss efforts.
Roberto, Christina A.; Sysko, Robyn; Bush, Jennifer; Pearl, Rebecca; Puhl, Rebecca M.; Schvey, Natasha A.; Dovidio, John F.
Current concepts of the pathogenesis of sarcoidosis suggest that the alveolitis of this disorder is related to increased numbers of mononuclear phagocytes and activated T-lymphocytes within the lung. To determine if 67Ga scanning, a procedure commonly used in the evaluation of inflammation, would be useful in staging the alveolitis of sarcoidosis, researchers studied 41 patients with this disorder and correlated estimates of pulmonary /sup 67/Ga accumulation with clinical, roentgenographic, physiologic, and bronchoalveolar lavage studies in these patients. Although 65% of patients with sarcoidosis showed increased amounts of /sup 67/Ga accumulation in the lung compared with control subjects, only weak correlations (r less than +/- 0.42, all comparisons) were found between the degree of gallium uptake and the clinical, roentgenographic, or physiologic data. In contrast, there was a strong correlation of /sup 67/Ga uptake and the number of lymphocytes and T-lymphocytes recovered from the lungs of these patients by bronchoalveolar lavage (p less than 0.0001, r greater than or equal to 0.67, both comparisons). This data suggested that gallium uptake reflects the intensity of the T-lymphocytes mediated component of the alveolitis in sarcoidosis. Because /sup 67/Ga scans are noninvasive, simple to perform, and widely available, they should prove useful to stage the activity of sarcoidosis and to make decisions regarding therapy directed against the alveolitis of the disease.
Line, B.R.; Hunninghake, G.W.; Keogh, B.A.; Jones, A.E.; Johnston, G.S.; Crystal, R.G.
Current concepts of the pathogenesis of sarcoidosis suggest that the alveolitis of this disorder is related to increased numbers of mononuclear phagocytes and activated T-lymphocytes within the lung. To determine if 67Ga scanning, a procedure commonly used in the evaluation of inflammation, would be useful in staging the alveolitis of sarcoidosis, we studied 41 patients with this disorder and correlated estimates of pulmonary 67Ga accumulation with clinical, roentgenographic, physiologic, and bronchoalveolar lavage studies in these patients. Although 65% of patients with sarcoidosis showed increased amounts of 67Ga accumulation in the lung compared with control subjects, only weak correlations (r less than +/- 0.42, all comparisons) were found between the degree of gallium uptake and the clinical, roentgenographic, or physiologic data. In contrast, there was a strong correlation of 67Ga uptake and the number of lymphocytes and T-lymphocytes recovered from the lungs of these patients by bronchoalveolar lavage (p less than 0.0001, r greater than or equal to 0.67, both comparisons). This data suggested that gallium uptake reflects the intensity of the T-lymphocytes mediated component of the alveolitis in sarcoidosis. Because 67Ga scans are noninvasive, simple to perform, and widely available, they should prove useful to stage the activity of sarcoidosis and to make decisions regarding therapy directed against the alveolitis of the disease.
Line, B.R.; Hunninghake, G.W.; Keogh, B.A.; Jones, A.E.; Johnston, G.S.; Crystal, R.G.
Purpose The blood neutrophil to lymphocyte ratio (NLR) has been identified as a potentially useful marker of clinical outcome in disease states with an inflammatory component. The objective of this study was to evaluate the relationship between NLR and clinical status in children with cystic fibrosis. Methods This was a retrospective chart review. Data collected included NLR, body mass index, and forced expiratory volume in 1 second (FEV1) while asymptomatic, and during hospitalizations for pulmonary exacerbation. An NLR breakpoint of 3 was used for comparisons of body mass index and FEV1. Results A total of 159 charts were reviewed. An NLR ? 3 was significantly associated with lower body mass index and lower FEV1. NLR during hospitalization was significantly higher than NLR while asymptomatic. NLR measured during the first 3 months of life was negatively correlated with FEV1 at age 12. Conclusion NLR correlates with clinical status in children with cystic fibrosis and may be a useful biomarker in this population.
O'Brien, Catherine E.; Price, Elvin T.
