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  1. Writing clinical scenarios for clinical science questions.

    PubMed

    Smith, Phil Em; Mucklow, John C

    2016-04-01

    Written knowledge assessments for physicians in training typically involve multiple-choice questions that use a clinical scenario in a single-best-answer format. The Royal College of Physicians Part 1 MRCP(UK) examination includes basic sciences themes that are challenging to assess through a clinical scenario. A realistic clinical setting based on everyday clinical practice and integral to the question is the clearest demonstration that the knowledge being assessed is clinically relevant. However, without special attention to detail, the scenario in a clinical science question can appear redundant or artificial. Reading unnecessary material frustrates candidates and threatens the reputation of the assessment. In this paper we discuss why a clinical scenario is important for basic science questions and offer advice on setting realistic and plausible clinical scenarios for such questions. PMID:27037383

  2. Answers to common clinical questions.

    PubMed

    Bowman, Marjorie A; Neale, Anne Victoria

    2012-01-01

    Again, we present a rich issue with great information to address common clinical questions. A common class of drug (proton pump inhibitors) and insufficiently common diet (high fiber content) are related to improved diabetes control. Four good health habits make a huge difference, especially for obese patients. Meaningful use is just not always that meaningful. Computed tomography scans for common chest complaints probably are overused in emergency rooms. Continuous insurance is important to receipt of prevention services, even for those with access to care when they do not have insurance. Practice-based research can be difficult to accomplish, yet can yield some good results--in this case, improved colon cancer screening rates. Consider hyperaldosteronism in patients with resistant hypertension. Reflect on the mistakes other family physicians report; we often learn from others' mistakes. Surgical mesh migration can cause many things, but would you guess it would cause symptoms of irritable bowel syndrome? A nice primer on what is known about chemoprevention of prostate cancer. And, how to influence care outcomes: high-leverage, not just measurable, activities. PMID:22218615

  3. Matching research design to clinical research questions

    PubMed Central

    Aslam, Sadaf; Georgiev, Helen; Mehta, Kedar; Kumar, Ambuj

    2012-01-01

    The importance of randomized controlled trials (RCTs) versus observational studies has been debated for several years. However, the question is not whether RCTs are better than observational study designs. RCTs certainly provide the most unbiased answers in scenarios where it is logistically and ethically feasible to conduct both RCTs and observational studies. That is, study design is not a choice but a function of matching the research question to provide the most unbiased answers. The basic concept that underpins every clinical research project is the requirement of a clearly defined research question domain. Broadly, the clinical research question domain relates to prognosis, diagnostic accuracy, treatment or adverse events. While RCTs provide the most unbiased answers on questions related to the efficacy of treatments, other designs are better suited to answer questions related to prognosis or diagnostic accuracy of tests. In this paper, we illustrate the significance of matching study design to the research question domain while using clinical scenarios as an example. Although there are several other question domains that also concern the practice of medicine, we are only focusing on study designs concerning the issue of prognosis and diagnostic accuracy in this paper. PMID:22529457

  4. Matching research design to clinical research questions.

    PubMed

    Aslam, Sadaf; Georgiev, Helen; Mehta, Kedar; Kumar, Ambuj

    2012-01-01

    The importance of randomized controlled trials (RCTs) versus observational studies has been debated for several years. However, the question is not whether RCTs are better than observational study designs. RCTs certainly provide the most unbiased answers in scenarios where it is logistically and ethically feasible to conduct both RCTs and observational studies. That is, study design is not a choice but a function of matching the research question to provide the most unbiased answers. The basic concept that underpins every clinical research project is the requirement of a clearly defined research question domain. Broadly, the clinical research question domain relates to prognosis, diagnostic accuracy, treatment or adverse events. While RCTs provide the most unbiased answers on questions related to the efficacy of treatments, other designs are better suited to answer questions related to prognosis or diagnostic accuracy of tests. In this paper, we illustrate the significance of matching study design to the research question domain while using clinical scenarios as an example. Although there are several other question domains that also concern the practice of medicine, we are only focusing on study designs concerning the issue of prognosis and diagnostic accuracy in this paper. PMID:22529457

  5. Frequently Asked Questions about Clinical Research

    MedlinePlus

    ... Links for Patient Care Education All About the Human Genome Project Fact Sheets Genetic Education Resources for Teachers ... Research at NHGRI Clinical researchers at the National Human Genome Research Institute (NHGRI) are developing advanced methods for ...

  6. Developing Good Clinical Questions and Finding the Best Evidence to Answer Those Questions

    PubMed Central

    Burns, Patricia B.; Chung, Kevin C.

    2015-01-01

    Evidence based medicine (EBM) involves the integration of the best scientific evidence available with physician experience and patient preferences. One of the first steps in EBM involves developing a question based on issues encountered with patients or a disease and finding evidence to answer the question. This paper is a guide to plastic surgeons in how to begin the practice of EBM by developing clinical questions and finding evidence to answer these questions. PMID:20679843

  7. AskHERMES: An online question answering system for complex clinical questions

    PubMed Central

    Cao, YongGang; Liu, Feifan; Simpson, Pippa; Antieau, Lamont; Bennett, Andrew; Cimino, James J.; Ely, John; Yu, Hong

    2012-01-01

    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. PMID:21256977

  8. Clinical correlates with diaper dermatitis.

    PubMed

    Benjamin, L

    1987-01-01

    Three types of clinical studies were carried out to better understand diaper dermatitis in a general infant population. In 'snapshot' clinical studies, skin condition under the diaper was evaluated at a given point in time across a large base of infants. Correlations were sought between diaper dermatitis incidence and severity and a number of factors, including sex, diet, maturity, type of diaper, history of allergy, contact with fecal matter, presence of Candida albicans, and diaper change frequency. Severe diaper rash correlated strongly with the presence of C. albicans, and the frequency of rash correlated with duration of contact with feces and inversely with diaper change frequency. Diaper rash peaked at ages 9-12 months and was lower for breast-fed than for formula-fed infants. Exclusive use of disposable diapers correlated with lower rash levels than when some or all cloth diapers were used. In a longitudinal study, infants were observed daily for 50 days in order to determine the frequency and duration of rash episodes. In this study, the tendency for some infants to be rash-prone was clearly indicated. In a third type of study, over 10,000 infant visits to physicians' offices were used to record skin condition. Results showed a three-to fourfold increase in diaper rash if the child had diarrhea during the previous 48 h. PMID:3299331

  9. Clinical Correlations in Cerebral Palsy

    PubMed Central

    MINCIU, Ioana

    2012-01-01

    ABSTRACT Background: Cerebral palsy (CP) is a group of persistent (but not necessarily unchanged), movement, posture, muscle tone and motor skills disorders non-progressive, with early onset, due to non-progressive impairments, occurring on an immature brain or a brain under development (prenatal, perinatal, postnatal during the first 3-4 years of life). It is associated to a variable extent with: cognitive disorders, epilepsy, sensory deficits, behaviour disorders. Aim: The study of the correlations between the clinical forms/subtypes of CP, comorbidities, and severity of functional impairment. Material and method: It is a retrospective trial aimed only at patients with the diagnosis of cerebral palsy admitted at Paediatric Neurology Clinic of the "Alexandru Obregia" Clinical Hospital in 2010. Results, discussions and conclusions: Patients with cerebral palsy corresponding with the criteria for inclusion: 379. The spastic CP type has prevailed. Comorbidities like mental retardation, epilepsy, and ophthalmic disorders were found with greater frequency than in the studies in the literature. The unilateral spastic form was statistically correlated with slight functional impairment (GMFCS I), with the absence of comorbidities or mild mental retardation, or with focal epilepsy when there is epilepsy. The bilateral spastic, tetraparetic and dyskinetic forms were correlated significantly with severe functional impairment (GMFCS IV, V), with profound or severe retardation, microcephaly, swallowing disorders, statural, ponderal hypotrophy, blindness and epilepsy. The bilateral spastic paraparetic form, which in the literature is mentioned as having fewer associated disorders (for example strabismus, slight retardation), when there is severe functional impairment, it may have the same comorbidities as the tetraparetic form (similar to the cases studied in the hospital). Comorbidities are the main admission cause and it correlates with the severity and prognosis. PMID:23483832

  10. Respiratory microbiota: addressing clinical questions, informing clinical practice

    PubMed Central

    Rogers, Geraint B; Shaw, Dominick; Marsh, Robyn L; Carroll, Mary P; Serisier, David J; Bruce, Kenneth D

    2015-01-01

    Over the last decade, technological advances have revolutionised efforts to understand the role played by microbes in airways disease. With the application of ever more sophisticated techniques, the literature has become increasingly inaccessible to the non-specialist reader, potentially hampering the translation of these gains into improvements in patient care. In this article, we set out the key principles underpinning microbiota research in respiratory contexts and provide practical guidance on how best such studies can be designed, executed and interpreted. We examine how an understanding of the respiratory microbiota both challenges fundamental assumptions and provides novel clinical insights into lung disease, and we set out a number of important targets for ongoing research. PMID:25035125

  11. Republished: Respiratory microbiota: addressing clinical questions, informing clinical practice

    PubMed Central

    Rogers, Geraint B; Shaw, Dominick; Marsh, Robyn L; Carroll, Mary P; Serisier, David J; Bruce, Kenneth D

    2015-01-01

    Over the last decade, technological advances have revolutionised efforts to understand the role played by microbes in airways disease. With the application of ever more sophisticated techniques, the literature has become increasingly inaccessible to the non-specialist reader, potentially hampering the translation of these gains into improvements in patient care. In this article, we set out the key principles underpinning microbiota research in respiratory contexts and provide practical guidance on how best such studies can be designed, executed and interpreted. We examine how an understanding of the respiratory microbiota both challenges fundamental assumptions and provides novel clinical insights into lung disease, and we set out a number of important targets for ongoing research. PMID:26304986

  12. Correlation between Question Intonation and Focus of Interrogation--Evidence from French Dislocated Questions.

    ERIC Educational Resources Information Center

    Shen, Xiao-nan

    This study explores the relationship between question intonation patterns in French using dislocated questions and question-focus (Q- focus). A dislocated question is defined as an interrogative sentence whose sequence is interrupted by the topicalization of a constituent at the left ("Toi, tu viens?"), at the right (Tu viens, toi?"), or in the…

  13. Questioning Skills Demonstrated by Approved Clinical Instructors During Clinical Field Experiences

    PubMed Central

    Barnum, Mary G

    2008-01-01

    Context: The current trend in athletic training clinical education places greater emphasis on the quality of interactions occurring between Approved Clinical Instructors (ACIs) and athletic training students (ATSs). Among other attributes, the ability of ACIs to facilitate and direct quality clinical learning experiences may be influenced by the skill with which the ACI is able to use selected teaching strategies. Objective: To gain insight into ACIs' use of questioning as a specific teaching strategy during the clinical education experiences of undergraduate ATSs. Design: Qualitative case study design involving initial and stimulated-recall interviews, prolonged field observations, and audio recording of ACI-ATS interactions. Setting: The primary athletic training facility at one athletic training education program accredited by the Commission on Accreditation of Athletic Training Education. Patients or Other Participants: The 8 ACI participants included 3 full-time athletic training education program faculty members and 5 graduate-level assistants. The 24 ATS participants included 1 senior, 17 juniors, and 6 sophomores. Data Collection and Analysis: Transcribed data collected from 8 initial interviews, 23 field observations, 23 audio-recorded ACI-ATS interactions and 54 stimulated-recall interviews were analyzed through microscopic, open, and axial coding, as well as coding for process. The cognition level of questions posed by ACIs was analyzed according to Sellappah and colleagues' Question Classification Framework. Results: The ACI participants posed 712 questions during the 23 observation periods. Of the total questions, 70.37% were classified as low-level cognitive questions and 17.00% as high-level cognitive questions. The remaining 12.64% were classified as other. Conclusions: Although all ACIs used questioning during clinical instruction, 2 distinct questioning patterns were identified: strategic questioning and nonstrategic questioning. The way ACIs sequenced questions (their questioning pattern) appeared to be more important than the number of specific cognitive-level questions posed. Nonstrategic questioning appears to support knowledge and comprehension, whereas strategic questioning appears to support critical thinking. PMID:18523565

  14. The MiPACQ Clinical Question Answering System

    PubMed Central

    Cairns, Brian L.; Nielsen, Rodney D.; Masanz, James J.; Martin, James H.; Palmer, Martha S.; Ward, Wayne H.; Savova, Guergana K.

    2011-01-01

    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. PMID:22195068

  15. Questions

    ERIC Educational Resources Information Center

    Kuntz, Haley

    2007-01-01

    A canoe trip guide for young people gets used to the never-ending flow of questions. Kids are constantly inquiring about how many kilometres have been traveled that day, how many kilometres to go that day, what is for dinner, and when the next set of moving water is coming up. With kids, the questions are endless. Questions often are used as a…

  16. Herpes Zoster Vaccination: Controversies and Common Clinical Questions.

    PubMed

    Van Epps, Puja; Schmader, Kenneth E; Canaday, David H

    2016-01-01

    Herpes zoster, clinically referred to as shingles, is an acute, cutaneous viral infection caused by reactivation of the varicella zoster virus, the same virus that causes chickenpox. The incidence of herpes zoster and its complications increase with decline in cell-mediated immunity, including age-associated decline. The most effective management strategy for herpes zoster is prevention of the disease through vaccination in those who are most vulnerable. Despite the demonstrated efficacy in reducing the incidence and severity of herpes zoster, the uptake of vaccine remains low. Here, we will discuss the controversies that surround the live herpes zoster vaccine and address the common clinical questions that arise. We will also discuss the new adjuvanted herpes zoster vaccine currently under investigation. PMID:26184711

  17. Therapeutic Applications of Extracellular Vesicles: Clinical Promise and Open Questions

    PubMed Central

    Breakefield, Xandra O.; Leonard, Joshua N.

    2015-01-01

    This review provides an updated perspective on rapidly proliferating efforts to harness extracellular vesicles (EVs) for therapeutic applications. We summarize current knowledge, emerging strategies, and open questions pertaining to clinical potential and translation. Potentially useful EVs comprise diverse products of various cell types and species. EV components may also be combined with liposomes and nanoparticles to facilitate manufacturing as well as product safety and evaluation. Potential therapeutic cargoes include RNA, proteins, and drugs. Strategic issues considered herein include choice of therapeutic agent, means of loading cargoes into EVs, promotion of EV stability, tissue targeting, and functional delivery of cargo to recipient cells. Some applications may harness natural EV properties, such as immune modulation, regeneration promotion, and pathogen suppression. These properties can be enhanced or customized to enable a wide range of therapeutic applications, including vaccination, improvement of pregnancy outcome, and treatment of autoimmune disease, cancer, and tissue injury. PMID:25292428

  18. Therapeutic applications of extracellular vesicles: clinical promise and open questions.

    PubMed

    György, Bence; Hung, Michelle E; Breakefield, Xandra O; Leonard, Joshua N

    2015-01-01

    This review provides an updated perspective on rapidly proliferating efforts to harness extracellular vesicles (EVs) for therapeutic applications. We summarize current knowledge, emerging strategies, and open questions pertaining to clinical potential and translation. Potentially useful EVs comprise diverse products of various cell types and species. EV components may also be combined with liposomes and nanoparticles to facilitate manufacturing as well as product safety and evaluation. Potential therapeutic cargoes include RNA, proteins, and drugs. Strategic issues considered herein include choice of therapeutic agent, means of loading cargoes into EVs, promotion of EV stability, tissue targeting, and functional delivery of cargo to recipient cells. Some applications may harness natural EV properties, such as immune modulation, regeneration promotion, and pathogen suppression. These properties can be enhanced or customized to enable a wide range of therapeutic applications, including vaccination, improvement of pregnancy outcome, and treatment of autoimmune disease, cancer, and tissue injury. PMID:25292428

  19. Information needs of clinical teams: analysis of questions received by the Clinical Informatics Consult Service

    PubMed Central

    Jerome, Rebecca N.; Giuse, Nunzia B.; Wilder Gish, Kimbra; Sathe, Nila A.; Dietrich, Mary S.

    2001-01-01

    Objectives: To examine the types of questions received by Clinical Informatics Consult Service (CICS) librarians from clinicians on rounds and to analyze the number of clearly differentiated viewpoints provided in response. Design: Questions were retrieved from an internal database, the CICS Knowledge Base, and analyzed for redundancy by subject analysis. The unique questions were classified into ten categories by subject. Treatment-related questions were analyzed for the number of viewpoints represented in the librarian's response. Results: The CICS Knowledge Base contained 476 unique questions and 71 redundant questions. Among the unique queries, the top two categories accounted for 67%: treatment (36%) and disease description (31%). Within the treatment-related subset, 138 questions (59%) required representation of more than one viewpoint in the librarian's response. Discussion: Questions generated by clinicians frequently require comprehensive, critical appraisal of the medical literature, a need that can be filled by librarians trained in such techniques. This study demonstrates that many questions require representation of more than one viewpoint to answer completely. Moreover, the redundancy rate underscores the need for resources like the CICS Knowledge Base. By critically analyzing the medical literature, CICS librarians are providing a time-saving and valuable service for clinicians and charting new territory for librarians. PMID:11337949

  20. Clinical Research Trials and You: Questions and Answers

    MedlinePlus

    ... write down answers). Where can I find a mental health clinical trial? Around the Nation and Worldwide The ... Center in Bethesda, Maryland The National Institute of Mental Health (NIMH) is the lead federal agency for research ...

  1. Electrophysiologic correlations with clinical outcomes in CIDP.

    PubMed

    Bril, Vera; Banach, Marta; Dalakas, Marinos C; Deng, Chunqin; Donofrio, Peter; Hanna, Kim; Hartung, Hans-Peter; Hughes, Richard A C; Katzberg, Hans; Latov, Norman; Merkies, Ingemar S J; Van Doorn, Pieter A

    2010-10-01

    Data are lacking on correlations between changes in nerve conduction (NC) studies and treatment response in chronic inflammatory demyelinating polyneuropathy (CIDP). This report examined data from a randomized, double-blind trial of immune globulin intravenous, 10% caprylate/chromatography purified (IGIV-C [Gamunex]; n = 59) versus placebo (n = 58) every 3 weeks for up to 24 weeks in CIDP. Motor NC results and clinical measures were assessed at baseline and endpoint/week 24. Improvement from baseline in adjusted inflammatory neuropathy cause and treatment score correlated with improvement in proximally evoked compound muscle action potential (CMAP) amplitudes (r = -0.53; P < 0.001) of all nerves tested and with improvement in CMAP amplitude of the most severely affected motor nerve (r = -0.36; P < 0.001). Correlations were observed between improvement in averaged CMAP amplitudes and dominant-hand grip strength (r = 0.44; P < 0.001) and Medical Research Council sum score (r = 0.38; P < 0.001). Overall, the change in electrophysiologic measures of NC in CIDP correlated with clinical response to treatment. PMID:20665514

  2. A Three-Question Framework to Facilitate Clinical Decision Making

    ERIC Educational Resources Information Center

    Sibold, Jeremy

    2012-01-01

    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

  3. A Three-Question Framework to Facilitate Clinical Decision Making

    ERIC Educational Resources Information Center

    Sibold, Jeremy

    2012-01-01

    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…

  4. Oral Food Challenges: The Design must Reflect the Clinical Question.

    PubMed

    Feeney, Mary; Marrs, Tom; Lack, Gideon; Du Toit, George

    2015-08-01

    Oral food challenges are the gold-standard diagnostic investigation for diagnosing food allergy. They allow a subject to consume an age-appropriate portion of allergenic food under surveillance to assess whether a reproducible immune-mediated adverse response is demonstrated. The specific design of food challenge must closely reflect the anticipated management step being considered. In clinical practice, food challenges are most commonly used to investigate the subject's status of allergy or tolerance to a food. However, other characteristics of food allergy are increasingly being investigated through recent studies. In particular, studies investigating food allergy prevention strategies, the impact of oral immunotherapy on subjects' threshold for allergic reactions and also their potential acquisition of long-term tolerance each utilize differing designs of oral food challenges to investigate their specific hypothesis. We examine how oral food challenges may be designed to assess specific characteristics of the food allergic response. PMID:26183500

  5. [Intercultural communication in the clinical context: a question of partnership].

    PubMed

    Vissandjée, B; Dupére, S

    2000-06-01

    This article is intended to promote reflection on the intercultural competence of nurses and other health professionals. It discusses the different types of interpretation used to communicate with patients who do not speak English or French, legal and ethical consequences, and impact on health-care quality. The authors offer recommendations for both research and clinical nursing, as well as the health-care system in general, and highlight the challenges faced by nurses in a pluralist society. The literature review reveals an inherent complexity in the use of diverse types of interpreters. Finally, the authors argue that the intricacy of the cross-cultural communication trio is intensified by a lack of adequate preparation of nurses and other health professionals and interpreters regarding cross-cultural communication. PMID:11141819

  6. Dementia prevention: shared questions for research and clinical management.

    PubMed

    Robertson, Maggie; Brown, Eleanor; Whalley, Lawrence

    2014-02-01

    The emergence of advanced genetic technologies raises many challenges for dementia care and the conduct of related social, behavioural and clinical research. Genetic tests are already used to identify possible participants in dementia prevention trials. These tests are unlike any other in clinical medicine as they have the capacity to predict disease onset after intervals of many years with implications for other family members. Genetic counselling professionals support services in paediatrics, cancer diagnosis and some adult-onset diseases. Their capacity cannot meet the needs for pre- and post-test support of the many "at-risk" families living with late onset dementia. Most dementias are common, complex conditions in which multiple genetic and environmental factors play important and potentially modifiable roles. Large scale prevention studies are needed to test the effectiveness of interventions. Some economy of effort will be achieved by the preferential inclusion of "at-risk" families. Many such families are in contact with dementia care services and will be motivated to participate in prevention studies. However, practice standards and consensus-based guidelines do not yet exist. Support services are not available on a scale sufficient to prevent harm when risk is poorly communicated causing unnecessary psychological morbidity in unaffected family members. There is a pressing need for research to inform the development of study guidelines and to identify how services are strengthened to support these families during and after their participation in trials. Discourse analysis provides a useful method to collect and analyse data of this type and supports the conclusions of this review. PMID:24378185

  7. How do students with dyslexia perform in extended matching questions, short answer questions and observed structured clinical examinations?

    PubMed

    Gibson, Sandra; Leinster, Samuel

    2011-08-01

    There are an increasing number of students with learning difficulties attending university, and currently much debate about the suitability and ability of students with dyslexia at both medical school and once they graduate into clinical practice. In this study we describe the performance of students with dyslexia compared to fellow students in extended matching questions (EMQ), short answer question (SAQ) and observed structured clinical examinations (OSCE) and discuss the implications of differences identified. End of year assessment results for 5 cohorts of medical students were analysed. Students with dyslexia did less well overall in all assessment types in year 1 but this difference was not evident in later years. Dyslexic students who were allowed extra time in written assessments did better than dyslexic students who did not have their assessment concessions in place. When station type within OSCE assessments was analysed students with dyslexia did less well in both examination skills and data interpretation stations in years 1, 2 & 3. In conclusion, differences in performance in written assessments are only evident early in training and may be partly due to delayed adjustment to medical school or implementation of assessment concessions. Performance in individual OSCE stations is dependent on station type. Why students with specific learning difficulties (SpLDs) perform less well in examination skills and data analysis OSCE stations requires further investigation. PMID:21249518

  8. Factors associated with successful answering of clinical questions using an information retrieval system*

    PubMed Central

    Hersh, William R.; Crabtree, M. Katherine; Hickam, David H.; Sacherek, Lynetta; Rose, Linda; Friedman, Charles P.

    2000-01-01

    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. PMID:11055299

  9. Insights and clinical questions about the active surveillance of low-risk papillary thyroid microcarcinomas [Review].

    PubMed

    Ito, Yasuhiro; Oda, Hitomi; Miyauchi, Akira

    2016-04-25

    Over 20 years ago, two Japanese institutions initiated an active surveillance policy for papillary microcarcinomas (PMCs) without high-risk features (such as clinical lymph node and distant metastases) and suspected trachea or recurrent laryngeal nerve invasion. Since the most recent American Thyroid Association (ATA) guidelines adopt active surveillance as a therapy option for low-risk PMCs, the number of institutions worldwide carrying out this policy can be expected to increase. However, before adopting an active surveillance strategy, some important clinical questions must be considered. In this review, conceivable clinical questions with our answers based on the present accumulation of low-risk PMC surveillance data are presented. PMID:26632168

  10. Clinical correlates of olfactory hallucinations in schizophrenia.

    PubMed

    Langdon, Robyn; McGuire, Jonathan; Stevenson, Richard; Catts, Stanley V

    2011-06-01

    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

  11. Clinical Considerations of Biological Correlates of Suicide.

    ERIC Educational Resources Information Center

    Motto, Jerome A.

    1986-01-01

    Reviews possible biochemical markers for suicide risk but notes that none has clear application for clinical work in suicide prevention. Comments on other biological aspects of suicide including genetics, plasma drug levels, electroconvulsive therapy (ECT) and psychoimmunology. Encourages ECT use. Cautions against hasty clinical use of other…

  12. A Web-Based Compendium of Clinical Questions and Medical Evidence To Educate Internal Medicine Residents.

    ERIC Educational Resources Information Center

    Crowley, Steven H.; Owens, Thomas A.; Schardt, Connie M.; Wardell, Sarah I.; Peterson, Josh; Garrison, Scott; Keitz, Sheri A.

    2003-01-01

    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)

  13. More questions than answers! Clinical dilemmas in psychopharmacology in pregnancy and lactation

    PubMed Central

    Desai, Geetha; Babu, Girish N.; Rajkumar, Ravi P.; Chandra, Prabha S.

    2009-01-01

    Women in childbearing age frequently suffer from mental illness. Maternal psychiatric disorders may have a devastating impact on the fetus and the newborn. Thus treating or preventing relapse of these disorders during pregnancy and puerperium is a clinical and ethical duty with the necessity to avoid or minimize fetal or neonatal drug exposure. Though there are many guidelines and comprehensive reviews regarding drug safety in pregnancy and lactation, the application of these recommendations into clinical practice appears to be complex. Hence, we present some clinical questions with answers considering the available literature on safety of psychotropics in pregnancy and lactation. PMID:19742205

  14. Clinical Questions in Online Health Communities: The Case of See your doctor Threads

    PubMed Central

    Huh, Jina

    2015-01-01

    Online health communities are known to provide psychosocial support. However, concerns for misinformation being shared around clinical information persist. An existing practice addressing this concern includes monitoring and, as needed, discouraging asking clinical questions in the community. In this paper, I examine such practice where moderators redirected patients to see their health care providers instead of consulting the community. I observed that, contrary to common beliefs, community members provided constructive tips and persuaded the patients to see doctors rather than attempting to make a diagnosis or give medical advice. Moderators posts on redirecting patients to see their providers were highly associated with no more follow up replies, potentially hindering active community dynamic. The findings showed what is previously thought of as a solutionquality control through moderationmight not be best and that the community, in coordination with moderators, can provide critical help in addressing clinical questions and building constructive information sharing community environment. PMID:26146665

  15. Neural Correlates of Intolerance of Uncertainty in Clinical Disorders.

    PubMed

    Wever, Mirjam; Smeets, Paul; Sternheim, Lot

    2015-01-01

    Intolerance of uncertainty is a key contributor to anxiety-related disorders. Recent studies highlight its importance in other clinical disorders. The link between its clinical presentation and the underlying neural correlates remains unclear. This review summarizes the emerging literature on the neural correlates of intolerance of uncertainty. In conclusion, studies focusing on the neural correlates of this construct are sparse, and findings are inconsistent across disorders. Future research should identify neural correlates of intolerance of uncertainty in more detail. This may unravel the neurobiology of a wide variety of clinical disorders and pave the way for novel therapeutic targets. PMID:26185902

  16. Three approaches to use of questioning by clinical lecturers: a pilot study.

    PubMed

    Giddings, L S; Dyson, L C; Entwistle, M J; Macdiarmid, R; Marshall, D C; Simpson, S M

    2000-03-01

    In the current health care climate nurses require very good problem solving and critical thinking skills. Questioning as a teaching strategy is viewed as one way to promote such student learning. Using a comparative descriptive quantitative and a qualitative approach, this pilot study investigated the types of questions asked of students by lecturers working within the preceptorship model in the clinical setting. A convenience sample of five volunteer nursing lecturers were tape recorded during their interactions with undergraduate students (n = 8). Initially two auditing approaches were used to analyse the interview data: relevant parts of Mogan and Warbinek's (1994) Observation of Nursing Teachers in Clinical Settings instrument (ONTICS Tool) and Craig and Page's (1981) conceptual framework as adapted by Sellappah, Hussey, Blackmore and McMurray (1998). The data were further analysed by qualitative content analysis. This study supported the findings of the ONTICS tool and Sellappah et al's framework that teachers asked predominantly directive style and low level questions. What the two approaches did not adequately capture was the complexity of the lecturers' questioning behaviours or the effects of contextual factors. The content analysis process however, identified three broad categories forming a model that effectively integrated aspects of the context of the lecturer/student interaction. It also represented lecturer questioning behaviours more comprehensively. The preliminary model offered has the potential to highlight the importance of lecturers asking questions that lead students to extend their thinking about practice. It could also contribute to student learning by assisting lecturers to understand the value and critical nature of their questioning and serve as a framework for staff development. PMID:11221306

  17. Urologic pathology with clinical and radiologic correlations

    SciTech Connect

    Someren, A.

    1989-01-01

    This book is devoted to the kidneys, urinary passages, renal transplantation, male genitalia, and adrenal glands. Each chapter has the same format: congenital conditions are discussed then, inflammatory and nonneoplastic disorders; and, finally, neoplasms. For each disease process, the clinical presentation, radiologic findings, pathologic characteristics, therapy, and prognosis are discussed.

  18. Endotoxemia: methods of detection and clinical correlates.

    PubMed Central

    Hurley, J C

    1995-01-01

    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. PMID:7621402

  19. Smartphone use to answer clinical questions: a descriptive study of APNs.

    PubMed

    Grabowsky, Adelia

    2015-01-01

    This study examines the use of smartphones by Alabama Advanced Practice Nurses to find information to address clinical questions and seeks to describe the types of questions answered using smartphones; barriers to information seeking; apps and online resources perceived as most helpful; and training/resource needs. Information collected in this study can be used by libraries that serve nursing students to develop training and resources to assist both nursing students and practicing nurses to become more efficient and effective information seekers. PMID:25927507

  20. [Autoimmune thyroid disease. Clinical and biological correlations].

    PubMed

    El Hajj, Georges; Yahya, Ali Fadlallah; Medlej, Rita; Sebaaly, Ghada; Souaid, Mirna; Halaby, Georges

    2009-01-01

    In this article, we analyze the clinical and biological data concerning the autoimmune thyroid diseases in patients recruited in an endocrinology clinic at the university hospital center of Hôtel-Dieu de France between March 2005 and November 2005. We studied 121 patients (51 with Basedow disease and 70 with Hashimoto thyroiditis), between 13 and 68 years old, with a BMI of 24.68 kg/m2 and with a female predominance (105 women). Symptoms of hyperthyroidism represented the most frequent cause of consultation. The distribution of patients regarding their thyroid disease showed that 42.1% of patients had hyperthyroidism (only one patient had subclinical hyperthyroidism), 21.5% had a subclinical hypothyroidism, 28.1% had clinical hypothyroidism and 8.3% had euthyroid goiter. Half of the patients had at least a member of their family whith a thyroid disease. The autoimmune thyroid diseases are strongly associated to other autoimmune diseases and to repetitive spontaneous abortion. Thus, 39% of the married women had had at least one spontaneous abortion and 26.4% of the patients had one or more autoimmune disease associated to their thyroid disease; diabetes mellitus type 1 representing the most frequent one. Concerning the treatment, we remarked a remission of 30 patients (66.7%) with Basedow disease after 18 months of antithyroid drug treatment of 45 patients. In Hashimoto thyroiditis, we remarked a frequent evolution of patients with subclinical hypothyroidism to overt hypothyroidism when medical treatment was not initiated. PMID:20027797

  1. IDENTIFICATION OF QUESTIONABLE EXCLUSION CRITERIA IN MENTAL DISORDER CLINICAL TRIALS USING A MEDICAL ENCYCLOPEDIA.

    PubMed

    Ma, Handong; Weng, Chunhua

    2016-01-01

    Precision medicine requires precise evidence-based practice and precise definition of the patients included in clinical studies for evidence generalization. Clinical research exclusion criteria define confounder patient characteristics for exclusion from a study. However, unnecessary exclusion criteria can weaken patient representativeness of study designs and generalizability of study results. This paper presents a method for identifying questionable exclusion criteria for 38 mental disorders. We extracted common eligibility features (CEFs) from all trials on these disorders from ClinicalTrials.gov. Network Analysis showed scale-free property of the CEF network, indicating uneven usage frequencies among CEFs. By comparing these CEFs' term frequencies in clinical trials' exclusion criteria and in the PubMed Medical Encyclopedia for matching conditions, we identified unjustified potential overuse of exclusion CEFs in mental disorder trials. Then we discussed the limitations in current exclusion criteria designs and made recommendations for achieving more patient-centered exclusion criteria definitions. PMID:26776188

  2. IDENTIFICATION OF QUESTIONABLE EXCLUSION CRITERIA IN MENTAL DISORDER CLINICAL TRIALS USING A MEDICAL ENCYCLOPEDIA*

    PubMed Central

    HANDONG, MA; WENG, CHUNHUA

    2015-01-01

    Precision medicine requires precise evidence-based practice and precise definition of the patients included in clinical studies for evidence generalization. Clinical research exclusion criteria define confounder patient characteristics for exclusion from a study. However, unnecessary exclusion criteria can weaken patient representativeness of study designs and generalizability of study results. This paper presents a method for identifying questionable exclusion criteria for 38 mental disorders. We extracted common eligibility features (CEFs) from all trials on these disorders from ClinicalTrials.gov. Network Analysis showed scale-free property of the CEF network, indicating uneven usage frequencies among CEFs. By comparing these CEFs’ term frequencies in clinical trials’ exclusion criteria and in the PubMed Medical Encyclopedia for matching conditions, we identified unjustified potential overuse of exclusion CEFs in mental disorder trials. Then we discussed the limitations in current exclusion criteria designs and made recommendations for achieving more patient-centered exclusion criteria definitions. PMID:26776188

  3. Hemoglobin Variants: Biochemical Properties and Clinical Correlates

    PubMed Central

    Thom, Christopher S.; Dickson, Claire F.; Gell, David A.; Weiss, Mitchell J.

    2013-01-01

    Diseases affecting hemoglobin synthesis and function are extremely common worldwide. More than 1000 naturally occurring human hemoglobin variants with single amino acid substitutions throughout the molecule have been discovered, mainly through their clinical and/or laboratory manifestations. These variants alter hemoglobin structure and biochemical properties with physiological effects ranging from insignificant to severe. Studies of these mutations in patients and in the laboratory have produced a wealth of information on hemoglobin biochemistry and biology with significant implications for hematology practice. More generally, landmark studies of hemoglobin performed over the past 60 years have established important paradigms for the disciplines of structural biology, genetics, biochemistry, and medicine. Here we review the major classes of hemoglobin variants, emphasizing general concepts and illustrative examples. PMID:23388674

  4. The Effect of Preservice Laserdisc Presentation of Question Types and Wait-Time Use on Questioning and Wait-Time Use in Clinical Experiences.

    ERIC Educational Resources Information Center

    Wallace, Stephen R.; And Others

    This study explored whether the addition of visual examples through laser disc instruction influenced the learning and application of convergent and divergent questioning techniques and wait-time by preservice elementary education teachers during their clinical experience. The study compared the difference in the frequency of convergent and…

  5. How Do Students with Dyslexia Perform in Extended Matching Questions, Short Answer Questions and Observed Structured Clinical Examinations?

    ERIC Educational Resources Information Center

    Gibson, Sandra; Leinster, Samuel

    2011-01-01

    There are an increasing number of students with learning difficulties attending university, and currently much debate about the suitability and ability of students with dyslexia at both medical school and once they graduate into clinical practice. In this study we describe the performance of students with dyslexia compared to fellow students in…

  6. Using existing data to address important clinical questions in critical care

    PubMed Central

    Cooke, Colin R.; Iwashyna, Theodore J.

    2013-01-01

    Objective With important technological advances in healthcare delivery and the internet, clinicians and scientists now have access to overwhelming number of available databases capturing patients with critical illness. Yet investigators seeking to answer important clinical or research questions with existing data have few resources that adequately describe the available sources and the strengths and limitations of each. This article reviews an approach to selecting a database to address health services and outcomes research questions in critical care, examines several databases that are commonly used for this purpose, and briefly describes some strengths and limitations of each. Data Sources Narrative review of the medical literature. Summary The available databases that collect information on critically ill patients are numerous and vary in the types of questions they can optimally answer. Selection of a data source must not only consider accessibility, but also the quality of the data contained within the database, and the extent to which it captures the necessary variables for the research question. Questions seeking causal associations (e.g. effect of treatment on mortality) usually either require secondary data that contain detailed information about demographics, laboratories, and physiology to best address non-random selection or sophisticated study design. Purely descriptive questions (e.g. incidence of respiratory failure) can often be addressed using secondary data with less detail such as administrative claims. Though each database has its own inherent limitations, all secondary analyses will be subject to the same challenges of appropriate study design and good observational research. Conclusion The literature demonstrates that secondary analyses can have significant impact on critical care practice. While selection of the optimal database for a particular question is a necessary part of high-quality analyses, it is not sufficient to guarantee an unbiased study. Thoughtful and well-constructed study design and analysis approaches remain equally important pillars of robust science. Only through responsible use of existing data will investigators ensure that their study has the greatest impact on critical care practice and outcomes. PMID:23328262

  7. Clinical and CT correlates in the diagnosis of intracranial tumours.

    PubMed Central

    Sotaniemi, K A; Rantala, M; Pyhtinen, J; Myllylä, V V

    1991-01-01

    The correlation between clinical and CT findings in cerebral tumours was prospectively studied in 1191 consecutive referrals for cerebral CT. CT revealed a mass lesion in 51 cases (4.3%): 32 neoplasms, five haematomas and one abscess. The diagnostic specificity of CT for neoplasmic tumours was 86% (32 of 37). The clinical suspicion of a cerebral neoplasm was correct in 25 cases (78%) and the clinical localisatory hypothesis was correct in 20 cases (63%) of the neoplasms. A cerebral tumour was found in 5% (11 out of 226) of patients investigated for their first seizure and in 1% (two of 207) investigated for headache without clinical signs. PMID:1895130

  8. Enhancing decision making about participation in cancer clinical trials: development of a question prompt list

    PubMed Central

    Brown, Richard F.; Shuk, Elyse; Leighl, Natasha; Butow, Phyllis; Ostroff, Jamie; Edgerson, Shawna; Tattersall, Martin

    2016-01-01

    Purpose Slow accrual to cancer clinical trials impedes the progress of effective new cancer treatments. Poor physician–patient communication has been identified as a key contributor to low trial accrual. Question prompt lists (QPLs) have demonstrated a significant promise in facilitating communication in general, surgical, and palliative oncology settings. These simple patient interventions have not been tested in the oncology clinical trial setting. We aimed to develop a targeted QPL for clinical trials (QPL-CT). Method Lung, breast, and prostate cancer patients who either had (trial experienced) or had not (trial naive) participated in a clinical trial were invited to join focus groups to help develop and explore the acceptability of a QPL-CT. Focus groups were audio-recorded and transcribed. A research team, including a qualitative data expert, analyzed these data to explore patients’ decision-making processes and views about the utility of the QPL-CT prompt to aid in trial decision making. Results Decision making was influenced by the outcome of patients’ comparative assessment of perceived risks versus benefits of a trial, and the level of trust patients had in their doctors’ recommendation about the trial. Severity of a patient’s disease influenced trial decision making only for trial-naive patients. Conclusion Although patients were likely to prefer a paternalistic decision-making style, they expressed valuation of the QPL as an aid to decision making. QPL-CT utility extended beyond the actual consultation to include roles both before and after the clinical trial discussion. PMID:20593202

  9. Antibody-Mediated Rejection: Emergence of Animal Models to Answer Clinical ?Questions

    PubMed Central

    Baldwin, William M.; Valujskikh, Anna; Fairchild, Robert L.

    2010-01-01

    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. PMID:20346069

  10. Statistical aspect of translational and correlative studies in clinical trials.

    PubMed

    Pang, Herbert; Wang, Xiaofei

    2016-02-01

    In this article, we describe statistical issues related to the conduct of translational and correlative studies in cancer clinical trials. In the era of personalized medicine, proper biomarker discovery and validation is crucial for producing groundbreaking research. In order to carry out the framework outlined in this article, a team effort between oncologists and statisticians is the key for success. PMID:26932435

  11. Upper Limb Assessment in Tetraplegia: Clinical, Functional and Kinematic Correlations

    ERIC Educational Resources Information Center

    Cacho, Enio Walker Azevedo; de Oliveira, Roberta; Ortolan, Rodrigo L.; Varoto, Renato; Cliquet, Alberto

    2011-01-01

    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…

  12. Upper Limb Assessment in Tetraplegia: Clinical, Functional and Kinematic Correlations

    ERIC Educational Resources Information Center

    Cacho, Enio Walker Azevedo; de Oliveira, Roberta; Ortolan, Rodrigo L.; Varoto, Renato; Cliquet, Alberto

    2011-01-01

    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

  13. A perfect childhood? Clinical correlates of minimization and denial on the childhood trauma questionnaire.

    PubMed

    MacDonald, Kai; Thomas, Michael L; MacDonald, Tina M; Sciolla, Andres F

    2015-03-01

    Childhood trauma has pervasive and enduring effects on myriad health outcomes, and the Childhood Trauma Questionnaire (CTQ) is a widely used screening tool. To assess recall and reporting biases, the CTQ includes a Minimization/Denial (MD) Scale, although this scale is typically omitted or not reported on. As this practice is not supported by empirical data, we sought to examine the clinical correlates of the CTQ MD Scale, as well as its function as a response bias index (i.e., its moderation effects). We examined correlations between the MD Scale and attachment style, temperament, personality, depression, and clinical diagnoses in a group of 200 adult psychiatric outpatients. Regression analyses were performed to assess the impact of MD on the relationships between the CTQ and clinical variables. Twenty percent of our sample met MD criteria. When patients were grouped as MD-positive versus MD-negative, significant between-group differences were found on several clinical measures. MD status, however, did not significantly moderate the relationships between the CTQ and clinical variables. This is one of the first clinically focused examinations of the CTQ's MD Scale. Although the MD Scale was associated with several clinical variables, it did not significantly moderate the relationship between the CTQ and clinical variables. These findings, therefore, call into question the value of the MD Scale as a response bias index, although they should be replicated in larger studies before the currently ubiquitous practice of ignoring it can be considered evidence-based. PMID:24981003

  14. ALAT-2014 Chronic Obstructive Pulmonary Disease (COPD) Clinical Practice Guidelines: questions and answers.

    PubMed

    Montes de Oca, María; López Varela, María Victorina; Acuña, Agustín; Schiavi, Eduardo; Rey, María Alejandra; Jardim, José; Casas, Alejandro; Tokumoto, Antonio; Torres Duque, Carlos A; Ramírez-Venegas, Alejandra; García, Gabriel; Stirbulov, Roberto; Camelier, Aquiles; Bergna, Miguel; Cohen, Mark; Guzmán, Santiago; Sánchez, Efraín

    2015-08-01

    ALAT-2014 COPD Clinical Practice Guidelines used clinical questions in PICO format to compile evidence related to risk factors, COPD screening, disease prognosis, treatment and exacerbations. Evidence reveals the existence of risk factors for COPD other than tobacco, as well as gender differences in disease presentation. It shows the benefit of screening in an at-risk population, and the predictive value use of multidimensional prognostic indexes. In stable COPD, similar benefits in dyspnea, pulmonary function and quality of life are achieved with LAMA or LABA long-acting bronchodilators, whereas LAMA is more effective in preventing exacerbations. Dual bronchodilator therapy has more benefits than monotherapy. LAMA and combination LABA/IC are similarly effective, but there is an increased risk of pneumonia with LABA/IC. Data on the efficacy and safety of triple therapy are scarce. Evidence supports influenza vaccination in all patients and anti-pneumococcal vaccination in patients <65years of age and/or with severe airflow limitation. Antibiotic prophylaxis may decrease exacerbation frequency in patients at risk. The use of systemic corticosteroids and antibiotics are justified in exacerbations requiring hospitalization and in some patients managed in an outpatient setting. PMID:25596991

  15. Correlation of Clinical Disease Severity to Radiographic Thumb Osteoarthritis Index

    PubMed Central

    Ladd, Amy L; Messana, Joseph; Berger, Aaron J.; Weiss, Arnold-Peter C.

    2014-01-01

    Purpose To determine if a slight modification of the 1987 Eaton-Glickel staging and interpreting 4 standardized radiographs for trapeziometacarpal arthritis improved analysis, to determine if a quantifiable index measurement from a single Robert (pronated anteroposterior) view enhanced reproducibility, and to examine whether improved radiographic staging correlated to clinically relevant disease and thus support validity. Methods We analyzed 4 thumb radiographs (posteroanterior, lateral, a Robert, and stress views) in 60 consecutive subjects representing an adult population spectrum of asymptomatic to advanced disease. Two experienced hand surgeons, 1 chief resident, and 1 medical student performed the analysis on each subject’s radiographs. We analyzed all 4 radiographs for Eaton and modified Eaton staging and then later analyzed only the Robert view for the thumb osteoarthritis (ThOA) index measurement. The radiographs were randomized and re-read a week later for each classification at separate times. Surgically excised trapeziums from 20/60 subjects were inspected for first metacarpal surface disease and correlated to the 3 classifications. Results All 3 staging classifications demonstrated high reproducibility, with the intraclass correlation coefficient averaging 0.73 for the Eaton, 0.83 for the modified Eaton, and 0.95 for the ThOA index. Articular wear and metacarpal surface eburnation correlated highest to the ThOA index, with advanced disease ≥ 1.55 correlating to Eaton III/IV and modified Eaton stage 3/4 in a linear relationship. Discussion The ThOA index based on a Robert view provided a measurable alternative to Eaton staging and correlated to severity of surgically relevant thumb TMC OA. Clinical Relevance A simple reproducible radiographic measurement may enhance TMC OA classification and provide a reliable means to predict clinical disease. Level of Evidence Level of Evidence II/Diagnostic PMID:25617217

  16. Counseling in fetal medicine: evidence-based answers to clinical questions on morbidly adherent placenta.

    PubMed

    D'Antonio, F; Palacios-Jaraquemada, J; Lim, P S; Forlani, F; Lanzone, A; Timor-Tritsch, I; Cali, G

    2016-03-01

    Although the incidence of morbidly adherent placenta (MAP) has risen progressively in the last two decades, there remains uncertainty about the diagnosis and management of this condition. The aim of this review is to provide up-to-date and evidence-based answers to common clinical questions regarding the diagnosis and management of MAP. Different risk factors have been associated with MAP; however, previous Cesarean section and placenta previa are the most frequently associated. Ultrasound is the primary method for diagnosing MAP and has a good overall diagnostic accuracy for its detection. When considering the different ultrasound signs of MAP, color Doppler seems to provide the best diagnostic performance. Magnetic resonance imaging has the same accuracy in diagnosing MAP as does ultrasound examination; its use should be considered when a resective procedure, such as hysterectomy, is planned as it can provide detailed information about the topography of placental invasion and predict difficulties that may arise in surgery. The optimal gestational age for delivery in pregnancies with MAP is yet to be established; planning surgery between 35 and 36 weeks of gestation provides the best balance between fetal maturity and the risk of unexpected episodes of heavy bleeding, which are more likely to occur with delivery after this timepoint, especially in severe cases of MAP. The optimal surgical approach to MAP depends on multiple factors, including availability of an experienced team, specific surgical skills and hospital resources. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd. PMID:26195324

  17. The effect of Tomm's therapeutic questioning styles on therapeutic alliance: a clinical analog study.

    PubMed

    Dozier, R M; Hicks, M W; Cornille, T A; Peterson, G W

    1998-01-01

    Tomm (1988) suggests that circular and reflexive questions tend to elicit feelings of freedom/acceptance whereas lineal and strategic questions usually trigger feelings of judgment/constraint. Employing an analog methodology, each of Tomm's four questioning styles was portrayed in the form of a 5-minute videotaped intake scenario. Forty family triads with a mother, father, and adolescent son were randomly assigned to one of four experimental conditions with ten families each. Each condition involved viewing one of four questioning style scenarios. All participants (N = 120 individuals--40 mothers, 40 fathers, and 40 adolescent sons) completed the Family Therapy Alliance Scale (FTAS; Pinsof & Catherall, 1986) and a validity-check instrument. The results indicated that circular and reflexive questioning styles elicited significantly higher (p < 0.001) alliance scores on the FTAS than did either lineal or strategic questions. Implications for the use of different types of questions in family therapy are discussed. PMID:9693949

  18. Variation in Question Asking during Cancer Clinical Interactions: a Potential Source of Disparities in Access to Information

    PubMed Central

    Eggly, Susan; Harper, Felicity W.K.; Penner, Louis A.; Gleason, Marci J.; Foster, Tanina; Albrecht, Terrance L.

    2010-01-01

    Objective To investigate whether patient demographic characteristics and patients' companions influence variation in patient question asking during cancer clinical interactions, thus representing a potential disparity in access to information. Methods Data included 109 oncologist-patient-companion interactions video recorded at a comprehensive cancer center. Interactions were observed and analyzed using the Karmanos Information Seeking Analysis System (K-ISAS). Results Significant relationships were found between patient race/ethnicity and question asking. Black patients asked fewer questions and a smaller proportion of direct questions (relative to the total frequency of questions) than White patients. Black patients were also less likely to have companions present during the interaction, which resulted in fewer questions asked on Black patients' behalf. Conclusion Differences in question asking by Black and White patients suggest that Black patients may receive less information from their oncologists than White patients. Practice/Research Implications Patients should be encouraged to ask more questions and more direct questions and to bring a companion to the interaction to assist them in gaining information from their physician. Future research is needed to investigate ways to eliminate this potential source of disparities in access to information. PMID:20430566

  19. Analysis of short-answer question styles versus gender in pre-clinical veterinary education.

    PubMed

    Foster, Neil

    2011-01-01

    One large study in medical education has reported that the choice of question format (or question content) could introduce a gender bias, with men outperforming women on questions with a true-false component or that required knowledge of anatomy or physiology. The purpose of our study was to ascertain whether this finding is also true in veterinary medical education. Two veterinary student cohorts were analyzed across four different modules over a three-year period (804 questions in total). The results of the study show that the women's and men's performance did not differ in any of the question types analyzed across any module or year. When students' (both women and men) overall average performance on different question types was compared with their performance on standard multiple-choice questions (MCQs), performance levels increased when students were asked to answer MCQs that contained an image-based prop (IMCQ) such as a photograph, X-ray image, or diagram. In contrast, students' performance was consistently lower when answering assertion-reason questions (ARQs), and this performance could not be explained by the demographic makeup of the two cohorts analyzed. When comparing standard MCQs with MCQs that contained a true-false question stem, no specific trend in the data could be determined. In conclusion, this study suggests that the short-answer question style does not bias against one gender in veterinary medical education, but that overall students do perform differently according to question type and, in particular, less well when ARQs are used in examinations. PMID:21805937

  20. Correlation of Reconstructed Scaphoid Morphology with Clinical Outcomes

    PubMed Central

    Afshar, Ahmadreza; Mohammadi, Afshin; Zohrabi, Kian; Navaeifar, Nasrin; Sami, Sam H.; Taleb, Hassan

    2015-01-01

    Background: Scaphoid malunion alters the carpal kinematics and impairs clinical outcome because of pain, weakness, restricted range of motion and predisposing the wrist joint to early osteoarthritis. The aim of this study was to evaluate the influence of the scaphoid morphological angles on clinical outcomes in patients with reconstructed scaphoid by non-vascularized bone graft. Methods: Seventeen male patients with the mean age of 31.7±3.7 years and mean non-union time of 31.5±14.7 months were enrolled in this retrospective study. Average follow up was 48.8±9.4 months. At the last follow-up, the patients were evaluated clinically for pain, wrist range of motion, grip strength, and wrist functional status. They were also evaluated radiologically by wrist radiographs and computerized tomography (CT). The overall clinical outcomes were evaluated by the Cooney wrist function score. The morphology of the reconstructed scaphoids was evaluated by the lateral intrascaphoid angle, antroposterior intrascaphoid angle, dorsal cortical angle, measuring the length (mm), and height-to-length ratio on CT scan. The radiological measurements were compared against the overall clinical outcomes. Results: There were 7 excellent, 7 good, 3 fair clinical results. The mean Cooney wrist function score was 83±4. The mean lateral intrascaphoid angle was 34.8±1.4 degrees, mean antroposterior intrascaphoid angle was 33.4±2.2 degrees, mean dorsal cortical angle was 158.3±4.8 degrees, mean scaphoid length was 22.1± 0.7 mm, and mean scaphoid height-to-length ratio was 0.74±0.04. There were no significant statistical correlations between the lateral intrascaphoid angles, antroposterior intrascaphoid angles, dorsal cortical angles, scaphoid lengths and scaphoid height-to-length ratios and Cooney wrist scores in the patients. Conclusion: In the current study, all the patients had some degree of scaphoid malunion; however, the radiological measurements of the reconstructed scaphoids did not correlate with the clinical outcomes. PMID:26550587

  1. Vaginismus and its correlates in an Iranian clinical sample.

    PubMed

    Farnam, F; Janghorbani, M; Merghati-Khoei, E; Raisi, F

    2014-01-01

    Although vaginismus is a relatively common female sexual dysfunction in Iran, there are scant studies reporting on its clinical and social features. The aim of the present study was to compare the social and clinical characteristics of women with vaginismus with those of healthy women. The study comprises 22 patients with vaginismus and 22 healthy controls who presented to the health clinics of Tehran University of Medical Sciences, Iran. We used three assessment tools: interview, a (34-item) questionnaire for demographic and clinical characteristics of vaginismus and a 13-item questionnaire of Female Sexual Distress Scale-Revised (FSDS-R) for sexual distress. The majority (73%) of women with vaginismus had primary vaginismus (unconsummated marriage). These women demonstrated significant higher phobia than healthy women, including fear of genital pain and penetration, fear of bleeding during intercourse, height phobia, aversion to looking or touching the genitalia, fear of vaginal disproportion and also disgust of semen. Compared with the healthy women, these women displayed a significantly higher sexual distress score, defecation or urination problems, general anxiety, higher education levels and lower self-esteem. Our findings suggest that there is a strong correlation between vaginismus, phobia and anxiety. PMID:24830673

  2. Cognitive Impairment in Individuals with Insomnia: Clinical Significance and Correlates

    PubMed Central

    Fortier-Brochu, Émilie; Morin, Charles M.

    2014-01-01

    Study Objectives: The aims of this study were to (1) investigate the nature of cognitive impairment in individuals with insomnia, (2) document their clinical significance, (3) examine their correlates, and (4) explore differences among individuals with insomnia with and without cognitive complaints. Design: Participants underwent 3 consecutive nights of polysomnography. On the morning following the third night, they completed a battery of questionnaires and neuropsychological tests. Participants: The sample included 25 adults with primary insomnia (mean age: 44.4 ± 11.5 y, 56% women) and 16 controls (mean age: 42.8 ± 12.9 y, 50% women) matched for sex, age, and education. Intervention: N/A. Measurement and Results: Participants completed neuropsychological tests covering attention, memory, working memory, and executive functions, as well as questionnaires assessing the subjective perception of performance, depression, anxiety, fatigue, sleepiness, and hyperarousal. There were significant group differences for the attention and episodic memory domains. Clinically significant deficits were more frequent in the insomnia group. Within the insomnia group, individuals with cognitive complaints exhibited significantly poorer performance on a larger number of neuropsychological variables. All impaired aspects of performance were significantly associated with either subjective or objective sleep continuity, and some were also independently related to sleep microstructure (i.e., relative power for alpha frequencies) or selected psychological variables (i.e., beliefs or arousal). Conclusions: These findings suggest clinically significant alterations in attention and episodic memory in individuals with insomnia. Objective deficits were more pronounced and involved more aspects of performance in a subgroup of individuals with cognitive complaints. These deficits appear associated with sleep continuity, and may also be related to sleep microstructure and dysfunctional beliefs. Citation: Fortier-Brochu É, Morin CM. Cognitive impairment in individuals with insomnia: clinical significance and correlates. SLEEP 2014;37(11):1787-1798. PMID:25364074

  3. COMPASS identifies T-cell subsets correlated with clinical outcomes.

    PubMed

    Lin, Lin; Finak, Greg; Ushey, Kevin; Seshadri, Chetan; Hawn, Thomas R; Frahm, Nicole; Scriba, Thomas J; Mahomed, Hassan; Hanekom, Willem; Bart, Pierre-Alexandre; Pantaleo, Giuseppe; Tomaras, Georgia D; Rerks-Ngarm, Supachai; Kaewkungwal, Jaranit; Nitayaphan, Sorachai; Pitisuttithum, Punnee; Michael, Nelson L; Kim, Jerome H; Robb, Merlin L; O'Connell, Robert J; Karasavvas, Nicos; Gilbert, Peter; C De Rosa, Stephen; McElrath, M Juliana; Gottardo, Raphael

    2015-06-01

    Advances in flow cytometry and other single-cell technologies have enabled high-dimensional, high-throughput measurements of individual cells as well as the interrogation of cell population heterogeneity. However, in many instances, computational tools to analyze the wealth of data generated by these technologies are lacking. Here, we present a computational framework for unbiased combinatorial polyfunctionality analysis of antigen-specific T-cell subsets (COMPASS). COMPASS uses a Bayesian hierarchical framework to model all observed cell subsets and select those most likely to have antigen-specific responses. Cell-subset responses are quantified by posterior probabilities, and human subject-level responses are quantified by two summary statistics that describe the quality of an individual's polyfunctional response and can be correlated directly with clinical outcome. Using three clinical data sets of cytokine production, we demonstrate how COMPASS improves characterization of antigen-specific T cells and reveals cellular 'correlates of protection/immunity' in the RV144 HIV vaccine efficacy trial that are missed by other methods. COMPASS is available as open-source software. PMID:26006008

  4. COMPASS identifies T-cell subsets correlated with clinical outcomes

    PubMed Central

    Lin, Lin; Finak, Greg; Ushey, Kevin; Seshadri, Chetan; Hawn, Thomas R.; Frahm, Nicole; Scriba, Thomas J.; Mahomed, Hassan; Hanekom, Willem; Bart, Pierre-Alexandre; Pantaleo, Giuseppe; Tomaras, Georgia D.; Rerks-Ngarm, Supachai; Kaewkungwal, Jaranit; Nitayaphan, Sorachai; Pitisuttithum, Punnee; Michael, Nelson L.; Kim, Jerome H.; Robb, Merlin L.; O’Connell, Robert J.; Karasavvas, Nicos; Gilbert, Peter; DeRosa, Stephen; McElrath, M. Juliana

    2015-01-01

    Advances in flow cytometry and other single-cell technologies have enabled high-dimensional, high-throughput measurements of individual cells and allowed interrogation of cell population heterogeneity. Computational tools to take full advantage of these technologies are lacking. Here, we present COMPASS, a computational framework for unbiased polyfunctionality analysis of antigen-specific T-cell subsets. COMPASS uses a Bayesian hierarchical framework to model all observed functional cell subsets and select those most likely to exhibit antigen-specific responses. Cell-subset responses are quantified by posterior probabilities, while subject-level responses are quantified by two novel summary statistics that can be correlated directly with clinical outcome, and describe the quality of an individual’s (poly)functional response. Using three clinical datasets of cytokine production we demonstrate how COMPASS improves characterization of antigen-specific T cells and reveals novel cellular correlates of protection in the RV144 HIV vaccine efficacy trial that are missed by other methods. COMPASS is available as open-source software. PMID:26006008

  5. Clinical correlations of microstructural changes in progressive supranuclear palsy.

    PubMed

    Tessitore, Alessandro; Giordano, Alfonso; Caiazzo, Giuseppina; Corbo, Daniele; De Micco, Rosa; Russo, Antonio; Liguori, Sara; Cirillo, Mario; Esposito, Fabrizio; Tedeschi, Gioacchino

    2014-10-01

    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

  6. Abdominal Wall Endometrioma: Ultrasonographic Features and Correlation with Clinical Findings

    PubMed Central

    Solak, Aynur; Genç, Berhan; Yalaz, Seyhan; Şahin, Neslin; Sezer, Taylan Özgür; Solak, İlhami

    2013-01-01

    Background: The diagnosis of abdominal wall endometrioma (AWE) is often confused with other surgical conditions. Certain factors relating to knowledge of the clinical history of the disease make correct diagnosis and treatment difficult. Aims: To present the clinical findings and ultrasonographic (US) features of AWE with special emphasis on size-related features. Study Design: This study reviewed abdominal wall endometriomas during a 2-year period in the Radiology Department of Sifa University Hospital, Izmir. Methods: Eleven women (mean age 32.6 years) with 12 scar endometriomas (mean diameter 29.2 mm) were consecutively evaluated by US and Colour Doppler examination (CDUS) prior to surgery. Lesions were grouped into large (≥3 cm) and small nodules. Vascularisation was classified as location (central, peripheral and mixed) and severity (absent, moderately vascular and hypervascular). In each patient, the nature of pain (absent, cyclic: associated with menstruation and continuous), historical and clinical data were documented. Four patients underwent Magnetic Resonance Imaging and their findings were presented. Fisher’s exact test, χ2 test for categorical data and the unpaired T-test for continuous variables were used for statistical analysis. Results: In all the women, US of the AWE showed the presence of a solid hypoechoic mass (less echogenic than the surrounding hyperechoic fat) within the abdominal wall. There was a significant correlation between AWE sizes with repeated caesareans and the mean time between the last operation and admission to hospital (p<0.05). Large endometriomas showed increased central vascularity (p<0.05). Cyclic pain was more frequent in small lesions, whereas continuous pain was more commonly found in patients with larger lesions (p<0.05). Conclusion: AWE is often misdiagnosed clinically because endometriosis may occur years after the caesarean section, the pain is often non-cyclic in nature, and there is not always a palpable tender mass. The sonographic and Doppler findings, along with proper correlation with clinical data, may substantially contribute to the correct diagnosis of endometrioma. PMID:25207093

  7. Clinical Correlates of Depressive Symptoms in Familial Parkinson's Disease

    PubMed Central

    Pankratz, Nathan; Marder, Karen S.; Halter, Cheryl A.; Rudolph, Alice; Shults, Cliff W.; Nichols, William C.; Foroud, Tatiana

    2010-01-01

    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. PMID:18785635

  8. Clinical correlates of depressive symptoms in familial Parkinson's disease.

    PubMed

    Pankratz, Nathan; Marder, Karen S; Halter, Cheryl A; Rudolph, Alice; Shults, Cliff W; Nichols, William C; Foroud, Tatiana

    2008-11-15

    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

  9. Correlation of Fluconazole MICs with Clinical Outcome in Cryptococcal Infection

    PubMed Central

    Aller, A. I.; Martin-Mazuelos, E.; Lozano, F.; Gomez-Mateos, J.; Steele-Moore, L.; Holloway, W. J.; Gutiérrez, M. J.; Recio, F. J.; Espinel-Ingroff, A.

    2000-01-01

    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 described in National Committee for Clinical Standards (NCCLS) document M27-A, e.g., use of yeast nitrogen base medium and a final inoculum of 104 CFU/ml. The fluconazole MIC at which 50% of isolates are inhibited (MIC50) and MIC90, obtained spectrophotometrically after 48 h of incubation, were 4 and 16 μg/ml, respectively. Of the 25 patients studied, 4 died of active cryptococcal disease and 2 died of other causes. Therapeutic failure was observed in five patients who were infected with isolates for which fluconazole MICs were ≥16 μg/ml. Four of these patients had previously had oropharyngeal candidiasis (OPC); three had previously had episodes of cryptococcal infection, and all five treatment failure patients had high cryptococcal antigen titers in either serum or cerebrospinal fluid (titers, >1:4,000). Although 14 of the 18 patients who responded to fluconazole therapy had previously had OPC infections, they each had only a single episode of cryptococcal infection. It appears that the clinical outcome after fluconazole maintenance therapy may be better when the infecting C. neoformans strain is inhibited by lower concentrations of fluconazole for eradication (MICs, <16 μg/ml) than when the patients are infected with strains that require higher fluconazole concentrations (MICs, ≥16 μg/ml). These findings also suggest that the MICs determined by the modified NCCLS microdilution method can be potential predictors of the clinical response to fluconazole therapy and may aid in the identification of patients who will not respond to fluconazole therapy. PMID:10817706

  10. Clinical and multimodal biomarker correlates of ADNI neuropathological findings

    PubMed Central

    2013-01-01

    Background Autopsy series commonly report a high percentage of coincident pathologies in demented patients, including patients with a clinical diagnosis of dementia of the Alzheimer type (DAT). However many clinical and biomarker studies report cases with a single neurodegenerative disease. We examined multimodal biomarker correlates of the consecutive series of the first 22 Alzheimer’s Disease Neuroimaging Initiative autopsies. Clinical data, neuropsychological measures, cerebrospinal fluid Aβ, total and phosphorylated tau and α-synuclein and MRI and FDG-PET scans. Results Clinical diagnosis was either probable DAT or Alzheimer’s disease (AD)-type mild cognitive impairment (MCI) at last evaluation prior to death. All patients had a pathological diagnosis of AD, but only four had pure AD. A coincident pathological diagnosis of dementia with Lewy bodies (DLB), medial temporal lobe pathology (TDP-43 proteinopathy, argyrophilic grain disease and hippocampal sclerosis), referred to collectively here as MTL, and vascular pathology were present in 45.5%, 40.0% and 22.7% of these patients, respectively. Hallucinations were a strong predictor of coincident DLB (100% specificity) and a more severe dysexecutive profile was also a useful predictor of coincident DLB (80.0% sensitivity and 83.3% specificity). Occipital FDG-PET hypometabolism accurately classified coincident DLB (80% sensitivity and 100% specificity). Subjects with coincident MTL showed lower hippocampal volume. Conclusions Biomarkers can be used to independently predict coincident AD and DLB pathology, a common finding in amnestic MCI and DAT patients. Cohorts with comprehensive neuropathological assessments and multimodal biomarkers are needed to characterize independent predictors for the different neuropathological substrates of cognitive impairment. PMID:24252435

  11. Correlation of quality of life with clinical symptoms and signs at the time of glaucoma diagnosis.

    PubMed Central

    Mills, R P

    1998-01-01

    PURPOSE: To examine the relationship between clinical measures of visual function and patient-reported measures of symptoms and health status in a large cohort of glaucoma patients at the time of diagnosis. SUBJECTS AND METHODS: The 607 patients in the Collaborative Initial Glaucoma Treatment Study (CIGTS) received standardized examinations of visual acuity and visual field at enrollment. In addition, they completed a health-related quality-of-life instrument, which included the Visual Activities Questionnaire (VAQ), Sickness Impact Profile (SIP), a symptom and a comorbidity chart, a question about their degree of worry about becoming blind, and many other items. RESULTS: The SIP total and dimension scores correlated only weakly, and not significantly, with visual acuity and visual field measures. The VAQ total and subscale scores, particularly the peripheral vision subscale, correlated weakly and significantly with visual acuity and visual field scores, especially those from the better eye. Worry about blindness and symptoms attributed to glaucoma correlated weakly but significantly to visual field scores from the worse eye. Attempts to improve correlations by scoring the visual fields differently, including only paracentral and pericentral test locations in the scores, and simulating binocular visual field scores were largely unsuccessful. CONCLUSIONS: At diagnosis, most patients were relatively free of glaucoma-induced impairments, so clinical measures were poor predictors of a patient's perception of health-related quality of life. The vision-specific VAQ and glaucoma-related symptom score correlated better than the generic SIP with clinical measures at the time of enrollment into CIGTS. PMID:10360308

  12. Ascitic microbiota composition is correlated with clinical severity in cirrhosis with portal hypertension.

    PubMed

    Rogers, Geraint B; van der Gast, Christopher J; Bruce, Kenneth D; Marsh, Peter; Collins, Jane E; Sutton, Julian; Wright, Mark

    2013-01-01

    Identification of pathogenic bacteria in ascites correlates with poor clinical outcomes. Ascites samples are commonly reported culture-negative, even where frank infection is indicated. Culture-independent methods have previously reported bacterial DNA in ascites, however, whether this represents viable bacterial populations has not been determined. We report the first application of 16S rRNA gene pyrosequencing and quantitative PCR in conjunction with propidium monoazide sample treatment to characterise the viable bacterial composition of ascites. Twenty five cirrhotic patients undergoing paracentesis provided ascites. Samples were treated with propidium monoazide to exclude non-viable bacterial DNA. Total bacterial load was quantified by 16S rRNA Q-PCR with species identity and relative abundance determined by 16S rRNA gene pyrosequencing. Correlation of molecular microbiology data with clinical measures and diagnostic microbiology was performed. Viable bacterial signal was obtained in 84% of ascites samples, both by Q-PCR and pyrosequencing. Approximately 190,000 ribosomal pyrosequences were obtained, representing 236 species, including both gut and non gut-associated species. Substantial variation in the species detected was observed between patients. Statistically significant relationships were identified between the bacterial community similarity and clinical measures, including ascitic polymorphonuclear leukocyte count and Child-Pugh class. Viable bacteria are present in the ascites of a majority of patients with cirrhosis including those with no clinical signs of infection. Microbiota composition significantly correlates with clinical measures. Entry of bacteria into ascites is unlikely to be limited to translocation from the gut, raising fundamental questions about the processes that underlie the development of spontaneous bacterial peritonitis. PMID:24086392

  13. Primary sleep disorders in people with epilepsy: clinical questions and answers.

    PubMed

    Grigg-Damberger, Madeleine M; Foldvary-Schaefer, Nancy

    2015-01-01

    The questions facing clinicians with patients with sleep disorder and epilepsy are addressed in this article. Both adult and child epilepsy are discussed in the context of the most typical questions a clinician would have, such as "Are parasomnias more common in people with epilepsy?", "Is sleep architecture abnormal in children with epilepsy", along with outcomes of numerous questionnaire-based, case-based, and double-blind placebo studies on such aspects as sleep duration, daytime sleepiness, anxiety and fears, limb movement, nocturnal seizures, agitation, behavioral disorders, and learning disorders. PMID:25455580

  14. Head and neck neurovascular trauma: Clinical and angiographic correlation

    PubMed Central

    Ssenyonga, Peter Kato; Le Feuvre, David

    2015-01-01

    A retrospective review of all angiograms done for craniocervical trauma, over an eight-year period at Groote Schuur Hospital identified 61 patients out of 823 angiographically studied who had extradural vascular injury and required endovascular treatment. Multiple lesions were identified in nine (14,8%) patients and associated injuries were found in 23 patients (37%). The mechanism of injury was blunt in nine (14.8%) patients and penetrating in 52 (85.2%). There was a statistically significant correlation between the presenting clinical feature and the underlying angiographic lesion. Patients with active bleeding were more likely to have a vessel laceration, an expanding hematoma was associated with false aneurysm and a pulsatile mass with arteriovenous fistula. Endovascular treatment with emphasis on vessel occlusion rather than preservation was successful in all cases except one which required surgical vessel ligation. PMID:25934784

  15. Microscopic Enteritis; clinical features and correlations with symptoms

    PubMed Central

    Shahraki, Touran; Shahraki, Mansour; Bold, Justine; Danciu, Mihai; Al Dulaimi, David; Villanacci, Vincenzo; Bassotti, Gabrio

    2012-01-01

    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. PMID:24834216

  16. Clinical correlates of prescription opioid analgesic use in pregnancy.

    PubMed

    Smith, Megan V; Costello, Darce; Yonkers, Kimberly A

    2015-03-01

    A 2012 committee opinion from the American College of Obstetricians and Gynecologists highlights the considerable increase in opioid addiction in recent years, yet little is known about clinical correlates of prescribed opioids among pregnant women. This study examines clinical and demographic factors associated with the use of opioid analgesics in pregnancy. Data were derived from a prospective cohort study of pregnant women. Participants were administered the Composite International Diagnostic Interview to identify depressive and anxiety disorders and data on medication use were gathered at three assessment points and classified according to the Anatomical Therapeutic Chemical Code (ATC) classification system ATC group N02A. Participants included 2,748 English or Spanish speaking pregnant women. Six percent (n = 165) of women used opioid analgesics at any point in pregnancy. More pregnant women using opioids met diagnostic criteria for major depressive disorder (16 vs. 8 % for non users), generalized anxiety disorder (18 vs. 9 % for non users), post-traumatic stress disorder (11 vs. 4 % for non users) and panic disorder (6 vs. 4 % for non users). Women who reported opioid use were also significantly more likely than non users to report using illicit drugs and almost three times as likely to report smoking cigarettes in the second or third trimester of pregnancy (4 and 23 %, respectively) as compared to non-opioid users (0.5 and 8 %). The use of opioids in pregnancy was associated with higher levels of psychiatric comorbidity and use of other substances as compared to non-opioid users. PMID:24951127

  17. Gray Matter Pathology in MS: Neuroimaging and Clinical Correlations

    PubMed Central

    Honce, Justin Morris

    2013-01-01

    It is abundantly clear that there is extensive gray matter pathology occurring in multiple sclerosis. While attention to gray matter pathology was initially limited to studies of autopsy specimens and biopsies, the development of new MRI techniques has allowed assessment of gray matter pathology in vivo. Current MRI techniques allow the direct visualization of gray matter demyelinating lesions, the quantification of diffuse damage to normal appearing gray matter, and the direct measurement of gray matter atrophy. Gray matter demyelination (both focal and diffuse) and gray matter atrophy are found in the very earliest stages of multiple sclerosis and are progressive over time. Accumulation of gray matter damage has substantial impact on the lives of multiple sclerosis patients; a growing body of the literature demonstrates correlations between gray matter pathology and various measures of both clinical disability and cognitive impairment. The effect of disease modifying therapies on the rate accumulation of gray matter pathology in MS has been investigated. This review focuses on the neuroimaging of gray matter pathology in MS, the effect of the accumulation of gray matter pathology on clinical and cognitive disability, and the effect of disease-modifying agents on various measures of gray matter damage. PMID:23878736

  18. Major Pathophysiological Correlations of Rosacea: A Complete Clinical Appraisal

    PubMed Central

    Vemuri, Ravi Chandra; Gundamaraju, Rohit; Sekaran, Shamala Devi; Manikam, Rishya

    2015-01-01

    Background: Rosacea is a characteristic cutaneous disorder with a diverse clinical manifestations ranging from facial vascular hyper-reactivity to sebaceous gland hyperplasia. Many theories on pathophysiology of rosacea were proposed over the past decade, however the pathogenicity is poorly understood. Aim: To review the evidence on different pathophysiological correlations of rosacea. Methods: A literature search was conducted for studies published between 1990 to March 2014. The inclusion criteria was pathophysiology, randomized controlled trials, controlled trials on rosacea. Results: Out of 5141 articles, 14 high quality studies met all the selection criteria. Of 14 articles, 5 are randomized control trials (RCTs), 2 are controlled trial, 3 comparative trials, 2 observational trials, 1 prospective and 1 diagnostic trial. The studies were categorized into two groups: the trigger factors and sub-types & symptoms. Of 7 high quality studies, 4 provided strong evidence that immune responses causing disease triggered by external/internal factors such as sunlight, food and chemical agents, 3 trials provided significant evidence of microorganisms as causative agents. The remaining trials did not provide significant evidences on pathophysiology. Conclusion: Vasculature, chronic inflammatory responses, environmental triggers, food and chemicals ingested and microorganisms either alone or in combination are responsible for rosacea. Many promising drugs are under various phases of clinical trials and interestingly, probiotics could also possibly be used as one of the treatment option. PMID:26005373

  19. Blood and marrow transplant clinical trials network (BMT CTN): addressing unanswered questions.

    PubMed

    Weisdorf, Daniel; Carter, Shelly; Confer, Dennis; Ferrara, James; Horowitz, Mary

    2007-03-01

    Prospective clinical trials for blood transplantation and BMT are made more difficult by limited patient numbers, heterogeneity of clinical management strategies, and high-intensity therapy with frequent and toxic competing hazards. To address the challenges of prospective clinical study of BMT, the Blood and Marrow Transplant Clinical Trials Network (BMT CTN), sponsored by the National Heart, Lung, and Blood Institute/National Cancer Institute, was established. The network's charge is to design and execute multicenter clinical trials requiring participation from the network and from noncore centers for successful performance and to address rare diseases and unique populations that could not be well studied in individual centers. The BMT CTN organizational structure, current portfolio of studies, and scientific agenda are reviewed. Opportunities for investigators in any institution to propose trials and participate are outlined. PMID:17317578

  20. Childhood Ataxia: Clinical Features, Pathogenesis, Key Unanswered Questions, and Future Directions

    PubMed Central

    Ashley, Claire N.; Hoang, Kelly D.; Lynch, David R.; Perlman, Susan L.; Maria, Bernard L.

    2013-01-01

    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. PMID:22859693

  1. Superior canal dehiscence syndrome: clinical manifestations and radiologic correlations.

    PubMed

    Saliba, Issam; Maniakas, Anastasios; Benamira, Lina Zahra; Nehme, Jade; Benoit, Mélanie; Montreuil-Jacques, Véronique

    2014-11-01

    The objective of this study is to describe the superior canal dehiscence syndrome (SCDS) and its vestibule-cochlear manifestations, while analyzing dehiscence size, audiogram and vestibular-evoked myogenic potential (VEMP) changes following dehiscence obliteration. We conducted a prospective study in a tertiary referral center. All Patients diagnosed and surgically treated for SCDS were operated through a middle fossa craniotomy (MFC). Clinical and radiological data were collected. The main outcome measures were Air-bone gaps, Pure-tone average (PTA), speech discrimination scores (SDS) and VEMP thresholds and were correlated to dehiscence size. 28 patients were included in this study with a mean dehiscence size of 4.68 mm. Phonophobia and imbalance were the most debilitating cochlear and vestibular symptoms, respectively. At 2 months postoperatively, low-frequency air-bone gaps showed a statistically significant improvement (p < 0.001). SDS and PTA did not show any statistically significant changes 2 months postoperatively (p = 0.282 and p = 0.295, respectively). VEMP threshold differences between operated and contralateral ears were statistically significant preoperatively (p < 0.001) and non-significant 2 months postoperatively (p = 0.173). Dehiscence size only showed a statistically significant correlation with preoperative total cochlear symptoms, while remaining insignificant with all other variables measured. Air-bone gaps, VEMP and computerized tomography remain essential tools in diagnosing and following SCDS. Dehiscence size is an independent factor in the analysis of SCDS, with cochlear symptomatology being associated to dehiscence sizes. Finally, it is shown that overall symptomatology, audiometric results and VEMP thresholds return to normal values post-obliteration, confirming the continuing success of the MFC approach for SCDS obliteration. PMID:24162764

  2. Clinical Correlates of Prescription Opioid Analgesic Use in Pregnancy

    PubMed Central

    Smith, Megan V.; Costello, Darce; Yonkers, Kimberly A.

    2014-01-01

    Objective A 2012 committee opinion from the American College of Obstetricians and Gynecologists highlights the considerable increase in opioid addiction in recent years, yet little is known about clinical correlates of prescribed opioids among pregnant women. This study examines clinical and demographic factors associated with the use of opioid analgesics in pregnancy. Methods Data were derived from a prospective cohort study of pregnant women. Participants were administered the Composite International Diagnostic Interview to identify depressive and anxiety disorders and data on medication use were gathered at three assessment points and classified according to the Anatomical Therapeutic Chemical Code (ATC) classification system ATC group N02A. Participants included 2,748 English or Spanish speaking pregnant women. Results Six percent (n=165) of women used opioid analgesics at any point in pregnancy. More pregnant women using opioids met diagnostic criteria for major depressive disorder (16% vs. 8% for non users), generalized anxiety disorder (18% vs. 9% for non users), post-traumatic stress disorder (11% vs. 4% for non users) and panic disorder (6% vs. 4% for non users). Women who reported opioid use were also significantly more likely than non users to report using illicit drugs and almost three times as likely to report smoking cigarettes in the second or third trimester of pregnancy (4% and 23%, respectively) as compared to non-opioid users (0.5% and 8%). Conclusion The use of opioids in pregnancy was associated with higher levels of psychiatric comorbidity and use of other substances as compared to non-opioid users. PMID:24951127

  3. Age at Onset and Clinical Correlates in Body Dysmorphic Disorder

    PubMed Central

    Bjornsson, Andri S.; Didie, Elizabeth R.; Grant, Jon E.; Menard, William; Stalker, Emily; Phillips, Katharine A.

    2013-01-01

    OBJECTIVE Age at onset is an important clinical feature of all disorders. However, no prior studies have focused on this important construct in body dysmorphic disorder (BDD). In addition, across a number of psychiatric disorders, early age at disorder onset is associated with greater illness severity and greater comorbidity with other disorders. However, clinical correlates of age at onset have not been previously studied in BDD. METHODS Age at onset and other variables of interest were assessed in two samples of adults with DSM-IV BDD; sample 1 consisted of 184 adult participants in a study of the course of BDD, and sample 2 consisted of 244 adults seeking consultation or treatment for BDD. Reliable and valid measures were used. Subjects with early-onset BDD (age 17 or younger) were compared to those with late-onset BDD. RESULTS BDD had a mean age at onset of 16.7 (SD=7.3) in sample 1 and 16.7 (SD=7.2) in sample 2. 66.3% of subjects in sample 1 and 67.2% in sample 2 had BDD onset before age 18. A higher proportion of females had early-onset BDD in sample 1 but not in sample 2. On one of three measures in sample 1, those with early-onset BDD currently had more severe BDD symptoms. Individuals with early-onset BDD were more likely to have attempted suicide in both samples and to have attempted suicide due to BDD in sample 2. Early age at BDD onset was associated with a history of physical violence due to BDD and psychiatric hospitalization in sample 2. Those with early-onset BDD were more likely to report a gradual onset of BDD than those with late-onset in both samples. Participants with early-onset BDD had a greater number of lifetime comorbid disorders on both Axis I and Axis II in sample 1 but not in sample 2. More specifically, those with early-onset BDD were more likely to have a lifetime eating disorder (anorexia nervosa or bulimia nervosa) in both samples, a lifetime substance use disorder (both alcohol and non-alcohol) and borderline personality disorder in sample 1, and a lifetime anxiety disorder and social phobia in sample 2. CONCLUSIONS BDD usually began during childhood or adolescence. Early onset was associated with gradual onset, a lifetime history of attempted suicide, and greater comorbidity in both samples. Other clinical features reflecting greater morbidity were also more common in the early-onset group, although these findings were not consistent across the two samples. PMID:23643073

  4. Aromatase inhibition 2013: clinical state of the art and questions that remain to be solved.

    PubMed

    Lnning, Per Eystein; Eikesdal, Hans Petter

    2013-08-01

    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

  5. CLINICAL AND THERAPEUTIC CORRELATIONS IN PATIENTS WITH SLIGHT ACUTE PANCREATITIS

    PubMed Central

    MUNHOZ-FILHO, Clewis Henri; BATIGÁLIA, Fernando; FUNES, Hamilton Luiz Xavier

    2015-01-01

    Background Acute pancreatitis is an inflammatory disease of the pancreas due to enzymatic autodigestion which can cause necrosis or multiple organ failure; its pathophysiology is not fully known yet. Aim To evaluate the correlation between clinical and therapeutic data in patients with mild acute pancreatitis. Methods A retrospective study in 55 medical records of patients admitted with acute mild pancreatitis was realized to analyze the association between age, leukocytosis, serum glutamic-oxaloacetic transaminase and lactate dehydrogenase, glucose, antibiotics, time admission and Ranson´s scores. Results There was a positive association between less intensive care (strict hydration, analgesia and monitoring of vital signs), early antibiotic therapy (monotherapy), early return to diet after 48 hours and laboratory control of the serum amylase and lipase (high in the first week and decreasing after 10 days, without any prognostic value). Conclusions Changes in the management of patients with mild acute pancreatitis, such as enteral nutrition, rational use of lower spectrum antibiotics and intensive care, have contributed significantly to the reduction of hospitalization time and mortality. PMID:25861064

  6. Recurrent orbital schwannomas: clinical course and histopathologic correlation

    PubMed Central

    2012-01-01

    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. PMID:22937797

  7. Hemimegalencephaly: Clinical, EEG, neuroimaging, and IMP-SPECT correlation

    SciTech Connect

    Konkol, R.J.; Maister, B.H.; Wells, R.G.; Sty, J.R. )

    1990-11-01

    Iofetamine-single photon emission computed tomography (IMP-SPECT) was performed on 2 girls (5 1/2 and 6 years of age) with histories of intractable seizures, developmental delay, and unilateral hemiparesis secondary to hemimegalencephaly. Electroencephalography (EEG) revealed frequent focal discharges in 1 patient, while a nearly continuous burst suppression pattern over the malformed hemisphere was recorded in the other. IMP-SPECT demonstrated a good correlation with neuroimaging studies. In spite of the different EEG patterns, which had been proposed to predict contrasting clinical outcomes, both IMP-SPECT scans disclosed a similar decrease in tracer uptake in the malformed hemisphere. These results are consistent with the pattern of decreased tracer uptake found in other interictal studies of focal seizures without cerebral malformations. In view of recent recommendations for hemispherectomy in these patients, we suggest that the IMP-SPECT scan be used to compliment EEG as a method to define the extent of abnormality which may be more relevant to long-term prognosis than EEG alone.

  8. Metabolic brain imaging correlated with clinical features of brain tumors

    SciTech Connect

    Alavi, J.; Alavi, A.; Dann, R.; Kushner, M.; Chawluk, J.; Powlis, W.; Reivich, M.

    1985-05-01

    Nineteen adults with brain tumors have been studied with positron emission tomography utilizing FDG. Fourteen had biopsy proven cerebral malignant glioma, one each had meningioma, hemangiopericytoma, primitive neuroectodermal tumor (PNET), two had unbiopsied lesions, and one patient had an area of biopsy proven radiation necrosis. Three different patterns of glucose metabolism are observed: marked increase in metabolism at the site of the known tumor in (10 high grade gliomas and the PNET), lower than normal metabolism at the tumor (in 1 grade II glioma, 3 grade III gliomas, 2 unbiopsied low density nonenhancing lesions, and the meningioma), no abnormality (1 enhancing glioma, the hemangiopericytoma and the radiation necrosis.) The metabolic rate of the tumor or the surrounding brain did not appear to be correlated with the history of previous irradiation or chemotherapy. Decreased metabolism was frequently observed in the rest of the affected hemisphere and in the contralateral cerebellum. Tumors of high grade or with enhancing CT characteristics were more likely to show increased metabolism. Among the patients with proven gliomas, survival after PETT scan tended to be longer for those with low metabolic activity tumors than for those with highly active tumors. The authors conclude that PETT may help to predict the malignant potential of tumors, and may add useful clinical information to the CT scan.

  9. Experiences in adding multiple-choice questions to an objective structural clinical examination (OSCE) in undergraduate dental education.

    PubMed

    Näpänkangas, R; Harila, V; Lahti, S

    2012-02-01

    In the University of Oulu, the competencies of fourth-year dental students have traditionally been assessed with a written examination before they go to work for the first time as dentists outside the Institute of Dentistry. In 2009, the objective structural clinical examination (OSCE) modified with multiple-choice questions was introduced as a tool for assessing clinical competencies. The aim of the study was to evaluate the validity of the modified OSCE (m-OSCE) by measuring the attitude of examiners (teachers) and dental students towards the m-OSCE and to evaluate whether the OSCE is preferred to the written examination in the assessment of knowledge and clinical skills. Additionally, the aim was to evaluate the reliability of the multiple-choice examination. Altogether 30 students (86%) and 11/12 examiners (92%) responded to the questionnaire. Most of the students considered the multiple-choice questions easy, but complained about the complex formulation of the questions. The test stations were easy for 87% of the students, but the time allocated was too short. Most of the students (73%) and examiners (91%) preferred the m-OSCE to the written examination. All students and examiners found the immediate assessment of the tasks good. Based on the evaluations of m-OSCE, it could be concluded that both students and examiners preferred the m-OSCE to the pure written examination in assessment, which indicate that m-OSCE had good face validity. Combining multiple methods in assessment of knowledge and clinical skills whilst simultaneously taking into account the feasibility and available resources provides more valid results. PMID:22251338

  10. Questioning the Questions

    ERIC Educational Resources Information Center

    Tienken, Christopher H.; Goldberg, Stephanie; DiRocco, Dominic

    2010-01-01

    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…

  11. 21 CFR 320.28 - Correlation of bioavailability with an acute pharmacological effect or clinical evidence.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... pharmacological effect or clinical evidence. 320.28 Section 320.28 Food and Drugs FOOD AND DRUG ADMINISTRATION... Correlation of bioavailability with an acute pharmacological effect or clinical evidence. Correlation of in vivo bioavailability data with an acute pharmacological effect or clinical evidence of safety...