OBJECTIVE—To determine non-invasively the relation between the degree of axonal loss and the extent of demyelination in chronic lesions visible on MRI in patients with different subgroups of clinically definite multiple sclerosis using 1H magnetic resonance spectroscopy (1H MRS) and magnetisation transfer imaging (MT). Conventional MRI is unable to differentiate between the various pathological processes occurring in the multiple sclerosis lesion. There are, however, newer MR techniques which show promise in this respect.?METHODS—1H MRS and MT were performed in 18 patients with clinically definite multiple sclerosis who had a wide range of disability and disease duration.?RESULTS—A significant correlation was found between a reduction in the concentration of N-acetyl aspartate (NAA; an in vivo marker of axonal loss or dysfunction) and a reduction in MT ratio (a probable marker of demyelination) in patients who had entered the secondary progressive stage of the disease. Patients with minimal disability after a disease duration of greater than 10years—so called benign multiple sclerosis—showed a relative preservation of NAA and MT.?CONCLUSIONS—Because a reduction in MT seems to be a relative marker for demyelination and a reduction of NAA from chronic lesions is indicative of axonal loss, this study supports the hypothesis that demyelination and axonal loss occur in the same chronic multiple sclerosis lesions. In addition, the degree of axonal loss and demyelination correlates with clinical heterogeneity.??
Davie, C; Silver, N; Barker, G; Tofts, P; Thompson, A; McDonald, W; Miller, D
The whole spectrum of chromosomal abnormalities and their prognostic significance in children and adolescents with acute myeloid leukemia (AML) has not been fully elucidated yet, although a considerable amount of knowledge has been gained recently. Moreover, the incidence and prognostic impact of monosomal karyotypes (MKs), which are new cytogenetic categories reported recently in adults with AML, are currently unknown for childhood and adolescent AML. In this study, we investigated the cytogenetic and clinical characteristics of 140 children and adolescents (?21 y) with AML, and correlated their cytogenetic features with both the clinical characteristics and outcomes of our patient cohort. The most frequent cytogenetic abnormality found in our study was the t(15;17), followed by the t(8;21). Striking differences in the genetic abnormalities and French-American-British subtypes were found among infants, children, and adolescents. Of 124 cases, 15 (12.1%) met the criteria of the MK definition, and 12 of the 15 MKs (80%) were complex karyotypes. Of 124 cases, 27 (21.8%) had cytogenetic abnormalities sufficient to be diagnosed as AML with myelodyspastic sydrome-related features. As expected, patients with the t(15;17) had the most favorable outcomes, whereas patients with 11q23 rearrangements and monosomy 7 had the worst outcomes. These data expand our knowledge by providing novel insights into the cytogenetic features and their correlations with clinical characteristics and outcomes in childhood and adolescent AML. PMID:23411131
Manola, Kalliopi N; Panitsas, Fotios; Polychronopoulou, Sophia; Daraki, Aggeliki; Karakosta, Maria; Stavropoulou, Cryssa; Avgerinou, Georgia; Hatzipantelis, Emmanuel; Pantelias, Gabriel; Sambani, Constantina; Pagoni, Maria
The reviews by Rogers, Sewell, Harrison, and Jordan (2006/this issue), and by Nichols (2006/this issue) offer markedly contrasting appraisals of the MMPI-2 Restructured Clinical (RC) Scales introduced by Tellegen et al. (2003). The one common feature is that both reviews draw on the same atypical MMPI-2 (Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) data set for their empirical analyses, with results warranting critical scrutiny. Rogers et al.'s critique provides an evaluation of the RC Scales from the perspective of Jackson's (1970) method of test development. One significant issue in Rogers et al.'s review concerns social desirability, prompting us to clarify our own views on this topic. We also highlight and discuss problems associated with Rogers et al.'s use of the unrepresentative data set. Nichols's polemical critique neglects empirical and theoretical support for demoralization as a central construct and misconstrues as "construct drift" the purposeful process of developing the RC scales. Nichols's criticisms and proposals overlook requirements for assessing syndromes and for construct validation and even rudiments of scale development. Our reply incorporates evidence, including new findings, refuting his criticisms and confirming that demoralization is a pervasive MMPI dimension, that the RC Scales capture the major distinctive features of the original Clinical Scales, and that they generate correspondingly meaningful validity patterns. PMID:16972818