  12. 21 CFR 320.28 - Correlation of bioavailability with an acute pharmacological effect or clinical evidence.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... pharmacological effect or clinical evidence. 320.28 Section 320.28 Food and Drugs FOOD AND DRUG ADMINISTRATION... Correlation of bioavailability with an acute pharmacological effect or clinical evidence. Correlation of in vivo bioavailability data with an acute pharmacological effect or clinical evidence of safety...

  13. Correlating Photoreceptor Mosaic Structure to Clinical Findings in Stargardt Disease

    PubMed Central

    Razeen, Moataz M.; Cooper, Robert F.; Langlo, Christopher S.; Goldberg, Mara R.; Wilk, Melissa A.; Han, Dennis P.; Connor, Thomas B.; Fishman, Gerald A.; Collison, Frederick T.; Sulai, Yusufu N.; Dubra, Alfredo; Carroll, Joseph; Stepien, Kimberly E.

    2016-01-01

    Purpose To demonstrate a method for correlating photoreceptor mosaic structure with optical coherence tomography (OCT) and microperimetry findings in patients with Stargardt disease. Methods A total of 14 patients with clinically diagnosed Stargardt disease were imaged using confocal and split-detection adaptive optics scanning light ophthalmoscopy. Cone photoreceptors were identified manually in a band along the temporal meridian. Resulting values were compared to a normative database (n = 9) to generate cone density deviation (CDD) maps. Manual measurement of outer nuclear layer plus Henle fiber layer (ONL+HFL) thickness was performed, in addition to determination of the presence of ellipsoid zone (EZ) and interdigitation zone (IZ) bands on OCT. These results, along with microperimetry data, were overlaid with the CDD maps. Results Wide variation in foveal structure and CDD maps was seen within this small group. Disruption of ONL+HFL and/or IZ band was seen in all patients, with EZ band preservation in regions with low cone density in 38% of locations analyzed. Normality of retinal lamellar structure on OCT corresponded with cone density and visual function at 50/78 locations analyzed. Outer retinal tubulations containing photoreceptor-like structures were observed in 3 patients. Conclusions The use of CDD color-coded maps enables direct comparison of cone mosaic local density with other measures of retinal structure and function. Larger normative datasets and improved tools for automation of image alignment are needed. Translational Relevance The approach described facilitates comparison of complex multimodal data sets from patients with inherited retinal degeneration, and can be expanded to incorporate other structural imaging or functional testing. PMID:26981328

  14. Creating and using real-world evidence to answer questions about clinical effectiveness.

    PubMed

    de Lusignan, Simon; Crawford, Laura; Munro, Neil

    2015-01-01

    New forms of evidence are needed to complement evidence generated from randomised controlled trials (RCTs). Real-World Evidence (RWE) is a potential new form of evidence, but remains undefined. This paper sets to fill that gap by defining RWE as the output from a rigorous research process which: (1) includes a clear a priori statement of a hypothesis to be tested or research question to be answered; (2) defines the data sources that will be used and critically appraises their strengths and weaknesses; and (3) applies appropriate methods, including advanced analytics. These elements should be set out in advance of the study commencing, ideally in a published protocol.The strengths of RWE studies are that they are more inclusive than RCTs and can enable an evidence base to be developed around real-world effectiveness and to start to address the complications of managing other real-world problems such as multimorbidity. Computerised medical record systems and big data provide a rich source of data for RWE studies. However, guidance is needed to help assess the rigour of RWE studies so that the strength of recommendations based on their output can be determined. Additionally, RWE advanced analytics methods need better categorisation and validation.We predict that the core role of RCTs will shift towards assessing safety and achieving regulatory compliance. RWE studies, notwithstanding their limitations, may become established as the best vehicle to assess efficacy. PMID:26577427

  15. Ethical questions in human clinical psychopharmacology: should the focus be on placebo administration?

    PubMed

    Kotzalidis, Gd; Pacchiarotti, I; Manfredi, G; Savoja, V; Torrent, C; Mazzarini, L; Tatarelli, C; Amann, B; Di Marzo, S; Snchez-Moreno, J; Sani, G; Girardi, P; Colom, F; Vieta, E

    2008-08-01

    Of all ethical issues in clinical trial designs, only placebo use is dealt with acrimony and unwarranted, rhetoric emphasis. Many misconceptions are biased and may hamper research in the mechanisms of healing and recovery if placebo is banned from clinical trials, as some influential ethicists propose. Current treatments in psychiatry are by no means optimal and may vary in their effect across studies, rendering difficult to find the best available therapeutic method with which to compare new drugs. Because drugs possess specific mechanisms, it is not possible to compare drugs with different mechanisms as to their relevance in the pathophysiology of a given disorder. Placebo acts through non-specific mechanisms and is the ideal control for any disorder whose pathophysiology is relatively unknown and its treatment is still suboptimal. Sticking to short-term patient benefit in a trial reflects an individualistically oriented thinking in contemporary ethics and is likely to limit further research and efforts to better understand the mechanisms of disease and drug action, but also those related to general body reactance and self-healing, which are enhanced by placebo administration. Because in history ethics are swinging between two opposed views, it is possible that in the near future, the balance will move towards communitarianism, which is more likely to better serve long-term patient needs. Ethicists should also consider some other aspects of human experimentation, such as the consistency of research lines and the trend to substitute older drugs with their metabolites or enantiomers. PMID:18515445

  16. Infantile hemangioendothelioma of the liver: a radiologic-pathologic-clinical correlation

    SciTech Connect

    Dachman, A.H.; Lichtenstein, J.E.; Friedman, A.C.; Hartman, D.S.

    1983-06-01

    Infantile hemangioendothelioma is the most common symptomatic vascular liver tumor of infancy. It is considered a benign tumor; however, aggressive behavior is occasionally seen microscopically, and rarely distant metastases have been reported. The exact incidence of infantile hemangioendothelioma is difficult to determine because often it has been either misdiagnosed or mislabeled as cavernous hemangioma in the literature. Cavernous hemangioma is the most common primary liver tumor in older age groups but is rarely found in infants as a clinically significant tumor. Levick and Rubie were the first to recognize an association between hemangioendothelioma of the liver and congestive heart failure, and there were subsequent reports substantiating this association. However, it is our impression and the finding of others that congestive heart failure is distinctly less common than abdominal mass or hepatomegaly as the presenting sign in infantile hemangioendothelioma. Congestive heart failure is rarely a feature of cavernous hemangioma. Because of the errors in terminology and questions regarding clinical presentation, a radiologic-pathologic-clinical correlation study of infantile hemangioendothelioma and review of the literature was undertaken.

  17. Tumors of the Central Nervous System: Clinical Aspects, Molecular Mechanisms, Unanswered Questions, and Future Research Directions

    PubMed Central

    Babcock, Michael A.; Kostova, Felina V.; Fountain, Jane; Guha, Abhijit; Packer, Roger J.; Pollack, Ian F.; Maria, Bernard L.

    2013-01-01

    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. PMID:18952577

  18. Questioning the Questions

    ERIC Educational Resources Information Center

    Tienken, Christopher H.; Goldberg, Stephanie; DiRocco, Dominic

    2009-01-01

    Well-known 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 classic work "The Republic" (2003). Today, teachers still use questions as one way to help students develop productive thinking skills and to understand concepts and topics.…

  19. The role of Clinical Officers in the Kenyan health system: a question of perspective

    PubMed Central

    2013-01-01

    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. PMID:23866692

  20. Molecular/clinical correlations in females with fragile X

    SciTech Connect

    Sobesky, W.E.; Riddle, J.; Hagerman, R.J.

    1996-08-09

    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.

  1. Seasonality and its distinct clinical correlates in bipolar II disorder.

    PubMed

    Kim, Ji Sun; Ha, Tae Hyon; Chang, Jae Seung; Park, Yoon Seong; Huh, Iksoo; Kim, Jayoun; Hong, Kyung Sue; Park, Taesung; Ha, Kyooseob

    2015-02-28

    Seasonality is one of the key features in subjects with mood disorders and is involved in the multi-faceted nature of the clinical course. However, few studies have explored the clinical implications of seasonality in bipolar disorders. We examined the differential effects of seasonality on clinical variables between bipolar I and II disorder (BD I and II). Seasonality was assessed using the Seasonal Pattern Assessment Questionnaire (SPAQ) in 204 subjects with BD I and 308 with BD II. Following the comparisons between BD I and II groups, clinical characteristics related to seasonality were explored. Next, to predict the presence of seasonality, a logistic regression model was applied. The global seasonality score on the SPAQ was significantly higher in the BD II group than in the BD I group. In the BD I group, seasonality was associated with suicide attempt history. In the BD II group, on the other hand, seasonality was associated with female gender, depressive predominance, and premenstrual dysphoric disorder (PMDD). In the regression models, the presence of PMDD and female gender was significantly associated with seasonality in the BD II group. Our findings suggest that high seasonality tendency, a vulnerability maker for cyclic worsening, may contribute to a differential pattern of clinical characteristics in BD II. PMID:25537487

  2. Magnetic resonance imaging and clinical correlations in multiple sclerosis.

    PubMed

    Huber, S J; Paulson, G W; Chakeres, D; Pakalnis, A; Brogan, M; Phillips, B L; Myers, M A; Rammohan, K W

    1988-08-01

    We examined the relationship between magnetic resonance imaging (MRI) cerebral findings and clinical evaluations in 66 patients with clinically definite multiple sclerosis (MS). MRI observations included total number and location of lesions visualized, degree of periventricular involvement, degree of degeneration of the corpus callosum, and extent of generalized parenchymal atrophy. Overall physical disability was evaluated by the Kurtzke Expanded Disability Status Scale (EDSS) and individual symptoms were rated according to the Kurtzke Functional Systems (FS) scale. Our results suggest that MRI brain abnormalities are significantly related to the overall severity of disease, but MRI is not particularly useful to predict the presence or absence of individual symptoms. These findings do suggest that the MRI may provide useful information to monitor clinical progression of patients with MS, but the lesions visualized need not always be symptomatic nor are we sure that all symptomatic lesions, particularly in the spinal cord and optic nerves, will be visualized. PMID:3171594

  3. Panic symptoms in schizophrenia: comorbidity and clinical correlates.

    PubMed

    Ulas, Halis; Alptekin, Koksal; Akdede, Berna Binnur; Tumuklu, Mevhibe; Akvardar, Yildiz; Kitis, Arzu; Polat, Selma

    2007-12-01

    The aim of the present study was to investigate the prevalence of panic attack (PA) and panic disorder (PD) in patients with schizophrenia and detect the clinical features. Forty-nine patients with schizophrenia were included in the study. Positive and Negative Syndrome Scale (PANSS), Hamilton Depression Rating Scale (HDRS), Clinical Global Impression (CGI), Extrapyramidal Symptom Rating Scale (ESRS) and Bandelow Panic and Agoraphobia Rating Scale were administered. Fifteen patients were found to have PA and seven patients had PD. Patients with panic symptoms had higher scores of PANSS, HDRS, CGI and ESRS. Comorbid panic symptoms in schizophrenia may be related to positive symptoms, extrapyramidal side-effects and depression. PMID:18081631

  4. Upper gastrointestinal bleeding in cirrhosis: clinical and endoscopic correlations.

    PubMed Central

    Ters, J; Bordas, J M; Bru, C; Diaz, F; Bruguera, M; Rodes, J

    1976-01-01

    The clinical data of 180 episodes of upper gastrointestinal bleeding in 168 patients with cirrhosis of the liver are examined. The source of bleeding had been determined by early endoscopy in all cases. In men under the age of 50 years, and without symptoms of liver failure, bleeding was due to ruptured gastro-oesophageal varices in 84% of cases. Severe liver failure was associated with acute lesions of gastric mucosa in many cases. No presumptive diagnosis of the source of haemorrhage could be based on the examination of other clinical data (presence of ascites, mode of presentation and pattern of bleeding, history of ulcer disease, alcoholism, and previous medication. PMID:1083824

  5. A Case of Sanfillippo's Disease Correlating Clinical and Biochemical Findings.

    PubMed

    Datta, Priyanka; Prasad, Anushre; Shenoy, Vijetha; Hebbar, Shrikiran; Mundkur, Suneel C; Rao, Pragna

    2014-10-01

    The mucopolysaccharidoses (MPSs) are a heterogeneous group of rare inherited disorders caused by deficiency of lysosomal enzyme necessary to break down mucopolysaccharides or glycosaminoglycans (GAGs). We had combined clinical findings and ophthalmological features. Biochemical test for urine glycosaminoglycans was done for confirmation of diagnosis in the patient. The case of Sanfillippo's disease was characterized by delayed development, hyperactivity with aggressive behaviour. Coarse facial feature, hirsutism and sleep disorder. Urine GAG tests for MPS was positive in the case. Based on clinical findings and biochemical tests for MPS, this case was diagnosed as a type III mucopolysaccharidoses. Urinary GAG's electrophoresis is an important screening test for MPS suspected cases. PMID:25298638

  6. Correlates of Successful Response to a Behavioral Weight Control Clinic.

    ERIC Educational Resources Information Center

    And Others; Gormally, Jim

    1980-01-01

    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)

  7. Clinical and neuroimaging correlation of movement disorders in multiple sclerosis: case series and review of the literature.

    PubMed

    Potulska-Chromik, Anna; Rudzinska, Monika; Nojszewska, Monika; Podlecka-Piętowska, Aleksandra; Szczudlik, Andrzej; Zakrzewska-Pniewska, Beata; Gołębiowski, Marek

    2014-01-01

    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

  8. Depression in women living with HIV: clinical and psychosocial correlates.

    PubMed

    Mello, Valeria A; Segurado, Aluisio A; Malbergier, Andre

    2010-06-01

    The number of Brazilian women living with HIV has increased significantly in past years, rendering studies of their particular care demands including psychiatric issues. This study measures the prevalence of major depression, using the Structured Clinical Interview for DSM-IV Axis I Disorders, in a sample of 120 women living with HIV in treatment at a reference centre in São Paulo. Socio-demographic variables, HIV-related clinical and laboratory data, including CD4+ cell counts and HIV plasma viral loads, as well as psychosocial features (intimate relationships, disclosure of HIV serostatus, partner's serostatus and patient's emotional and financial support) were investigated as factors potentially associated with depression. The prevalence of major depression at the time of evaluation was 25.8% (95% CI 18.2-33.4%). Clinical status (p = 0.002), lack of emotional support (p = 0.02), use of antidepressants (p = 0.028) and length of time since HIV diagnosis (p = 0.05) were associated with major depression in univariate analysis. In multivariate multiple-regression model, HIV clinical status, lack of emotional support and higher plasma viral loads were associated with depression. Sixty per cent of the women have a major depression diagnosis during lifetime. We conclude that major depression is highly prevalent among women living with HIV, but it is still underdiagnosed and undertreated. PMID:19760048

  9. Annual Research Review: Attachment disorders in early childhood – clinical presentation, causes, correlates and treatment

    PubMed Central

    Zeanah, Charles H.; Gleason, Mary Margaret

    2015-01-01

    Background Though noted in the clinical literature for more than 50 years, attachment disorders have been studied systematically only recently. In part because of the ubiquity of attachments in humans, determining when aberrant behavior is best explained as an attachment disorder as opposed to insecure attachment has led to some confusion. In this selective review, we consider the literature on reactive attachment disorder and disinhibited social engagement disorder and describe an emerging consensus about a number of issues, while also noting some areas of controversy and others where we lack clear answers. We include a brief history of the classification of the disorders, as well as measurement issues. We describe their clinical presentation, causes and vulnerability factors, and clinical correlates, including the relation of disorders to secure and insecure attachment classifications. We also review what little is known and what more we need to learn about interventions. Methods We conducted a literature search using PubMed, PsycINFO, and Cochrane Library databases, using search terms “reactive attachment disorder,” “attachment disorder,” “indiscriminate behavior,” “indiscriminate friendliness,” “indiscriminate socially disinhibited reactive attachment disorder,” “disinhibited social engagement disorder,” and “disinhibited social behavior.” We also contacted investigators who have published on these topics. Findings A growing literature has assessed behaviors in children who have experienced various types of adverse caregiving environments reflecting signs of putative attachment disorders, though fewer studies have investigated categorically defined attachment disorders. The evidence for two separate disorders is considerable, with reactive attachment disorder indicating children who lack attachments despite the developmental capacity to form them, and disinhibited social engagement disorder indicating children who lack developmentally appropriate reticence with unfamiliar adults and who violate socially sanctioned boundaries. Conclusions Though many questions remain to be answered, especially regarding appropriate interventions, we know considerably more about attachment disorders than we did only a decade ago. PMID:25359236

  10. Lumbosacral plexus lesions: correlation of clinical signs and computed tomography.

    PubMed Central

    Vock, P; Mattle, H; Studer, M; Mumenthaler, M

    1988-01-01

    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 extraspinal mass lesions, but only moderately well predicts functional signs. Images PMID:3351532

  11. Teaching respiratory physiology: clinical correlation with a human patient simulator.

    PubMed

    Euliano, T Y

    2000-01-01

    In recent years students have increasingly objected to laboratory exercises involving animal subjects. We have replaced the valuable animal experiments with demonstrations using a full-scale human patient simulator. In small groups first-year medical students observe realistic clinical situations such as opioid-induced hypoventilation, pneumothorax, and pulmonary edema. Students obtain information through physical examination, arterial blood gas analysis and chest radiography. They practice interventions such as providing supplemental oxygen and mask ventilation, monitor the results, and develop a basic differential diagnosis and treatment plan. We utilize the clinical context to review fundamental concepts of respiratory physiology including the alveolar air equation and oxyhemoglobin dissociation curve. The students give these laboratory exercises uniformly superior evaluations. PMID:12580230

  12. Clinical correlates of arterial lactate levels in STEMI patients.

    PubMed

    Weil, Max Harry; Tang, Wanchun

    2011-01-01

    Increases in blood lactate reflect decreases in systemic blood flows associated with low blood flow states characteristic of circulatory shock. Accordingly, the report by Vermeulen and colleagues documents the use of the blood lactate measurement as a prognostic indicator in settings of ST elevation myocardial infarction. That lactate value therefore identified high-risk patients as a complication, often with clinical signs of cardiogenic shock of corresponding severities. PMID:21345276

  13. Computed tomography in cases of coccidioidal meningitis, with clinical correlation

    SciTech Connect

    Shetter, A.G.; Fischer, D.W.; Flom, R.A.

    1985-06-01

    Cranial computed tomographic (CT) scans of 22 patients with coccidioidal meningitis were reviewed and their clinical course was analyzed. Abnormalities of the ventricular system or the basilar cisterns or both were present in 16 instances. Although it is not a definitive diagnostic tool, the CT scan is helpful in suggesting a diagnosis of coccidioidal meningitis and in predicting the prognosis of patients affected by the disease. 19 references, 4 figures, 2 tables.

  14. Late-onset pathological gambling: clinical correlates and gender differences.

    PubMed

    Grant, Jon E; Kim, Suck Won; Odlaug, Brian L; Buchanan, Stephanie N; Potenza, Marc N

    2009-01-01

    Age at illness onset has significant clinical implications for psychiatric disorders. Prior research has not systematically examined age at illness onset and its relationship to the clinical characteristics of pathological gambling (PG). Among a sample of 322 consecutive subjects with current DSM-IV PG, those with late-onset (at or after age 55 years) PG were compared to those with earlier onsets (at or prior to age 25, 26-54 years old) on measures of PG severity, co-occurring disorders, social and legal problems, and family history. Forty-two (13.4%) subjects reported onset of PG at or after age 55 years, 63 (19.6%) reported onset prior to age 25 years, and the majority (n=217; 67.4%) reported onset between the ages of 26 and 54 years. The late-onset group were less likely to declare bankruptcy (p=.029) or have credit card debt attributable to gambling (p=.006). Late-onset PG subjects were significantly more likely to have an anxiety disorder (p<.001) and significantly less likely to have a father (p=.025) or a mother (p=.048) with a gambling problem. Exploratory analyses identified an age-by-gender interaction with respect to treatment-seeking, with more pronounced age-related shortening in the duration between problem onset and treatment seeking observed in men. Age at onset of PG is associated with multiple important clinical features. Long durations of PG prior to treatment-seeking indicate the need for improved prevention efforts among individuals with early PG onset. Late-onset PG is relatively common and has distinct clinical characteristics suggesting that this population might benefit from unique prevention and treatment strategies. PMID:18499125

  15. Clinical phenomenology and neuroimaging correlates in ALS-FTD.

    PubMed

    Lomen-Hoerth, Catherine

    2011-11-01

    The overlap of frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) has been well documented in FTD patients with co-morbid motor neuron degeneration and in ALS patients with frontotemporal dysfunction. Up to 15% of FTD patients and 30% of ALS patients experience the overlap syndrome. The syndrome may be difficult to identify since patients often present either to a neuromuscular clinic or a memory disorder's center, each which may have limited expertise in the other specialty. Survival is greatly impacted for both disorders in the co-morbid condition, making identification of this syndrome critical. The clinical characteristics of the overlap syndrome with new diagnostic criteria will be discussed along with screening strategies, including the UCSF Screening battery and clinical neurophysiology techniques. Treatable mimics of this disorder will also be described and management techniques. Neuroimaging findings will be summarized, which show that the frontotemporal impairment in ALS patients lies on a continuum. Identification of the overlap syndrome also provides a unique opportunity to study very early signs of FTD and conversely, very early signs of ALS, to gain greater insight into both disorders. PMID:21971978

  16. Clinical Outcomes and Correlates of TP53 Mutations and Cancer

    PubMed Central

    Robles, Ana I.; Harris, Curtis C.

    2010-01-01

    The initial observation that p53 accumulation might serve as a surrogate biomarker for TP53 mutation has been the cornerstone for vast translational efforts aimed at validating its clinical use for the diagnosis, prognosis, and treatment of cancer. Early on, it was realized that accurate evaluation of p53 status and function could not be achieved through protein-expression analysis only. As our understanding of the p53 pathway has evolved and more sophisticated methods for assessment of p53 functional integrity have become available, the clinical and molecular epidemiological implications of p53 abnormalities in cancers are being revealed. They include diagnostic testing for germline p53 mutations, and the assessment of selected p53 mutations as biomarkers of carcinogen exposure and cancer risk and prognosis. Here, we describe the strengths and limitations of the most frequently used techniques for determination of p53 status in tumors, as well as the most remarkable latest findings relating to its clinical and epidemiological value. PMID:20300207

  17. [Rhombencephalitis caused by Listeria: clinical-radiological correlation].

    PubMed

    Aymerich, N; Lacruz, F; Gllego, J; Soriano, G; Ayuso, T; Villanueva, J A

    2004-01-01

    Rhombencephalitis due to Listeria is a serious and infrequent infection of the brainstem. It principally affects subjects who were previously healthy. It shows itself clinically in two phases: the first with unspecific symptoms, which could last one week, and the second with the appearance of focal neurologic signs at the level of the brainstem. We present the case of a patient with rhombencephalitis due to Listeria that began initially with headache, nauseas and fever and after ten days the patient showed an asymmetrical affection of cranial nerves, cerebellar signs and sensory deficits in the left hemibody. Subsequently this became complicated with acute respiratory insufficiency, requiring admission to the Intensive Care Unit, and with episodes of urinary retention that required exploration. The early magnetic resonance image showed hypertense patch lesions that were objectified in T2 sequences at the level of the bulb and the pons. Facing a clinical-radiological suspicion of rombencephalitis due to Listeria, treatment was begun with ampicillin and tombramycin. After some days a positive haemoculture for Listeria monocytogenes serotype 4B resistant to ampicilin was detected, therefore it was replaced with vancomycin. The patient survived and on discharge he had oculomotor disorder and micturition problems as sequels. We would like to emphasise the importance of early recognition of the clinical signs of the disease and the early permormance of magnetic resonance, with diagnostic support, to be able to start a suitable antibiotic treatment as quickly as possible. PMID:15381957

  18. Identifying questions in the American Association of Swine Veterinarian's PRRS risk assessment survey that are important for retrospectively classifying swine herds according to whether they reported clinical PRRS outbreaks in the previous 3 years.

    PubMed

    Holtkamp, Derald J; Lin, Hui; Wang, Chong; O'Connor, Annette M

    2012-09-01

    The American Association of Swine Veterinarian's (AASV) Production Animal Disease Risk Assessment Program (PADRAP) is a web-based program that offers a set of risk assessment surveys being used by veterinarians who are members of the AASV. Members use PADRAP to help producers systematically assess risk factors that may be associated with clinical outcomes. As assessments are performed the completed surveys are added to the dataset maintained at the Iowa State University College of Veterinary Medicine. One of the surveys included in PADRAP is the porcine reproductive and respiratory syndrome (PRRS) Risk Assessment for the Breeding Herd. The aim of the study was to categorize questions in version 2 of the PRRS Risk Assessment for the Breeding Herd survey as important or unimportant for classifying herds according to whether they reported clinical PRRS outbreaks in the previous 3 years. The results elucidate the relative importance of risk factors and areas of risk factors for clinical outcomes and removing unimportant questions may reduce the time required to complete the survey without affecting the quality of information obtained. Surveys from 896 sow herd sites in the United States and Canada completed between March 2005 and March 2009 were included in the analysis. The survey contained a large number of questions with a complex correlation structure among the questions. Responses for several questions were dependent upon responses to others. To address these issues, an approach was developed using a series of statistical methods including random forest, principle component analysis, logistic regression and receiver operating characteristic (ROC) analysis to classify the herds using the questions in the survey as explanatory variables. Questions were ranked by importance and systematically excluded from least important to most important. The questions excluded, without significantly affecting the performance of the model for classifying herds were identified as unimportant. Thirty-eight of the 127 questions analyzed were identified as unimportant for classifying herds according to whether they reported clinical PRRS outbreaks in the previous 3 years. Sections of the survey where a large number of questions were identified as unimportant included (1) entry of semen into the breeding herd and (2) transportation of live animals. Sections with a high percentage of questions identified as unimportant included (1) characteristics of the site, (2) disposal of dead animals and waste management and (3) employee and visitors. PMID:22475927

  19. Clinical correlation between HBV infection and concomitant bacterial infections

    PubMed Central

    Li, Wei; Jin, Ronghua; Chen, Peng; Zhao, Guoxian; Li, Ning; Wu, Hao

    2015-01-01

    Bacterial infections are common in patients suffering viral hepatitis and critical for prognosis. However, any correlation between HBV and concomitant bacterial infections is not well characterized. A retrospective study was conducted from Jan 2012 to Jan 2014 on 1333 hospitalized patients infected with bacteria. Among them, 491 HBV-infected patients were co-infected with E. coli (268), S. aureus (61), P. aeruginosa (64) or K. pneumoniae (98). A group of 300 complication-free chronically HBV-infected patients were controls. We found that HBV DNA levels were elevated in patients with each of the bacterial infections (all P < 0.05). ALT and HBeAg were strong determinants of high HBV DNA concentration. Patterns of determinants varied in infections by Gram-positive and Gram-negative bacteria. Patients with HBV DNA ≥ 2000 IU/mL had higher rates of all four concomitant bacterial infections (all P < 0.001). All types of strains isolated from HBV-positive patients showed less resistance to tested antimicrobials. The HBV DNA serum concentrations were inversely correlated to the number of ineffective antimicrobials in E. coli, P. aeruginosa and K. pneumoniae infections (P = 0.022, 0.017 and 0.016, respectively), but not S. aureus (P = 0.194). In conclusion, bacterial infections are associated with a high level of HBV replication, which, in turn, has a significant positive impact on bacterial resistance to antimicrobials. These correlations vary between Gram-negative and Gram-positive bacteria. PMID:26634436

  20. Chronic widespread pain: clinical comorbidities and psychological correlates.

    PubMed

    Burri, Andrea; Ogata, Soshiro; Vehof, Jelle; Williams, Frances

    2015-08-01

    Recent studies have provided consistent evidence for a genetic influence on chronic widespread pain (CWP). The aim of this study was to investigate (1) the etiological structure underlying CWP by examining the covariation between CWP and psychological comorbidities and psychoaffective correlates and (2) the decomposition of the covariation into genetic and environmental components. A total of 3266 female twins (mean age 56.6 years) were subject to multivariate analyses. Using validated questionnaires to classify twins as having CWP, the prevalence of CWP was 20.8%. In the multivariate analysis, the most suitable model was the common pathway model. This model revealed 2 underlying latent variables, one common to anxiety, emotional intelligence, and emotional instability (f1) and the other common to depression and CWP (f2), the latter being highly heritable (86%). Both latent variables (f1 and f2) shared an additive genetic and a nonshared environmental factor. In addition, a second additive genetic factor loading only on f2 was found. This study reveals the structure of genetic and environmental influences of CWP and its psychoaffective correlates. The results show that the clustering of CWP and depression is due to a common, highly heritable, underlying latent trait. In addition, we found evidence that CWP, anxiety, emotional instability, and emotional intelligence are influenced by different underlying latent traits sharing the same genetic and nonshared environmental factors. This is the first study to reveal the structure and relative importance of genetic and environmental influences on complex etiological mechanisms of CWP and its correlates. PMID:25851458

  1. Sonography of Common Peripheral Nerve Disorders With Clinical Correlation.

    PubMed

    Jacobson, Jon A; Wilson, Thomas J; Yang, Lynda J-S

    2016-04-01

    Sonography is now considered an effective method to evaluate peripheral nerves. Low cost, high resolution, the ability to image an entire limb in a short time, and dynamic assessment are several of the positive attributes of sonography. This article will review the normal appearance of peripheral nerves as shown with sonography. In addition, the most common applications for sonography of the peripheral nerves will be reviewed, which include entrapment neuropathies, intraneural ganglion cyst, nerve trauma, and peripheral nerve sheath tumors. Clinical information related to nerve disorders is also included, as it provides valuable information that can be obtained during sonographic examinations, increasing diagnostic accuracy. PMID:26931790

  2. Clinical correlates of common corneal neovascular diseases: a literature review

    PubMed Central

    Abdelfattah, Nizar Saleh; Amgad, Mohamed; Zayed, Amira A; Salem, Hamdy; Elkhanany, Ahmed E; Hussein, Heba; Abd El-Baky, Nawal

    2015-01-01

    A large subset of corneal pathologies involves the formation of new blood and lymph vessels (neovascularization), leading to compromised visual acuity. This article aims to review the clinical causes and presentations of corneal neovascularization (CNV) by examining the mechanisms behind common CNV-related corneal pathologies, with a particular focus on herpes simplex stromal keratitis, contact lenses-induced keratitis and CNV secondary to keratoplasty. Moreover, we reviewed CNV in the context of different types of corneal transplantation and keratoprosthesis, and summarized the most relevant treatments available so far. PMID:25709930

  3. Pulmonary Tumor Thrombotic Microangiopathy: Clinical, Radiologic, and Histologic Correlation

    PubMed Central

    Godbole, Rohit; Ghatol, Abhijeet; Betancourt, Jamie; Sacoolidge, John; Kamangar, Nader

    2015-01-01

    Pulmonary tumor thrombotic microangiopathy (PTTM) is a clinicopathologic disease entity in which the tumor cells embolize to the pulmonary vasculature leading to a series of maladaptive reactions including the activation of coagulation and fibrocellular intimal thickening. The resultant stenosis of blood vessels leads to pulmonary hypertension and eventual death from cor pulmonale. In this report, we present a case of PTTM presenting as the initial manifestation of metastatic gastric carcinoma in a young man. Although unusual in its occurrence as the initial manifestation of gastric carcinoma, the case is illustrative in its clinical, radiological and histological presentation. PMID:26312142

  4. Pulmonary Tumor Thrombotic Microangiopathy: Clinical, Radiologic, and Histologic Correlation.

    PubMed

    Godbole, Rohit; Ghatol, Abhijeet; Betancourt, Jamie; Sacoolidge, John; Kamangar, Nader

    2015-01-01

    Pulmonary tumor thrombotic microangiopathy (PTTM) is a clinicopathologic disease entity in which the tumor cells embolize to the pulmonary vasculature leading to a series of maladaptive reactions including the activation of coagulation and fibrocellular intimal thickening. The resultant stenosis of blood vessels leads to pulmonary hypertension and eventual death from cor pulmonale. In this report, we present a case of PTTM presenting as the initial manifestation of metastatic gastric carcinoma in a young man. Although unusual in its occurrence as the initial manifestation of gastric carcinoma, the case is illustrative in its clinical, radiological and histological presentation. PMID:26312142

  5. Histomorphological Features of Intestinal Atresia and its Clinical Correlation

    PubMed Central

    Singh, Meeta; Khurana, Nita; Sathish, Agarwal

    2015-01-01

    Introduction Intestinal atresia accounts for approximately one third of all cases of neonatal intestinal obstruction. There is controversy regarding pathogenesis of congenital atresia and stenosis of small bowel. Studies regarding clinical manifestations and specific histopathological features of neonatal intestinal atresia are scarce in Indian literature. Aim To understand the histomorphological features and thus suggest pathophysiology of cases with Intestinal Atresia. Materials and Methods Out of 147 cases, of intestinal obstruction in newborn studied over a period of 5 years, 39 cases of intestinal atresia were found. Their histomorphological details with clinical manifestations were studied. Results Type II was the commonest type of atresia. Associated anomalies noted were gastroschisis, volvulus, anal stenosis, microcolon, annular pancreas, meconium cyst and duplication cyst. Histological changes observed were ulceration, flattening, abnormal villous configuration, luminal obliteration, narrowing, haemangiomatous proliferation of blood vessels, fibrosis, haemorrhage, calcification, and mesenchymal condensation around the blood vessels. Gangrene and perforation has also noted in some cases. Conclusion An intrauterine intestinal ischemia due to vascular pathology followed by resorption of the bowel is the possible explanation for the development of intestinal atresia. PMID:26674207

  6. [Refsum's disease. Epidemiologic, clinical and biological correlation. 6 cases].

    PubMed

    Petit, H; Leys, D; Skjeldal, O H; Caron, J C; Lambert, P; Lehembre, P; Hache, J C

    1986-01-01

    Nine patients with symptoms and signs of Refsum's disease are reported. In 6 a systemic accumulation of phytanic acid was demonstrated, together with low phytanic acid oxidase activity in skin fibroblasts in 5 of them. In 3, no disorder of phytanic acid metabolism was demonstrated. In 3, the diagnosis was made during the pre-clinical period. The disease seems more frequent in Northern France, which agrees with the hypothesis of a genetic mutation which would have taken place in Scandinavia some centuries ago and was subsequently spread by the Vikings. The effects of a dietary treatment on serum phytanic acid levels and clinical disorders are reported. The general condition of the patients improved remarkably but only partially. The diet is unpalatable and in some patients the level of serum phytanic acid increased, due to the mobilization of body fat. Patients with very high levels of phytanic acid might be initially treated by plasmapheresis. For the same reason, the diet should supply enough calories to keep body weight unchanged, and body weight loss whatever its cause should be avoided. PMID:2431446

  7. Clinical correlates of alexithymia among patients with personality disorder.

    PubMed

    Joyce, Anthony S; Fujiwara, Esther; Cristall, Maarit; Ruddy, Carlee; Ogrodniczuk, John S

    2013-01-01

    The literature portrays patients with alexithymia as unusual and difficult to treat; research to date has not clarified the nature of this condition. This study addressed associations between alexithymia and constructs relevant to clinical intervention, namely attachment, quality of object relations, emotion regulation, defense style, personality disorder, and treatment outcome. Fifty-one patients admitted to an intensive group-oriented day treatment program were recruited. Prior to therapy, patients were administered self-report and structured interview measures of predictor and outcome variables; outcome measures were re-administered at completion of the 18-week program. Alexithymia was common in this sample, with four of five patients endorsing moderate or greater problems. Associations with attachment avoidance, primitive object relations, suppression of emotional expression, use of immature defenses, and severity of borderline personality disorder were identified. Alexithymia did not, however, predict outcome. Findings are considered in terms of how the construct informs views of personality disorder. PMID:23731378

  8. Correlation of salivary immunoglobulin A against lipopolysaccharide of Porphyromonas gingivalis with clinical periodontal parameters

    PubMed Central

    Pudakalkatti, Pushpa S.; Baheti, Abhinav S.

    2015-01-01

    Background: A major challenge in clinical periodontics is to find a reliable molecular marker of periodontal tissue destruction. Aim: The aim of the present study was to assess, whether any correlation exists between salivary immunoglobulin A (IgA) level against lipopolysaccharide of Porphyromonas gingivalis and clinical periodontal parameters (probing depth and clinical attachment loss). Materials and Methods: Totally, 30 patients with chronic periodontitis were included for the study based on clinical examination. Unstimulated saliva was collected from each study subject. Probing depth and clinical attachment loss were recorded in all selected subjects using University of North Carolina-15 periodontal probe. Extraction and purification of lipopolysaccharide were done from the standard strain of P. gingivalis (ATCC 33277). Enzyme linked immunosorbent assay (ELISA) was used to detect the level of IgA antibodies against lipopolysaccharide of P. gingivalis in the saliva of each subject by coating wells of ELISA kit with extracted lipopolysaccharide antigen. Statistical Analysis: The correlation between salivary IgA and clinical periodontal parameters was checked using Karl Pearson's correlation coefficient method and regression analysis. Results: The significant correlation was observed between salivary IgA level and clinical periodontal parameters in chronic periodontitis patients. Conclusion: A significant strong correlation was observed between salivary IgA against lipopolysaccharide of P. gingivalis and clinical periodontal parameters which suggest that salivary IgA level against lipopolysaccharide of P. gingivalis can be used to predict the severity of periodontal destruction in chronic periodontitis patients. PMID:26321825

  9. Anhedonia and Substance Dependence: Clinical Correlates and Treatment Options

    PubMed Central

    Hatzigiakoumis, Daniele Stavros; Martinotti, Giovanni; Giannantonio, Massimo Di; Janiri, Luigi

    2011-01-01

    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. PMID:21556280

  10. Anhedonia and substance dependence: clinical correlates and treatment options.

    PubMed

    Hatzigiakoumis, Daniele Stavros; Martinotti, Giovanni; Giannantonio, Massimo Di; Janiri, Luigi

    2011-01-01

    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. PMID:21556280

  11. Clinical correlates of the "rods and rings" antinuclear antibody pattern.

    PubMed

    Climent, Joan; Morandeira, Francisco; Castellote, José; Xiol, Javier; Niubó, Jordi; Calatayud, Laura; Mestre, Mariona; Bas, Jordi

    2016-03-01

    The "rods and rings" (RR) antinuclear antibody (ANA) pattern is believed to be restricted to hepatitis C virus (HCV) infection and related to the treatment. This is a 4-year retrospective study of all patients with RR pattern from the 20 000 serum samples received at the Hospital Universitari de Bellvitge for ANA testing. Two control groups with HCV patients without RR pattern: ANA-positive (n = 74) and ANA negative (n = 75) were included. Eighty-seven patients had samples with the RR pattern. Seventy-three were infected with HCV (prevalence of 15% in the HCV population). The RR pattern could not be related to ribavirin treatment, clinical status, biochemistry data, hepatic fibrosis, IL28B genotype, HCV genotype or the presence of autoantibodies related with autoimmune hepatitis. As 14 cases presented other diseases, mainly of autoimmune origin, the presence of RR antibodies may also be explained by alterations in immune regulation caused by autoimmunity or HCV in a particular genetic background. PMID:26699543

  12. Simulated prostate biopsy: prostate cancer distribution and clinical correlation

    NASA Astrophysics Data System (ADS)

    Bauer, John J.; Zeng, Jianchao; Zhang, Wei; Sesterhenn, Isabell A.; Dean, Robert; Moul, Judd W.; Mun, Seong K.

    2000-04-01

    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.

  13. Clinical-pathologic correlations in vascular cognitive impairment and dementia.

    PubMed

    Flanagan, Margaret; Larson, Eric B; Latimer, Caitlin S; Cholerton, Brenna; Crane, Paul K; Montine, Kathleen S; White, Lon R; Keene, C Dirk; Montine, Thomas J

    2016-05-01

    The most common causes of cognitive impairment and dementia are Alzheimer's disease (AD) and vascular brain injury (VBI), either independently, in combination, or in conjunction with other neurodegenerative disorders. The contribution of VBI to cognitive impairment and dementia, particularly in the context of AD pathology, has been examined extensively yet remains difficult to characterize due to conflicting results. Describing the relative contribution and mechanisms of VBI in dementia is important because of the profound impact of dementia on individuals, caregivers, families, and society, particularly the stability of health care systems with the rapidly increasing age of our population. Here we discuss relationships between pathologic processes of VBI and clinical expression of dementia, specific subtypes of VBI including microvascular brain injury, and what is currently known regarding contributions of VBI to the development and pathogenesis of the dementia syndrome. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. PMID:26319420

  14. Questioning the relationship between the χ4 susceptibility and the dynamical correlation length in a glass former.

    PubMed

    Colin, Rémy; Alsayed, Ahmed M; Gay, Cyprien; Abou, Bérengère

    2015-12-14

    Clusters of fast and slow correlated particles, identified as dynamical heterogeneities (DHs), constitute a central aspect of glassy dynamics. A key factor of the glass transition scenario is a significant increase of the cluster size ξ4 as the transition is approached. In need of easy-to-compute tools to measure ξ4, the dynamical susceptibility χ4 was introduced recently, and used in various experimental studies to probe DHs. Here, we investigate DHs in dense microgel suspensions using image correlation analysis, and compute both χ4 and the four-point correlation function G4. The spatial decrease of G4 provides a direct access to ξ4, which is found to grow significantly with increasing volume fraction. However, this increase is not captured by χ4. We show that the assumptions that validate the connection between χ4 and ξ4 are not fulfilled in our experiments. PMID:26412312

  15. Clinical correlates of raphe serotonergic dysfunction in early Parkinson's disease.

    PubMed

    Qamhawi, Zahi; Towey, David; Shah, Bina; Pagano, Gennaro; Seibyl, John; Marek, Kenneth; Borghammer, Per; Brooks, David James; Pavese, Nicola

    2015-10-01

    Post-mortem and neuroimaging studies suggest that the serotonergic system, which originates from the brainstem raphe nuclei, is disrupted in Parkinson's disease. This could contribute to the occurrence of non-motor symptoms and tremor, which are only partially explained by dopamine loss. However, the level of involvement of the serotonergic raphe nuclei in early Parkinson's disease is still debated. (123)I-FP-CIT single photon emission computed tomography is a marker of dopamine and serotonin transporter availability. While (123)I-FP-CIT binds primarily to dopamine transporters in the striatum, its binding in the brainstem raphe nuclei reflects serotonin transporter availability. We interrogated baseline single photon emission computed tomography scans of subjects recruited by the Parkinson's Progression Markers Initiative to determine: (i) the integrity of the brainstem raphe nuclei in early Parkinson's disease; and (ii) whether raphe serotonin transporter levels correlate with severity of tremor and symptoms of fatigue, depression, and sleep disturbance. Three hundred and forty-five patients with early drug-naïve Parkinson's disease, 185 healthy controls, and 56 subjects with possible Parkinson's disease without evidence of dopaminergic deficit were included. In the Parkinson's disease cohort, 37 patients had a tremulous, 106 patients had a pure akinetic-rigid, and 202 had a mixed phenotype. Patients with Parkinson's disease had significantly lower serotonin transporter availability in the brainstem raphe nuclei compared to controls (P < 0.01) and subjects without evidence of dopaminergic deficit (P < 0.05). However, only 13% of patients with Parkinson's disease individually had reduced signals. Raphe serotonin transporter availability over the entire Parkinson's disease cohort were associated with rest tremor amplitude (β = -0.106, P < 0.05), rest tremor constancy (β = -0.109, P < 0.05), and index of rest tremor severity (β = -0.104, P < 0.05). The tremulous Parkinson's disease subgroup had significantly lower raphe serotonin transporter availability but less severe striatal dopaminergic deficits compared to akinetic-rigid patients with no resting tremor (P < 0.05). In tremulous patients, raphe serotonin transporter availability was also associated with rest tremor constancy (β = -0.380, P < 0.05) and index of rest tremor severity (β = -0.322, P < 0.05). There was no association between raphe serotonin transporter availability and fatigue, depression, excessive daytime sleepiness, or rapid eye movement sleep behaviour disorder in early Parkinson's disease. We conclude that the raphe nuclei are affected in a subgroup of early drug-naïve Parkinson's disease patients and that reduced raphe serotonin transporter availability is associated with the severity of resting tremor but not non-motor symptoms. PMID:26209314

  16. Surgical Clinical Correlates in Anatomy: Design and Implementation of a First-Year Medical School Program

    ERIC Educational Resources Information Center

    Haubert, Lisa M.; Jones, Kenneth; Moffatt-Bruce, Susan D.

    2009-01-01

    Medical students state the need for a clinically oriented anatomy class so to maximize their learning experience. We hypothesize that the first-year medical students, who take the Surgical Clinical Correlates in Anatomy program, will perform better than their peers in their anatomy course, their surgical clerkships and ultimately choose surgical

  17. Clinical Correlates of Comorbid Obsessive-Compulsive Disorder and Depression in Youth

    ERIC Educational Resources Information Center

    Canavera, Kristin E.; Ollendick, Thomas H.; Ehrenreich May, Jill T.; Pincus, Donna B.

    2010-01-01

    A burgeoning body of literature addresses the comorbidity of depression and OCD in adults. The purpose of this study was to extend this area of research to children and adolescents by examining the clinical correlates associated with co-occurring depressive disorders in a clinical sample of youth with OCD. Participants included children and…

  18. Surgical Clinical Correlates in Anatomy: Design and Implementation of a First-Year Medical School Program

    ERIC Educational Resources Information Center

    Haubert, Lisa M.; Jones, Kenneth; Moffatt-Bruce, Susan D.

    2009-01-01

    Medical students state the need for a clinically oriented anatomy class so to maximize their learning experience. We hypothesize that the first-year medical students, who take the Surgical Clinical Correlates in Anatomy program, will perform better than their peers in their anatomy course, their surgical clerkships and ultimately choose surgical…

  19. Diagnosis of cystocele--the correlation between clinical and radiological evaluation.

    PubMed

    Altman, Daniel; Mellgren, Anders; Kierkegaard, Jonas; Zetterstrm, Jan; Falconer, Christian; Lpez, Annika

    2004-01-01

    In patients with genital prolapse involving several compartments simultaneously, radiologic investigation can be used to complement the clinical assessment. Contrast medium in the urinary bladder enables visualization of the bladder base at cystodefecoperitoneography (CDP). The aim of the present study was to evaluate the correlation between clinical examination using the Pelvic Organ Prolapse Quantification system (POP-Q) and CDP. Thirty-three women underwent clinical assessment and CDP. Statistical analysis using Pearson's correlation coefficient ( r) demonstrated a wide variability between the current definition of cystocele at CDP and POP-Q ( r=0.67). An attempt to provide an alternative definition of cystocele at CDP had a similar outcome ( r=0.63). The present study demonstrates a moderate correlation between clinical and radiologic findings in patients with anterior vaginal wall prolapse. It does not support the use of bladder contrast at radiologic investigation in the routine preoperative assessment of patients with genital prolapse. PMID:14752591

  20. HIV/AIDS Information Needs of Sexually Transmitted Infection Clinic Patients: Content Analysis of Questions Asked during Prevention Counseling

    ERIC Educational Resources Information Center

    Kalichman, Seth C.; Cain, Demetria; Knecht, Joanna; Hill, Justin

    2008-01-01

    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…

  1. Theory of mind correlates with clinical insight but not cognitive insight in patients with schizophrenia.

    PubMed

    Zhang, Qi; Li, Xu; Parker, Giverny J; Hong, Xiao-Hong; Wang, Yi; Lui, Simon S Y; Neumann, David L; Cheung, Eric F C; Shum, David H K; Chan, Raymond C K

    2016-03-30

    Research on the relationship between insight and social cognition, in particular Theory of Mind (ToM), in schizophrenia has yielded mixed findings to date. Very few studies, however, have assessed both clinical insight and cognitive insight when examining their relationships with ToM in schizophrenia. The current study thus investigated the relationship between clinical insight, cognitive insight, and ToM in a sample of 56 patients with schizophrenia and 30 healthy controls. Twenty-seven patients were classified as low in clinical insight according to their scores on the 'insight' item (G12) of the Positive and Negative Syndrome Scale (PANSS). Moreover, cognitive insight and ToM were assessed with the Beck Cognitive Insight Scale (BCIS) and the Yoni task, respectively. The results indicated that patients with poor clinical insight performed worse on tasks of second-order cognitive and affective ToM, while the ToM performance of patients with high clinical insight was equivalent to that of healthy controls. Furthermore, while clinical insight was correlated with ToM and clinical symptoms, cognitive insight did not correlate with clinical insight, ToM, or clinical symptoms. Clinical insight thus appears to be an important factor related to ToM in schizophrenia. PMID:26833279

  2. Autoantibodies to endostatin in patients with breast cancer: correlation to endostatin levels and clinical outcome.

    PubMed

    Bachelot, T; Ratel, D; Menetrier-Caux, C; Wion, D; Blay, J-Y; Berger, F

    2006-04-10

    Circulating autoantibodies to self-antigens overexpressed by cancer cells are common in cancer patients. As specific proteins are expressed during neoangiogenesis, a similar phenomenon might occur with particular antigens of tumour vessels. Collagen XVIII, from which endostatin is cleaved, is highly expressed in the perivascular basement membrane of tumour-associated blood vessels and autoantibodies to endostatin have been reported in cancer patients. The present study analyses the incidence of naturally occurring autoantibodies to endostatin in the sera of breast cancer patients and their relation to endostatin serum levels and patient clinical outcome. Serum samples from 36 patients with localised breast cancer and 59 patients with a fully documented history of metastatic breast cancer were used. The immunoreactivity of serum samples was tested against purified recombinant human endostatin and endostatin levels were determined by immunoassay. We could detect anti-endostatin antibodies in the sera of 66% of the patients with localised disease and 42% of the patients with metastatic disease (P=0.03). There was no correlation between the presence of antibodies to endostatin and circulating levels of endostatin. The detection of autoantibodies to endostatin was associated with better prognosis in metastatic breast cancer patients (median survival time: 20 vs 8 months, P = 0.03), as was the presence of low levels of serum endostatin (median survival time: 20 vs 9 months, P = 0.007). These results show that a natural immune reaction against endostatin can occur in breast cancer patients. This could have important therapeutic implications with regard to endostatin therapy and raises the question of a possible role of this humoral reaction against endostatin in the neoplastic process. PMID:16552441

  3. Autoantibodies to endostatin in patients with breast cancer: correlation to endostatin levels and clinical outcome

    PubMed Central

    Bachelot, T; Ratel, D; Menetrier-Caux, C; Wion, D; Blay, J-Y; Berger, F

    2006-01-01

    Circulating autoantibodies to self-antigens overexpressed by cancer cells are common in cancer patients. As specific proteins are expressed during neoangiogenesis, a similar phenomenon might occur with particular antigens of tumour vessels. Collagen XVIII, from which endostatin is cleaved, is highly expressed in the perivascular basement membrane of tumour-associated blood vessels and autoantibodies to endostatin have been reported in cancer patients. The present study analyses the incidence of naturally occurring autoantibodies to endostatin in the sera of breast cancer patients and their relation to endostatin serum levels and patient clinical outcome. Serum samples from 36 patients with localised breast cancer and 59 patients with a fully documented history of metastatic breast cancer were used. The immunoreactivity of serum samples was tested against purified recombinant human endostatin and endostatin levels were determined by immunoassay. We could detect anti-endostatin antibodies in the sera of 66% of the patients with localised disease and 42% of the patients with metastatic disease (P=0.03). There was no correlation between the presence of antibodies to endostatin and circulating levels of endostatin. The detection of autoantibodies to endostatin was associated with better prognosis in metastatic breast cancer patients (median survival time: 20 vs 8 months, P=0.03), as was the presence of low levels of serum endostatin (median survival time: 20 vs 9 months, P=0.007). These results show that a natural immune reaction against endostatin can occur in breast cancer patients. This could have important therapeutic implications with regard to endostatin therapy and raises the question of a possible role of this humoral reaction against endostatin in the neoplastic process. PMID:16552441

  4. Social Cognition in Psychosis: Multidimensional Structure, Clinical Correlates, and Relationship With Functional Outcome

    PubMed Central

    Mancuso, Francesco; Horan, William P.; Kern, Robert S.; Green, Michael F.

    2010-01-01

    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. PMID:21112743

  5. An exploration of comorbid symptoms and clinical correlates of clinically significant hoarding symptoms

    PubMed Central

    Hall, Brian J.; Tolin, David F.; Frost, Randy O.; Steketee, Gail

    2016-01-01

    Background Hoarding Disorder is currently being considered for inclusion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, yet remains poorly understood. Consensus is building that hoarding may constitute a separate disorder, although comorbidity remains high and complicates the diagnostic picture. The purpose of this investigation was to explore patterns of comorbidity among people who engage in hoarding behavior in order to better understand its clinical presentation and phenomenology. Methods Data were collected from a large internet sample (N = 363) of people who self-identified as having hoarding problems, met criteria for clinically significant hoarding, and completed all measures for this study. Participants self-reported their symptoms of disorders commonly co-occurring with hoarding (obsessive compulsive disorder [OCD], depression, and attention deficit hyperactivity disorder [ADHD]), along with other clinical problems. Results: Latent class analysis results indicated that the participants were grouped into three classes: “non-comorbid” hoarding (42%), hoarding with depression (42%), and hoarding with depression and inattention (16%). Conclusions Depression symptoms were the most commonly co-occurring symptom in this sample. Contrary to previous theory relating to hoarding etiology, OCD symptoms were not significantly co-occurring and a large percentage of the study participants were free from comorbid symptoms of OCD, depression, and ADHD. This suggests that hoarding disorder is not primarily the consequence of other psychiatric conditions. Implications for DSM-5, clinical treatment, and future research directions are discussed. PMID:23213052

  6. An Oracle: Antituberculosis Pharmacokinetics-Pharmacodynamics, Clinical Correlation, and Clinical Trial Simulations To Predict the Future▿

    PubMed Central

    Pasipanodya, Jotam; Gumbo, Tawanda

    2011-01-01

    Antimicrobial pharmacokinetic-pharmacodynamic (PK/PD) science and clinical trial simulations have not been adequately applied to the design of doses and dose schedules of antituberculosis regimens because many researchers are skeptical about their clinical applicability. We compared findings of preclinical PK/PD studies of current first-line antituberculosis drugs to findings from several clinical publications that included microbiologic outcome and pharmacokinetic data or had a dose-scheduling design. Without exception, the antimicrobial PK/PD parameters linked to optimal effect were similar in preclinical models and in tuberculosis patients. Thus, exposure-effect relationships derived in the preclinical models can be used in the design of optimal antituberculosis doses, by incorporating population pharmacokinetics of the drugs and MIC distributions in Monte Carlo simulations. When this has been performed, doses and dose schedules of rifampin, isoniazid, pyrazinamide, and moxifloxacin with the potential to shorten antituberculosis therapy have been identified. In addition, different susceptibility breakpoints than those in current use have been identified. These steps outline a more rational approach than that of current methods for designing regimens and predicting outcome so that both new and older antituberculosis agents can shorten therapy duration. PMID:20937778

  7. Clinical significance and correlates of disruptive behavior in environmentally at-risk preschoolers.

    PubMed

    Wakschlag, L S; Keenan, K

    2001-06-01

    Examines the clinical significance and correlates of disruptive behavior disorder symptoms (DBDSX) in preschoolers. Participants were 129 predominantly minority preschoolers (2 1/2 to 5 1/2) residing in low-income environments, half of whom were clinic-referred for disruptive behavior. Children with higher levels of DBDSX were more impaired in parent-child, preschool and clinic contexts. Correlates of DBDSX included both prenatal and infancy risks (low soothability as infants, prenatal exposure to cigarettes) and concurrent parenting factors (harshness, low levels of behavioral responsiveness, and parenting stress). In general, the clinical and risk profile of DBDSX in preschoolers at environmental risk appears to be similar to that of older children. Based on the results of this study, etiologic and prevention research on disruptive behavior disorders should begin in the first few years of life. PMID:11393926

  8. Clinically relevant correlates of accurate perception of patients' thoughts and feelings.

    PubMed

    Hall, Judith A; Ship, Amy N; Ruben, Mollie A; Curtin, Elizabeth M; Roter, Debra L; Clever, Sarah L; Smith, C Christopher; Pounds, Karen

    2015-01-01

    The goal was to explore the clinical relevance of accurate understanding of patients' thoughts and feelings. Between 2010 and 2012, four groups of participants (nursing students, medical students, internal medicine residents, and undergraduate students) took a test of accuracy in understanding the thoughts and feelings of patients who were videorecorded during their actual medical visits and who afterward reviewed their video to identify their thoughts and feelings as they occurred (Test of Accurate Perception of Patients' Affect, or TAPPA). Participants' accuracy scores were then correlated with participants' attitudes toward patient-centered care, clinical course background, recall of clinical conversation, evaluations of clinical performance made by preceptors, evaluations of interpersonal skill made by standardized patients in clinical encounters, and independent coding of behavior in a clinical encounter. Accuracy in understanding patients' thoughts and feelings was significantly correlated with nursing students' clinical course experience, clinicians' favorable attitudes to psychosocial discussion, standardized patients' evaluations of medical students' interpersonal skill, independent coding of medical students' patient-centered behavior while taking a social history, and undergraduates' more accurate recall of what an actor-physician said on video. Accuracy in perceiving patients' thoughts and feelings can be objectively measured and is a skill relevant to clinical performance. PMID:24949868

  9. A retrospective study of peanut and tree nut allergy: Sensitization and correlations with clinical manifestations.

    PubMed

    Yang, Lihua; Clements, Stacy; Joks, Rauno

    2015-01-01

    Peanut (PN) and tree nut (TN) allergies are among the leading causes of fatal food-induced anaphylaxis and are increasing in prevalence, especially in children. Their cosensitization and concurrent clinical allergy have been understudied. This retrospective study investigated the correlation between PN and TN allergy, both in terms of in vitro sensitization (IVS) and clinical allergic manifestations. We conducted a retrospective medical record review at the Allergy Clinic at University Hospital of Brooklyn. Fourteen hundred six charts were reviewed, of which 76 (5.4%) had documented relevant clinical allergy: PN allergy but not TN allergy (n = 29) or TN allergy but not PN allergy (n = 11) or both (n = 30). Six patients with PN allergy but no TN exposure history were not included in the analysis. The majority of patients (67/76, 88.1%) had a concurrent history of asthma, rhinoconjunctivitis, or AD. Sensitivity of TN IVS predicting PN IVS was 38/39 (97%). Similarly, sensitivity of PN IVS predicting TN IVS was 38/42 (91%). Sensitivity of TN clinical allergy predicting PN allergy was 30/59 (51%). Sensitivity of PN clinical allergy predicting TN allergy was 30/41 (73%). The total number of organ systems involved in reported clinical reactions correlated with IVS to TN (p = 0.004) but not IVS to PN (p = 0.983). In summary, we found PN sensitization predicts TN sensitization in vitro, with lower predictability for clinical reactions. PMID:25860169

  10. A retrospective study of peanut and tree nut allergy: Sensitization and correlations with clinical manifestations

    PubMed Central

    Yang, Lihua; Clements, Stacy

    2015-01-01

    Peanut (PN) and tree nut (TN) allergies are among the leading causes of fatal food-induced anaphylaxis and are increasing in prevalence, especially in children. Their cosensitization and concurrent clinical allergy have been understudied. This retrospective study investigated the correlation between PN and TN allergy, both in terms of in vitro sensitization (IVS) and clinical allergic manifestations. We conducted a retrospective medical record review at the Allergy Clinic at University Hospital of Brooklyn. Fourteen hundred six charts were reviewed, of which 76 (5.4%) had documented relevant clinical allergy: PN allergy but not TN allergy (n = 29) or TN allergy but not PN allergy (n = 11) or both (n = 30). Six patients with PN allergy but no TN exposure history were not included in the analysis. The majority of patients (67/76, 88.1%) had a concurrent history of asthma, rhinoconjunctivitis, or AD. Sensitivity of TN IVS predicting PN IVS was 38/39 (97%). Similarly, sensitivity of PN IVS predicting TN IVS was 38/42 (91%). Sensitivity of TN clinical allergy predicting PN allergy was 30/59 (51%). Sensitivity of PN clinical allergy predicting TN allergy was 30/41 (73%). The total number of organ systems involved in reported clinical reactions correlated with IVS to TN (p = 0.004) but not IVS to PN (p = 0.983). In summary, we found PN sensitization predicts TN sensitization in vitro, with lower predictability for clinical reactions. PMID:25860169

  11. Notes on the concept of normal values employed in clinical practice. [statistical correlation with environment effects

    NASA Technical Reports Server (NTRS)

    Platonova, A. T.

    1974-01-01

    The question of the considerable variations in various blood parameters under the influence of changes in environmental factors is discussed. Recommendations are given that so-called normal values should be given special attention. Fibrinolytic and fibrinogenolytic activity studies on the blood in healthy human beings revealed significant differences for individual months and even on specific days. Changes in the activity of fibrinolysis and fibrinogenolysis show a correlation with changes in the meteorological conditions, seasonal variations and changes in solar activity.

  12. Routine Clinical-Pathologic Correlation of Pigmented Skin Tumors Can Influence Patient Management

    PubMed Central

    Longo, Caterina; Piana, Simonetta; Lallas, Aimilios; Moscarella, Elvira; Lombardi, Mara; Raucci, Margherita; Pellacani, Giovanni; Argenziano, Giuseppe

    2015-01-01

    Background Several studies have demonstrated the benefit of integrating clinical with pathologic information, to obtain a confident diagnosis for melanocytic tumors. However, all those studies were conducted retrospectively and no data are currently available about the role of a clinical-pathologic correlation approach on a daily basis in clinical practice. Aim of the Study In our study, we evaluated the impact of a routine clinical-pathologic correlation approach for difficult skin tumors seen over 3 years in a tertiary referral center. Results Interestingly, a re-appraisal was requested for 158 out of 2015 (7.7%) excised lesions because clinical-pathologic correlation was missing. Of note, in 0.6% of them (13 out of 2045) the first histologic diagnosis was revised in the light of clinical information that assisted the Pathologist to re-evaluate the histopathologic findings that might be bland or inconspicuous per se. Conclusion In conclusion, our study demonstrated that an integrated approach involving clinicians and pathologists allows improving management of selected patients by shifting from a simply disease-focused management (melanoma versus nevus) to a patient-centered approach. PMID:26325678

  13. Multidetector spiral CT arthrography of the shoulder. Clinical applications and limits, with MR arthrography and arthroscopic correlations.

    PubMed

    Lecouvet, Frédéric E; Simoni, Paolo; Koutaïssoff, Sophie; Vande Berg, Bruno C; Malghem, Jacques; Dubuc, Jean-Emile

    2008-10-01

    Although MR imaging and MR arthrography are the first choice modalities for shoulder imaging, CT arthrography (CTA) may be used successfully to address many clinical questions. The advent of submillimeter multiple detector CT technology and subsequent excellent three-plane resolution has considerably increased the quality of CTA examinations and has propelled this technique to the forefront in a growing number of indications. The combined use of iodinated contrast material for fluoroscopic confirmation of the articular position of the needle before injection of gadolinium chelates for MR arthrography offers the unique opportunity to compare CTA and MRA findings in carefully selected cases. This paper illustrates capabilities and limits of CTA for the study of rotator cuff tears, shoulder instability, cartilage lesions, anatomical variants and abnormalities of the glenoid labrum, with correlations to MR arthrography and surgical findings. PMID:18400443

  14. Correlation between clinical classification, PEF and FEV1: guidelines and reality.

    PubMed

    Palma-Carlos, A G; Palma-Carlos, M L

    2002-10-01

    The currently proposed guidelines and consensus for asthma include Peak expiratory flow (PEF) and forced expiratory volume in the first second (FEV1) as two criteria to classify asthma severity. The report between these functional data and clinical classification degrees has been evaluated in 153 asthmatic patients. Concordance between functional evaluation and clinical degree has been found only for moderate persistent asthma but not for intermittent or mild persistent asthma. These results suggest that the correlation between clinical evaluation and lung function proposed in the guidelines must be reevaluated. PMID:12449664

  15. Submaximal delayed-onset muscle soreness: correlations between MR imaging findings and clinical measures

    NASA Technical Reports Server (NTRS)

    Evans, G. F.; Haller, R. G.; Wyrick, P. S.; Parkey, R. W.; Fleckenstein, J. L.; Blomqvist, C. G. (Principal Investigator)

    1998-01-01

    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.

  16. Prevalence and Clinical Correlates of Deliberate Self-Harm among a Community Sample of Italian Adolescents

    ERIC Educational Resources Information Center

    Cerutti, R.; Manca, M.; Presaghi, F.; Gratz, Kim L.

    2011-01-01

    The aims of this study were to investigate the rates of deliberate self-harm (DSH) behavior among an Italian adolescent sample, as well as to explore its clinical correlates. On a sample of 234 adolescents in Italian secondary schools (Mean age = 16.47; SD = 1.7) were assessed the DSH as well as externalizing symptoms (including both conduct…

  17. Demographic and Clinical Correlates of Autism Symptom Domains and Autism Spectrum Diagnosis

    ERIC Educational Resources Information Center

    Frazier, Thomas W.; Youngstrom, Eric A.; Embacher, Rebecca; Hardan, Antonio Y.; Constantino, John N.; Law, Paul; Findling, Robert L.; Eng, Charis

    2014-01-01

    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…

  18. Correlates of Self-Reported and Clinically Assessed Depression in Outpatient Alcoholics.

    ERIC Educational Resources Information Center

    Steer, Robert A.; And Others

    1983-01-01

    Assesses levels of depression presented by 76 male and 29 female alcoholics using Beck Depression Inventory and Hamilton Psychiatric Rating Scale for Depression. To estimate overall depression from the self-report and clinical instruments, Z scores for both measures were summed. Correlations were calculated between composite scores and alcoholics'

  19. Changes in the Neuropsychological Correlates of Clinical Dimensions between the Acute and Stable Phase of Schizophrenia

    ERIC Educational Resources Information Center

    Guillem, F.; Ganeva, E.; Pampoulova, T.; Stip, E.; Lalonde, P.; Sasseville, M.

    2005-01-01

    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…

  20. The Phenomenology and Clinical Correlates of Suicidal Thoughts and Behaviors in Youth with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Storch, Eric A.; Sulkowski, Michael L.; Nadeau, Josh; Lewin, Adam B.; Arnold, Elysse B.; Mutch, P. Jane; Jones, Anna M.; Murphy, Tanya K.

    2013-01-01

    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,

  1. Correlates of Self-Reported and Clinically Assessed Depression in Outpatient Alcoholics.

    ERIC Educational Resources Information Center

    Steer, Robert A.; And Others

    1983-01-01

    Assesses levels of depression presented by 76 male and 29 female alcoholics using Beck Depression Inventory and Hamilton Psychiatric Rating Scale for Depression. To estimate overall depression from the self-report and clinical instruments, Z scores for both measures were summed. Correlations were calculated between composite scores and alcoholics'…

  2. Mental Health and Clinical Correlates in Lesbian, Gay, Bisexual, and Queer Young Adults

    ERIC Educational Resources Information Center

    Grant, Jon E.; Odlaug, Brian L.; Derbyshire, Katherine; Schreiber, Liana R. N.; Lust, Katherine; Christenson, Gary

    2014-01-01

    Objective: This study examined the prevalence of mental health disorders and their clinical correlates in a university sample of lesbian, gay, bisexual, and queer (LGBQ) students. Participants: College students at a large public university. Methods: An anonymous, voluntary survey was distributed via random e-mail generation to university students…

  3. The Phenomenology and Clinical Correlates of Suicidal Thoughts and Behaviors in Youth with Autism Spectrum Disorders

    ERIC Educational Resources Information Center

    Storch, Eric A.; Sulkowski, Michael L.; Nadeau, Josh; Lewin, Adam B.; Arnold, Elysse B.; Mutch, P. Jane; Jones, Anna M.; Murphy, Tanya K.

    2013-01-01

    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,…

  4. Rage Attacks in Pediatric Obsessive-Compulsive Disorder: Phenomenology and Clinical Correlates

    ERIC Educational Resources Information Center

    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.

    2012-01-01

    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…

  5. Suicidal Behaviors among Adolescents in Puerto Rico: Rates and Correlates in Clinical and Community Samples

    ERIC Educational Resources Information Center

    Jones, Jennifer; Ramirez, Rafael Roberto; Davies, Mark; Canino, Glorisa; Goodwin, Renee D.

    2008-01-01

    This study examined rates and correlates of suicidal behavior among youth on the island of Puerto Rico. Data were drawn from two probability samples, one clinical (n = 736) and one community-based sample (n = 1,896), of youth ages 12 to 17. Consistent with previous studies in U.S. mainland adolescent populations, our results demonstrate that most

  6. Prevalence and Clinical Correlates of Deliberate Self-Harm among a Community Sample of Italian Adolescents

    ERIC Educational Resources Information Center

    Cerutti, R.; Manca, M.; Presaghi, F.; Gratz, Kim L.

    2011-01-01

    The aims of this study were to investigate the rates of deliberate self-harm (DSH) behavior among an Italian adolescent sample, as well as to explore its clinical correlates. On a sample of 234 adolescents in Italian secondary schools (Mean age = 16.47; SD = 1.7) were assessed the DSH as well as externalizing symptoms (including both conduct

  7. The correlation of student performance in preclinical and clinical prosthodontic assessments.

    PubMed

    Curtis, Donald A; Lind, Samuel L; Brear, Sheila; Finzen, Frederick C

    2007-03-01

    Tracking student performance in preclinical and clinical courses can be helpful in developing and refining a curriculum. Our objective was to correlate student performance on three fixed prosthodontic examinations taken by eighty junior dental students. Examinations included a knowledge-based objective structured clinical examination (OSCE), a manual skills exercise completed on a typodont (Typodont), and a competency casting exam (Casting CE) on a patient. Multiple regression analysis indicated that the OSCE and Typodont exam scores, as independent variables, were not statistically significant predictors (P=0.07; P=0.87, respectively) of Casting CE exam performance, which was the dependent variable. Correlations were weak for the OSCE (r=0.21) and nearly nonexistent for the Typodont exam(r=0.03) when compared to the Casting CE. Our results indicate a weak correlation between an OSCE-based knowledge exam measuring students' knowledge of critical errors in preparations and castings and a competency exam involving the preparation of a full veneer crown. Results also indicate virtually no correlation between a typodont preparation examination designed to provide a measure of students' clinical skill and a clinical competency exam involving the preparation of a full crown. PMID:17389571

  8. The Correlation of Learning Styles with Student Performance In Academic and Clinical Course Work.

    ERIC Educational Resources Information Center

    Cunningham, M. Jo; Trickey, Becki A.

    1983-01-01

    The purpose of this study was to determine any correlation between learning styles and performance in the academic and clinical course work of occupational therapy students at the Medical University of South Carolina. (Availability: RAM Associates LTD., P.O. Box N, Laurel, MD 20707) (SSH)

  9. Rage Attacks in Pediatric Obsessive-Compulsive Disorder: Phenomenology and Clinical Correlates

    ERIC Educational Resources Information Center

    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.

    2012-01-01

    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

  10. Mental Health and Clinical Correlates in Lesbian, Gay, Bisexual, and Queer Young Adults

    ERIC Educational Resources Information Center

    Grant, Jon E.; Odlaug, Brian L.; Derbyshire, Katherine; Schreiber, Liana R. N.; Lust, Katherine; Christenson, Gary

    2014-01-01

    Objective: This study examined the prevalence of mental health disorders and their clinical correlates in a university sample of lesbian, gay, bisexual, and queer (LGBQ) students. Participants: College students at a large public university. Methods: An anonymous, voluntary survey was distributed via random e-mail generation to university students

  11. Demographic and Clinical Correlates of Autism Symptom Domains and Autism Spectrum Diagnosis

    ERIC Educational Resources Information Center

    Frazier, Thomas W.; Youngstrom, Eric A.; Embacher, Rebecca; Hardan, Antonio Y.; Constantino, John N.; Law, Paul; Findling, Robert L.; Eng, Charis

    2014-01-01

    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

  12. Pseudomonas aeruginosa quorum sensing molecules correlate with clinical status in cystic fibrosis

    PubMed Central

    Halliday, Nigel; Cámara, Miguel; Barrett, David A.; Williams, Paul; Forrester, Douglas L.; Simms, Rebecca; Smyth, Alan R.; Honeybourne, David; Whitehouse, Joanna L.; Nash, Edward F.; Dewar, Jane; Clayton, Andrew; Knox, Alan J.; Fogarty, Andrew W.

    2015-01-01

    Pseudomonas aeruginosa produces quorum sensing signal molecules that are potential biomarkers for infection. A prospective study of 60 cystic fibrosis patients with chronic P. aeruginosa, who required intravenous antibiotics for pulmonary exacerbations, was undertaken. Clinical measurements and biological samples were obtained at the start and end of the treatment period. Additional data were available for 29 of these patients when they were clinically stable. Cross-sectionally, quorum sensing signal molecules were detectable in the sputum, plasma and urine of 86%, 75% and 83% patients, respectively. They were positively correlated between the three biofluids. Positive correlations were observed for most quorum sensing signal molecules in sputum, plasma and urine, with quantitative measures of pulmonary P. aeruginosa load at the start of a pulmonary exacerbation. Plasma concentrations of 2-nonyl-4-hydroxy-quinoline (NHQ) were significantly higher at the start of a pulmonary exacerbation compared to clinical stability (p<0.01). Following the administration of systemic antibiotics, plasma 2-heptyl-4-hydroxyquinoline (p=0.02) and NHQ concentrations (p<0.01) decreased significantly. In conclusion, quorum sensing signal molecules are detectable in cystic fibrosis patients with pulmonary P. aeruginosa infection and are positively correlated with quantitative measures of P. aeruginosa. NHQ correlates with clinical status and has potential as a novel biomarker for P. aeruginosa infection. PMID:26022946

  13. T1- Thresholds in Black Holes Increase Clinical-Radiological Correlation in Multiple Sclerosis Patients

    PubMed Central

    Thaler, Christian; Faizy, Tobias; Sedlacik, Jan; Holst, Brigitte; Stellmann, Jan-Patrick; Young, Kim Lea; Heesen, Christoph; Fiehler, Jens; Siemonsen, Susanne

    2015-01-01

    Background Magnetic Resonance Imaging (MRI) is an established tool in diagnosing and evaluating disease activity in Multiple Sclerosis (MS). While clinical-radiological correlations are limited in general, hypointense T1 lesions (also known as Black Holes (BH)) have shown some promising results. The definition of BHs is very heterogeneous and depends on subjective visual evaluation. Objective We aimed to improve clinical-radiological correlations by defining BHs using T1 relaxation time (T1-RT) thresholds to achieve best possible correlation between BH lesion volume and clinical disability. Method 40 patients with mainly relapsing-remitting MS underwent MRI including 3-dimensional fluid attenuated inversion recovery (FLAIR), magnetization-prepared rapid gradient echo (MPRAGE) before and after Gadolinium (GD) injection and double inversion-contrast magnetization-prepared rapid gradient echo (MP2RAGE) sequences. BHs (BHvis) were marked by two raters on native T1-weighted (T1w)-MPRAGE, contrast-enhancing lesions (CE lesions) on T1w-MPRAGE after GD and FLAIR lesions (total-FLAIR lesions) were detected separately. BHvis and total-FLAIR lesion maps were registered to MP2RAGE images, and the mean T1-RT were calculated for all lesion ROIs. Mean T1 values of the cortex (CTX) were calculated for each patient. Subsequently, Spearman rank correlations between clinical scores (Expanded Disability Status Scale and Multiple Sclerosis Functional Composite) and lesion volume were determined for different T1-RT thresholds. Results Significant differences in T1-RT were obtained between all different lesion types with highest T1 values in visually marked BHs (BHvis: 1453.3±213.4 ms, total-FLAIR lesions: 1394.33±187.38 ms, CTX: 1305.6±35.8 ms; p<0.05). Significant correlations between BHvis/total-FLAIR lesion volume and clinical disability were obtained for a wide range of T1-RT thresholds. The highest correlation for BHvis and total-FLAIR lesion masks were found at T1-RT>1500 ms (Expanded Disability Status Scale vs. lesion volume: rBHvis = 0.442 and rtotal-FLAIR = 0.497, p<0.05; Multiple Sclerosis Functional Composite vs. lesion volume: rBHvis = -0.53 and rtotal-FLAIR = -0.627, p<0.05). Conclusion Clinical-radiological correlations in MS patients are increased by application of T1-RT thresholds. With the short acquisition time of the MP2RAGE sequences, quantitative T1 maps could be easily established in clinical studies. PMID:26659852

  14. [Phenotypic heterogeneity and phenotype-genotype correlations in dystrophinopathies: Contribution of genetic and clinical databases].

    PubMed

    Humbertclaude, V; Hamroun, D; Picot, M-C; Bezzou, K; Bérard, C; Boespflug-Tanguy, O; Bommelaer, C; Campana-Salort, E; Cances, C; Chabrol, B; Commare, M-C; Cuisset, J-M; de Lattre, C; Desnuelle, C; Echenne, B; Halbert, C; Jonquet, O; Labarre-Vila, A; N'guyen-Morel, M-A; Pages, M; Pepin, J-L; Petitjean, T; Pouget, J; Ollagnon-Roman, E; Richelme, C; Rivier, F; Sacconi, S; Tiffreau, V; Vuillerot, C; Béroud, C; Tuffery-Giraud, S; Claustres, M

    2013-01-01

    The objective of this work was to study the natural history of dystrophinopathies and the genotype-phenotype correlations made possible by the development of the clinical part of the French DMD database. The collection of 70,000 clinical data for 600 patients with an average longitudinal follow-up of 12years enabled clarification of the natural history of Duchenne and Becker muscular dystrophies and clinical presentations in symptomatic females. We were able to specify the phenotypic heterogeneity of motor, orthopedic and respiratory involvements (severe, standard and intermediary form), of the cardiac disorder (severe, standard or absent cardiomyopathy, absence of correlation between motor and cardiac involvements), and of brain function (mental deficiency in the patients with Becker muscular dystrophy, psychopathological disorders in dystrophinopathies). Phenotypic variability did not correlate with a specific mutational spectrum. We propose a model of phenotypic analysis based on the presence or not of muscular and cardiac involvements (described by age at onset and rate of progression) and brain involvement (described by the type and the severity of the cognitive impairment and of the psychological disorders). The methodology developed for the DMD gene can be generalized and used for other databases dedicated to genetic diseases. Application of this model of phenotypic analysis for each patient and further development of the database should contribute substantially to clinical research providing useful tools for future clinical trials. PMID:23954141

  15. Identification of women at risk of depression in pregnancy: using women's accounts to understand the poor specificity of the Whooley and Arroll case finding questions in clinical practice.

    PubMed

    Darwin, Zoe; McGowan, Linda; Edozien, Leroy C

    2016-02-01

    Antenatal mental health assessment is increasingly common in high-income countries. Despite lacking evidence on validation or acceptability, the Whooley questions (modified PHQ-2) and Arroll 'help' question are used in the UK at booking (the first formal antenatal appointment) to identify possible cases of depression. This study investigated validation of the questions and women's views on assessment. Women (n = 191) booking at an inner-city hospital completed the Whooley and Arroll questions as part of their routine clinical care then completed a research questionnaire containing the Edinburgh postnatal depression scale (EPDS). A purposive subsample (n = 22) were subsequently interviewed. The Whooley questions 'missed' half the possible cases identified using the EPDS (EPDS threshold ≥10: sensitivity 45.7 %, specificity 92.1 %; ≥13: sensitivity 47.8 %, specificity 86.1 %), worsening to nine in ten when adopting the Arroll item (EPDS ≥10: sensitivity 9.1 %, specificity 98.2 %; ≥13: sensitivity 9.5 %, specificity 97.1 %). Women's accounts indicated that under-disclosure relates to the context of assessment and perceived relevance of depression to maternity services. Depression symptoms are under-identified in current local practice. While validated tools are needed that can be readily applied in routine maternity care, psychometric properties will be influenced by the context of disclosure when implemented in practice. PMID:25647071

  16. Diffusion-weighted MRI findings and clinical correlations in sporadic Creutzfeldt-Jakob disease.

    PubMed

    Gao, Ting; Lyu, Jin-Hao; Zhang, Jia-Tang; Lou, Xin; Zhao, Wei; Xing, Xiao-Wei; Yang, Ming; Yao, Yan; Tan, Qing-Che; Tian, Cheng-Lin; Huang, Xu-Sheng; Ma, Lin; Yu, Sheng-Yuan

    2015-06-01

    The objective of this study is to investigate the hyperintense lesions on diffusion-weighted magnetic resonance imaging (DWI) and its clinical correlation in sporadic Creutzfeldt-Jakob disease (sCJD). Patients who suffered from sCJD and followed up at the Department of Neurology at the General Hospital of the People's Liberation Army during the period of June 1, 2007 to July 1, 2014 were reviewed. The location of the hyperintense lesions on DWI, apparent diffusion coefficient (ADC) values of the hyperintense lesions were correlated with symptoms and clinical course. A total of 58 sCJD patients and ten healthy controls were included. Hyperintense lesions on DWI were observed in all the patients. The patients with basal ganglia (BG) hyperintense lesions on DWI had shorter disease duration and higher incidence of myoclonus (92 versus 44 %) than those without BG hyperintense lesions. The patients with occipital cortex hyperintense lesions on DWI had shorter disease duration between symptom onset and akinetic mutism than those without these lesions. The lower of the BG ADC value the faster presence of akinetic mutism and the shorter disease duration the patients will have. The presence of BG and occipital cortex hyperintense lesions on DWI and BG ADC values is correlated with the clinical course and clinical symptoms. PMID:25860342

  17. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD?

    PubMed Central

    Camiciottoli, Gianna; Diciotti, Stefano; Bigazzi, Francesca; Lombardo, Simone; Bartolucci, Maurizio; Paoletti, Matteo; Mascalchi, Mario; Pistolesi, Massimo

    2015-01-01

    A substantial proportion of patients with chronic obstructive pulmonary disease (COPD) develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory–expiratory low dose computed tomography (CT) and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28) and in females (n=27). Women with a predominant conductive airway phenotype (n=10) showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001). Intrathoracic tracheal collapsibility was directly correlated with inspiratory–expiratory volume variation at CT and with forced expiratory volume (1 second), and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD are closely correlated. In patients with a predominant emphysematous phenotype, a reduced collapsibility may reflect the mechanical properties of the stiff hyperinflated emphysematous lung. The high collapsibility in patients with predominant airway disease, mild airway obstruction, and in women with this phenotype may reflect chronic airway inflammation. The lack of relationship with such symptoms as wheezing, cough, and dyspnea could indicate that intrathoracic tracheal collapsibility itself should be considered neither an abnormal feature of COPD nor a relevant clinical finding. PMID:25960647

  18. Is intrathoracic tracheal collapsibility correlated to clinical phenotypes and sex in patients with COPD?

    PubMed

    Camiciottoli, Gianna; Diciotti, Stefano; Bigazzi, Francesca; Lombardo, Simone; Bartolucci, Maurizio; Paoletti, Matteo; Mascalchi, Mario; Pistolesi, Massimo

    2015-01-01

    A substantial proportion of patients with chronic obstructive pulmonary disease (COPD) develops various degree of intrathoracic tracheal collapsibility. We studied whether the magnitude of intrathoracic tracheal collapsibility could be different across clinical phenotypes and sex in COPD. Intrathoracic tracheal collapsibility measured at paired inspiratory-expiratory low dose computed tomography (CT) and its correlation with clinical, functional, and CT-densitometric data were investigated in 69 patients with COPD according to their predominant conductive airway or emphysema phenotypes and according to sex. Intrathoracic tracheal collapsibility was higher in patients with predominant conductive airway disease (n=28) and in females (n=27). Women with a predominant conductive airway phenotype (n=10) showed a significantly greater degree of collapsibility than women with predominant emphysema (28.9%±4% versus 11.6%±2%; P<0.001). Intrathoracic tracheal collapsibility was directly correlated with inspiratory-expiratory volume variation at CT and with forced expiratory volume (1 second), and inversely correlated with reduced CT lung density and functional residual capacity. Intrathoracic tracheal collapsibility was not correlated with cough and wheezing; however, intrathoracic tracheal collapsibility and clinical phenotypes of COPD are closely correlated. In patients with a predominant emphysematous phenotype, a reduced collapsibility may reflect the mechanical properties of the stiff hyperinflated emphysematous lung. The high collapsibility in patients with predominant airway disease, mild airway obstruction, and in women with this phenotype may reflect chronic airway inflammation. The lack of relationship with such symptoms as wheezing, cough, and dyspnea could indicate that intrathoracic tracheal collapsibility itself should be considered neither an abnormal feature of COPD nor a relevant clinical finding. PMID:25960647

  19. CT densitovolumetry in children with obliterative bronchiolitis: correlation with clinical scores and pulmonary function test results*,**

    PubMed Central

    Mocelin, Helena; Bueno, Gilberto; Irion, Klaus; Marchiori, Edson; Sarria, Edgar; Watte, Guilherme; Hochhegger, Bruno

    2013-01-01

    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. PMID:24473764

  20. Ventricular maps in 804 ADNI subjects: correlations with CSF biomarkers and clinical decline.

    PubMed

    Chou, Yi-Yu; Leporé, Natasha; Saharan, Priyanka; Madsen, Sarah K; Hua, Xue; Jack, Clifford R; Shaw, Leslie M; Trojanowski, John Q; Weiner, Michael W; Toga, Arthur W; Thompson, Paul M

    2010-08-01

    Ideal biomarkers of Alzheimer's disease (AD) should correlate with accepted measures of pathology in the cerebrospinal fluid (CSF); they should also correlate with, or predict, future clinical decline, and should be readily measured in hundreds to thousands of subjects. Here we explored the utility of automated 3D maps of the lateral ventricles as a possible biomarker of AD. We used our multi-atlas fluid image alignment (MAFIA) method, to compute ventricular models automatically, without user intervention, from 804 brain MRI scans with 184 AD, 391 mild cognitive impairment (MCI), and 229 healthy elderly controls (446 men, 338 women; age: 75.50 +/- 6.81 [SD] years). Radial expansion of the ventricles, computed pointwise, was strongly correlated with current cognition, depression ratings, Hachinski Ischemic scores, language scores, and with future clinical decline after controlling for any effects of age, gender, and educational level. In statistical maps ranked by effect sizes, ventricular differences were highly correlated with CSF measures of Abeta(1-42), and correlated with ApoE4 genotype. These statistical maps are highly automated, and offer a promising biomarker of AD for large-scale studies. PMID:20620663

  1. Modeling clinical outcome using multiple correlated functional biomarkers: A Bayesian approach.

    PubMed

    Long, Qi; Zhang, Xiaoxi; Zhao, Yize; Johnson, Brent A; Bostick, Roberd M

    2016-04-01

    In some biomedical studies, biomarkers are measured repeatedly along some spatial structure or over time and are subject to measurement error. In these studies, it is often of interest to evaluate associations between a clinical endpoint and these biomarkers (also known as functional biomarkers). There are potentially two levels of correlation in such data, namely, between repeated measurements of a biomarker from the same subject and between multiple biomarkers from the same subject; none of the existing methods accounts for correlation between multiple functional biomarkers. We propose a Bayesian approach to model a clinical outcome of interest (e.g. risk for colorectal cancer) in the presence of multiple functional biomarkers while accounting for potential correlation. Our simulations show that the proposed approach achieves good performance in finite samples under various settings. In the presence of substantial or moderate correlation, the proposed approach outperforms an existing approach that does not account for correlation. The proposed approach is applied to a study of biomarkers of risk for colorectal neoplasms and our results show that the risk for colorectal cancer is associated with two functional biomarkers, APC and TGF-α, in particular, with their values in the region between the proliferating and differentiating zones of colorectal crypts. PMID:23070593

  2. Clinical Correlates of Co-Occurring Cannabis and Tobacco Use: A Systematic Review

    PubMed Central

    Peters, Erica N.; Budney, Alan J.; Carroll, Kathleen M.