Tellegen, Auke; Ben-Porath, Yossef S; Sellbom, Martin; Arbisi, Paul A; McNulty, John L; Graham, John R
Myofibroblasts provide a force to decrease the surface area of breast implant capsules as the collagen matrix matures. 17-?-Oestradiol promotes myofibroblast differentiation and contraction. The aim of the study was to investigate the expression of oestrogen receptors ? and ? in capsular tissue. The study enrolled 70 women (80 capsules) who underwent expander or implant removal, following breast reconstruction. Specimens were stained with haematoxylin/eosin, Masson trichrome and immunohistochemistry and immunofluorescence stainings for alpha-smooth muscle actin (?-SMA), oestrogen receptor-alpha (ER-?) and oestrogen receptor-beta (ER-?). The relationship between anti-oestrogenic therapy and capsular severity was evaluated. A retrospective analysis of 233 cases of breast reconstruction was conducted. Myofibroblasts expressed ER-?, ER-? or both. In the whole sample, ?-SMA score positively correlated with ER-? (p = 0.022) and ER-? expression (p < 0.004). ER-? expression negatively correlated with capsular thickness (p < 0.019). In capsules surrounding expanders ?-SMA and ER-?, expressions negatively correlated with time from implantation (p = 0.002 and p = 0.016, respectively). The incidence of grade III-IV contracture was higher in patients who did not have anti-oestrogenic therapy (p < 0.036); retrospective analysis of 233 cases confirmed this finding (p < 0.0001). This study demonstrates the expression of oestrogen receptors in myofibroblasts of capsular tissue. A lower contracture severity was found in patients who underwent anti-oestrogenic therapy. PMID:24389289
Persichetti, Paolo; Segreto, Francesco; Carotti, Simone; Marangi, Giovanni Francesco; Tosi, Daniele; Morini, Sergio
Abstract Objectives. To investigate the relationship between enthesitis and disease activity, functional status, fatigue, joint mobility, radiological damage, laboratory parameter and quality of life in patients with ankylosing spondylitis (AS). Methods. A total of 421 patients with AS (323 male and 98 female) who were included in the Turkish League Against Rheumatism Registry were enrolled in the study. The Bath AS Disease Activity Index (BASDAI), fatigue, the Bath AS Functional Index (BASFI), the Bath AS Metrology Index (BASMI), the Maastricht AS Enthesitis Score (MASES), AS quality of life (ASQoL), the Bath AS Radiology Index (BASRI) and erythrocyte sedimentation rate (ESR) were evaluated. Results. Enthesitis was detected in 27.3% of patients. There were positive correlations between MASES and BASDAI, BASFI and fatigue (p < 0.05). MASES was not correlated with BASRI, BASMI, ASQoL and ESR. The mean MASES score was 1.1 ± 2.4. The most frequent regions of enthesopathies were right iliac crest, spinous process of L5 and proximal to the insertion of left achilles tendon, respectively. Conclusions. Enthesitis was found to be associated with higher disease activity, higher fatigue, worse functional status and lower disease duration. As enthesitis was correlated with BASDAI, we conclude that enthesitis can reflect the disease activity in patients with AS. PMID:24252034
Rezvani, Aylin; Bodur, Hatice; Ataman, Sebnem; Kaya, Taciser; Bu?dayc?, Derya Soy; Demir, Saliha Ero?lu; Koçyi?it, Hikmet; Altan, Lale; U?urlu, Hatice; K?rnap, Mehmet; Gür, Ali; Kozano?lu, Erkan; Ak?nc?, Ay?en; Tekeo?lu, Ibrahim; Sahin, Gün?ah; Bal, Ajda; Sivrio?lu, Konçuy; Yazgan, Pelin; Ayd?n, Gülümser; Hepgüler, Simin; Olmez, Ne?e; Sendur, Omer Faruk; Yener, Mahmut; Altay, Zühal; Ayhan, Figen; Durmu?, O?uz; Duruöz, Mehmet Tuncay; Günendi, Zafer; Nac?r, Bar??; Oken, Oznur; Tokta?, Hasan; Delialio?lu, Sibel Ünsal; Evcik, Deniz; Sertpoyraz, Filiz Meryem
The histologic characteristics that are the basis for diagnosis of central nervous system conditions cannot be visualized directly using magnetic resonance (MR) methods, but clinical diagnosis may be based on the frequency and pattern of MR imaging signs, which represent predominantly the gross morphologic features of lesions. Additional quantitative MR measures of myelination, cell swelling, gliosis, and neuronal loss may also be used for more specific characterization of lesions. These measures include magnetization transfer ratio, apparent diffusion coefficient, and the concentrations or ratios of metabolites identified by spectroscopy. Confidence that an MR abnormality is responsible for the clinical signs depends primarily on the degree of correspondence between the site of the lesion and the neuroanatomical localization.
Vite, Charles H.; Cross, Johnny R.