    2012-01-01

    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. PMID:22340422

  3. Correlation of clinical outcome to the estimated radiation dose from Boron Neutron Capture Therapy (BNCT)

    SciTech Connect

    Chadha, M.; Coderre, J.A.; Chanana, A.D.

    1996-12-31

    A phase I/II trial delivering a single fraction of BNCT using p-Boronophenylalanine-Fructose and epithermal neutrons at the the Brookhaven Medical Research Reactor was initiated in September 1994. The primary endpiont of the study was to evaluate the feasibility and safety of a given BNCT dose. The clinical outcome of the disease was a secondary endpoint of the study. The objective of this paper is to evaluate the correlation of the clinical outcome of patients to the estimated radiation dose from BNCT.

  4. Questioning Techniques.

    ERIC Educational Resources Information Center

    Patterson, Michelle

    1999-01-01

    Questions are so much a part of the classroom routine and they should stimulate learning and thinking. Introduces the Questioning and Understanding to Improve Learning and Thinking (QUILT) method which incorporates Bloom's Taxonomy and wait time. (ASK)

  5. Critiquing Questions

    ERIC Educational Resources Information Center

    Zimmerman, Lynn W.

    2015-01-01

    Question formation is a basic part of teaching and learning English. However, teachers often focus on the ability to form the question properly and not as much on the quality of the information the question is seeking. Whether teaching English language learners or students who want to be English teachers, teachers need to carefully consider the…

  6. Four Questions

    ERIC Educational Resources Information Center

    Hark-Weber, Amara G., Ed.

    2013-01-01

    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…

  7. Clinical Characteristics and Genotype-Phenotype Correlation of Korean Patients with Spinal and Bulbar Muscular Atrophy

    PubMed Central

    Song, Ju Sun; Kim, Kyung-Ah; Kim, Jong-Won; Sung, Duk Hyun; Kim, Byoung Joon

    2015-01-01

    Purpose Spinal and bulbar muscular atrophy (SBMA) is an X-linked motor neuron disease characterized by proximal muscle weakness, muscle atrophy, and fasciculation. Although SBMA is not uncommon in Korea, there is only one study reporting clinical characteristics and genotype-phenotype correlation in Korean patients. Materials and Methods In this study, age at the onset of symptoms, the score of severity assessed by impairment of activities of daily living milestones, and rate of disease progression, and their correlations with the number of CAG repeats in the androgen receptor (AR) gene, as well as possible correlations among clinical characteristics, were analyzed in 40 SBMA patients. Results The median ages at onset and at diagnosis were 44.5 and 52.5 years, respectively, and median interval between onset and diagnosis and median rate of disease progression were 5.0 years and 0.23 score/year, respectively. The median number of CAG repeats in the AR gene was 44 and the number of CAG repeats showed a significant inverse correlation with the age at onset of symptoms (r=-0.407, p=0.009). In addition, patients with early symptom onset had slower rate of disease progression. Conclusion As a report with the largest and recent Korean cohort, this study demonstrates clinical features of Korean patients with SBMA and reaffirms the inverse correlation between the age at disease onset and the number of CAG repeats. Interestingly, this study shows a possibility that the rate of disease progression may be influenced by the age at onset of symptoms. PMID:26069122

  8. Clinical Correlations With Lewy Body Pathology in LRRK2-Related Parkinson Disease

    PubMed Central

    Kalia, Lorraine V.; Lang, Anthony E.; Hazrati, Lili-Naz; Fujioka, Shinsuke; Wszolek, Zbigniew K.; Dickson, Dennis W.; Ross, Owen A.; Van Deerlin, Vivianna M.; Trojanowski, John Q.; Hurtig, Howard I.; Alcalay, Roy N.; Marder, Karen S.; Clark, Lorraine N.; Gaig, Carles; Tolosa, Eduardo; Ruiz-Martínez, Javier; Marti-Masso, Jose F.; Ferrer, Isidre; de Munain, Adolfo López; Goldman, Samuel M.; Schüle, Birgitt; Langston, J. William; Aasly, Jan O.; Giordana, Maria T.; Bonifati, Vincenzo; Puschmann, Andreas; Canesi, Margherita; Pezzoli, Gianni; De Paula, Andre Maues; Hasegawa, Kazuko; Duyckaerts, Charles; Brice, Alexis; Stoessl, A. Jon; Marras, Connie

    2015-01-01

    IMPORTANCE Mutations in leucine-rich repeat kinase 2 (LRRK2) are the most common cause of genetic Parkinson disease (PD) known to date. The clinical features of manifesting LRRK2 mutation carriers are generally indistinguishable from those of patients with sporadic PD. However, some PD cases associated with LRRK2 mutations lack Lewy bodies (LBs), a neuropathological hallmark of PD. We investigated whether the presence or absence of LBs correlates with different clinical features in LRRK2-related PD. OBSERVATIONS We describe genetic, clinical, and neuropathological findings of 37 cases of LRRK2-related PD including 33 published and 4 unpublished cases through October 2013. Among the different mutations, the LRRK2 p.G2019S mutation was most frequently associated with LB pathology. Nonmotor features of cognitive impairment/dementia, anxiety, and orthostatic hypotension were correlated with the presence of LBs. In contrast, a primarily motor phenotype was associated with a lack of LBs. CONCLUSIONS AND RELEVANCE To our knowledge, this is the first report of clinicopathological correlations in a series of LRRK2-related PD cases. Findings from this selected group of patients with PD demonstrated that parkinsonian motor features can occur in the absence of LBs. However, LB pathology in LRRK2-related PD may be a marker for a broader parkinsonian symptom complex including cognitive impairment. PMID:25401511

  9. Clinical Correlates of Awareness for Balance, Function, and Memory: Evidence for the Modality Specificity of Awareness

    PubMed Central

    O'Connell, Megan E.; Crossley, Margaret; Morgan, Debra

    2014-01-01

    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

  10. Correlation between clinical symptoms and magnetic resonance imaging findings in patients with temporomandibular joint internal derangement

    PubMed Central

    Jung, Young-Wook; Park, Sung-Hoon; On, Sung-Woon

    2015-01-01

    Objectives The purpose of this study was to clarify which findings in magnetic resonance imaging (MRI) are good predicators of pain and mouth opening limitation in patients with temporomandibular joint (TMJ) internal derangement (ID). Materials and Methods Clinical examinations for pain and mouth opening limitation were conducted for suspected TMJ ID. MRI scans were taken within a week of clinical examinations. On the oblique-sagittal plane image, readings were obtained in terms of the functional aspect of disc position, degree of displacement, disc deformity, joint effusion, and osteoarthrosis. Multiple logistic regression analyses were conducted to identify the predictors of pain and mouth opening limitation. Results A total of 48 patients (96 TMJs) were studied, including 39 female patients and 9 male patients whose ages ranged from 10 to 65 years. The resultant data showed significant correlations between pain and the MR imaging of the degree of disc displacement (P<0.05). The probability of there being pain in moderate to significant cases was 9.69 times higher than in normal cases. No significant correlation was found between mouth opening limitation and MRI findings. Conclusion We identified a significant correlation between clinical symptoms and MRI findings of ID. The degree of anterior disc displacement may be useful for predicting pain in patients with TMJ ID. PMID:26131429

  11. Anatomo-clinical atlases correlate clinical data and electrode contact coordinates: application to subthalamic deep brain stimulation.

    PubMed

    Lalys, Florent; Haegelen, Claire; Mehri, Maroua; Drapier, Sophie; Vérin, Marc; Jannin, Pierre

    2013-01-30

    For patients suffering from Parkinson's disease with severe movement disorders, functional surgery may be required when medical therapy is not effective. In Deep Brain Stimulation (DBS), electrodes are implanted within the brain to stimulate deep structures such as SubThalamic Nucleus (STN). The quality of patient surgical outcome is generally related to the accuracy of nucleus targeting during surgery. In this paper, we focused on identifying optimum sites for STN DBS by studying symptomatic motor improvement along with neuropsychological side effects. We described successive steps for constructing digital atlases gathering patient's location of electrode contacts automatically segmented from postoperative images, and clinical scores. Three motor and five neuropsychological scores were included in the study. Correlations with active contact locations were carried out using an adapted hierarchical ascendant classification. Such analysis enabled the extraction of representative clusters to determine the optimum site for therapeutic STN DBS. For each clinical score, we built an anatomo-clinical atlas representing its improvement or deterioration in relation with the anatomical location of electrodes and from a population of implanted patients. To the best of our knowledge, we reported for the first time a discrepancy between a very good motor improvement by targeting the postero-superior region of the STN and an inevitable deterioration of the categorical and phonemic fluency in the same region. Such atlases and associated analysis may help better understanding of functional mapping in deep structures and may help pre-operative decision-making process and especially targeting. PMID:23147008

  12. Injury to the Preterm Brain and Cerebral Palsy: Clinical Aspects, Molecular Mechanisms, Unanswered Questions, and Future Research Directions

    PubMed Central

    Babcock, Michael A.; Kostova, Felina V.; Ferriero, Donna M.; Johnston, Michael V.; Brunstrom, Jan E.; Hagberg, Henrik; Maria, Bernard L.

    2013-01-01

    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. PMID:19745084

  13. Cutting a Long Story Short? The Clinical Relevance of Asking Parents, Nurses, and Young Children Themselves to Identify Children's Mental Health Problems by One or Two Questions

    PubMed Central

    Joukamaa, Matti; Tamminen, Tuula

    2014-01-01

    Background and Aims. Assessing young children's mental health is a crucial and challenging task. The aim of the study was to evaluate the clinical relevance of asking parents, nurses, and young children themselves to identify children's mental health problems by only one or two questions. Methods. In regular health check-ups of 4- to 9-year-old children (n = 2682), parents and public health nurses assessed by one question whether the child had any emotional or behavioral difficulties. The child completed a self-evaluation enquiry on his/her emotional well-being. A stratified proportion of the participating parents were invited to a diagnostic interview. Results. Sensitivities were fairly good for the parents' (68%), nurses' (65%), and their combined (79%) one-question screens. Difficulties identified by parents and nurses were major risks (OR 10–14) for any child psychiatric disorders (P < 0.001). The child's self-evaluation was related to 2-fold to 3-fold risks (P < 0.05) for any psychiatric diagnosis, for any emotional diagnosis, and for negative situational factors. Conclusion. The one-question screen for parents and public health nurses together quite adequately identified the young children with mental health problems. The child's self-evaluation provided relevant and complementary information on his/her mental health and especially emotional problems. PMID:25614880

  14. Vestibular Performance During High-Acceleration Stimuli Correlates with Clinical Decline in SCA6.

    PubMed

    Huh, Young Eun; Kim, Ji-Soo; Kim, Hyo-Jung; Park, Seong-Ho; Jeon, Beom Seok; Kim, Jong-Min; Cho, Jin Whan; Zee, David S

    2015-06-01

    In spinocerebellar ataxia type 6 (SCA6), the vestibular dysfunction and its correlation with other clinical parameters require further exploration. We determined vestibular responses over a broad range of stimulus acceleration in 11 patients with SCA6 (six men, age range=33-72 years, mean age±SD=59±12 years) using bithermal caloric irrigations, rotary chair, and head impulse tests. Correlations were also pursued among disability scores, as measured using the International Cooperative Ataxia Rating Scale, disease duration, age at onset, cytosine-adenine-guanine (CAG) repeat length, and the gain of the vestibulo-ocular reflex (VOR). In response to relatively low-acceleration, low-frequency rotational and bithermal caloric stimuli, the VOR gains were normal or increased regardless of the severity of disease. On the other hand, with relatively high-acceleration, high-frequency head impulses, there was a relative increase in gain in the mildly affected patients and a decrease in gain in the more severely affected patients and gains were negatively correlated with the severity of disease (Spearman correlation, R=-0.927, p<0.001). Selective decrease of the vestibular responses during high-acceleration, high-frequency stimuli may be ascribed to degeneration of either the flocculus or vestibular nuclei. The performance of the VOR during high-acceleration, high-frequency head impulses may be a quantitative indicator of clinical decline in SCA6. PMID:25624155

  15. Antifungal Susceptibility Testing of Fluconazole by Flow Cytometry Correlates with Clinical Outcome

    PubMed Central

    Wenisch, Christoph; Moore, Caroline B.; Krause, Robert; Presterl, Elisabeth; Pichna, Peter; Denning, David W.

    2001-01-01

    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 vitro antifungal resistance test results. A total of 24 patients with candidemia for whom one or more blood cultures were positive for a Candida sp. were included. Susceptibility testing was performed by NCCLS M27-A and FACS methods. The correlation of MICs (NCCLS M27-A and FACS) and clinical outcome was calculated. In 83% of the cases, the MICs of fluconazole determined by FACS were within 1 dilution of the MICs determined by the NCCLS M27-A method. For proposed susceptibility breakpoints, there was 100% agreement between the M27-A and FACS methods. In the FACS assay, a fluconazole MIC of <1 μg/ml was associated with cure (P < 0.001) whereas an MIC of ≥1 μg/ml was associated with death (P < 0.001). The M27-A-derived fluconazole MICs did not correlate with outcome (P = 1 and P = 0.133). PMID:11427554

  16. Candida species isolation in peristomal skin in patients with abdominal stomas and correlation to clinical signs: a descriptive pilot study.

    PubMed

    Morales-Mendoza, Yamilett; Fernández-Martínez, Ramón; Fabián-Victoriano, Ma Rosy; Contreras-Ruiz, José; Vásquez-del-Mercado, Elsa; de Lourdes Suárez-Roa, Maria; Arenas-Guzman, Roberto

    2014-11-01

    The reported prevalence of candidiasis in peristomal skin varies greatly. Very few studies exist that correlate the clinical findings around the peristomal skin to the mycology. In this study, the authors report on Candida species prevalence, clinical correlation, and mycology. PMID:25325226

  17. Prevalence of premorbid personality disorder and its clinical correlates in patients with delusional disorder.

    PubMed

    de Portugal, Enrique; Díaz-Caneja, Covadonga M; González-Molinier, Manuel; de Castro, María Jesús; del Amo, Victoria; Arango, Celso; Cervilla, Jorge A

    2013-12-30

    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

  18. Spitz/Reed nevi: a review of clinical-dermatoscopic and histological correlation

    PubMed Central

    Pedrosa, Ana F.; Lopes, Jose M.; Azevedo, Filomena; Mota, Alberto

    2016-01-01

    Background: Spitz/Reed nevi are melanocytic lesions that may mimic melanoma at clinical, dermatoscopic and histopathological levels. Management strategies of these lesions remain controversial. Objectives: We aim a correlation among clinical-dermatoscopic and histological features of a series of Spitz/Reed nevi diagnosed during 7 years at the Department of Dermatology. Methods: Clinical, dermatoscopic and histological features of Spitz/Reed nevi diagnosed at our tertiary hospital from 2008 to 2014 were reviewed in order to seek correlation. Results: All described dermatoscopic patterns for Spitz/Reed nevi were found among the 47 enrolled patients; starburst and atypical/multicomponent patterns prevailed (57.4%). Reticular pattern predominated among children younger than 12 years, whereas homogeneous pattern was more frequent in patients older than 12 years, although these differences were not statistically significant (P=0.785). Among histological atypical lesions, all dermatoscopic patterns were represented, but the atypical/multicomponent predominated (56.3%). Two out of 11 dermatoscopically atypical lesions did not show histopathological counterpart. Conclusions: The excision of Spitz/Reed nevi in adults is supported, given the inability to accurately predict those with histopathological atypia, based on clinical and dermatoscopic features, which may raise concern about malignancy. PMID:27222770

  19. NCI Workshop Report: Clinical and Computational Requirements for Correlating Imaging Phenotypes with Genomics Signatures.

    PubMed

    Colen, Rivka; Foster, Ian; Gatenby, Robert; Giger, Mary Ellen; Gillies, Robert; Gutman, David; Heller, Matthew; Jain, Rajan; Madabhushi, Anant; Madhavan, Subha; Napel, Sandy; Rao, Arvind; Saltz, Joel; Tatum, James; Verhaak, Roeland; Whitman, Gary

    2014-10-01

    The National Cancer Institute (NCI) Cancer Imaging Program organized two related workshops on June 26-27, 2013, entitled "Correlating Imaging Phenotypes with Genomics Signatures Research" and "Scalable Computational Resources as Required for Imaging-Genomics Decision Support Systems." The first workshop focused on clinical and scientific requirements, exploring our knowledge of phenotypic characteristics of cancer biological properties to determine whether the field is sufficiently advanced to correlate with imaging phenotypes that underpin genomics and clinical outcomes, and exploring new scientific methods to extract phenotypic features from medical images and relate them to genomics analyses. The second workshop focused on computational methods that explore informatics and computational requirements to extract phenotypic features from medical images and relate them to genomics analyses and improve the accessibility and speed of dissemination of existing NIH resources. These workshops linked clinical and scientific requirements of currently known phenotypic and genotypic cancer biology characteristics with imaging phenotypes that underpin genomics and clinical outcomes. The group generated a set of recommendations to NCI leadership and the research community that encourage and support development of the emerging radiogenomics research field to address short-and longer-term goals in cancer research. PMID:25389451

  20. NCI Workshop Report: Clinical and Computational Requirements for Correlating Imaging Phenotypes with Genomics Signatures

    PubMed Central

    Colen, Rivka; Foster, Ian; Gatenby, Robert; Giger, Mary Ellen; Gillies, Robert; Gutman, David; Heller, Matthew; Jain, Rajan; Madabhushi, Anant; Madhavan, Subha; Napel, Sandy; Rao, Arvind; Saltz, Joel; Tatum, James; Verhaak, Roeland; Whitman, Gary

    2014-01-01

    The National Cancer Institute (NCI) Cancer Imaging Program organized two related workshops on June 26–27, 2013, entitled “Correlating Imaging Phenotypes with Genomics Signatures Research” and “Scalable Computational Resources as Required for Imaging-Genomics Decision Support Systems.” The first workshop focused on clinical and scientific requirements, exploring our knowledge of phenotypic characteristics of cancer biological properties to determine whether the field is sufficiently advanced to correlate with imaging phenotypes that underpin genomics and clinical outcomes, and exploring new scientific methods to extract phenotypic features from medical images and relate them to genomics analyses. The second workshop focused on computational methods that explore informatics and computational requirements to extract phenotypic features from medical images and relate them to genomics analyses and improve the accessibility and speed of dissemination of existing NIH resources. These workshops linked clinical and scientific requirements of currently known phenotypic and genotypic cancer biology characteristics with imaging phenotypes that underpin genomics and clinical outcomes. The group generated a set of recommendations to NCI leadership and the research community that encourage and support development of the emerging radiogenomics research field to address short-and longer-term goals in cancer research. PMID:25389451

  1. Correlations between Morphological, Molecular Biological, and Physiological Characteristics in Clinical and Nonclinical Isolates of Acanthamoeba spp.

    PubMed Central

    Walochnik, Julia; Obwaller, Andreas; Aspöck, Horst

    2000-01-01

    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. PMID:11010891

  2. Anatomic, clinical, and neuropsychological correlates of spelling errors in Primary Progressive Aphasia

    PubMed Central

    Shim, HyungSub; Hurley, Robert S.; Rogalski, Emily; Mesulam, M.-Marsel

    2012-01-01

    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). PMID:22579708

  3. Postoperative Expansion of Dural Sac Cross-Sectional Area after Unilateral Laminotomy for Bilateral Decompression: Correlation with Clinical Symptoms

    PubMed Central

    Chung, Seok-Won; Shin, Yong-Hwan; Baek, Oon-Ki; Lee, Sang-Ho

    2014-01-01

    Objective Dural sac cross-sectional area (DSCSA) is a way to measure the degree of central spinal canal compression. The objective was to investigate the correlation between the expansion ratio of DSCSA after unilateral laminotomy for bilateral decompression (ULBD) and the clinical results for lumbar spinal stenosis. Methods We retrospectively reviewed the clinical data and radiographs of 103 patients who underwent ULBD for symptomatic spinal stenosis in one year. We compared preoperative and postoperative clinical data and DSCSA and evaluated the correlation between clinical and radiographic measurements. Results There was a significant increase of DSCSA after ULBD (p=0.000) and mean expansion ratio of DSCSA was 203.7±147.2%(range -32.9-826.1%). Clinical outcomes, measured by VAS and ODI were improved significantly not only in early postoperative period, but also in the last follow-up. However, there were no statistically significant correlations between the preoperative DSCSA and clinical symptoms, Perioperative expansion ratio of DSCSA and clinical parameters were also not correlated to the improvement of clinical symptoms significantly in both early postoperative phase and last follow-up. Conclusion Our result indicates that the DSCSA itself has a definite limitation to be correlated to the clinical symptoms, and thus meticulous correlation between the clinical presentation and MRI imaging is essential in determination of surgical treatment. PMID:25620982

  4. Screening, assessment, and treatment of osteoporosis for the nurse practitioner: Key questions and answers for clinical practice—A Canadian perspective

    PubMed Central

    Rice, Peggy; Mehan, Upender; Hamilton, Celeste; Kim, Sandra

    2014-01-01

    Purpose Using a case-based approach, we review key clinical questions relevant to nurse practitioners (NPs) regarding the screening, assessment, and treatment of patients at risk for osteoporosis and fractures in a Canadian general practice setting. Data sources A case presentation with relevant questions and answers to guide management of a patient. Conclusions Osteoporosis is a common condition in both the aging male and female populations. Screening, diagnosis, and treatment of osteoporosis is lagging behind relative to other chronic disease states. NPs have a unique opportunity to help reduce this care gap by playing an integral role in the identification, risk stratification, and treatment of patients at risk for osteoporosis and fractures. Implications for practice This case highlights the important role an NP can have in screening a patient previously not diagnosed or managed for osteoporosis. Performing a focused history and physical exam of the patient to determine appropriate screening tests and fracture risk will help in guiding treatment decisions. PMID:24911524

  5. Non-infectious granulomatous diseases of the skin and their associated systemic diseases: an evidence-based update to important clinical questions.

    PubMed

    Hawryluk, Elena Balestreire; Izikson, Leonid; English, Joseph C

    2010-01-01

    Non-infectious granulomatous diseases of the skin are a broad group of distinct reactive inflammatory conditions that share important similarities. As a group, they are relatively difficult to diagnose and distinguish both clinically as well as histologically. Many of these disorders have significant associations with systemic diseases that impact the patient's overall prognosis. In this update, we offer a discussion of emerging concepts and controversies in this field, as presented through evidence-based answers to seven important clinical questions regarding palisading and epithelioid granulomata. These questions offer an opportunity to review ten non-infectious granulomatous conditions that have implications for systemic disease: granuloma annulare, annular elastolytic giant cell granuloma, necrobiosis lipoidica, methotrexate-induced accelerated rheumatoid nodulosis, necrobiotic xanthogranuloma, interstitial granulomatous dermatitis, interstitial granulomatous drug reaction, palisaded neutrophilic granulomatous dermatitis, sarcoidosis, and metastatic Crohn disease. Recent clinical, epidemiologic, and laboratory studies have shed some light on these diseases, the association of these conditions with systemic disorders, and their overall prognoses. PMID:20184390

  6. Gray and white matter alterations in hereditary spastic paraplegia type SPG4 and clinical correlations.

    PubMed

    Lindig, Tobias; Bender, Benjamin; Hauser, Till-Karsten; Mang, Sarah; Schweikardt, Daniel; Klose, Uwe; Karle, Kathrin N; Schüle, Rebecca; Schöls, Ludger; Rattay, Tim W

    2015-08-01

    Hereditary spastic paraplegias (HSP) are a group of clinically and genetically heterogeneous disorders with the hallmark of progressive spastic gait disturbance. We used advanced neuroimaging to identify brain regions involved in SPG4, the most common HSP genotype. Additionally, we analyzed correlations between imaging and clinical findings. We performed 3T MRI scans including isotropic high-resolution 3D T1, T2-FLAIR, and DTI sequences in 15 adult patients with genetically confirmed SPG4 and 15 age- and sex-matched healthy controls. Brain volume loss of gray and white matter was evaluated through voxel-based morphometry (VBM) for supra- and infratentorial regions separately. DTI maps of axial diffusivity (AD), radial diffusivity (RD), mean diffusivity (MD), fractional anisotropy (FA), and measured anisotropy (MA1) were analyzed through tract-based special statistics (TBSS). VBM and TBSS revealed a widespread affection of gray and white matter in SPG4 including the corpus callosum, medio-dorsal thalamus, parieto-occipital regions, upper brainstem, cerebellum, and corticospinal tract. Significant correlations with correlation coefficients r > 0.6 between clinical data and DTI findings could be demonstrated for disease duration and disease severity as assessed by the spastic paraplegia rating scale for the pontine crossing tract (AD) and the corpus callosum (RD and FA). Imaging also provided evidence that SPG4 underlies a primarily axonal rather than demyelinating damage in accordance with post-mortem data. DTI is an attractive tool to assess subclinical affection in SPG4. The correlation of imaging findings with disease duration and severity suggests AD, RD, and FA as potential progression markers in interventional studies. PMID:26050637

  7. Clinical Correlates of Apathy in Patients Recently Diagnosed with Parkinson's Disease: The ANIMO Study

    PubMed Central

    Cubo, Esther; Benito-León, Julián; Coronell, Carlos; Armesto, Diana

    2012-01-01

    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. PMID:22236943

  8. Multifocal motor neuropathy: correlation of nerve ultrasound, electrophysiological, and clinical findings.

    PubMed

    Kerasnoudis, Antonios; Pitarokoili, Kalliopi; Behrendt, Volker; Gold, Ralf; Yoon, Min-Suk

    2014-06-01

    We present nerve ultrasound findings in multifocal motor neuropathy (MMN) and examine their correlation with electrophysiology and functional disability. Eighty healthy controls and 12 MMN patients underwent clinical, sonographic, and electrophysiological evaluation a mean of 3.5 years (standard deviation [SD] ± 2.1) after disease onset. Nerve ultrasound revealed significantly higher cross-sectional area (CSA) values of the median (forearm, p < 0.001), ulnar (p < 0.001), and tibial nerve (ankle, p < 0.001) when compared with controls. Electroneurography documented signs of significantly lower values of the motor conduction velocity and compound muscle action potentials (cMAPs) in the upper arm nerves (median, ulnar, radial, p < 0.001). A significant correlation between sonographic and electrophysiological findings in the MMN group was found only between cMAP and CSA of the median nerve at the upper arm (r = 0.851, p < 0.001). Neither nerve sonography nor electrophysiology correlated with functional disability. MMN seems to show inhomogeneous CSA enlargement in various peripheral nerves, with weak correlation to electrophysiological findings. Neither nerve sonography nor electrophysiology correlated with functional disability. Multicentre, prospective studies are required to prove the applicability and diagnostic values of these findings. PMID:24862982

  9. Sexual distress, sexual dysfunction and relationship quality in women with systemic sclerosis: correlation with clinical variables.

    PubMed

    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

    2014-01-01

    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

  10. Depressive Symptoms during an Acute Schizophrenic Episode: Frequency and Clinical Correlates

    PubMed Central

    Rajkumar, Ravi Philip

    2015-01-01

    Introduction. Depressive symptoms are common in schizophrenia and are associated with poorer functioning, lower quality of life, and an elevated risk of suicidal behaviour. There are few studies on the occurrence and correlates of these symptoms in acutely ill patients with schizophrenia. Method. 72 acutely ill patients with schizophrenia were assessed for depression using the Calgary Depression Scale for Schizophrenia (CDSS). A cut-off score of ≥6 on the CDSS was used to identify clinically significant depressive symptoms. The relationship between depression and illness variables, including psychotic symptom dimensions as measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), was examined. Results. Eleven (15.3%) patients had clinically significant depressive symptoms. These patients scored higher on the positive and general psychopathology scales of the PANSS and had higher rates of suicidal behavior and poorer functioning. The severity of depressive symptoms was positively correlated with the PANSS positive subscale and negatively correlated with the PANSS negative subscale. Discussion. These findings confirm previous reports that depressive symptoms in active schizophrenia is related to the severity of positive psychotic symptoms and is a risk factor for suicidal behaviour in these patients. PMID:26664745

  11. White matter microstructure in body dysmorphic disorder and its clinical correlates

    PubMed Central

    Feusner, Jamie; Arienzo, Donatello; Li, Wei; Zhan, Liang; GadElkarim, Johnson; Thompson, Paul; Leow, Alex

    2012-01-01

    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. Fourteen medication-free BDD participants and 16 healthy controls were scanned using diffusion-weighted 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 (cl and cp). We correlated diffusion measures with clinical measures of symptom severity and poor insight/delusionality. Poor insight negatively correlated with FA and cl and positively correlated with MD in the inferior longitudinal fasciculus (ILF) and the forceps major (FM). FA and cl were lower in the ILF and IFOF 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

  12. Improving the clinical correlation of multiple sclerosis black hole volume change by paired-scan analysis☆

    PubMed Central

    Tam, Roger C.; Traboulsee, Anthony; Riddehough, Andrew; Li, David K.B.

    2012-01-01

    The change in T1-hypointense lesion (“black hole”) volume is an important marker of pathological progression in multiple sclerosis (MS). Black hole boundaries often have low contrast and are difficult to determine accurately and most (semi‐)automated segmentation methods first compute the T2-hyperintense lesions, which are a superset of the black holes and are typically more distinct, to form a search space for the T1w lesions. Two main potential sources of measurement noise in longitudinal black hole volume computation are partial volume and variability in the T2w lesion segmentation. A paired analysis approach is proposed herein that uses registration to equalize partial volume and lesion mask processing to combine T2w lesion segmentations across time. The scans of 247 MS patients are used to compare a selected black hole computation method with an enhanced version incorporating paired analysis, using rank correlation to a clinical variable (MS functional composite) as the primary outcome measure. The comparison is done at nine different levels of intensity as a previous study suggests that darker black holes may yield stronger correlations. The results demonstrate that paired analysis can strongly improve longitudinal correlation (from -0.148 to -0.303 in this sample) and may produce segmentations that are more sensitive to clinically relevant changes. PMID:24179734

  13. Clinical Effects and Brain Metabolic Correlates in Noninvasive Cortical Neuromodulation for Visceral Pain

    PubMed Central

    Fregni, Felipe; Potvin, Kimberly; DaSilva, Deborah; Wang, Xiaoen; Lenkinski, Robert; Freedman, Steven D.; Pascual-Leone, Alvaro

    2010-01-01

    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. PMID:20822942

  14. Mobilization of Circulating Endothelial Progenitor Cells Correlates with the Clinical Course of Hantavirus Disease

    PubMed Central

    Grouls, Stephan; Hettwer, David; Rafat, Neysan; Tönshoff, Burkhard; Zeier, Martin

    2014-01-01

    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. PMID:24155401

  15. Review of Clinical Correlates of P50 Sensory Gating Abnormalities in Patients with Schizophrenia

    PubMed Central

    Potter, David; Summerfelt, Ann; Gold, James; Buchanan, Robert W.

    2006-01-01

    A large percentage of patients with schizophrenia are characterized by an abnormality in P50 sensory gating. This abnormality has been shown to be genetically linked to the α-7 nicotinic receptor and is transiently reversed by acute nicotine administration. These observations have led to the development of pharmacological treatments designed to improve sensory gating. However, if normalization of P50 gating abnormalities is to guide drug development, then it becomes important to delineate the clinical correlates of enhanced P50 gating. We conducted a review of all available articles through March 2005 that have examined this issue. We found that, despite the prominent role that P50 abnormalities have played in our understanding of schizophrenia, there is a relative dearth of data examining P50 clinical correlates. There is evidence suggestive of an association between P50 and measures of attention, and multiple studies have failed to document a cross-sectional or longitudinal relationship between P50 and positive, negative, or other symptoms. These results suggest that considerably more work needs to be done to understand and validate the clinical significance of this impairment. PMID:16469942

  16. Histological evaluation of pulp tissue from second primary molars correlated with clinical and radiographic caries findings

    PubMed Central

    Gopinath, Vellore Kannan; Anwar, Khurshid

    2014-01-01

    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. PMID:24932190

  17. Mutation distributions and clinical correlations of PIK3CA gene mutations in breast cancer.

    PubMed

    Dirican, Ebubekir; Akkiprik, Mustafa; Özer, Ayşe

    2016-06-01

    Breast cancer (BCa) is the most common cancer and the second cause of death among women. Phosphoinositide 3-kinase (PI3K) signaling pathway has a crucial role in the cellular processes such as cell survival, growth, division, and motility. Moreover, oncogenic mutations in the PI3K pathway generally involve the activation phosphatidylinositol-4,5-bisphosphate 3-kinase-catalytic subunit alpha (PIK3CA) mutation which has been identified in numerous BCa subtypes. In this review, correlations between PIK3CA mutations and their clinicopathological parameters on BCa will be described. It is reported that PIK3CA mutations which have been localized mostly on exon 9 and 20 hot spots are detected 25-40 % in BCa. This relatively high frequency can offer an advantage for choosing the best treatment options for BCa. PIK3CA mutations may be used as biomarkers and have been major focus of drug development in cancer with the first clinical trials of PI3K pathway inhibitors currently in progress. Screening of PIK3CA gene mutations might be useful genetic tests for targeted therapeutics or diagnosis. Increasing data about PIK3CA mutations and its clinical correlations with BCa will help to introduce new clinical applications in the near future. PMID:26921096

  18. Correlations of Salivary Biomarkers with Clinical Assessments in Patients with Cystic Fibrosis

    PubMed Central

    Nie, Shuai; Zhang, Huaibin; Mayer, Kathryn M.; Oppenheim, Frank G.; Little, Frédéric F.; Greenberg, Jonathan; Uluer, Ahmet Z.; Walt, David R.

    2015-01-01

    Rationale Monitoring clinical disease status in cystic fibrosis frequently requires invasive collection of clinical samples. Due to its noninvasive collection process and direct anatomic relationship with the lower airway, saliva shows great potential as a biological fluid for cystic fibrosis monitoring. Objectives To measure the levels of multiple protein markers in human saliva supernatants and investigate the possibility of utilizing them to provide a more quantitative measure of disease state for use in research and monitoring of patients with cystic fibrosis clinically. Methods Whole saliva samples were collected and processed from cystic fibrosis patients at two distinct time points (2010 and 2013) and measured by two separate platforms. In this cross sectional study, a convenience sample of 71 participants were recruited with samples measured by multiplexed fluorescence microarray (fiber microarray) and another 117 participant samples were measured by an automated, point-of-care, analyzer (SDReader) using a microsphere-based array via fluorescence sandwich immunoassay. For comparison, saliva from 56 and 50 healthy subjects were collected, respectively. The levels of six target proteins were quantified. Various demographic and clinical data, including spirometry, medical history, and clinicians’ assessments were also collected from patients with cystic fibrosis on the day of saliva collection. Measurements and Main Results Similar trends were observed with both platforms and compared with healthy subjects, cystic fibrosis patients had significantly elevated levels of VEGF, IP-10, IL-8, and EGF as well as lower levels of MMP-9 (P ≤ 0.005) using fiber microarray and significantly elevated levels of IP-10, IL-8 with lower levels of MMP-9 and IL-1β (P ≤ 0.02) using the SDReader. The levels of the six proteins correlated with each other significantly, and in some cases, biomarker levels could be used to differentiate between subgroups of patients with different clinical presentations. For example, IP-10 levels significantly correlated with FEV1 and disease severity (as evaluated by clinicians) with both platforms (P < 0.05). Conclusions Significant variations of the levels of six proteins in saliva supernatants, and the correlations of these levels with clinical assessments, demonstrated the potential of saliva for cystic fibrosis research and monitoring. PMID:26258476

  19. Correlation Between Clinical Findings of Temporomandibular Disorders and MRI Characteristics of Disc Displacement

    PubMed Central

    Kumar, Raman; Pallagatti, Shambulingappa; Sheikh, Soheyl; Mittal, Amit; Gupta, Deepak; Gupta, Sonam

    2015-01-01

    Objectives : Temporomandibular joint (TMJ) dysfunction is a common condition that is best evaluated with magnetic resonance (MR) imaging. The first step in MR imaging of the TMJ is to evaluate the articular disk, or meniscus, in terms of its morphologic features and its location relative to the condyle in both closed- and open-mouth positions. Disk location is of prime importance because the presence of a displaced disk is a critical sign of TMJ dysfunction. However, disk displacement is also frequently seen in asymptomatic volunteers. It is important for the maxillofacial radiologist to detect early MR imaging signs of dysfunction, thereby avoiding the evolution of this condition to its advanced and irreversible phase which is characterized by osteoarthritic changes such as condylar flattening or osteophytes. Further the MR imaging techniques will allow a better understanding of the sources of TMJ pain and of any discrepancy between imaging findings and patient symptoms. Henceforth, the aim of the study was to evaluate whether MRI findings of various degrees of disk displacement could be correlated with the presence or absence of clinical signs and symptoms of temporomandibular disorders in symptomatic and asymptomatic subjects. Materials and Methods : In this clinical study, 44 patients (88 TMJs) were examined clinically and divided into two groups. Group 1 consisted of 22 patients with clinical signs and symptoms of TMDs either unilaterally or bilaterally and considered as study group. Group 2 consisted of 22 patients with no signs and symptoms of TMDs and considered as control group. MRI was done for both the TMJs of each patient. Displacement of the posterior band of articular disc in relation to the condyle was quantified as anterior disc displacement with reduction (ADDR), anterior disc displacement without reduction (ADDWR), posterior disc displacement (PDD). Results : Disk displacement was found in 18 (81.8%) patients of 22 symptomatic subjects in Group 1 on MRI and 4 (18.1%) were diagnosed normal with no disc displacement. In Group 2, 2 (9.1%) of 22 asymptomatic patients were diagnosed with disc displacement while 20 (90.1%) were normal. Sensitivity and Specificity tests were applied in both the groups to correlate clinical findings of TMD and MRI characterstics of disc displacement and results showed Sensitivity of 90% and Specificity of 83.3%. Conclusion : Disk displacement on MRI correlated well with presence or absence of clinical signs and symptoms of temporomandibular disorders with high Sensitivity and Specificity of 90% and 83.3% respectively. PMID:26464595

  20. Curiosity Questions

    ERIC Educational Resources Information Center

    Nelsen, Jane; DeLorenzo, Chip

    2010-01-01

    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…

  1. Essential Questions

    ERIC Educational Resources Information Center

    Wilhelm, Jeffrey D.

    2012-01-01

    The secret to teaching may be as simple as asking students good questions--and then giving them the opportunity to find the answers. The author shares how he uses essential questions that set the class off on an inquiry. Rather than consuming information that he distributes and then repeating it on a test, students carry out their own…

  2. Question Mapping

    ERIC Educational Resources Information Center

    Martin, Josh

    2012-01-01

    After accepting the principal position at Farmersville (TX) Junior High, the author decided to increase instructional rigor through question mapping because of the success he saw using this instructional practice at his prior campus. Teachers are the number one influence on student achievement (Marzano, 2003), so question mapping provides a…

  3. High level of chromosomal aberration in ovarian cancer genome correlates with poor clinical outcome

    PubMed Central

    Cope, Leslie; Wu, Ren-Chin; Shih, Ie-Ming; Wang, Tian-Li

    2015-01-01

    Objectives Structural aberration in chromosomes characterizes almost all human solid cancers and analysis of those alterations may reveal the history of chromosomal instability. However, the clinical significance of massive chromosomal abnormality in ovarian high-grade serous carcinoma (HGSC) remains elusive. In this study, we addressed this issue by analyzing the genomic profiles in 455 ovarian HGSCs available from The Cancer Genome Atlas (TCGA). Methods DNA copy number, mRNA expression, and clinical information were downloaded from the TCGA data portal. A chromosomal disruption index (CDI) was developed to summarize the extent of copy number aberrations across the entire genome. A Cox regression model was applied to identify factors associated with poor prognosis. Genes whose expression was associated with CDI were identified by a 2-stage multivariate linear regression and were used to find enriched pathways by Ingenuity Pathway Analysis. Results Multivariate survival analysis showed that a higher CDI was significantly associated with a worse overall survival in patients. Interestingly, the pattern of DNA copy number alterations across all the chromosomes was similar between tumors with high and low CDI, suggesting they did not arise from different mechanisms. We also observed that expression of several genes was highly correlated with the CDI, even after adjusting for local copy number variation. We found that molecular pathways involving DNA damage response and mitosis were significantly enriched in these CDI-correlated genes. Conclusion Our results provide a new insight into the role of chromosomal rearrangement in the development of HGSC and the promise of applying CDI in risk-stratifying HGSC patients, perhaps for different clinical managements. The genes whose expression is correlated with CDI are worthy of further study to elucidate the mechanism of chromosomal instability in HGSC. PMID:23200914

  4. Prevalence and clinical correlates of deliberate self-harm among a community sample of Italian adolescents.

    PubMed

    Cerutti, R; Manca, M; Presaghi, F; Gratz, Kim L

    2011-04-01

    The aims of this study were to investigate the rates of deliberate self-harm (DSH) behavior among an Italian adolescent sample, as well as to explore its clinical correlates. On a sample of 234 adolescents in Italian secondary schools (Mean age = 16.47; SD = 1.7) were assessed the DSH as well as externalizing symptoms (including both conduct disorder [CD] and oppositional defiant disorder [ODD] symptoms), borderline personality disorder [BPD] symptoms, dissociative symptoms, and the incidence of life-stressors. Consistent with past research on DSH in youth, 42% of the adolescents in this sample engaged in DSH. Results indicate a positive association between DSH and all psychopathological correlates, including BPD, dissociative, and ODD and CD symptoms. Further, findings revealed an association between DSH and specific life-stressors (i.e., psychological and sexual abuse, natural disasters and serious accidents, the loss of someone important, and the witnessing of family violence or a serious accident). PMID:20471075

  5. Proton pump inhibitors for gastroduodenal damage related to nonsteroidal anti-inflammatory drugs or aspirin: twelve important questions for clinical practice.

    PubMed

    Arora, Gaurav; Singh, Gurkirpal; Triadafilopoulos, George

    2009-07-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) and aspirin are among the most commonly used medications worldwide. Their use is associated with significant gastroduodenal adverse effects, including dyspepsia, bleeding, ulcer formation, and perforation. Given their long-term use by millions of patients, there is a substantial impact at the population level of these complications. In this evidence-based review, we have endeavored to answer 12 commonly encountered questions in clinical practice that deal with the following: extent of the problem of NSAID/aspirin-induced gastroduodenal damage and its impact on public health; role of proton pump inhibitors (PPIs) in the primary prevention, healing, and secondary prevention of NSAID/aspirin-induced gastroduodenal ulceration as assessed by using endoscopic end points; role of PPIs in the prevention of adverse clinical outcomes related to NSAID/aspirin use; whether PPIs are effective in NSAID-induced dyspepsia; comparison of PPI co-therapy with selective cyclooxygenase-2 inhibitors for risk reduction of adverse clinical outcomes; role of PPIs in preventing rebleeding from aspirin +/- clopidogrel therapy in high-risk patients; identifying high-risk patients who can benefit from PPI co-therapy; the role of other gastroprotective agents for prevention of NSAID/aspirin-induced gastroduodenal damage; and the cost-effectiveness of and limitations to the use of PPIs for prevention of gastroduodenal damage related to the use of NSAIDs or aspirin. We then summarized our recommendations on the use of PPIs for the clinical management of patients using NSAIDs or aspirin. PMID:19306941

  6. Ocular Surface Epithelial Thickness Evaluation in Dry Eye Patients: Clinical Correlations

    PubMed Central

    Liang, Qingfeng; Liang, Hong; Liu, Hanruo; Pan, Zhiqiang; Baudouin, Christophe; Labbé, Antoine

    2016-01-01

    Purpose. To evaluate the relationship between corneal and conjunctival epithelium thickness and ocular surface clinical tests in dry eye disease (DED) patients. Patients and Methods. Fifty-four patients with DED and 32 control subjects were included. Each patient underwent an ocular surface evaluation using the ocular surface disease index (OSDI), tear film break-up time (TBUT), corneal and conjunctival staining, tear film lipid layer analysis, and Schirmer test. The central corneal (CET), limbal (LET), and bulbar conjunctival epithelium thickness (BET) were acquired using spectral-domain optical coherence tomography (SD-OCT). Results. Compared to control subjects, mean BET was significantly thicker and mean LET was significantly lower in the DED group. There was no significant difference in mean CET between the two groups. The mean LET was correlated with OSDI and TBUT. The inferior LET was correlated with OSDI, Schirmer I test, TBUT, Oxford score, and corneal sensitivity. Mean BET was correlated with OSDI and TBUT, but not with Schirmer I test and Oxford score. Conclusions. In dry eye patients, a thinner limbal epithelium and a thicker bulbar conjunctival epithelium were observed. These changes were correlated to the severity of dry eye symptoms and tear film alterations. PMID:26925258

  7. Correlation of clinical, cytological and histological findings in oral squamous cell carcinomas

    PubMed Central

    SOUSA, MICHELE CARDOSO; ALVES, MONICA GHISLAINE OLIVEIRA; SOUZA, LUCIANO ALBINO; BRANDÃO, ADRIANA AIGOTTI HABERBECK; ALMEIDA, JANETE DIAS; CABRAL, LUIZ ANTONIO GUIMARÃES

    2014-01-01

    The present study aimed to investigate the efficiency of exfoliative cytology by correlating the clinical lesions of oral squamous cell carcinoma (OSCC) with exfoliative cytology and histopathological findings. Cases of OSCC diagnosed between 1984 and 2010 were analyzed. The inclusion criteria for the present study were the availability of detailed clinical findings and a diagnosis of the disease through exfoliative cytology and histopathology. The cases were assessed and assigned scores, which were then submitted to modal expression analysis, which considers the higher frequency scores, thus relating the variables. The cytological findings demonstrated that the majority of the cases had malignant potential. Exfoliative cytology should be used as a supplementary tool for the diagnosis of OSCC, as it enables the early detection of these lesions. However, cytology should not be used as a substitute for histopathological examination. PMID:25013502

  8. HUMAN GIARDIASIS IN MALAYSIA: CORRELATION BETWEEN THE PRESENCE OF CLINICAL MANIFESTATION AND GIARDIA INTESTINALIS ASSEMBLAGE.