The HLA haplotype and its relationships with clinical, biological and immunological parameters were analyzed in a group of 87 Spanish type 1 diabetic patients at the clinical onset of the disease. The frequency of HLA-B18, DR3 and DR4 antigens was significantly increased whereas DR2, DR5 and DR7 were decreased in comparison with 189 healthy unrelated controls without family history of diabetes. DR3 showed a maximum relative risk for diabetes (5.5) whereas DR4 had a lower one (4.0). HLA-DR4 patients were younger at the time of diagnosis than DR4 negative (16.7 vs 21.4 years). We found no statistically significant relationship between HLA antigens and the other variables studied including the presence of islet cell antibodies, complement fixing islet cell antibodies, insulin autoantibodies, organ-specific antibodies, fasting and maximal glucagon stimulated C-peptide levels, initial glycemia and glycosylated hemoglobin. PMID:2075784
Goday, A; Motaña, E; Ercilla, G; Fernandez, J; Gomis, R; Vilardell, E
The 2011 Pennington Biomedical Research Center's Scientific Symposium focused on adiposity in children and adolescents. The symposium was attended by 15 speakers and other invited experts. The specific objectives of the symposium were to (i) integrate the latest published and unpublished findings on the laboratory and clinical assessment of depot-specific adiposity in children and adolescents, (ii) understand the variation in depot-specific adiposity and related health outcomes associated with age, sex, maturation, ethnicity and other factors and (iii) identify opportunities for incorporating new markers of abdominal obesity into clinical practice guidelines for obesity in children and adolescents. This symposium provided an overview of important new advances in the field and identified directions for future research. The long-term goal of the symposium is to aid in the early identification of children and adolescents who are at increased health risk because of obesity and obesity-related conditions. PMID:22911903
Katzmarzyk, P T; Shen, W; Baxter-Jones, A; Bell, J D; Butte, N F; Demerath, E W; Gilsanz, V; Goran, M I; Hirschler, V; Hu, H H; Maffeis, C; Malina, R M; Müller, M J; Pietrobelli, A; Wells, J C K
Objective We conducted a retrospective investigation of potential clinical, demographic, and neuropsychological risk factors for suicide attempts in patients diagnosed with bipolar disorder. Method Participants included 67 adult inpatients and outpatients aged 18–60 years meeting DSM-IV criteria for bipolar disorder (bipolar I and II disorders, bipolar disorder not otherwise specified). We assessed demographic factors, mood symptoms, psychosis, trauma history, trait impulsivity, trait aggression, and reasons for living. The primary outcome measures were the Barratt Impulsiveness Scale-version II, Aggression Questionnaire, and 10 cognitive outcome variables. The cognitive outcome variables assessed cognitive performance across several domains, including processing speed, attention, verbal learning, and executive function. Another aspect of cognitive function, decision making, was assessed using the Iowa Gambling Task. The study was conducted from July 2007–July 2009. Results We found that nonattempters reported significantly higher trait impulsivity scores on the Barratt Impulsiveness Scale compared to attempters (t57 = 2.2, P = .03) and that, among attempters, lower trait impulsivity score was associated with higher scores of lethality of prior attempts (r25 = ?0.53, P = .01). Analyses revealed no other group differences on demographic, clinical, or neurocognitive variables when comparing attempters versus nonattempters. Regression models failed to identify any significant predictors of past suicide attempt. Conclusions The largely negative results of our study are particularly important in highlighting the clinical dilemma faced by many clinicians when trying to predict which patients will make serious suicide attempts and which patients are at a lower risk for acting on suicidal thoughts. A limitation of our work is that we examined stable trait measures of impulsivity among a euthymic sample rather than mood state or the impact of mood state on traits. Overall, we conclude that suicidal behavior is extremely difficult to predict, even when comprehensive clinical and neurocognitive information is available.
Gilbert, Alison M.; Garno, Jessica L; Braga, Raphael J.; Shaya, Yaniv; Goldberg, Terry E.; Malhotra, Anil K.; Burdick, Katherine E.
Adenosine is an endogenous purine metabolite whose concentration in human blood plasma rises from nanomolar to micromolar during stress or hypoxia. Leukocytes express seven-transmembrane adenosine receptors whose engagement modulates Toll-like receptor-mediated cytokine responses, in part via modulation of intracellular cyclic adenosine monophosphate (cAMP). Adenosine congeners are used clinically to treat arrhythmias and apnea of prematurity. Herein we consider the potential of adenosine congeners as innate immune response modifiers to prevent and/or treat infection.
Coombs, Melanie R. Power; Belderbos, Mirjam E.; Gallington, Leighanne C.; Bont, Louis; Levy, Ofer
Hemophilus influenzae septicemia is an important cause of life-threatening pneumonia in an immunocompromised patient. Eleven cases proved by blood culture were analyzed. Multilobar involvement with lobar or segmental consolidation pleural effusion were common radiographic findings, but there wer