    PubMed

    Anuar, Tengku Shahrul; Moktar, Norhayati; Salleh, Fatmah Md; Al-Mekhlafi, Hesham M

    2015-09-01

    Clinical manifestations of giardiasis vary from asymptomatic infection to chronic diarrhea. A total of 611 stool samples from Aboriginal participants residing in Jelebu, Gerik and Temerloh States, Malaysia, ages 2 to 74 years were screened for Giardia intestinalis using microscopic examination and sequence analysis of a fragment of nested-PCR amplified triosephosphate isomerase (tpi) gene. Demographic data was collected through a structured questionnaire. tpi was successfully amplified from 98/110 samples microscopically positive for G. intestinalis, with 62 and 36 belonging to assemblage A and B, respectively. There is a significant correlation between assemblage A and symptomatic infection only in participants of < 15 years of age. In the other age group, host factors may have more effects on the presence of clinical signs and symptoms than G. intestinalis assemblage types. PMID:26863854

  9. Clinical correlates of decreased anteroposterior metabolic gradients in positron emission tomography (PET) of schizophrenic patients

    SciTech Connect

    DeLisi, L.E.; Buchsbaum, M.S.; Holcomb, H.H.; Dowling-Zimmerman, S.; Pickar, D.; Boronow, J.; Morihisa, J.M.; van Kammen, D.P.; Carpenter, W.; Kessler, R.

    1985-01-01

    The finding in schizophrenic patients of a reversal of the normal frontal to posterior pattern of brain metabolic activity with positron emission tomography (PET) is of interest, but its relevance to psychopathology is unknown. Using PET, the authors studied 21 patients with chronic schizophrenia and 21 age- and sex-matched control subjects. Although eight of the 21 patients and only one of the control subjects showed a relatively lower anteroposterior metabolic gradient, no clinical correlates of this finding were noted. In addition, cerebral atrophy, as determined by CAT scan, was not associated with this aberrant metabolic pattern.

  10. Power and sample size determination in clinical trials with multiple primary continuous correlated endpoints.

    PubMed

    Lafaye de Micheaux, Pierre; Liquet, Benoit; Marque, Sébastien; Riou, Jérémie

    2014-01-01

    The use of two or more primary correlated endpoints is becoming increasingly common. A mandatory approach when analyzing data from such clinical trials is to control the family-wise error rate (FWER). In this context, we provide formulas for computation of sample size and for data analysis. Two approaches are discussed: an individual method based on a union-intersection procedure and a global procedure, based on a multivariate model that can take into account adjustment variables. These methods are illustrated with simulation studies and applications. An R package known as rPowerSampleSize is also available. PMID:24605975

  11. Correlating Streptococcus mutans with dental caries in young children using a clinically applicable microbiological method.

    PubMed

    Weinberger, S J; Wright, G Z

    1989-01-01

    The present study used a clinically applicable microbiological method to correlate Streptococcus mutans counts and dental caries prevalence in young children. The study population consisted of 37 subjects, between 16 and 60 months of age. Using a sterile tongue depressor, samples of unstimulated saliva were obtained from subjects and inoculated onto elevated agar plates containing a selective medium. Plates were incubated anaerobically at 37 degrees C for 48 h. chi 2 and multiple regression analyses gave highly significant relationships (p less than 0.01) between dental caries prevalence and the number of S. mutans colonies. PMID:2766328

  12. Mitochondrial DNAs decreased and correlated with clinical features in HCV patients from Yunnan, China.

    PubMed

    Zhang, A-Mei; Ma, Ke; Song, Yuzhu; Feng, Yue; Duan, Haiping; Zhao, Ping; Wang, Binghui; Xu, Gang; Li, Zheng; Xia, Xueshan

    2016-07-01

    Hepatitis C was the most popular chronic infectious liver disease worldwide. It was identified that Hepatitis C virus (HCV) infection could lead to mitochondrial dysfunction, though the mechanism was not fully understood. To investigate whether mtDNA copy number could be affected by HCV infection and be associated with clinical features of HCV patients, mtDNA copy numbers were analyzed in 242 patients with HCV infection and 226 matched control samples. The results suggested that mtDNA copy numbers significantly decreased in HCV patients (68.80 ± 3.33) than in control samples (81.54 ± 4.50) (p = 0.022). When males/females were separated from total patients to compare mtDNA copy numbers with gender matched controls, mtDNA copy numbers still significantly decreased in male HCV patients (p = 0.002). Further analysis indicated that level of high-density lipoprotein cholesterol (HDL-C) was negatively correlated with mtDNA copy numbers in total HCV patients (r = -0.128, p = 0.047), and this correlation was more significant in male HCV patients (r = -0.266, p = 0.030). Intriguingly, aspartate amino-transferase (AST) showed positive correlation with mtDNA copy numbers (r = 0.260, p = 0.034) in male HCV patients. Our results indicated that mtDNA copy numbers depleted and correlated with clinical features in male HCV patients. PMID:26099975

  13. Prevalence and correlates of cannabis use in an outpatient VA posttraumatic stress disorder clinic.

    PubMed

    Gentes, Emily L; Schry, Amie R; Hicks, Terrell A; Clancy, Carolina P; Collie, Claire F; Kirby, Angela C; Dennis, Michelle F; Hertzberg, Michael A; Beckham, Jean C; Calhoun, Patrick S

    2016-05-01

    Recent research has documented high rates of comorbidity between cannabis use disorders and posttraumatic stress disorder (PTSD) in veterans. However, despite possible links between PTSD and cannabis use, relatively little is known about cannabis use in veterans who present for PTSD treatment, particularly among samples not diagnosed with a substance use disorder. This study examined the prevalence of cannabis use and the psychological and functional correlates of cannabis use among a large sample of veterans seeking treatment at a Veterans Affairs (VA) PTSD specialty clinic. Male veterans (N = 719) who presented at a VA specialty outpatient PTSD clinic completed measures of demographic variables, combat exposure, alcohol, cannabis and other drug use, and PTSD and depressive symptoms. The associations among demographic, psychological, and functional variables were estimated using logistic regressions. Overall, 14.6% of participants reported using cannabis in the past 6 months. After controlling for age, race, service era, and combat exposure, past 6-month cannabis use was associated with unmarried status, use of tobacco products, other drug use, hazardous alcohol use, PTSD severity, depressive symptom severity, and suicidality. The present findings show that cannabis use is quite prevalent among veterans seeking PTSD specialty treatment and is associated with poorer mental health and use of other substances. It may be possible to identify and treat individuals who use cannabis in specialty clinics (e.g., PTSD clinics) where they are likely to present for treatment of associated mental health issues. (PsycINFO Database Record PMID:27214172

  14. Phenomenology and clinical correlates of family accommodation in pediatric anxiety disorders.

    PubMed

    Storch, Eric A; Salloum, Alison; Johnco, Carly; Dane, Brittney F; Crawford, Erika A; King, Morgan A; McBride, Nicole M; Lewin, Adam B

    2015-10-01

    Despite evidence documenting high prevalence of family accommodation in pediatric obsessive-compulsive disorder, examination in other pediatric anxiety disorders is limited. Preliminary evidence suggests that family accommodation is common amongst children with anxiety disorders; however, the impact on clinical presentation and functional impairment has not been addressed. This study assessed the nature and clinical correlates of family accommodation in pediatric anxiety, as well as validating a mechanistic model. Participants included 112 anxious youth and their parents who were administered a diagnostic clinical interview and measure of anxiety severity, as well as questionnaires assessing internalizing and externalizing symptoms, family accommodation and functional impairment. Some form of accommodation was present in all families. Family accommodation was associated with increased anxiety severity and externalizing behaviors, having a diagnosis of separation anxiety, and increased functional impairment. Family accommodation partially mediated the relationship between anxiety severity and functional impairment, as well as externalizing behaviors and functional impairment. Family accommodation is common in pediatric anxiety disorders, and is associated with more severe clinical presentations and functional impairment. These findings highlight the importance of parental involvement in treatment and the need to specifically target accommodation practices during interventions to mitigate negative outcomes in anxious youth. Further studies utilizing longitudinal data are needed to validate mechanistic models. PMID:26398305

  15. Clinical spectrum of SIX3-associated mutations in holoprosencephaly: correlation between genotype, phenotype and function

    PubMed Central

    Lacbawan, F; Solomon, B D; Roessler, E; El-Jaick, K; Domené, S; Vélez, J I; Zhou, N; Hadley, D; Balog, J Z; Long, R; Fryer, A; Smith, W; Omar, S; McLean, S D; Clarkson, K; Lichty, A; Clegg, N J; Delgado, M R; Levey, E; Stashinko, E; Potocki, L; VanAllen, M I; Clayton-Smith, J; Donnai, D; Bianchi, D W; Juliusson, P B; Njølstad, P R; Brunner, H G; Carey, J C; Hehr, U; Müsebeck, J; Wieacker, P F; Postra, A; Hennekam, R C M; van den Boogaard, M-J H; van Haeringen, A; Paulussen, A; Herbergs, J; Schrander-Stumpel, C T R M; Janecke, A R; Chitayat, D; Hahn, J; McDonald-McGinn, D M; Zackai, E H; Dobyns, W B; Muenke, M

    2012-01-01

    Background Holoprosencephaly (HPE) is the most common structural malformation of the human forebrain. There are several important HPE mutational target genes, including the transcription factor SIX3, which encodes an early regulator of Shh, Wnt, Bmp and Nodal signalling expressed in the developing forebrain and eyes of all vertebrates. Objective To characterise genetic and clinical findings in patients with SIX3 mutations. Methods Patients with HPE and their family members were tested for mutations in HPE-associated genes and the genetic and clinical findings, including those for additional cases found in the literature, were analysed. The results were correlated with a mutation-specific functional assay in zebrafish. Results In a cohort of patients (n = 800) with HPE, SIX3 mutations were found in 4.7% of probands and additional cases were found through testing of relatives. In total, 138 cases of HPE were identified, 59 of whom had not previously been clinically presented. Mutations in SIX3 result in more severe HPE than in other cases of non-chromosomal, non-syndromic HPE. An over-representation of severe HPE was found in patients whose mutations confer greater loss of function, as measured by the functional zebrafish assay. The gender ratio in this combined set of patients was 1.5:1 (F:M) and maternal inheritance was almost twice as common as paternal. About 14% of SIX3 mutations in probands occur de novo. There is a wide intrafamilial clinical range of features and classical penetrance is estimated to be at least 62%. Conclusions Our data suggest that SIX3 mutations result in relatively severe HPE and that there is a genotype–phenotype correlation, as shown by functional studies using animal models. PMID:19346217

  16. Oxidative Stress Correlates with Headache Symptoms in Fibromyalgia: Coenzyme Q10 Effect on Clinical Improvement

    PubMed Central

    Cordero, Mario D.; Cano-García, Francisco Javier; Alcocer-Gómez, Elísabet; De Miguel, Manuel; Sánchez-Alcázar, José Antonio

    2012-01-01

    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. PMID:22532869

  17. Increased cerebrospinal fluid concentrations of asymmetric dimethylarginine correlate with adverse clinical outcome in subarachnoid hemorrhage patients.

    PubMed

    Li, Hua; Wu, Wei; Liu, Ming; Zhang, Xin; Zhang, Qing-Rong; Ni, Li; Hang, Chun-Hua

    2014-08-01

    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

  18. Diffuse lung uptake (DLU) on Ga-67 scintigraph: Clinical, radiologic and pathologic correlation

    SciTech Connect

    Sy, W.M.; Seo, I.S.; Vieira, J.; Zaman, M.

    1985-05-01

    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.

  19. Spinocerebellar Ataxia Type 7: Clinical Course, Phenotype-Genotype Correlations, and Neuropathology

    PubMed Central

    Horton, Laura C.; Frosch, Matthew P.; Vangel, Mark G.; Weigel-DiFranco, Carol; Berson, Eliot L.; Schmahmann, Jeremy D.

    2012-01-01

    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. PMID:22915085

  20. Correlation of the NBME Advanced Clinical Examination in EM and the National EM M4 exams

    PubMed Central

    Hiller, Katherine; Miller, Emily S.; Lawson, Luan; Wald, David; Beeson, Michael; Heitz, Corey; Morrissey, Thomas; House, Joseph; Poznanski, Stacey

    2015-01-01

    Introduction Since 2011 two online, validated exams for fourth-year emergency medicine (EM) students have been available (National EM M4 Exams). In 2013 the National Board of Medical Examiners offered the Advanced Clinical Examination in Emergency Medicine (EM-ACE). All of these exams are now in widespread use; however, there are no data on how they correlate. This study evaluated the correlation between the EM-ACE exam and the National EM M4 Exams. Methods From May 2013 to April 2014 the EM-ACE and one version of the EM M4 exam were administered sequentially to fourth-year EM students at five U.S. medical schools. Data collected included institution, gross and scaled scores and version of the EM M4 exam. We performed Pearson’s correlation and random effects linear regression. Results 303 students took the EM-ACE and versions 1 (V1) or 2 (V2) of the EM M4 exams (279 and 24, respectively). The mean percent correct for the exams were as follows: EM-ACE 74.8 (SD-8.83), V1 83.0 (SD-6.41), V2 78.5 (SD-7.70). Pearson’s correlation coefficient for the V1/EM-ACE was 0.51 (0.42 scaled) and for the V2/EM-ACE was 0.59 (0.41 scaled). The coefficient of determination for V1/EM-ACE was 0.72 and for V2/EM-ACE = 0.71 (0.86 and 0.49 for scaled scores). The R-squared values were 0.25 and 0.30 (0.18 and 0.13, scaled), respectively. There was significant cluster effect by institution. Conclusion There was moderate positive correlation of student scores on the EM-ACE exam and the National EM M4 Exams. PMID:25671023

  1. 11C-Methionine-PET in Multiple Myeloma: Correlation with Clinical Parameters and Bone Marrow Involvement

    PubMed Central

    Lapa, Constantin; Knop, Stefan; Schreder, Martin; Rudelius, Martina; Knott, Markus; Jörg, Gerhard; Samnick, Samuel; Herrmann, Ken; Buck, Andreas K.; Einsele, Hermann; Lückerath, Katharina

    2016-01-01

    Multiple myeloma (MM) remains an essentially incurable hematologic malignancy originating from clonal plasma cells. This study evaluated the usefulness of the radiotracers 11C-methionine (MET) and 18F-2`-deoxy-2`-fluorodeoxyglucose (FDG) for staging and re-staging in MM. 43 patients with MM underwent both MET- and FDG-PET/CT for staging or re-staging within 3±2 days. Scans were compared on a patient and on a lesion basis. Tracer uptake was correlated with the degree of bone marrow (BM) involvement and standard clinical parameters of disease activity. Additionally, BM samples were stained for L-type amino acid transporter 1 (LAT1) expression in 15 patients. MET-PET detected focal lesions (FL) in 39/43 subjects (90.7%), whereas 10 patients were missed in FDG-PET/CT (detection rate, 33/43; 76.7%; p<0.05). MET depicted more FL in 28/43 patients (65.1%; p<0.001), whereas in the remainder (34.9%, n=15) both tracers yielded comparable results. LAT1 was highly expressed on the cell surface of myeloma cells. Both FDG and MET uptake correlated significantly with biopsy-proven BM involvement (p<0.001), with MET demonstrating a stronger correlation (SUVmean, r=0.9 vs r=0.6; SUVmax, r=0.88 vs r=0.58). Abnormal beta-2-microglobulin and free light chain levels correlated with the presence of focal intramedullary lesions detected in MET- or FDG-PET/CT (MET, p=0.006 and p=0.01, respectively; FDG, p=0.02 and p=0.01). MET appears to be superior to FDG for staging and re-staging of both intra- and extramedullary MM lesions. Tracer uptake correlates with BM involvement, β2m and FLC levels and appears to be a more accurate marker of tumor burden and disease activity. PMID:26877783

  2. Pathological and clinical correlates of FOXP3+ cells in renal allografts during acute rejection.

    PubMed

    Veronese, F; Rotman, S; Smith, R N; Pelle, T D; Farrell, M L; Kawai, T; Benedict Cosimi, A; Colvin, R B

    2007-04-01

    The localization and significance of regulatory T cells (Treg) in allograft rejection is of considerable clinical and immunological interest. We analyzed 80 human renal transplant biopsies (including seven donor biopsies) with a double immunohistochemical marker for the Treg transcription factor FOXP3, combined with a second marker for CD4 or CD8. Quantitative FOXP3 cell counts were performed and analyzed for clinical and pathologic correlates. FOXP3(+) cells were present in the interstitium in acute cellular rejection (ACR) type I and II, at a greater density than in acute humoral rejection or CNI toxicity (p < 0.01). Most FOXP3(+) cells were CD4(+) (96%); a minority expressed CD8. FOXP3(+)CD4(+) cells were concentrated in the tubules (p < 0.001), suggesting a selective attraction or generation at that site. Considering only patients with ACR, a higher density of FOXP3(+) correlated with HLA class II match (p = 0.03), but paradoxically with worse graft survival. We conclude that infiltration of FOXP3(+) cells occurs in ACR to a greater degree than in humoral rejection, however, within the ACR group, no beneficial effect on outcome was evident. Tregs concentrate in tubules, probably contributing to FOXP3 mRNA in urine; the significance and pathogenesis of 'Treg tubulitis' remains to be determined. PMID:17286616

  3. Correlation between Blood Activin Levels and Clinical Parameters of Type 2 Diabetes

    PubMed Central

    Wu, Hui; Wu, Michael; Chen, Yi; Allan, Carolyn A.; Phillips, David J.; Hedger, Mark P.

    2012-01-01

    Aims. Activins A and B, and their binding protein, follistatin, regulate glucose metabolism and inflammation. Consequently, their role in type 2 diabetes (T2D) was examined. Methods. Blood was taken from fasted participants (34 males; 58 females; 5075 years) with diabetes or during an oral glucose tolerance test (OGTT). Clinical parameters were assessed, and blood assayed for activins, follistatin, and C-reactive protein. Results. Serum levels of activin A (93.3 27.0?pg/mL, mean SD), B (81.8 30.8?pg/mL), or follistatin (6.52 3.15?ng/mL) were not different (P > 0.05) between subjects with normal OGTT (n = 39), impaired glucose tolerance and/or fasting glucose (n = 17), or T2D (n = 36). However, activin A and/or activin B were positively correlated with parameters of insulin resistance and T2D, including fasting glucose (P < 0.001), fasting insulin (P = 0.02), glycated hemoglobin (P = 0.003), and homeostasis model assessment of insulin resistance (HOMA-IR; P < 0.001). Follistatin was positively correlated with HOMA-IR alone (P = 0.01). Conclusions. These data indicate that serum measurements of activin A, B, or follistatin cannot discriminate risk for T2D in individual patients, but the activins display a positive relationship with clinical parameters of the disease. PMID:23304117

  4. Fermi questions

    NASA Astrophysics Data System (ADS)

    Bouffard, Karen

    1999-05-01

    This column contains problems and solutions for the general category of questions known as "Fermi" questions. Forcing the students to use their ability to estimate, giving answers in terms of order-of-magnitude, is not only a challenge for a competition, but a teaching strategy to use in the classroom to develop self-confidence and the ability to analyze answers as to whether or not they make sense, as opposed to relying on the "precision" of a calculator value.

  5. Correlation of Serotype-Specific Dengue Virus Infection with Clinical Manifestations

    PubMed Central

    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

    2012-01-01

    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. PMID:22563516

  6. Susceptibility testing of fungi: current status of correlation of in vitro data with clinical outcome.

    PubMed Central

    Ghannoum, M A; Rex, J H; Galgiani, J N

    1996-01-01

    In summary, it is clear that in vitro susceptibility testing can predict outcome in selected clinical situations. The clearest data are from the fluconazole-treated AIDS patients with oropharyngeal candidiasis. In this setting, the homogeneity of the underlying immune defect, combined with the ease of identification and monitoring of the infection, creates a near-perfect test situation. In more complex scenarios, such as the heterogeneous population of patients enrolled in a recent study of candidemia, no such clear-cut correlation was present. The importance of host factors in the correlation of the MIC with outcome cannot be overemphasized. Examples of these parameters include patient status (underlying disease, the presence of intravascular catheters, and CD4+ T-cell number), drug pharmacokinetics (absorption and distribution), patient compliance, and drug-drug interactions. Identification of relevant factors can substantially improve the degree of the MIC-outcome correlation and thus improve the clinical utility of in vitro testing. An important feature in this entire process is the role of standardized susceptibility testing procedures. While not without flaws, the proposed NCCLS reference method has been invaluable in allowing multiple investigators to contribute data that can be used to clarify the correlation between the fluconazole MIC and outcome. While the development of simplified second-generation methods is eagerly anticipated, the role of the reference method as a common touchstone is critical. Only by use of either the reference method itself or methods with a known relationship to the reference method can this broad collaborative process really proceed. Current work is focusing on defining interpretive breakpoints for fluconazole and Candida species, refinement of the in vitro procedures used to measure susceptibility to amphotericin B, ketoconazole, and itraconazole, and the acquisition of a broad base of data on the relationship between the MIC and outcome for these three drugs. Although considerable work remains to be done, the available data suggest that solutions to each of these problems are possible and that routine susceptibility testing of fungi will become meaningful for clinical decision making in the foreseeable future. PMID:8904400

  7. LETM1 overexpression is correlated with the clinical features and survival outcome of breast cancer

    PubMed Central

    Li, Nan; Zheng, Yahui; Xuan, Chouhui; Lin, Zhenhua; Piao, Longzhen; Liu, Shuangping

    2015-01-01

    Background: Leucine zipper/EF hand-containing transmembrane-1 (LETM1) is a mitochondrial inner membrane protein that was first identified in Wolf-Hirschhorn syndrome. However, high-level expression of LETM1 has been correlated with multiple human malignancies, suggesting roles in carcinogenesis and tumor progression. This study is aimed to explore the clinicopathological characteristics and prognostic value of LETM1 overexpression in breast cancer. Methods: Immunohistochemical (IHC) staining, and immunofluorescence (IF) were performed to examine LETM1 expression in breast cancer cell line/tissues compared with adjacent normal tissues. Statistical analysis was applied to evaluate the correlation between LETM1 overexpression and the clinicopathological features of breast cancer. Survival rates were calculated using the Kaplan-Meier method, and the relationship between prognostic factors and patient survival was analyzed using the Cox proportional hazard models. Results: LETM1 protein showed cytoplasmic staining pattern in breast cancer. The strongly positive rate of LETM1 protein was 61.6% (98/159) in breast cancer, which was significantly higher than in DCIS (29.7%, 11/37), hyperplasia (16.7%, 3/18) and adjacent normal breast tissues (15.9%, 7/44). High-level expression of LETM1 protein was correlated with lymph node metastasis, poor differentiation, late clinical stage, disease-free survival (DFS) and overall survival (OS) rates in breast cancer. Moreover, multivariate analysis suggested that LETM1 emerged as a significant independent prognostic factor along with clinical stage of patients with breast cancer. Conclusions: LETM1 plays an important role in the progression of breast cancer. High level expression of LETM1 is an independent poor prognostic factor of breast cancer. PMID:26722481

  8. Molecular analysis of sarcoidosis lymph nodes for microorganisms: a case–control study with clinical correlates

    PubMed Central

    Robinson, Lary A; Smith, Prudence; SenGupta, Dhruba J; Prentice, Jennifer L; Sandin, Ramon L

    2013-01-01

    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. PMID:24366580

  9. Adjusting head circumference for covariates in autism: clinical correlates of a highly heritable continuous trait

    PubMed Central

    Chaste, Pauline; Klei, Lambertus; Sanders, Stephan J.; Murtha, Michael T.; Hus, Vanessa; Lowe, Jennifer K.; Willsey, A. Jeremy; Moreno-De-Luca, Daniel; Yu, Timothy W.; Fombonne, Eric; Geschwind, Daniel; Grice, Dorothy E.; Ledbetter, David H.; Lord, Catherine; Mane, Shrikant M.; Martin, Christa Lese; Martin, Donna M.; Morrow, Eric M.; Walsh, Christopher A.; Sutcliffe, James S.; State, Matthew W.; Devlin, Bernie; Cook, Edwin H.; Kim, Soo-Jeong

    2013-01-01

    BACKGROUND Brain development follows a different trajectory in children with Autism Spectrum Disorders (ASD) than in typically developing children. A proxy for neurodevelopment could be head circumference (HC), but studies assessing HC and its clinical correlates in ASD have been inconsistent. This study investigates HC and clinical correlates in the Simons Simplex Collection cohort. METHODS We used a mixed linear model to estimate effects of covariates and the deviation from the expected HC given parental HC (genetic deviation). After excluding individuals with incomplete data, 7225 individuals in 1891 families remained for analysis. We examined the relationship between HC/genetic deviation of HC and clinical parameters. RESULTS Gender, age, height, weight, genetic ancestry and ASD status were significant predictors of HC (estimate of the ASD effect=0.2cm). HC was approximately normally distributed in probands and unaffected relatives, with only a few outliers. Genetic deviation of HC was also normally distributed, consistent with a random sampling of parental genes. Whereas larger HC than expected was associated with ASD symptom severity and regression, IQ decreased with the absolute value of the genetic deviation of HC. CONCLUSIONS Measured against expected values derived from covariates of ASD subjects, statistical outliers for HC were uncommon. HC is a strongly heritable trait and population norms for HC would be far more accurate if covariates including genetic ancestry, height and age were taken into account. The association of diminishing IQ with absolute deviation from predicted HC values suggests HC could reflect subtle underlying brain development and warrants further investigation. PMID:23746936

  10. Clinical correlates of hwa-byung and a proposal for a new anger disorder.

    PubMed

    Min, Sung Kil

    2008-09-01

    This paper reviewed the studies on hwa-byung (HB), which literally means anger disorder and this is known as the culture-related chronic anger syndrome of Koreans. Based on these studies and a review of the literature on the anger syndromes of other cultures, I have proposed a new anger disorder. The rationale for this proposition is first that the clinical correlates of HB, including the epidemiological data, the etiological factors, the symptoms and the clinical course, are unique and different from those of the depressive disorders, which have been postulated to be similar to HB. Second, the symptoms of HB are characterized by pent-up anger and somatic and behavioral symptoms related to the release and suppression of anger. Third, a group of patients with only HB and who visit psychiatrists for treatment have been identified. Fourth, anger is thought to be the basic target of treatment for HB patients. Last, anger syndromes like HB have been identified, with various names, in other cultures. By reducing the cultural variation of HB and integrating the common clinical correlates of the syndromes related to anger, a new anger disorder for the mood of anger can be conceptualized, like that for other mood disorders for the corresponding pathological moods. The research diagnostic criteria for HB and the new anger disorder are also suggested. I propose that the new anger disorder to be included in the new international classification system as a member of the larger family of mood disorders. International collaborative studies are needed not only to identify such anger disorder in various cultures, but also to explore giving better treatment to these patients based on the bio-psycho-social model of anger disorder. PMID:20046356

  11. Cytomorphologic spectrum of Hashimoto's thyroiditis and its clinical correlation: A retrospective study of 52 patients

    PubMed Central

    Chandanwale, Shirish S.; Gore, Charusheela R.; Bamanikar, Sunita A.; Gupta, Nidhi; Gupta, Kanika

    2014-01-01

    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. PMID:24987440

  12. Paediatric Obsessive-Compulsive Disorder and Depressive Symptoms: Clinical Correlates and CBT Treatment Outcomes.

    PubMed

    Brown, H M; Lester, K J; Jassi, A; Heyman, I; Krebs, G

    2015-07-01

    Depression frequently co-occurs with paediatric obsessive-compulsive disorder (OCD), yet the clinical correlates and impact of depression on CBT outcomes remain unclear. The prevalence and clinical correlates of depression were examined in a paediatric specialist OCD-clinic sample (N = 295; Mean = 15 [7 - 18] years, 42 % female), using both dimensional (Beck Depression Inventory-youth; n = 261) and diagnostic (Development and Wellbeing Assessment; n = 127) measures of depression. The impact of depressive symptoms and suspected disorders on post-treatment OCD severity was examined in a sub-sample who received CBT, with or without SSRI medication (N = 100). Fifty-one per-cent of patients reported moderately or extremely elevated depressive symptoms and 26 % (95 % CI: 18 - 34) met criteria for a suspected depressive disorder. Depressive symptoms and depressive disorders were associated with worse OCD symptom severity and global functioning prior to CBT. Individuals with depression were more likely to be female, have had a psychiatric inpatient admission and less likely to be attending school (ps < 0.01). OCD and depressive symptom severity significantly decreased after CBT. Depressive symptoms and depressive disorders predicted worse post-treatment OCD severity (βs = 0.19 and 0.26, ps < 0.05) but became non-significant when controlling for pre-treatment OCD severity (βs = 0.05 and 0.13, ns). Depression is common in paediatric OCD and is associated with more severe OCD and poorer functioning. However, depression severity decreases over the course of CBT for OCD and is not independently associated with worse outcomes, supporting the recommendation for treatment as usual in the presence of depressive symptoms. PMID:25301176

  13. Clinical Correlates of Hwa-Byung and a Proposal for a New Anger Disorder

    PubMed Central

    2008-01-01

    This paper reviewed the studies on hwa-byung (HB), which literally means anger disorder and this is known as the culture-related chronic anger syndrome of Koreans. Based on these studies and a review of the literature on the anger syndromes of other cultures, I have proposed a new anger disorder. The rationale for this proposition is first that the clinical correlates of HB, including the epidemiological data, the etiological factors, the symptoms and the clinical course, are unique and different from those of the depressive disorders, which have been postulated to be similar to HB. Second, the symptoms of HB are characterized by pent-up anger and somatic and behavioral symptoms related to the release and suppression of anger. Third, a group of patients with only HB and who visit psychiatrists for treatment have been identified. Fourth, anger is thought to be the basic target of treatment for HB patients. Last, anger syndromes like HB have been identified, with various names, in other cultures. By reducing the cultural variation of HB and integrating the common clinical correlates of the syndromes related to anger, a new anger disorder for the mood of anger can be conceptualized, like that for other mood disorders for the corresponding pathological moods. The research diagnostic criteria for HB and the new anger disorder are also suggested. I propose that the new anger disorder to be included in the new international classification system as a member of the larger family of mood disorders. International collaborative studies are needed not only to identify such anger disorder in various cultures, but also to explore giving better treatment to these patients based on the bio-psycho-social model of anger disorder. PMID:20046356

  14. Biochemical characterization of mutant phenylalanine hydroxylase enzymes and correlation with clinical presentation in hyperphenylalaninaemic patients.

    PubMed

    Dobrowolski, S F; Pey, A L; Koch, R; Levy, H; Ellingson, C C; Naylor, E W; Martinez, A

    2009-02-01

    The biochemical properties of mutant phenylalanine hydroxylase (PAH) enzymes and clinical characteristics of hyperphenylalaninaemic patients who bear these mutant enzymes were investigated. Biochemical characterization of mutant PAH enzymes p.D143G, p.R155H, p.L348V, p.R408W and p.P416Q included determination of specific activity, substrate activation, V(max), K(m) for (6R)-L-erythro-5,6,7,8-tetrahydrobiopterin (BH(4)), K (d) for BH(4), and protein stabilization by BH(4). Clinical data from 22 patients either homozygous, functionally hemizygous, or compound heterozygous for the mutant enzymes of interest were correlated with biochemical parameters of the mutant enzymes. The p.L348V and p.P416Q enzymes retain significant catalytic activity yet were observed in classic and moderate PKU patients. Biochemical studies demonstrated that BH(4) rectified the stability defects in p.L348V and p.P416Q; additionally, patients with these variants responded to BH(4) therapy. The p.R155H mutant displayed low PAH activity and decreased apparent affinity for L-Phe yet was observed in mild hyperphenylalaninaemia. The p.R155H mutant does not display kinetic instability, as it is stabilized by BH(4) similarly to wild-type PAH; thus the residual activity is available under physiological conditions. The p.R408W enzyme is dysfunctional in nearly all biochemical parameters, as evidenced by disease severity in homozygous and hemizygous patients. Biochemical assessment of mutant PAH proteins, especially parameters involving interaction with BH(4) that impact protein folding, appear useful in clinical correlation. As additional patients and mutant proteins are assessed, the utility of this approach will become apparent. PMID:18937047

  15. Correlation Between Student Performances on Course Level Integrated Clinical Skills Examinations and Objective Structured Clinical Examinations in a Chiropractic College Program

    PubMed Central

    Russell, Brent S.; Hoiriis, Kathryn T.; Guagliardo, Joseph

    2012-01-01

    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. PMID:23362360

  16. Microglial Activation Correlates with Disease Progression and Upper Motor Neuron Clinical Symptoms in Amyotrophic Lateral Sclerosis

    PubMed Central

    Brettschneider, Johannes; Toledo, Jon B.; Van Deerlin, Vivianna M.; Elman, Lauren; McCluskey, Leo; Lee, Virginia M.-Y.; Trojanowski, John Q.

    2012-01-01

    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. PMID:22720079

  17. Clinical correlations of aggrecan in the resected medial rectus muscle of patients with intermittent exotropia.

    PubMed

    Yamane, Takashi; Matsuo, Toshihiko; Hasebe, Satoshi; Ohtsuki, Hiroshi

    2003-08-01

    The purpose of this study was to elucidate the role of extracellular matrix components such as aggrecan, fibronectin, and laminin in the extraocular muscle of patients with strabismus. Resected tissues of the medial rectus muscle of 47 patients with intermittent exotropia obtained during recession-resection surgery were frozen under liquid nitrogen and pulverized by a Freezer/Mill to solubilize the tissue for enzyme immunoassay. The total amounts of aggrecan, fibronectin, and laminin in the resected tissue were correlated with clinical data of patients such as age, exodeviation, and refractive error. The amount of aggrecan decreased significantly with the advance of age (P < 0.0001, Spearman rank correlation test), while the amount of laminin or fibronectin had no correlation with age. Patients with basic type intermittent exotropia showed larger, although not significantly, amounts of aggrecan than those with convergence insufficiency type (P = 0.0538, Mann-Whitney U-test). The amount of aggrecan may be related to motor aspects of intermittent exotropia. PMID:14627072

  18. Brain structural correlates of schizotypy and psychosis proneness in a non-clinical healthy volunteer sample.

    PubMed

    Nenadic, Igor; Lorenz, Carsten; Langbein, Kerstin; Dietzek, Maren; Smesny, Stefan; Schönfeld, Nils; Fañanás, Lourdes; Sauer, Heinrich; Gaser, Christian

    2015-10-01

    Schizotypal traits are phenotypic risk factors for schizophrenia, associated with biological changes across a putative schizophrenia spectrum. In this study, we tested the hypothesis that brain structural changes in key brain areas relevant to this spectrum (esp. medial and lateral prefrontal cortex) would vary across different degrees of schizotypal trait expression and/or phenotypic markers of psychosis proneness in healthy non-clinical volunteers. We analysed high-resolution 3Tesla magnetic resonance images (MRI) of 59 healthy volunteers using voxel-based morphometry (VBM), correlating grey matter values to the positive and negative symptom factors of the schizotypal personality questionnaire (SPQ, German version) and a measure of psychosis proneness (community assessment of psychic experiences, CAPE). We found positive correlations between positive SPQ dimension and bilateral inferior and right superior frontal cortices, and positive CAPE dimension and left inferior frontal cortex, as well as CAPE negative dimension and right supplementary motor area (SMA) and left inferior parietal cortex. However, only the positive correlation of the right precuneus with negative schizotypy scores was significant after FWE correction for multiple comparisons. Our findings confirm an effect of schizotypal traits and psychosis proneness on brain structure in healthy subjects, providing further support to a biological continuum model. PMID:26164819

  19. Correlation of Clinical Stage and Performance Status With Quality of Life in Patients Seen in a Pancreas Multidisciplinary Clinic

    PubMed Central

    Moningi, Shalini; Walker, Amanda J.; Hsu, Charles C.; Reese, Jennifer Barsky; Wang, Jing-Ya; Fan, Katherine Y.; Rosati, Lauren M.; Laheru, Daniel A.; Weiss, Matthew J.; Wolfgang, Christopher L.; Pawlik, Timothy M.; Herman, Joseph M.

    2016-01-01

    Introduction The objectives of this study were to evaluate quality of life (QoL) in patients presenting to the Johns Hopkins Pancreas Multidisciplinary Clinic (PMDC), and to examine associations between disease status, performance status, and QoL in order to identify patient subgroups that are most at risk for reduced QoL. Patients and Methods Data from 77 patients were evaluated. At initial presentation, disease and performance status were assessed, as well as QoL, which was obtained with the European Organisation for Research and Treatment of Cancer QLQ-PAN26 questionnaire. Statistical analyses examined associations between QoL, disease status, and performance status. Results Digestive symptoms (P < .003) significantly differed by pancreatic disease status (resectable, resected, locally advanced, and metastatic). Patients with a worse performance status, defined as Eastern Cooperative Oncology Group ≥ 1, were more likely to report symptomatic pancreatic pain (P = .001), digestive symptoms (P = .017), cachexia (P = .004), and ascites (P < .001) compared with patients with a performance status of 0. The majority (92%) of patients reported a significant fear of future health problems, regardless of disease status or performance status. Conclusion Although several measures of QoL have been observed in all patients, certain measures appear to correlate specifically with worse disease status. Therefore, routine assessment of QoL is suggested in order to guide treatment decisions. Further investigation on optimizing the use of QoL measures and patient-reported outcomes to better tailor management is warranted. PMID:25563703

  20. Genotypic Diversity of Clinical Actinomyces Species: Phenotype, Source, and Disease Correlation among Genospecies

    PubMed Central

    Clarridge III, Jill E.; Zhang, Qing

    2002-01-01

    We determined the frequency distribution of Actinomyces spp. recovered in a routine clinical laboratory and investigated the clinical significance of accurate identification to the species level. We identified 92 clinical strains of Actinomyces, including 13 strains in the related Arcanobacterium-Actinobaculum taxon, by 16S rRNA gene sequence analysis and recorded their biotypes, sources, and disease associations. The clinical isolates clustered into 21 genogroups. Twelve genogroups (74 strains) correlated with a known species, and nine genogroups (17 strains) did not. The individual species had source and disease correlates. Actinomyces turicensis was the most frequently isolated species and was associated with genitourinary tract specimens, often with other organisms and rarely with inflammatory cells. Actinomyces radingae was most often associated with serious, chronic soft tissue abscesses of the breast, chest, and back. Actinomyces europaeus was associated with skin abscesses of the neck and genital areas. Actinomyces lingnae, Actinomyces gravenitzii, Actinomyces odontolyticus, and Actinomyces meyeri were isolated from respiratory specimens, while A. odontolyticus-like strains were isolated from diverse sources. Several of the species were commonly coisolated with a particular bacterium: Actinomyces israelii was the only Actinomyces spp. coisolated with Actinobacillus (Haemophilus) actinomycetemcomitans; Actinomyces meyeri was coisolated with Peptostreptococcus micros and was the only species other than A. israelii associated with sulfur granules in histological specimens. Most genogroups had consistent biotypes (as determined with the RapID ANA II system); however, strains were misidentified, and many codes were not in the database. One biotype was common to several genogroups, with all of these isolates being identified as A. meyeri. Despite the recent description of new Actinomyces spp., 19% of the isolates recovered in our routine laboratory belonged to novel genospecies. One novel group with three strains, Actinomyces houstonensis sp. nov., was phenotypically similar to A. meyeri and A. turicensis but was genotypically closest to Actinomyces neuii. A. houstonensis sp. nov. was associated with abscesses. Our data documented consistent site and disease associations for 21 genogroups of Actinomyces spp. that provide greater insights into appropriate treatments. However, we also demonstrated a complexity within the Actinomyces genus that compromises the biochemical identification of Actinomyces that can be performed in most clinical laboratories. It is our hope that this large group of well-defined strains will be used to find a simple and accurate biochemical test for differentiation of the species in routine laboratories. PMID:12202591

  1. Vitamin D insufficiency in myeloproliferative neoplasms and myelodysplastic syndromes: clinical correlates and prognostic studies.

    PubMed

    Pardanani, Animesh; Drake, Matthew T; Finke, Christy; Lasho, Terra L; Rozell, Shaina A; Jimma, Thitina; Tefferi, Ayalew

    2011-12-01

    Vitamin D insufficiency is commonly observed in the general population; observational studies have suggested an association with increased risk of cancer development. We examined the clinical and prognostic relevance of low plasma levels of 25-hydroxyvitamin D (25[OH]D) in myeloproliferative neoplasms (MPN) and myelodysplastic syndromes (MDS). A total of 409 patients were studied: 247 (60%) with primary myelofibrosis (PMF), 74 (18%) with de novo MDS, 63 (15%) with polycythemia vera (PV), and 25 (6%) with essential thrombocythemia (ET). Plasma 25(OH)D levels were measured by liquid chromatography-tandem mass spectrometry; a level lower than 25 ng/mL indicated vitamin D insufficiency and a level lower than 10 ng/mL indicated severe deficiency. The proportion of patients with 25(OH)D insufficiency was significantly greater in PMF (48%) and PV (43%) when compared with ET (28%) and MDS (28%) (P = 0.01). Severe 25(OH)D deficiency was significantly more frequent in ET (12%) and PMF (9%), compared with PV (3%) and MDS (1%) (P = 0.05). There were no significant correlations between 25(OH)D insufficiency, or severe deficiency, and a variety of clinical or laboratory variables in PMF, MDS, or PV. Furthermore, Vitamin D insufficiency did not influence either overall or leukemia-free survival in PMF, MDS, or PV (P > 0.05). We conclude that while hypovitaminosis D is relatively common in MPN and MDS, its clinical relevance for prognosis is limited. PMID:22086864

  2. Microbiological Profile of Adenoid Hypertrophy Correlates to Clinical Diagnosis in Children

    PubMed Central

    Szalmás, Anita; Csomor, Péter; Kónya, József; Sziklai, István; Szekanecz, Zoltán; Karosi, Tamás

    2013-01-01

    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. PMID:24175295

  3. Correlation between the severity of critically ill patients and clinical predictors of bronchial aspiration

    PubMed Central

    de Medeiros, Gisele Chagas; Sassi, Fernanda Chiarion; Zambom, Lucas Santos; de Andrade, Claudia Regina Furquim

    2016-01-01

    Objective: To determine whether the severity of non-neurological critically ill patients correlates with clinical predictors of bronchial aspiration. Methods: We evaluated adults undergoing prolonged orotracheal intubation (> 48 h) and bedside swallowing assessment within the first 48 h after extubation. We collected data regarding the risk of bronchial aspiration performed by a speech-language pathologist, whereas data regarding the functional level of swallowing were collected with the American Speech-Language-Hearing Association National Outcome Measurement System (ASHA NOMS) scale and those regarding health status were collected with the Sequential Organ Failure Assessment (SOFA). Results: The study sample comprised 150 patients. For statistical analyses, the patients were grouped by ASHA NOMS score: ASHA1 (levels 1 and 2), ASHA2 (levels 3 to 5); and ASHA3 (levels 6 and 7). In comparison with the other patients, those in the ASHA3 group were significantly younger, remained intubated for fewer days, and less severe overall clinical health status (SOFA score). The clinical predictors of bronchial aspiration that best characterized the groups were abnormal cervical auscultation findings and cough after swallowing. None of the patients in the ASHA 3 group presented with either of those signs. Conclusions: Critically ill patients 55 years of age or older who undergo prolonged orotracheal intubation (≥ 6 days), have a SOFA score ≥ 5, have a Glasgow Coma Scale score ≤ 14, and present with abnormal cervical auscultation findings or cough after swallowing should be prioritized for a full speech pathology assessment. PMID:27167432

  4. Bone mineral density and its correlation with clinical and laboratory factors in chronic peritoneal dialysis patients.

    PubMed

    Ersoy, Fettah Fevzi; Passadakis, Stauros Ploumis; Tam, Paul; Memmos, Evaggelos Dimitros; Katopodis, Pericles Konstantinos; Ozener, Cetin; Akçiçek, Fehmi; Camsari, Taner; Ateş, Kenan; Ataman, Rezzan; Vlachojannis, John George; Dombros, Athanasios Nicholas; Utaş, Cengiz; Akpolat, Tekin; Bozfakioğlu, Semra; Wu, George; Karayaylali, Ibrahim; Arinsoy, Turgay; Stathakis, Panagiotis Charalampos; Yavuz, Mahmut; Tsakiris, John Dimitrios; Dimitriades, Chrysostomos Athanasios; Yilmaz, Mehmet Emin; Gültekin, Meral; Karayalçin, Binnur; Yardimsever, Mehmet; Oreopoulos, Dimitrios George

    2006-01-01

    The aim of this study was to assess the clinical and laboratory correlations of bone mineral density (BMD) measurements among a large population of patients on chronic peritoneal dialysis (PD). This cross-sectional, multicenter study was carried out in 292 PD patients with a mean age of 56 +/- 16 years and mean duration of PD 3.1 +/- 2.1 years. Altogether, 129 female and 163 male patients from 24 centers in Canada, Greece, and Turkey were included in the study. BMD findings, obtained by dual-energy X-ray absorptiometry (DEXA) and some other major clinical and laboratory indices of bone mineral deposition as well as uremic osteodystrophy were investigated. In the 292 patients included in the study, the mean lumbar spine T-score was -1.04 +/- 1.68, the lumbar spine Z-score was -0.31 +/- 1.68, the femoral neck T-score was -1.38 +/- 1.39, and the femoral neck Z score was -0.66 +/- 1.23. According to the WHO criteria based on lumbar spine T-scores, 19.2% of 292 patients were osteoporotic, 36.3% had osteopenia, and 44.4% had lumbar spine T-scores within the normal range. In the femoral neck area, the prevalence of osteoporosis was slightly higher (26%). The prevalence of osteoporosis was 23.3% in female patients and 16.6% in male patients with no statistically significant difference between the sexes. Agreements of lumbar spine and femoral neck T-scores for the diagnosis of osteoporosis were 66.7% and 27.3% and 83.3% for osteopenia and normal BMD values, respectively. Among the clinical and laboratory parameters we investigated in this study, the body mass index (BMI) (P < 0.001), daily urine output, and urea clearance time x dialysis time/volume (Kt/V) (P < 0.05) were statistically significantly positive and Ca x PO(4) had a negative correlation (P < 0.05) with the lumbar spine T scores. Femoral neck T scores were also positively correlated with BMI, daily urine output, and KT/V; and they were negatively correlated with age. Intact parathyroid hormone levels did not correlate with any of the BMD parameters. Femoral neck Z scores were correlated with BMI (P < 0.001), and ionized calcium (P < 0.05) positively and negatively with age, total alkaline phosphatase (P < 0.05), and Ca x P (P < 0.01). The overall prevalence of fractures since the initiation of PD was 10%. Our results indicated that, considering their DEXA-based BMD values, 55% of chronic PD patients have subnormal bone mass-19% within the osteoporotic range and 36% within the osteopenic range. Our findings also indicate that low body weight is the most important risk factor for osteoporosis in chronic PD patients. An insufficient dialysis dose (expressed as KT/V) and older age may also be important risk factors for osteoporosis of PD patients. PMID:16369903

  5. Correlation between fundamental binding forces and clinical prognosis of Staphylococcus aureus infections of medical implants

    SciTech Connect

    Yongsunthon, Ruchirej; Fowler, Vance; Lower, Brian H.; Vellano, Francis P.; Alexander, Emily; Reller, L. Barth; Corey, G. Ralph; Lower, Steven

    2007-02-01

    Implanted medical devices (e.g., prosthetic heart valves, permanent pacemakers) significantly improve the quality of life for many humans. However, a common clinical observation is that such devices become colonized with potentially life-threatening Staphylococcus aureus biofilms, which are difficult to combat with host defenses or antibiotics. This study attempts to draw a correlation between the clinical outcome of patients with implanted cardiac devices and the fundamental binding forces ultimately responsible for the initiation of an S. aureus biofilm in-situ. Atomic force microscopy was used to measure forces between a fibronectin-coated probe (simulating a prosthetic implant) and 15 different strains of S. aureus isolated from either patients with infected cardiac devices (invasive population) or healthy human subjects (control population). The fibronectin-coated probe was repeatedly brought into and out of contact with a bacterium’s surface, “fishing” for a reaction with the cell’s fibronectin-binding proteins. More than 40,000 force profiles were measured on 5-10 different cells for each of the 15 clinical strains. A unique force-signature was observed for a binding event between the fibronectin-coated probe and the bacteria. When grouped by the frequency of this force-signature, there was a strong distinction (p=0.01) between the invasive and control populations of S. aureus. This discovery suggests that biofilm forming bacteria may be classified according to their “force taxonomy”, which could have a positive effect on health care as it bridges the long-standing disconnect between macroscopic, clinical investigations and nanometer-scale forces ultimately responsible for a bond between S. aureus and the surface of a prosthetic device.

  6. Polysomnographic Findings and Clinical Correlates in Huntington Disease: A Cross-Sectional Cohort Study

    PubMed Central

    Piano, Carla; Losurdo, Anna; Della Marca, Giacomo; Solito, Marcella; Calandra-Buonaura, Giovanna; Provini, Federica; Bentivoglio, Anna Rita; Cortelli, Pietro

    2015-01-01

    Study Objectives: To evaluate the sleep pattern and the motor activity during sleep in a cohort of patients affected by Huntington disease (HD). Design: Cross-sectional cohort study. Setting: Sleep laboratory. Patients: Thirty HD patients, 16 women and 14 men (mean age 57.3 ± 12.2 y); 30 matched healthy controls (mean age 56.5 ± 11.8 y). Interventions: Subjective sleep evaluation: Epworth Sleepiness Scale (ESS); Berlin's Questionnaire, interview for restless legs syndrome (RLS), questionnaire for REM sleep behavior disorder (RBD). Clinical evaluation: disease duration, clinical severity (unified Huntington disease motor rating scale [UHDMRS]), genetic tests. Laboratory-based full-night attended video-polysomnography (V-PSG). Measurements and Results: The duration of the disease was 9.4 ± 4.4 y, UHMDRS score was 55.5 ± 23.4, CAG repeats were 44.3 ± 4.1. Body mass index was 21.9 ± 4.0 kg/m2. No patients or caregivers reported poor sleep quality. Two patients reported symptoms of RLS. Eight patients had an ESS score ≥ 9. Eight patients had high risk of obstructive sleep apnea. At the RBD questionnaire, two patients had a pathological score. HD patients, compared to controls, showed shorter sleep, reduced sleep efficiency index, and increased arousals and awakenings. Four patients presented with sleep disordered breathing (SDB). Periodic limb movements (PLMs) during wake and sleep were observed in all patients. No episode of RBD was observed in the V-PSG recordings, and no patients showed rapid eye movement (REM) sleep without atonia. The disease duration correlated with ESS score (P < 0.02). UHMDRS correlated positively with the ESS score (P < 0.005), and negatively with the percentage of REM sleep. Conclusions: Patients with Huntington disease showed a severe sleep disruption and a high prevalence of periodic limb movements, but no evidence of sleep disordered breathing or REM sleep behavior disorder. Citation: Piano C, Losurdo A, Della Marca G, Solito M, Calandra-Buonaura G, Provini F, Bentivoglio AR, Cortelli P. Polysomnographic findings and clinical correlates in Huntington disease: a cross-sectional cohort study. SLEEP 2015;38(9):1489–1495. PMID:25845698

  7. Correlation between Circulating Fungal Biomarkers and Clinical Outcome in Invasive Aspergillosis

    PubMed Central

    Neofytos, Dionysios; Railkar, Radha; Mullane, Kathleen M.; Fredricks, David N.; Granwehr, Bruno; Marr, Kieren A.; Almyroudis, Nikolaos G.; Kontoyiannis, Dimitrios P.; Maertens, Johan; Fox, Rebecca; Douglas, Cameron; Iannone, Robert; Kauh, Eunkyung; Shire, Norah

    2015-01-01

    Objective means are needed to predict and assess clinical response in patients treated for invasive aspergillosis (IA). We examined whether early changes in serum galactomannan (GM) and/or β-D-glucan (BDG) can predict clinical outcomes. Patients with proven or probable IA were prospectively enrolled, and serial GM and BDG levels and GM optical density indices (GMI) were calculated twice weekly for 6 weeks following initiation of standard-of-care antifungal therapy. Changes in these biomarkers during the first 2 and 6 weeks of treatment were analyzed for associations with clinical response and survival at weeks 6 and 12. Among 47 patients with IA, 53.2% (25/47) and 65.9% (27/41) had clinical response by weeks 6 and 12, respectively. Changes in biomarkers during the first 2 weeks were associated with clinical response at 6 weeks (GMI, P = 0.03) and 12 weeks (GM+BDG composite, P = 0.05; GM, P = 0.04; GMI, P = 0.02). Changes in biomarkers during the first 6 weeks were also associated with clinical response at 6 weeks (GM, P = 0.05; GMI, P = 0.03) and 12 weeks (BDG+GM, P = 0.02; GM, P = 0.02; GMI, P = 0.01). Overall survival rates at 6 weeks and 12 weeks were 87.2% (41/47) and 79.1% (34/43), respectively. Decreasing biomarkers in the first 2 weeks were associated with survival at 6 weeks (BDG+GM, P = 0.03; BDG, P = 0.01; GM, P = 0.03) and at 12 weeks (BDG+GM, P = 0.01; BDG, P = 0.03; GM, P = 0.01; GMI, P = 0.007). Similar correlations occurred for biomarkers measured over 6 weeks. Patients with negative baseline GMI and/or persistently negative GMI during the first 2 weeks were more likely to have CR and survival. These results suggest that changes of biomarkers may be informative to predict and/or assess response to therapy and survival in patients treated for IA. PMID:26107507

  8. Correlation between Circulating Fungal Biomarkers and Clinical Outcome in Invasive Aspergillosis.

    PubMed

    Neofytos, Dionysios; Railkar, Radha; Mullane, Kathleen M; Fredricks, David N; Granwehr, Bruno; Marr, Kieren A; Almyroudis, Nikolaos G; Kontoyiannis, Dimitrios P; Maertens, Johan; Fox, Rebecca; Douglas, Cameron; Iannone, Robert; Kauh, Eunkyung; Shire, Norah

    2015-01-01

    Objective means are needed to predict and assess clinical response in patients treated for invasive aspergillosis (IA). We examined whether early changes in serum galactomannan (GM) and/or β-D-glucan (BDG) can predict clinical outcomes. Patients with proven or probable IA were prospectively enrolled, and serial GM and BDG levels and GM optical density indices (GMI) were calculated twice weekly for 6 weeks following initiation of standard-of-care antifungal therapy. Changes in these biomarkers during the first 2 and 6 weeks of treatment were analyzed for associations with clinical response and survival at weeks 6 and 12. Among 47 patients with IA, 53.2% (25/47) and 65.9% (27/41) had clinical response by weeks 6 and 12, respectively. Changes in biomarkers during the first 2 weeks were associated with clinical response at 6 weeks (GMI, P = 0.03) and 12 weeks (GM+BDG composite, P = 0.05; GM, P = 0.04; GMI, P = 0.02). Changes in biomarkers during the first 6 weeks were also associated with clinical response at 6 weeks (GM, P = 0.05; GMI, P = 0.03) and 12 weeks (BDG+GM, P = 0.02; GM, P = 0.02; GMI, P = 0.01). Overall survival rates at 6 weeks and 12 weeks were 87.2% (41/47) and 79.1% (34/43), respectively. Decreasing biomarkers in the first 2 weeks were associated with survival at 6 weeks (BDG+GM, P = 0.03; BDG, P = 0.01; GM, P = 0.03) and at 12 weeks (BDG+GM, P = 0.01; BDG, P = 0.03; GM, P = 0.01; GMI, P = 0.007). Similar correlations occurred for biomarkers measured over 6 weeks. Patients with negative baseline GMI and/or persistently negative GMI during the first 2 weeks were more likely to have CR and survival. These results suggest that changes of biomarkers may be informative to predict and/or assess response to therapy and survival in patients treated for IA. PMID:26107507

  9. Correlation between clinical and histological findings in parathyroid tumors suspicious for carcinoma.

    PubMed

    Chang, Yeon-Jeen; Mittal, Vijay; Remine, Stephen; Manyam, Harish; Sabir, Mubashir; Richardson, Todd; Young, Shun

    2006-05-01

    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

  10. The phenomenology and clinical correlates of suicidal thoughts and behaviors in youth with autism spectrum disorders.

    PubMed

    Storch, Eric A; Sulkowski, Michael L; Nadeau, Josh; Lewin, Adam B; Arnold, Elysse B; Mutch, P Jane; Jones, Anna M; Murphy, Tanya K

    2013-10-01

    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

  11. Cognitive Impairment in Multiple Sclerosis: Clinical Manifestation, Neuroimaging Correlates, and Treatment.

    PubMed

    Pflugshaupt, Tobias; Geisseler, Olivia; Nyffeler, Thomas; Linnebank, Michael

    2016-04-01

    Cognitive impairment is found in up to 70% of patients with multiple sclerosis (MS). Once thought of as a variant of subcortical dementia with a characteristic set of deficits, we now know that MS-related cognitive impairment can have many faces. This conceptual change in neuropsychology is embedded in a paradigm shift in the neuroscientific understanding of MS over the past 25 years: Partly based on modern neuroimaging techniques, the classical view of MS as an inflammatory demyelinating disease affecting the white matter of the central nervous system has been extended. In particular, many studies have shown that the MS pathology also includes neurodegeneration, and that gray matter structures such as the cerebral cortex can also show focal lesions, atrophy, or both. The authors present an updated summary of the clinical manifestation and neuroimaging correlates of cognitive impairment in MS, and discuss the relatively few treatment options available to date. PMID:27116727

  12. Clinical assessment of speech correlates well with lung function during induced bronchoconstriction.

    PubMed

    Tayler, Nicholas; Grainge, Christopher; Gove, Kerry; Howarth, Peter; Holloway, Judith

    2015-01-01

    Clinical assessment of asthma often includes a crude assessment of speech, for example whether the patient can speak in full sentences. To date, this statement, despite appearing in national asthma guidelines, has not been related to lung function testing in asthma exacerbation. Seven asthmatics underwent a bronchial challenge and were then recorded reading a standardised text for 1 min. The recordings were played to 88 healthcare professionals who were asked to estimate FEV1% predicted. Health care professionals' estimations showed moderate correlation to FEV1% predicted (rho=0.61 P<0.01). There were no significant differences between professionals grouped by seniority or speciality. Speech can intuitively be estimated by health care professionals with moderate accuracy. This gives an evidence basis for the assessment in speech in acute asthma and may provide a new avenue for monitoring. PMID:25719976

  13. Four Questions

    ERIC Educational Resources Information Center

    Hark-Weber, Amara G., Ed.

    2013-01-01

    Teaching artists often find themselves working in schools and communities that are new to them, whether these are situations close to home or farther afield. This issue of Four Questions highlights teaching artists who travel extensively as part of their teaching and artistic practices and bring their expertise, energy, and creativity to…

  14. Questionable Exercises.

    ERIC Educational Resources Information Center

    Liemohn, Wendell; Haydu, Traci; Phillips, Dawn

    1999-01-01

    This publication presents general guidelines for exercise prescription that have an anatomical basis but also consider the exerciser's ability to do the exercise correctly. It reviews various common questionable exercises, explaining how some exercises, especially those designed for flexibility and muscle fitness, can cause harm. Safer…

  15. Clinical and Histological Correlation in Post-Burn Hypertrophic Scar for Pain and Itching Sensation

    PubMed Central

    Choi, Young-Hee; Kim, Kwang-Min; Kim, Hye-One; Jang, Young-Chul

    2013-01-01

    Background Hypertrophic scar following a burn is caused by the excessive deposit of collagen resulting in an exaggerated wound healing response. The burn patient complains of pain and itching over the scar, which can give rise to cosmetic and functional problems. Objective The aim of this study was to investigate the clinical and histological correlation of a hypertrophic burn scar for itching and pain sensations. Methods Thirty-eight patients underwent a scar release and skin graft. the modified Vancouver scar scale and the verbal numerical rating scale were recorded. All biopsies were taken from scar tissue (scar) and normal tissue (normal). Histologically, tissues were observed in the epidermis, the monocytes around the vessels, the collagen fiber, elastic fiber, and the mast cells. Results The mean total score of MVSS was 8.4±2.7 (pliability 2.0±0.9; thickness 1.8±0.9; vascularity 2.0± 0.9; and pigmentation 2.1±0.9). Pain and itching were 2.4±2.0 and 2.9±3.0. Epidermis were 7.9±2.8 layers (scar) and 4.0±0.8 layers (normal). The collagen fibers were thin and dense (scar) and thicker and loose (normal). The elastic fibers were thin and nonexistent (scar) and thin and loose (normal). Mast cells were 11.2±5.8/high power field (scar) and 7.4±4.1 (normal). Conclusion As the scar tissue thickens, the itching becomes more severe. The stiffness of the scar with the pain appeared to be associated with the condition of the tissue. The correlation between clinical and histological post-burn hypertrophic scars will help further studies on the scar. This helped with the development of the base material for therapeutic strategies. PMID:24371389

  16. Molecular alterations in clinical stage III cutaneous melanoma: Correlation with clinicopathological features and patient outcome

    PubMed Central

    RUTKOWSKI, PIOTR; GOS, ALEKSANDRA; JURKOWSKA, MONIKA; ŚWITAJ, TOMASZ; DZIEWIRSKI, WIRGINIUSZ; ZDZIENICKI, MARCIN; PTASZYŃSKI, KONRAD; MICHEJ, WANDA; TYSAROWSKI, ANDRZEJ; SIEDLECKI, JANUSZ A.

    2014-01-01

    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. PMID:24959217

  17. Correlates of the timed 25 foot walk in a multiple sclerosis outpatient rehabilitation clinic.

    PubMed

    Bethoux, Francois A; Palfy, Dylan M; Plow, Matthew A

    2016-06-01

    The Timed 25 Foot Walk (T25FW), a test of maximum walking speed on a short distance, is commonly used to monitor ambulation status and to assess treatment outcomes in multiple sclerosis (MS). The main aim of this study was to determine how walking speed on the T25FW correlates with other clinician-reported and patient-reported measures in an outpatient MS rehabilitation clinic. We analyzed cross-sectional data systematically collected during a physiatry evaluation for the management of spasticity and walking limitations. In addition to demographic variables and the Expanded Disability Status Scale (EDSS), measures of body functions [lower extremity manual muscle testing (LE MMT), lower extremity Modified Ashworth Scale, Fatigue Severity Scale, leg pain], and measures of activity and quality of life (reported frequency of falls, Incapacity Status Scale, Rivermead Mobility Index, EQ5D health questionnaire, and Patient Health Questionnaire-9 items) were administered. A multivariate regression analysis was carried out. 199 patients were included in the analysis [age 49.41 (9.89) years, disease duration 15.40 (10.22) years, EDSS score 5.6 (1.2), and T25FW speed 70.93 (44.13) cm/s]. Both EDSS and LE MMT were correlated significantly with T25FW speed (R=0.692, P<0.001). After adjusting for EDSS and LE MMT, lower T25FW speed was associated with higher Incapacity Status Scale scores (R=0.316, P<0.001), lower Rivermead Mobility Index scores (R=0.540, P<0.001), and higher frequency of falls. EQ5D and Patient Health Questionnaire-9 items were not significantly associated with T25FW speed. Our findings support the clinical relevance of the T25FW in the rehabilitation of patients with MS. PMID:26926380

  18. Correlation between radiographic risk for glenoid component loosening and clinical scores in shoulder arthroplasty.

    PubMed

    Merolla, Giovanni; Campi, Fabrizio; Paladini, Paolo; Lollino, Nicola; Fauci, Francesco; Porcellini, Giuseppe

    2009-04-01

    Glenoid component loosening is the weak point in the failure of total shoulder arthroplasty (TSA). In this study we analyse the radiographic risk factors observed on 86 cemented polyethylene glenoid components and their relationship with clinical signs at a mean follow-up of 5.8 years. Clinical assessment included Simple Shoulder Test (SST) and Constant-Murley score. Radiograms were taken to detect periprosthetic radiolucency, tilt, medial displacement and polyethylene thinning. Pearson's correlation coefficient and Spearman's rank correlation coefficient were calculated for statistical analysis. In 61 patients (71%) lucent lines were less than 2 mm wide (grade 2) and in 6 cases (7%) they were >or=2 mm wide (grade 3 and 4). Thinning of the polyethylene was found in 11 cases (13%), glenoid tilt in 6 cases (7%) and medial migration of the component in 5 cases (6%). Complete glenoid prosthetic loosening was found in 3 cases (3.5%) associated with polyethylene wear and glenoid bone loss. The Constant-Murley score associated with radiolucency grade 3 and 4 was less than 45% (38.39 +/- 8.9) (p < 0.05), while a score less than 56% (30.72 +/- 8.7) was found in patients with glenoid tilt and medial migration (p < 0.01). The mean SST score was 4.8 +/- 2.8 in case of glenoid tilt and migration of the component (p < 0.01). Removal of the glenoid component and conversion to hemiarthroplasty or reverse prostheses is suggested in painful glenoid loosening. An exhaustive analysis of radiograms is essential to detect early and late complications or risk factors of glenoid loosening. PMID:19711167

  19. Computed Tomography Appearance of Early Radiation Injury to the Lung: Correlation With Clinical and Dosimetric Factors

    SciTech Connect

    Jenkins, Peter; Welsh, Anne

    2011-09-01

    Purpose: To systematically assess the spectrum of radiologic changes in the lung after radiation therapy for non-small-cell lung cancer. Methods and Materials: We reviewed the cases of 146 patients treated with radical radiotherapy at our institution. All patients had computed tomography (CT) scans performed 3 months after completion of therapy. Radiographic appearances were categorized using a standard grading system. The association of these abnormalities with pretreatment factors and clinical radiation pneumonitis (RP) was investigated. Results: New intrapulmonary abnormalities were seen in 92 patients (63%). These were ground-glass opacity in 16 (11%), patchy consolidation in 19 (13%), and diffuse consolidation in 57 (39%). Twenty-five patients (17%) developed clinical symptoms of RP. Although 80% of the patients with RP had areas of consolidation seen on the posttreatment CT scan, the majority (74%) of patients with such radiographic changes were asymptomatic. For patients with lung infiltrates, the minimum isodose encompassing the volume of radiologic abnormality was usually {>=}27 Gy. Traditional dose-volume metrics, pulmonary function tests, and the coadministration of angiotensin converting enzyme inhibitors (ACE-I) were all strongly correlated with the presence of radiologic injury on univariate analysis (p {<=} 0.002). There was also an inverse correlation between prior smoking history and CT scan changes (p = 0.02). On multivariate analysis, dosimetric parameters and the use of ACE-I retained significance (p = 0.005). Conclusions: Our findings suggest that there is substantial interindividual variation in lung radiosensitivity. ACE-I prevented the radiologic changes seen after high-dose radiation therapy, and their role as radioprotectants warrants further investigation.

  20. TYRP1 mRNA expression in melanoma metastases correlates with clinical outcome

    PubMed Central

    Journe, F; Boufker, H Id; Van Kempen, L; Galibert, M-D; Wiedig, M; Sals, F; Theunis, A; Nonclercq, D; Frau, A; Laurent, G; Awada, A; Ghanem, G

    2011-01-01

    Background: Clinical outcome of patients with high-risk melanoma cannot be reliably predicted on the basis of classical histopathological examination. Our study aimed to determine in melanoma metastases a gene expression profile associated with patient survival, and to identify and validate marker(s) of poor clinical outcome. Methods: Skin and lymph node metastases from melanoma patients (training population) were used to identify candidate prognostic marker(s) based on DNA microarray analysis. Additional skin metastases (validation population) were used to assess the prognostic value of the first ranked gene by real-time PCR. Results: We performed microarray analysis in the training population and generated a list of 278 probe sets associated with a shorter survival. We used the first ranked gene, tyrosinase-related protein 1 (TYRP1), further measured its expression in the validation population by real-time PCR and found it to be significantly correlated with distant metastasis-free survival (DMFS), overall survival (OS) and Breslow thickness. We also found that it was fairly well conserved in the course of the disease regardless of the delay to metastasis occurrence. Finally, although Tyrp1 protein (immunohistochemistry (IHC)) was only detected in about half of the samples, we showed that its expression also correlated with Breslow thickness. Conclusion: Our data indicate that TYRP1 mRNA expression level, at least in skin metastases, is a prognostic marker for melanoma, and is particularly useful when prognostic pathology parameters at the primary lesion are lacking. Its conserved expression further supports its use as a target for therapy. PMID:22045183

  1. Clinical and laboratory correlates of lung disease and cancer in adults with idiopathic hypogammaglobulinaemia.

    PubMed

    Brent, J; Guzman, D; Bangs, C; Grimbacher, B; Fayolle, C; Huissoon, A; Bethune, C; Thomas, M; Patel, S; Jolles, S; Alachkar, H; Kumaratne, D; Baxendale, H; Edgar, J D; Helbert, M; Hambleton, S; Arkwright, P D

    2016-04-01

    Idiopathic hypogammaglobulinaemia, including common variable immune deficiency (CVID), has a heterogeneous clinical phenotype. This study used data from the national UK Primary Immune Deficiency (UKPID) registry to examine factors associated with adverse outcomes, particularly lung damage and malignancy. A total of 801 adults labelled with idiopathic hypogammaglobulinaemia and CVID aged 18-96 years from 10 UK cities were recruited using the UKPID registry database. Clinical and laboratory data (leucocyte numbers and serum immunoglobulin concentrations) were collated and analysed using uni- and multivariate statistics. Low serum immunoglobulin (Ig)G pre-immunoglobulin replacement therapy was the key factor associated with lower respiratory tract infections (LRTI) and history of LRTI was the main factor associated with bronchiectasis. History of overt LRTI was also associated with a significantly shorter delay in diagnosis and commencing immunoglobulin replacement therapy [5 (range 1-13 years) versus 9 (range 2-24) years]. Patients with bronchiectasis started immunoglobulin replacement therapy significantly later than those without this complication [7 (range 2-22) years versus 5 (range 1-13) years]. Patients with a history of LRTI had higher serum IgG concentrations on therapy and were twice as likely to be on prophylactic antibiotics. Ensuring prompt commencement of immunoglobulin therapy in patients with idiopathic hypogammaglobulinaemia is likely to help prevent LRTI and subsequent bronchiectasis. Cancer was the only factor associated with mortality. Overt cancer, both haematological and non-haematological, was associated with significantly lower absolute CD8(+) T cell but not natural killer (NK) cell numbers, raising the question as to what extent immune senescence, particularly of CD8(+) T cells, might contribute to the increased risk of cancers as individuals age. PMID:26646609

  2. Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological Correlates.

    PubMed

    Gerra, Gilberto; Manfredini, Matteo; Somaini, Lorenzo; Maremmani, Icro; Leonardi, Claudio; Donnini, Claudia

    2016-01-01

    A variety of studies evidenced a relationship between drug use disorders and sexual dysfunction. In particular, heroin and opioid agonist medications to treat heroin dependence have been found to be associated with erectile dysfunction and reduced libido. Controversial findings also indicate the possibility of factors other than the pharmacological effects of opioid drugs concurring to sexual dysfunction. With the present study, we investigated the link between sexual dysfunction and long-term exposure to opioid receptor stimulation (heroin dependence, methadone maintenance treatment, methadone dosage), the potentially related hormonal changes reflecting hypothalamus-pituitary-gonadal axis function and prolactin (PRL) pituitary release, the role of adverse childhood experiences in the clinical history and the concomitant symptoms of comorbid mental health disorders in contributing to sexual problems. Forty male patients participating in a long-term methadone treatment program were included in the present study and compared with 40 healthy control subjects who never used drugs nor abused alcohol. All patients and controls were submitted to the Arizona Sexual Experiences Scale (ASEX), Child Experiences of Care and Abuse-Questionnaire (CECA-Q) and the Symptom Check List-90 Scale. A blood sample for testosterone and PRL assays was collected. Methadone dosages were recorded among heroin-dependent patients on maintenance treatment. Methadone patients scored significantly higher than controls on the 5-item rating ASEX scale, on CECA-Q and on Symptoms Check List 90 (SCL 90) scale. Testosterone plasma levels were significantly lower and PRL levels significantly higher in methadone patients with respect to the healthy control group. ASEX scores reflecting sexual dysfunction were directly and significantly correlated with CECA-Q neglect scores and SCL 90 psychiatric symptoms total score. The linear regression model, when applied only to addicted patients, showed that methadone dosages were not significantly correlated with sexual dysfunction scores except for 'erectile dysfunction', for which an inverse association was evidenced. Testosterone values showed a significant inverse correlation with ASEX sexual dysfunction scores, CECA-Q neglect scores and psychiatric symptom at SCL 90 among methadone patients. PRL levels were directly and significantly correlated with sexual dysfunction scores, psychiatric symptoms at SCL 90 and CECA-Q neglect scores. Both testosterone and PRL did not correlate with methadone dosages. The present findings appear to support the view of childhood adversities and comorbid psychiatric symptoms contributing to sexual dysfunction and related hormonal changes among methadone patients, challenging the assumption that attributes sexual problems entirely to the direct pharmacological effects of opioid agonist medications. PMID:26595117

  3. Clinical correlation of calpain-1 and glypican-3 expression with gallbladder carcinoma

    PubMed Central

    LUO, WEIQING; REN, ZHIGANG; GAO, SHENG; JIN, HAILONG; ZHANG, GEER; ZHOU, LIN; ZHENG, SHUSEN

    2016-01-01

    Gallbladder carcinoma (GBC) possesses a poor prognosis, which is primarily attributed to the lack of early and timely surgical intervention. Calpain-1 and glypican-3 have been implicated in the progression of various types of cancer. The present study aimed to detect the expression of calpain-1 and glypican-3 in GBC, and analyzed whether the expression levels of these proteins correlated with any clinicopathological variables. A total of 100 patients with GBC and 30 patients with cholecystitis who accepted surgical treatment were enrolled in the present study. Pathological and clinical data were obtained from all patients. The expression of calpain-1 and glypican-3 was detected in paraffin-embedded tissues by immunohistochemistry. Calpain-1 expression was manually assessed with an immunohistochemical H-score with a slight modification. Glypican-3 expression was assessed as negative and positive. The correlations between protein expression and clinicopathological characteristics, and the associations between the proteins were analyzed. All patients exhibited positive expression of calpain-1. Notably, the high expression rate of calpain-1 was significantly increased in patients with GBC, compared with patients with cholecystitis (32.0 vs. 6.7%; χ2=7.668; P=0.006), suggesting that calpain-1 expression may be associated with progression from cholecystitis to GBC. In addition, the positive rate of glypican-3 expression was 53.0% in patients with GBC and 63.3% in patients with cholecystitis, with no significant difference (χ2=0.997; P=0.318). Furthermore, the expression of calpain-1 and glypican-3 had no significant correlation with gender, age, degree of tumor differentiation and tumor-node-metastasis classification in patients with GBC. Notably, the expression of calpain-1 and glypican-3 displayed a significant positive correlation in patients with GBC (r=0.517; P<0.01), but a significantly negative correlation (r=-0.856; P<0.01) in patients with cholecystitis. In conclusion, calpain-1 expression may be associated with progression from cholecystitis to GBC. Combined detection of calpain-1 and glypican-3 may be beneficial for prognosis assessment of GBC. PMID:26893741

  4. Preschool anxiety disorders: comprehensive assessment of clinical, demographic, temperamental, familial, and life stress correlates.

    PubMed

    Dougherty, Lea R; Tolep, Marissa R; Bufferd, Sara J; Olino, Thomas M; Dyson, Margaret; Traditi, Jennifer; Rose, Suzanne; Carlson, Gabrielle A; Klein, Daniel N

    2013-01-01

    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

  5. Complement Effectors of Inflammation in Cystic Fibrosis Lung Fluid Correlate with Clinical Measures of Disease

    PubMed Central

    Sass, Laura A.; Hair, Pamela S.; Perkins, Amy M.; Shah, Tushar A.; Krishna, Neel K.; Cunnion, Kenji M.

    2015-01-01

    In cystic fibrosis (CF), lung damage is mediated by a cycle of obstruction, infection, and inflammation. Here we explored complement inflammatory effectors in CF lung fluid. In this study soluble fractions (sols) from sputum samples of 15 CF patients were assayed for complement effectors and analyzed with clinical measurements. The pro-inflammatory peptide C5a was increased 4.8-fold (P = 0.04) in CF sols compared with controls. Incubation of CF sols with P. aeruginosa or S. aureus increased C5a concentration 2.3-fold (P = 0.02). A peptide inhibitor of complement C1 (PIC1) completely blocked the increase in C5a concentration from P. aeruginosa in CF sol in vitro (P = 0.001). C5a concentration in CF sol correlated inversely with body mass index (BMI) percentile in children (r = -0.77, P = 0.04). C3a, which has anti-inflammatory effects, correlated positively with FEV1% predicted (rs = 0.63, P = 0.02). These results suggest that complement effectors may significantly impact inflammation in CF lung fluid. PMID:26642048

  6. Complement Effectors of Inflammation in Cystic Fibrosis Lung Fluid Correlate with Clinical Measures of Disease.

    PubMed

    Sass, Laura A; Hair, Pamela S; Perkins, Amy M; Shah, Tushar A; Krishna, Neel K; Cunnion, Kenji M

    2015-01-01

    In cystic fibrosis (CF), lung damage is mediated by a cycle of obstruction, infection, and inflammation. Here we explored complement inflammatory effectors in CF lung fluid. In this study soluble fractions (sols) from sputum samples of 15 CF patients were assayed for complement effectors and analyzed with clinical measurements. The pro-inflammatory peptide C5a was increased 4.8-fold (P = 0.04) in CF sols compared with controls. Incubation of CF sols with P. aeruginosa or S. aureus increased C5a concentration 2.3-fold (P = 0.02). A peptide inhibitor of complement C1 (PIC1) completely blocked the increase in C5a concentration from P. aeruginosa in CF sol in vitro (P = 0.001). C5a concentration in CF sol correlated inversely with body mass index (BMI) percentile in children (r = -0.77, P = 0.04). C3a, which has anti-inflammatory effects, correlated positively with FEV1% predicted (rs = 0.63, P = 0.02). These results suggest that complement effectors may significantly impact inflammation in CF lung fluid. PMID:26642048

  7. Preschool Anxiety Disorders: Comprehensive Assessment of Clinical, Demographic, Temperamental, Familial, and Life Stress Correlates

    PubMed Central

    Dougherty, Lea R.; Tolep, Marissa R.; Bufferd, Sara J.; Olino, Thomas M.; Dyson, Margaret; Traditi, Jennifer; Rose, Suzanne; Carlson, Gabrielle A.; Klein, Daniel N.

    2013-01-01

    This study examined correlates of preschoolers’ anxiety disorders using a comprehensive, multi-method design. Participants included a community sample of 541 three-year-old children, of whom 106 (19.6%) met criteria for at least one 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 six 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

  8. Clinical Correlates and Mediators of Self-Concept in Youth with Chronic Tic Disorders.

    PubMed

    Hanks, Camille E; McGuire, Joseph F; Lewin, Adam B; Storch, Eric A; Murphy, Tanya K

    2016-02-01

    This study investigated the clinical correlates and mediators of self-concept in youth with Chronic Tic Disorders (CTD). Ninety-seven youth aged 6-17 (M = 11.1 ± 2.89; 79.4 % male) with CTD were administered the Yale Global Tic Severity Scale, the Piers-Harris Children's Self-Concept Scale-Second Edition, and self-report and clinician-administered measures assessing behavioral and psychological difficulties and comorbid conditions. Youth with CTD had a slightly below average level of self-concept, with 20 % (n = 19) exhibiting low self-concept. Youth with CTD-only had greater self-concept relative to youth with CTD and obsessive-compulsive disorder (OCD) (p = 0.04) or CTD, OCD, and attention deficit hyperactivity disorder (ADHD) combined (p = 0.009). Medium-to-large-sized associations were observed between youth's self-concept and clinical characteristics (e.g., severity of ADHD, OCD and depressive symptoms). Youth's self-concept partially mediated the relationship between tic severity and depressive symptom severity, and the interaction between tic impairment and youth's reliance on avoidant coping strategies moderated youth's self-concept. Implications, limitations, and recommendations for future interventions are discussed. PMID:25791488

  9. Correlation between Clinical Characteristics and Chest Computed Tomography Findings of Pulmonary Cryptococcosis

    PubMed Central

    Yoshida, Masahiro; Yabe, Masami; Baba, Emiri; Okuda, Keitaro; Fujimoto, Shota; Katagi, Hiroaki; Takagi, Masamichi; Kuwano, Kazuyoshi

    2015-01-01

    Objective. The aim of this study was to review HIV-negative patients with pulmonary cryptococcosis to analyze the correlations between clinical characteristics and chest computed tomography (CT) findings. Methods. We retrospectively analyzed medical records of 16 HIV-negative patients with pulmonary cryptococcosis diagnosed at our institution, and clinical characteristics of the patients with nodules or masses without ground-glass attenuation (GGA)/consolidation type were compared with those of patients with inclusive GGA or consolidation type. Results. Host status was immunocompromised (81.2%) in most of the patients, and 6 (37.5%) were asymptomatic. The most frequent radiologic abnormalities on chest CT scans were one or more nodules (87.5%), GGA (37.5%), and consolidations (18.8%). Most lesions were located in the lower lung. Levels of hemoglobin and platelets were significantly lower in patients with inclusive GGA or consolidation type. Although the differences were not significant, patients with inclusive GGA or consolidation type tended to have a C-reactive protein level of ≥1.0 mg/dL. Conclusion. If a patient with anemia and thrombocytopenia shows GGA or consolidation in the lung, pulmonary cryptococcosis should be given careful consideration. PMID:25767722

  10. Neutrophilic Bronchial Inflammation Correlates with Clinical and Functional Findings in Patients with Noncystic Fibrosis Bronchiectasis

    PubMed Central

    Dente, Federico L.; Bilotta, Marta; Bartoli, Maria Laura; Bacci, Elena; Cianchetti, Silvana; Latorre, Manuela; Malagrinò, Laura; Nieri, Dario; Roggi, Maria Adelaide; Vagaggini, Barbara; Paggiaro, Pierluigi

    2015-01-01

    Background. Neutrophilic bronchial inflammation is a main feature of bronchiectasis, but not much is known about its relationship with other disease features. Aim. To compare airway inflammatory markers with clinical and functional findings in subjects with stable noncystic fibrosis bronchiectasis (NCFB). Methods. 152 NFCB patients (62.6 years; females: 57.2%) underwent clinical and functional cross-sectional evaluation, including microbiologic and inflammatory cell profile in sputum, and exhaled breath condensate malondialdehyde (EBC-MDA). NFCB severity was assessed using BSI and FACED criteria. Results. Sputum neutrophil percentages inversely correlated with FEV1 (P < 0.0001; rho = −0.428), weakly with Leicester Cough Questionnaire score (P = 0.068; rho = −0.58), and directly with duration of the disease (P = 0.004; rho = 0.3) and BSI severity score (P = 0.005; rho = 0.37), but not with FACED. Sputum neutrophilia was higher in colonized subjects, P. aeruginosa colonized subjects showing greater sputum neutrophilia and lower FEV1. Patients with ≥3 exacerbations in the last year showed a significantly greater EBC-MDA than the remaining patients. Conclusions. Sputum neutrophilic inflammation and biomarkers of oxidative stress in EBC can be considered good biomarkers of disease severity in NCFB patients, as confirmed by pulmonary function, disease duration, bacterial colonization, BSI score, and exacerbation rate. PMID:26819500

  11. Correlation between clinical symptoms and peripheral immune response in HAM/TSP.

    PubMed

    da Silva Dias, George Alberto; Sousa, Rita Catarina Medeiros; Gomes, Letícia Figueiredo; Caldas, Cezar Augusto Muniz; Nassiri, Reza; Quaresma, Juarez Antônio Simões; Fuzii, Hellen Thais

    2016-03-01

    HTLV-1 infects principally CD4+ T cells that are the main reservoirs of the virus in vivo, which play an important role in the immunological response. Most of the infected patients are asymptomatic. However, 2-3% of patients will develop HAM/TSP or Adult T lymphoma. HAM/TSP is a chronic inflammatory disease of the central nervous system, which is characterized by unremitting myelopathic symptoms. Studies have shown that cytokines levels alterations (IFN-γ and TNF-α) were associated with tissue injury in HAM/TSP. The aims of this study were to compare the gene expression of IFN-γ, IL-4 and IL-10 of asymptomatic and HAM/TSP HTLV-1 infected patients, and to correlate the gene expression with those of clinical symptoms. 28 subjects were included, 20 asymptomatic HTLV-1 and 8 with HAM/TSP. Spasticity was evaluated using the Modified Ashworth Scale and the degree of walking aid was classified on a progressive scale. The relative gene expression of IFN-γ, IL-4, and IL-10 was measured by Real-Time PCR. Results showed high gene expression of IFN-γ for all patients, but it was higher among HAM/TSP. A significant correlation was observed between IFN-γ gene expression and the degree of walking aid, and IFN-γ gene expression was higher among wheelchair users compared to non-wheelchair users. No association was found with IL-4 and IL-10. These findings indicate that HAM/TSP patients express higher amounts of IFN-γ than asymptomatic patients, and more importantly, the expression of this cytokine was strongly correlated with the need of walking aid. PMID:26626960

  12. Similarities between Brugada syndrome and ischemia-induced ST-segment elevation. Clinical correlation and synergy.

    PubMed

    Chinushi, Masaomi; Furushima, Hiroshi; Tanabe, Yasutaka; Washizuka, Takashi; Aizawaz, Yoshifusa

    2005-10-01

    Vasospastic angina (VSA) and Brugada syndrome (BS) are classified into different categories of cardiac disease, but both can be causes of sudden cardiac death from ventricular fibrillation (VF). The coexistence of VSA and BS in the same patient is possible, and this raises several questions: (1) what is the incidence of the coexistence of BS and VSA in the same patient? (2) is susceptibility to VF enhanced by the coexistence of the 2 diseases? and (3) is there any possibility of Ca-antagonists being used for the treatment of VSA-aggravated BS? In our institution, VSA coexisted in 5 of the 38 patients with BS (13.1%). Anginal episodes were confirmed clinically in 4 of the 5 patients, and syncope attack occurred after the symptom of chest pain in 2 patients. However, VF did not develop during the coronary vasospasm in any of the patients. Treatment with Ca-antagonist was effective for VSA, and neither aggravation of Brugada-type electrocardiographic abnormality nor an increase in the incidence of syncope attack was observed. Although the coexistence of BS and VSA in the same patient is not rare, neither enhanced susceptibility to VF nor the proarrhythmic effect of Ca-antagonist has been confirmed in our experience. However, careful attention is required in such patients because the influence of myocardial ischemia and/or the effect of Ca-antagonist may be different in each patient with BS. PMID:16226069

  13. Domains and correlates of clinical balance impairment associated with Huntington's disease.

    PubMed

    Jacobs, Jesse V; Boyd, James T; Hogarth, Penelope; Horak, Fay B

    2015-03-01

    This study sought to (a) determine the domains of clinical balance impairments associated with Huntington's disease (HD), and (b) evaluate associations between balance test scores and other disease-related impairments. Eighteen subjects with genetically definite HD and 17 age-matched control subjects were evaluated on the Mini-BESTest for their clinical balance impairments as well as the Unified HD Rating Scale (UHDRS) motor and total functional capacity scales, Activity-Specific Balance Confidence (ABC) Scale-short form, Montreal Cognitive Assessment (MoCA), and Symbol Digit Modalities Test (SDMT). Results showed that subjects with HD exhibited significantly lower total Mini-BESTest scores than subjects without HD (mean (95% CI)=76 (64-87)% with HD, 98 (96-99)% without HD; p=0.0011). Mini-BESTest item scores were significantly lower for subjects with HD on one-leg stance, postural responses, standing with eyes closed on foam, and dual-task timed up-and-go. Mini-BESTest scores significantly correlated with UHDRS motor (r(2)=0.68; p=0.00003) and total functional capacity (r(2)=0.75; p=0.000006) scores as well as with scores on the ABC short form (r(2)=0.45; p=0.0024), SDMT (r(2)=0.42; p=0.0036), and MoCA (r(2)=0.23; p=0.046) assessments. This study, therefore, demonstrates that balance impairments associated with HD span domains of anticipatory postural adjustments, postural responses, stance in challenging sensory conditions, and gait. Although preliminary, clinical balance impairment appears to be an efficient proxy evaluation of multiple HD-related factors due to associations with functional capacity, other motor impairments, balance confidence, and cognitive abilities. PMID:25797790

  14. Input functions for 6-[fluorine-18]Fluorodopa quantitation in parkinsonism: Comparative studies and clinical correlations

    SciTech Connect

    Takikawa, S.; Dhawan, V.; Chaly, T.; Robeson, W.; Dahl, R.; Zanzi, I.; Mandel, F.; Spetsieris, P.; Eidelberg, D.

    1994-06-01

    PET has been used to quantify striatal 6-[{sup 18}F]fluro-L-dopa (FDOPA) uptake as a measure of presynaptic dopaminergic function. Striatal FDOPA uptake rate constants (K{sub 1}) can be calculated using dynamic PET imaging with measurements of the plasma FDOPA input function determined either directly or by several estimation procedures. The authors assessed the comparative clinical utility of these methods by calculating the striato-occipital ratio (SOR) and striatal K{sub 1} values in 12 patients with mild to moderate PD and 12 age-matched normal volunteers. The plasma FDOPA time-activity curve (K{sub 1}{sup FD}); the plasma {sup 18}F time-activity curve (K{sub i}{sup P}); the occipital time-activity curve (K{sub i}{sup OCC}); and a simplified population-derived FDOPA input function (K{sub i}{sup EFD}) were used to calculate striatal K{sub i}. Mean values for all striatal K{sub i} estimates and SOR were significantly lower in the PD group. Although all measured parameters discriminated PD patients with normals, K{sub i}{sup FD} and K{sub i}{sup EFD} provided the best between-group separation. K{sub i}{sup FD}, K{sub i}{sup EFD}, and K{sub i}{sup OCC} measures correlated significantly with quantitative disease severity ratings, although K{sub i}{sup FD} predicted quantitative clinical disability most accurately. These results suggest that K{sub i}{sup FD} may be an optimal marker of the parkinsonian disease process. K{sub i}{sup EFD} may be a useful alternative to K{sub i}{sup FD} for most clinical research applications. 40 refs., 4 figs., 7 tabs.

  15. Bronchodilator response in adults with bronchiectasis: correlation with clinical parameters and prognostic implications

    PubMed Central

    Guan, Wei-Jie; Gao, Yong-Hua; Xu, Gang; Li, Hui-Min; Yuan, Jing-Jing; Zheng, Jin-Ping

    2016-01-01

    Background Bronchial dilation testing is an important tool to assess airway reversibility in adults with bronchiectasis. This study aims to investigate the association of bronchodilator response (BDR) and clinical parameters in bronchiectasis, and the utility of BDR to indicate lung function decline and risks of bronchiectasis exacerbations (BEs). Methods We recruited 129 patients with clinically stable bronchiectasis. Baseline measurements included assessment of sputum inflammation and matrix metalloproteinase-8 and -9, sputum bacterial culture, spirometry, bronchial dilation test (for baseline FEV1 less than 80% predicted only) and chest high-resolution computed tomography (HRCT). Bronchiectasis patients were followed-up for 1 year to determine the incidence of BEs and lung function trajectories. Significant BDR was defined as FEV1 improvement from pre-dose value by at least 200 mL and 12%. Clinical trial registry No.: NCT01761214; URL: www.clinicaltrials.gov. Results BDR was negatively correlated with baseline FEV1 percentage predicted, but not blood or sputum eosinophil count. Significant BDR was not associated with greater proportion of never-smokers, poorer past history, greater HRCT scores, poorer diffusing capacity or increased sputum matrix metalloproteinases (all P>0.05). There was a trend towards higher bronchiectasis severity index (BSI) and greater proportion of patients with Pseudomonas aeruginosa isolation or infection. Significant BDR at baseline was linked to poorer spirometry, but not more rapid lung function decline, throughout follow-up. Patients with significant BDR demonstrated non-significantly lower risks of experiencing the first BEs than those without (P=0.09 for log-rank test). Conclusions Significant BDR is associated with poorer lung function compared with non-significant BDR. Whether BDR predicts future risks of BEs needs to be tested in a larger cohort. PMID:26904207

  16. Correlations of Clinical and Laboratory Measures of Balance in Older Men and Women: The MOBILIZE Boston Study

    PubMed Central

    Nguyen, Uyen-Sa D.T.; Kiel, Douglas P.; Li, Wenjun; Galica, Andrew M.; Kang, Hyun Gu; Casey, Virginia A.; Hannan, Marian T.

    2012-01-01

    Objective Impaired balance is associated with falls in older adults. However, there is no accepted gold standard on how balance should be measured. Few studies have examined measures of postural sway and clinical balance concurrently in large samples of community-dwelling older adults. We examined the associations among four types of measures of laboratory- and clinic-based balance in a large population-based cohort of older adults. Methods We evaluated balance measures in the MOBILIZE Boston Study (276 men, 489 women, 6497 years). Measures included: (1) laboratory-based anteroposterior (AP) path length and average sway speed, mediolateral (ML) average sway and root-mean-square, and area of ellipse postural sway; (2) Short Physical Performance Battery (SPPB); (3) Berg Balance Scale; and (4) one-leg stand. Spearman Rank Correlation Coefficients (r) were assessed among the balance measures. Results Area of ellipse sway was highly correlated with the ML sway measures (r >0.9, p < 0.0001), and sway speed was highly correlated with AP sway (r=0.97, p < 0.0001). The Berg Balance Scale was highly correlated with SPPB (r=0.7, p<0.001), and one-leg stand (r=0.8, p<0.001). Correlations between the laboratory- and clinic-based balance measures were low but statistically significant (0.2 < r < 0.3, p<0.0001). Conclusion Clinic-based balance measures, and laboratory-based measures comparing area of ellipse with ML sways or sway speed with AP sway, are highly correlated. Clinic- with laboratory-based measures are less correlated. As both laboratory- and clinic-based measures inform balance in older adults but are not highly correlated with each other, future work should investigate the differences. PMID:22745045

  17. Clinical Evaluation of 168 Korean Patients with Rosacea: The Sun Exposure Correlates with the Erythematotelangiectatic Subtype

    PubMed Central

    Bae, You In; Yun, Sook-Jung; Lee, Jee-Bum; Kim, Seong-Jin; Won, Young Ho

    2009-01-01

    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. PMID:20523797

  18. AB077. Clinical symptoms, molecular genetics, genotype and phenotype correlations of children with congenital hyperinsulinism

    PubMed Central

    Duong, Dang Anh; Dung, Vu Chi; Dat, Nguyen Phu; Ngoc, Can Thi Bich; Thao, Bui Phuong; Khanh, Nguyen Ngoc; Dien, Tran Minh

    2015-01-01

    Background and objective Congenital hyperinsulinism (HI) causes severe hypoglycemia in neonates and infants. Molecular genetic results is very important which help clinicians will have suitable treatment. The study aims to describe clinical symptoms, signs of HI patients and to identify mutations in the ABCC8 and KCNJ11, HNF4A and GLUD genes, genotype and phenotype correlations of children with HI. Methods A prospective study was conducted on 68 cases with congenital HI diagnosed and treated in National Hospital of Pediatric from January 2007 to April 2015. Patients were selected by using inclusion criteria of Hussain K [2008]. During the work-up clinical, biochemal was collected. Genomic DNA was extracted from peripheral leukocytes using standard procedures. Single exon of KCNJ11; 39 exons of ABCC8; were amplified & sequenced. Sequencing reactions were analyzed on an ABI 3730 capillary sequencer & were compared to published sequences using Mutation Surveyor version 3.24. Results Major clinical symptoms, signs of HI patients when hypoglycemia are: lethargy (69.12%), poor feeding (66.2%), cyanosis (57.4%), ear hair (52.9%), seizure (42.6%), grunting (42.7%), apnea (23.5%), hypotonia (27.9%), diaphoresis (19.12%), unconsciousness (11.7%), hypothermia (2.9%). Glucose level on admission 0.99±0.94 mmol/L, insulin level and C-peptid when hypoglycemia are 214.2±190.6 pmol/L and 1.78±1.5 nmol/L. Gene mutations were detected in 64.29% of cases including mutation of genes ABCC8 (88.89%), KCNJ11 (8.33%), HNF4A (2.78%). Mutation of ABCC8 included homozygous mutations (25%), compound heterozygous mutation (31.25%), one dominant mutation from father (40.63%), one dominant mutation from mother (3.13%). All cases with homozygous mutations, 83.3% of cases with compound heterozygous mutation and 83.3% of cases with one dominant mutation of ABCC8 gene from father did not respond to diazoxide treatment and required 95% pancreatectomy. Other cases with non-mutation usual respond to diazoxide. Conclusions Children with congenital HI causes severe hypoglycemia in neonates and infants with clinical symptoms, signs of hypoglycemia are changeful and not specific for mutation or no mutation. So, children with HI should be analyzed for identifying mutations which helps in making diagnosis and suitable treatment decision.

  19. Mucocutaneous Manifestations of HIV and the Correlation with WHO Clinical Staging in a Tertiary Hospital in Nigeria

    PubMed Central

    Oninla, Olumayowa Abimbola

    2014-01-01

    Skin diseases are indicators of HIV/AIDS which correlates with WHO clinical stages. In resource limited environment where CD4 count is not readily available, they can be used in assessing HIV patients. The study aims to determine the mucocutaneous manifestations in HIV positive patients and their correlation with WHO clinical stages. A prospective cross-sectional study of mucocutaneous conditions was done among 215 newly diagnosed HIV patients from June 2008 to May 2012 at adult ART clinic, Wesley Guild Hospital Unit, OAU Teaching Hospitals Complex, Ilesha, Osun State, Nigeria. There were 156 dermatoses with oral/oesophageal/vaginal candidiasis (41.1%), PPE (24.4%), dermatophytic infections (8.9%), and herpes zoster (3.8%) as the most common dermatoses. The proportions of dermatoses were 4.5%, 21.8%, 53.2%, and 20.5% in stages 1–4, respectively. A significant relationship (using Pearson's Chi square with P value <0.05) was obtained between dermatoses and WHO clinical stages. Pearson's correlation coefficient showed a positive correlation between the number of dermatoses and the WHO clinical stages. Dermatoses can therefore serve as diagnostic and prognostic markers in resource limited settings to initiate HAART in clinical stages 3 and 4. PMID:25587439

  20. Lesion analysis for cingulotomy and limbic leucotomy: comparison and correlation with clinical outcomes

    PubMed Central

    Yang, Jimmy C.; Ginat, Daniel T.; Dougherty, Darin D.

    2014-01-01

    Object Cingulotomy and limbic leucotomy are lesioning surgeries with demonstrated benefit for medically intractable psychiatric illnesses. They represent significant refinements of the prefrontal lobotomy used from the 1930s through the 1950s. However, the associations between anatomical characterization of these lesions and outcome data are not well understood. To elucidate these procedures and associations, the authors sought to define and compare the neuroanatomy of cingulotomy and limbic leucotomy and to test a method that uses neuroanatomical data and voxel-based lesion–symptom mapping (VLSM) to reveal potential refinements to modern psychiatric neurosurgical procedures. Methods T1-weighted MR images of patients who had undergone cingulotomy and limbic leucotomy were segmented and registered onto the Montreal Neurological Institute T1-weighted template brain MNI152. Using an atlas-based approach, the authors calculated, by case, the percentage of each anatomical structure affected by the lesion. Because of the infrequency of modern lesion procedures and the requirement for higher-resolution clinical imaging, the sample size was small. The pilot study correlated cingulotomy and limbic leucotomy lesion characteristics with clinical outcomes for patients with obsessive-compulsive disorder. For this study, preoperative and postoperative Yale-Brown Obsessive Compulsive Scale scores for 11 cingulotomy patients and 8 limbic leucotomy patients were obtained, and lesion masks were defined and compared anatomically by using an atlas-based method. Statistically significant voxels were additionally calculated by using VLSM techniques that correlated lesion characteristics with postoperative scores. Results Mean lesion volumes were 13.3 ml for cingulotomy and 11.8 ml for limbic leucotomy. As expected, cingulotomy was isolated to the anterior cingulum. The subcaudate tractotomy portion of limbic leucotomy additionally affected Brodmann area 25, the medial orbitofrontal cortex, and the nucleus accumbens. Initial results indicated that the dorsolateral regions of the cingulotomy lesion and the posteroventral regions of the subcaudate tractotomy lesion were associated with improved postoperative Yale-Brown Obsessive Compulsive Scale scores. Conclusions Cingulotomy and limbic leucotomy are lesioning surgeries that target pathological circuits implicated in psychiatric disease. Lesion analysis and VLSM contextualize outcome data and have the potential to be useful for improving lesioning neurosurgical procedures. PMID:24236652

  1. Correlation of thermal and mechanical effects of the holmium laser for various clinical applications

    NASA Astrophysics Data System (ADS)

    Grimbergen, Matthijs C. M.; Verdaasdonck, Rudolf M.; van Swol, Christiaan F. P.

    1998-05-01

    The Holmium laser has become established in orthopedic surgery and urology due to its unique combination of mechanical and thermal properties induced by explosive vapor bubbles. In a specialized setup, real-time high-speed and thermal images of dynamic vapor bubbles and thermal relaxation at a water tissue interface were obtained simultaneously. The thermal effects in the tissue model were correlated to the characteristics of the bubbles dependent on pulse energy (0.2 - 4 J), pulse repetition frequency (5 - 40 Hz), distance and angle of fiber delivery system (diameter 365 micrometer) to the tissue surface. Up to a fiber-to-tissue distance of 50% of the radius of the bubble, only a superficial tissue layer was heated. During bubble implosion, the tissue surface was attracted to the fiber, ripping of irregularities, and was effectively cooled by turbulence. In case of hard tissues, the bubble detached from the fiber imploding towards the hard surface. At closer distances (less than 50% of bubble radius), the tissue itself was vaporized resulting in mechanical damage and thermal relaxation into the tissue, especially above repetition rates of 5 Hz. There is a strong correlation between the path length of the free beam within the bubble and the degree of mechanical and thermal damage in the tissue directly irradiated by this beam. During clinical applications the surgeon should be aware of the size of the vapor bubble in relation to the distance and angle with the tissue for safe optimal use of the mechanical and thermal properties of the Holmium laser.

  2. Reduced 25-OH vitamin D in patients with autoimmune cytopenias, clinical correlations and literature review.

    PubMed

    Fattizzo, Bruno; Zaninoni, Anna; Giannotta, Juri A; Binda, Francesca; Cortelezzi, Agostino; Barcellini, Wilma

    2016-07-01

    Vitamin D deficiency is widespread in Western Countries and has been found related to autoimmune and hematologic disease incidence and clinical course. We evaluated vitamin D levels, vitamin D receptor (VDR) and T helper (Th)1, Th2 and Th17 immunomodulatory cytokines in patients with immune thrombocytopenic purpura (ITP, N=44), primary autoimmune hemolytic anemia (AIHA, n=35), Evans' syndrome (n=5) and chronic idiopathic neutropenia (CIN, n=19) and also tested vitamin D effect on the in vitro production of anti-erythrocyte autoantibodies. 25-OH-vitamin D levels were significantly lower and vitamin D receptor higher in patients than in controls. Among ITP cases, those with very low vitamin D levels displayed reduced platelet counts, irrespective of the bleeding history. In AIHA patients, LDH values negatively correlated with vitamin D levels in mixed forms, and reticulocyte counts were positively related with vitamin D. Considering treatment, AIHA patients who had been treated with 2 therapy lines or more showed lower mean 25-OH-vitamin D levels than those untreated or treated with one line of therapy only. IL-6, IL-10, IL-17 and IFN-γ levels were higher in patients versus controls, whereas TNF-α was significantly reduced. Finally, vitamin D at concentrations of 10, 20, and 40ng/mL reduced the in vitro production of anti-erythrocyte autoantibodies both in pokeweed-stimulated and unstimulated cultures. In conclusion, vitamin D is reduced in autoimmune cytopenias and correlate with disease severity, supporting its possible protective role against the development of autoimmunity. Literature review showed vitamin D deficiency reports both in onco- and in non onco-hematologic diseases with a relationship with disease severity/activity in myeloid and lymphoid neoplasms, as well as in sickle cell disease. Supplementation has produced weak results in autoimmune and hematologic diseases, and further studies are needed. PMID:26988993

  3. Histopathological correlations of appendectomies: a clinical audit of a single center

    PubMed Central

    2015-01-01

    Background Acute appendicitis is a common presentation in surgical assessment units and appendectomy accounts for a large number of emergency operations in the UK. Histopathological examination of the appendectomy specimens are routinely carried out. The aim of this study is to correlate the histological findings of appendectomy specimens with the clinical diagnosis of acute appendicitis. Methods This is a retrospective analysis of 238 appendectomies carried out in a single UK center between January and December 2013. The Histopathology reports of appendectomy specimens were retrieved. Results A total of 238 appendectomies were performed during the study period. The mean age of the patients was 32 years (range, 7-81 years). Adult patients (>16 years) represented 79.4% of the study population. The female sex accounted for 46.6% of all the patients. Of the 238 resected appendix, 211 (88.7%) had histopathology findings consistent with appendicitis. Approximately 1.7% of the 238 specimens were abnormal pathologies other than inflammation of the appendix. The negative appendectomy (normal appendix on histology) rate was 11.3%. The female sex accounted for 59.1% of the negative appendectomies. Adults (>16 years) represented 77.8% of the negative appendectomies. Conclusions The observed high rates of negative appendectomy in the female sex can be reduced by utilizing combined clinical assessment and diagnostic imaging modalities. The findings of abnormal pathologies on histopathological examination of the appendix which could potentially impact on the management of the patients justify the current practice of routine histopathological examination of resected appendix. PMID:26207247

  4. Health-related quality of life in patients with dual diagnosis: clinical correlates

    PubMed Central

    2012-01-01

    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. PMID:22950596

  5. Clinical Correlates of Mass Effect in Autosomal Dominant Polycystic Kidney Disease

    PubMed Central

    Kim, Hyunsuk; Park, Hayne Cho; Ryu, Hyunjin; Kim, Kiwon; Kim, Hyo Sang; Oh, Kook-Hwan; Yu, Su Jong; Chung, Jin Wook; Cho, Jeong Yeon; Kim, Seung Hyup; Cheong, Hae Il; Lee, Kyubeck; Park, Jong Hoon; Pei, York; Hwang, Young-Hwan; Ahn, Curie

    2015-01-01

    Mass effect from polycystic kidney and liver enlargement can result in significant clinical complications and symptoms in autosomal dominant polycystic kidney disease (ADPKD). In this single-center study, we examined the correlation of height-adjusted total liver volume (htTLV) and total kidney volume (htTKV) by CT imaging with hepatic complications (n = 461) and abdominal symptoms (n = 253) in patients with ADPKD. “Mass-effect” complications were assessed by review of medical records and abdominal symptoms, by a standardized research questionnaire. Overall, 91.8% of patients had 4 or more liver cysts on CT scans. Polycystic liver disease (PLD) was classified as none or mild (htTLV < 1,600 mL/m); moderate (1,600 ≤ htTLV <3,200 mL/m); and severe (htTLV ≥ 3,200 mL/m). The prevalence of moderate and severe PLD in our patient cohort was 11.7% (n = 54/461) and 4.8% (n = 22/461), respectively, with a female predominance in both the moderate (61.1%) and severe (95.5%) PLD groups. Pressure-related complications such as leg edema (20.4%), ascites (16.6%), and hernia (3.6%) were common, and patients with moderate to severe PLD exhibited a 6-fold increased risk (compared to no or mild PLD) for these complications in multivariate analysis. Similarly, abdominal symptoms including back pain (58.8%), flank pain (53.1%), abdominal fullness (46.5%), and dyspnea/chest-discomfort (44.3%) were very common, and patients with moderate to severe PLD exhibited a 5-fold increased risk for these symptoms. Moderate to severe PLD is a common and clinically important problem in ~16% of patients with ADPKD who may benefit from referral to specialized centers for further management. PMID:26641645

  6. Correlation between endogenous polyamines in human cardiac tissues and clinical parameters in patients with heart failure.

    PubMed

    Meana, Clara; Rubín, José Manuel; Bordallo, Carmen; Suárez, Lorena; Bordallo, Javier; Sánchez, Manuel

    2016-02-01

    Polyamines contribute to several physiological and pathological processes, including cardiac hypertrophy in experimental animals. This involves an increase in ornithine decarboxylase (ODC) activity and intracellular polyamines associated with cyclic adenosine monophosphate (cAMP) increases. The aim of the study was to establish the role of these in the human heart in living patients. For this, polyamines (by high performance liquid chromatography) and the activity of ODC and N(1) -acetylpolyamine oxidases (APAO) were determined in the right atrial appendage of 17 patients undergoing extracorporeal circulation to correlate with clinical parameters. There existed enzymatic activity associated with the homeostasis of polyamines. Left atria size was positively associated with ODC (r = 0.661, P = 0.027) and negatively with APAO-N(1) -acetylspermine (r = -0.769, P = 0.026), suggesting that increased levels of polyamines are associated with left atrial hemodynamic overload. Left ventricular ejection fraction (LVEF) and heart rate were positively associated with spermidine (r = 0.690, P = 0.003; r = 0.590, P = 0.021) and negatively with N(1) -acetylspermidine (r = -0.554, P = 0.032; r = -0.644, P = 0.018). LVEF was negatively correlated with cAMP levels (r = -0.835, P = 0.001) and with cAMP/ODC (r = -0.794, P = 0.011), cAMP/spermidine (r = -0.813, P = 0.001) and cAMP/spermine (r = -0.747, P = 0.003) ratios. Abnormal LVEF patients showed decreased ODC activity and spermidine, and increased N(1) -acetylspermidine, and cAMP. Spermine decreased in congestive heart failure patients. The trace amine isoamylamine negatively correlated with septal wall thickness (r = -0.634, P = 0.008) and was increased in cardiac heart failure. The results indicated that modifications in polyamine homeostasis might be associated with cardiac function and remodelling. Increased cAMP might have a deleterious effect on function. Further studies should confirm these findings and the involvement of polyamines in different stages of heart failure. PMID:26578237

  7. Prevalence and Clinical Correlates of a Short Onset REM Period (SOREMP) during Routine PSG

    PubMed Central

    Cairns, Alyssa; Bogan, Richard

    2015-01-01

    Study Objectives: The objectives of this study were to quantify the (1) sensitivity and specificity of nocturnal PSG SOREMP (REM latency ≤ 15 min) for narcolepsy in those being evaluated for hypersomnolence and (2) prevalence and predictors of SOREMP during baseline PSG for patients being evaluated for various sleep disorders. Design: This was a retrospective analysis of a large repository of de-identified PSG and MSLT test results from 2007 to 2013. Setting and Patients: Patient records were retrieved from a repository of studies completed at a variety of sleep laboratories across the USA. Included in the analyses were 79,651 general sleep clinic patients (without an MSLT; 48% male; 72% Caucasian) and an additional 3,059 patients (31.3% male; 72% Caucasian) being evaluated for hypersomnolence (with a consecutive MSLT). Interventions: NA. Measurements and Results: For patients being evaluated for hypersomnolence, the prevalence of PSG SOREMP increased in a dose-response fashion with the number of REM onsets that occurred on a consecutive MSLT (0.5% for no MSLT SOREMPs to > 33.0% for those with 5 MSLT SOREMPs). Overall, having a PSG SOREMP was highly specific (99.5%; 95% CI: 99.1–99.7%) but not sensitive (6.7%; 95% CI: 4.7–9.2%) for narcolepsy. The prevalence of PSG SOREMP for patients in the general sleep clinic sample (i.e., not being evaluated by a consecutive MSLT) was 0.8% and was much higher in those that work night/swing shift. In adjusted models, African American race contributed to the most variance in PSG SOREMP. Conclusions: A short onset rapid eye movement (REM) latency occurs rarely in general sleep clinic samples (< 1.0%), but is highly specific for the diagnosis of narcolepsy. Although rare, the prevalence of the phenomenon is much higher than the estimated prevalence of narcolepsy and may provide a critical opportunity for practitioners to identify narcolepsy in sleep clinic patients. These data also suggest that the utility of polysomnography (PSG) short onset REM peroid (SOREMP) for the diagnosis of narcolepsy may be altered by a history of shift/night work and/ or other factors that may allow for a rebound of REM sleep (e.g., undergoing a positive airway pressure titration), supporting published guidelines that other sleep disorders and insufficient and/or poorly timed sleep should be ruled out and/or adequately controlled for prior to conducting sleep testing. Further research is needed to understand racial differences in PSG SOREMP and narcolepsy. This study was limited in that data on cataplexy (with exception to that in final diagnosis) and habitual sleep duration were not available. Citation: Cairns A, Bogan R. Prevalence and clinical correlates of a short onset REM period (SOREMP) during routine PSG. SLEEP 2015;38(10):1575–1581. PMID:26039966

  8. SUSCEPTIBILITY TEST FOR FUNGI: CLINICAL AND LABORATORIAL CORRELATIONS IN MEDICAL MYCOLOGY

    PubMed Central

    ALASTRUEY-IZQUIERDO, Ana; MELHEM, Marcia S.C.; BONFIETTI, Lucas X.; RODRIGUEZ-TUDELA, Juan L.

    2015-01-01

    SUMMARY During recent decades, antifungal susceptibility testing has become standardized and nowadays has the same role of the antibacterial susceptibility testing in microbiology laboratories. American and European standards have been developed, as well as equivalent commercial systems which are more appropriate for clinical laboratories. The detection of resistant strains by means of these systems has allowed the study and understanding of the molecular basis and the mechanisms of resistance of fungal species to antifungal agents. In addition, many studies on the correlation of in vitro results with the outcome of patients have been performed, reaching the conclusion that infections caused by resistant strains have worse outcome than those caused by susceptible fungal isolates. These studies have allowed the development of interpretative breakpoints for Candida spp. and Aspergillus spp., the most frequent agents of fungal infections in the world. In summary, antifungal susceptibility tests have become essential tools to guide the treatment of fungal diseases, to know the local and global disease epidemiology, and to identify resistance to antifungals. PMID:26465371

  9. A comparison of Aβ amyloid pathology staging systems and correlation with clinical diagnosis

    PubMed Central

    Boluda, Susana; Toledo, Jon B.; Irwin, David J.; Raible, Kevin M.; Byrne, Matt D.; Lee, Edward B.; Lee, Virginia M.-Y.

    2015-01-01

    Current neuropathological Alzheimer's disease (AD) criteria from the National Institute on Aging-Alzheimer's Association (NIA-AA) incorporate two staging systems for Aβ pathology, namely the Thal Aβ phase (TAP) and the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) methods. The goal of this study was to compare and contrast results obtained with these two different staging systems for Aβ pathology since this is critical for future correlations of Aβ amyloid imaging data with Aβ neuropathology data based on immunohistochemical detection of Aβ deposits. A total of 123 cases, divided into 82 training and 41 validation cases, with a diagnosis of either unremarkable adult brain (normal) or AD and CERAD scores ranging from none to frequent were included. There was no clear and consistent relationship between CERAD and the TAP Aβ scores with the exception of scores for the highest plaque burdens (i.e., CERAD C3 and TAP A3) in the cases studied here. However, we developed an algorithm that relates CERAD scores to TAP scores with high agreement (94 % in training and 98 % in the validation set). In addition, TAP scores were a better predictor of dementia (sensitivity of 94 % specifcity 87.7 %) than CERAD scores (sensitivity of 57 % specifcity 100 %). Yet, further research is needed to define strategies to relate CERAD and TAP Aβ plaque scores to compare their utility and for determining the clinical associations of these different amyloid staging systems with aging and AD. PMID:24916271

  10. Hoarding in Youth with Autism Spectrum Disorders and Anxiety: Incidence, Clinical Correlates, and Behavioral Treatment Response.

    PubMed

    Storch, Eric A; Nadeau, Joshua M; Johnco, Carly; Timpano, Kiara; McBride, Nicole; Jane Mutch, P; Lewin, Adam B; Murphy, Tanya K

    2016-05-01

    This study examined the nature and correlates of hoarding among youth with autism spectrum disorders (ASD). Forty children with ASD and a comorbid anxiety disorder were administered a battery of clinician-administered measures assessing presence of psychiatric disorders and anxiety severity. Parents completed questionnaires related to child hoarding behaviors, social responsiveness, internalizing and externalizing behaviors, and functional impairment. We examined the impact of hoarding behaviors on treatment response in a subsample of twenty-six youth who completed a course of personalized cognitive-behavioral therapy targeting anxiety symptoms. Hoarding symptoms were common and occurred in a clinically significant manner in approximately 25 % of cases. Overall hoarding severity was associated with increased internalizing and anxiety/depressive symptoms, externalizing behavior, and attention problems. Discarding items was associated with internalizing and anxious/depressive symptoms, but acquisition was not. Hoarding decreased following cognitive-behavioral therapy but did not differ between treatment responders and non-responders. These data are among the first to examine hoarding among youth with ASD; implications of study findings and future directions are highlighted. PMID:26749256

  11. Treatment of leukemia with large doses of methotrexate and folinic acid: clinical-biochemical correlates

    PubMed Central

    Hryniuk, William M.; Bertino, Joseph R.

    1969-01-01

    Patients with acute leukemia were given repeated cycles consisting of infusions of methotrexate followed by “rescue” with folinic acid. Peripheral blood leukemic cells were harvested from patients before cyclical treatment, and the rates of incorporation of thymidine and of deoxyuridine into deoxyribonucleic acid (DNA) were measuared in vitro. There was no relationship between the pretreatment incorporation of either deoxynucleoside into DNA and the clinical response to therapy. Methotrexate suppressed deoxyuridine incorporation into DNA by the leukemic blasts in vitro, but the patients whose cells were most sensitive to this effect did not necessarily go into remission when treated. Leukemic cells were sampled during methotrexate infusions and the deoxynucleoside incorporation rates were determined. Thymidine incorporation into DNA was variably affected. If, by the end of the first infusion, it remained elevated, remission rarely followed, whereas if it was below the pretreatment value, remission was much more likely. In all cases, deoxyuridine incorporation was suppressed during the infusion. The greatest suppression occurred in patients who went on to remission, but the suppression did not correlate with that expected from pretreatment in vitro tests unless due weight was given to the concomitant effects of the methotrexate therapy on thymidine incorporation. Leukemic blasts surviving successive cycles of therapy became progressively more resistant to the suppressing effects of methotrexate in vitro. This resistance became especially marked in the blasts of patients who did not go into remission. During methotrexate infusions, inhibition of leukemic cell dihydrofolate reductase activity was greatest in blasts of patients whose disease subsequently remitted. PMID:5259150

  12. Molecular-clinical correlations in males with an expanded FMR1 mutation

    SciTech Connect

    Merenstein, S.A.; Sobesky, W.E.; Tran, H.X.

    1996-08-09

    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.

  13. Do clinical features of Lesch-Nyhan disease correlate more closely with hypoxanthine or guanine recycling?

    PubMed

    Schretlen, David J; Callon, Wynne; Ward, Rebecca E; Fu, Rong; Ho, Tiffany; Gordon, Barry; Harris, James C; Jinnah, H A

    2016-01-01

    Lesch-Nyhan disease (LND) is a rare, X-linked recessive neurodevelopmental disorder caused by deficiency of hypoxanthine-guanine phosphoribosyltransferase (HGprt), an enzyme in the purine salvage pathway. HGprt has two functions; it recycles hypoxanthine and guanine. Which of these two functions is more relevant for pathogenesis is unclear because some evidence points to hypoxanthine recycling, but other evidence points to guanine recycling. In this study, we selectively assayed hypoxanthine (Hprt) and guanine (Gprt) recycling in skin fibroblasts from 17 persons with LND, 11 with an attenuated variant of the disease (LNV), and 19 age-, sex-, and race-matched healthy controls (HC). Activity levels of both enzymes differed across groups (p < 0.0001), but only Gprt distinguished patients with LND from those with LNV (p < 0.05). Gprt also showed slightly stronger correlations than Hprt with 13 of 14 measures of the clinical phenotype, including the severity of dystonia, cognitive impairment, and behavioral abnormalities. These findings suggest that loss of guanine recycling might be more closely linked to the LND/LNV phenotype than loss of hypoxanthine recycling. PMID:26067813

  14. Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects.

    PubMed

    Cozzani, Emanuele; Drosera, Massimo; Gasparini, Giulia; Parodi, Aurora

    2014-01-01

    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. PMID:24649358

  15. Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects

    PubMed Central

    Cozzani, Emanuele; Drosera, Massimo; Parodi, Aurora

    2014-01-01

    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. PMID:24649358

  16. VNS induced desynchronization in gamma bands correlates with positive clinical outcome in temporal lobe pharmacoresistant epilepsy.

    PubMed

    Fraschini, Matteo; Puligheddu, Monica; Demuru, Matteo; Polizzi, Lorenzo; Maleci, Alberto; Tamburini, Giorgio; Congia, Socrate; Bortolato, Marco; Marrosu, Francesco

    2013-03-01

    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

  17. Molecular detection and quantification of pertussis and correlation with clinical outcomes in children.

    PubMed

    DeVincenzo, J P; Guyton, Cliff; Rea, Harrison; Elmore, Evan; Patel, Shivam; Wynn, Luke; Harrison, Lisa; El Saleeby, Chadi M; Bagga, Bindiya

    2013-05-01

    Pertussis is an under-recognized serious infection. Conventional cultures are insensitive and of limited utility after antibiotic exposure. We corroborated the utility of real-time polymerase chain reaction (PCR) as a diagnostic tool in pertussis and investigated its role as a prognostic tool by evaluating its benefit in the quantification of pertussis bacterial load. All pertussis-positive PCR tests (n = 104) submitted over 5 years were collected for retrospective study. PCR cycle threshold was compared to quantitative culture in 43. Compared to PCR, the sensitivity of culture was 41%. Our PCR assay reliably quantified bacterial load and was quantitatively reproducible. Higher bacterial load correlated with longer duration of hospitalization (P = 0.0003), and multivariate logistic regression models demonstrated this association to be independent. The study confirmed PCR as a superior diagnostic tool in pertussis. PCR quantification of bacterial load at initial diagnosis predicts later clinical disease severity, suggesting a potential benefit of PCR as a prognostic tool in pertussis. PMID:23490009

  18. Trauma experience among homeless female veterans: correlates and impact on housing, clinical, and psychosocial outcomes.

    PubMed

    Tsai, Jack; Rosenheck, Robert A; Decker, Suzanne E; Desai, Rani A; Harpaz-Rotem, Ilan

    2012-12-01

    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 (β = .18, p < .001), trauma from accidents or disasters was associated with poorer physical health (β = -.23, p < .001), and trauma from being robbed was related to greater use of drugs (β = .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

  19. Development of Sunitinib in Hepatocellular Carcinoma: Rationale, Early Clinical Experience, and Correlative Studies

    PubMed Central

    Zhu, Andrew X.; Duda, Dan G.; Sahani, Dushyant V.; Jain, Rakesh K.

    2016-01-01

    The approval of a multitargeted receptor tyrosine kinase inhibitor, sorafenib, with activity against vascular endothelial growth factor receptor-2 and -3, Raf-1 and B-Raf, platelet-derived growth factor receptor-α and -β, and other kinases, has ushered in the era of molecular targeted agents in advanced hepatocellular carcinoma (HCC). Sunitinib malate is an oral, multitargeted inhibitor of vascular endothelial growth factor receptor-1, -2, and -3, platelet-derived growth factor receptor-α and -β, and other kinases implicated in tumor growth, angiogenesis, and metastasis. Sunitinib has been approved in metastatic renal cell carcinoma and gastrointestinal stromal tumor and is undergoing active clinical development in HCC. Early evidence of antitumor activity and a promising safety profile for this agent have emerged from single arm phase II trials in United States, European, and Asian patients with advanced HCC. Correlative studies of imaging and circulating biomarkers have provided insights into the potential mechanism of action of sunitinib. Additional phase II studies using either single agent or in combination with chemotherapeutic agents are ongoing, and a phase III trial comparing sunitinib and sorafenib in advanced HCC is actively accruing patients. Here, we review the current progress and future directions for the development of sunitinib in advanced HCC. PMID:19672141

  20. Intraligamentous ganglion cysts of the anterior cruciate Ligament: MR findings with clinical and arthroscopic correlations

    SciTech Connect

    Do-Dai, D.D.; Youngberg, R.A.; Lanchbury, F.D.; Pitcher, J.D. Jr.; Garver, T.H.

    1996-01-01

    Magnetic resonance findings with clinical and arthroscopic correlation of intraligamentous cysts of the anterior cruciate ligament (ACL) are presented. Three cases of intraligamentous cysts of the ACL were identified out of 681 knee MRI examinations over a 2-year period. Arthroscopy and postoperative MRI were performed in all three patients, each of whom experienced knee pain with extreme flexion and extension. In all three cases the intraligamentous cyst was homogeneously hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging relative to the ACL. Two of the three ACL cysts required a 70{degrees} scope for adequate visualization and establishment of posteromedial and posterolateral portals for arthroscopic treatment. One cyst could not be visualized arthroscopically and probing of the ACL from the anterior portal resulted in drainage of the cyst. No patient had presence of ACL cyst on follow-up MRI or recurrence of symptoms at a mean of 24 months. Intraligamentous cyst of ACL is a rare cause of knee pain. It should be suspected in patients having chronic pain with extremes of motion. Magnetic resonance findings are diagnostic and help to guide arthroscopy. 14 refs., 3 figs.

  1. Mutational patterns in the breast cancer mitochondrial genome, with clinical correlates.

    PubMed

    McMahon, Sarah; LaFramboise, Thomas

    2014-05-01

    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

  2. Mutational patterns in the breast cancer mitochondrial genome, with clinical correlates

    PubMed Central

    LaFramboise, Thomas

    2014-01-01

    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

  3. Baseline OCT Measurements in the Idiopathic Intracranial Hypertension Treatment Trial, Part II: Correlations and Relationship to Clinical Features

    PubMed Central

    2014-01-01

    Purpose. The accepted method to evaluate and monitor papilledema, Frisén grading, uses an ordinal approach based on descriptive features. Part I showed that spectral-domain optical coherence tomography (SD-OCT) in a clinical trial setting provides reliable measurement of the effects of papilledema on the optic nerve head (ONH) and peripapillary retina, particularly if a 3-D segmentation method is used for analysis.1 We evaluated how OCT parameters are interrelated and how they correlate with vision and other clinical features in idiopathic intracranial hypertension (IIH) patients. Methods. A total of 126 subjects in the IIH Treatment Trial (IIHTT) OCT substudy had Cirrus SD-OCT optic disc and macula scans analyzed by using a 3-D segmentation algorithm to derive retinal nerve fiber layer (RNFL) thickness, total retinal thickness (TRT), retinal ganglion cell layer plus inner plexiform layer (GCL+IPL) thickness, and ONH volume. The SD-OCT parameter values were correlated with high- and low-contrast acuity, perimetric mean deviation, Frisén grading, and IIH features. Results. At study entry, the average RNFL thickness, TRT, and ONH volume showed significant strong correlations (r ≥ 0.90) with each other. The same OCT parameters showed a strong (r > 0.76) correlation with Frisén grade and a mild (r > 0.24), but significant, correlation with lumbar puncture opening pressure. For all eyes at baseline, neither visual acuity (high or low contrast) nor mean deviation correlated with any OCT measure of swelling or GCL+IPL thickness. Conclusions. In newly diagnosed IIH, OCT demonstrated alterations of the peripapillary retina and ONH correlate with Frisén grading of papilledema. At presentation, OCT measures of papilledema, in patients with newly diagnosed IIH and mild vision loss, do not correlate with clinical features or visual dysfunction. (ClinicalTrials.gov number, NCT01003639.) PMID:25370513

  4. Cross-sectional correlation of single-item health literacy screening questions with established measures of health literacy in patients with rheumatoid arthritis.

    PubMed

    Quinzanos, Itziar; Hirsh, Joel M; Bright, Christina; Caplan, Liron

    2015-09-01

    Research suggests that health literacy (HL) is associated with rheumatoid arthritis (RA) patients' functional status. Single-item health literacy screening (SILS) questionnaires may establish patients' HL; however, the wording of SILS may be misinterpreted by RA patients as a query regarding physical limitations. Despite this threat to validity, multiple publications have employed the SILSs as a measure of health literacy. We assessed the construct validity of two SILS's versions by correlating scores with standardized HL measures. English-speaking adult RA patients at a hospital serving low-income patients were enrolled in a cross-sectional study. Subjects completed two SILS versions, as well as two longer HL measurement tools [short test of functional health literacy in adults (s-TOFHLA) and the rapid estimate of adult literacy in medicine (REALM)]. Spearman correlation was used to compare these tools. The study enrolled 110 subjects. There was a good correlation between the two SILS versions (r = 0.705). The correlation of SILS2 and REALM or s-TOFHLA was less robust. The distribution of scores within each SILS2 category demonstrated substantial variation. The SILS2 has construct validity in the assessment of HL in patients with RA, though its correlation with traditional methods of assessing HL is weak. PMID:25744280

  5. Correlation of the clinical and physical image quality in chest radiography for average adults with a computed radiography imaging system

    PubMed Central

    Wood, T J; Beavis, A W; Saunderson, J R

    2013-01-01

    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. PMID:23568362

  6. MicroRNA expression patterns in adrenocortical carcinoma variants and clinical pathologic correlations.

    PubMed

    Duregon, Eleonora; Rapa, Ida; Votta, Arianna; Giorcelli, Jessica; Daffara, Fulvia; Terzolo, Massimo; Scagliotti, Giorgio V; Volante, Marco; Papotti, Mauro

    2014-08-01

    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, β-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

  7. [Expression of serum vascular endothelial growth factor correlates with clinical outcome in multiple myeloma].

    PubMed

    Usnarska-Zubkiewicz, Lidia; Mazur, Grzegorz; Wróbel, Tomasz; Poreba, Małgorzata; Kuliczkowski, Kazimierz

    2003-07-01

    A total of 34 multiple myeloma (MM) patients (17 recently diagnosed and 17 in progression of the disease) treated at the Department of Haematology, Blood Neoplasms and Bone Marrow Transplantation Medical University in Wrocław were studied. Among the 19 females and 15 males, aged 31-72 years, there were 17 IgG, 9 IgA and 1 IgM, one with plasma cell leukaemia and 6 with light chain disease. Staging according to Durie and Salmon disclosed: 7--IIA stage, 15--IIIA and 12--IIIB. Blood hyperviscosity symptoms (HS) developed in 9 patients, and precomatic state or coma was observed in four of them. Control group was constituted of 14 healthy subjects--10 women and 4 men aged 32-51 years. Vascular endothelial growth factor (VEGF) serum concentration in MM patients varied from 0 pg/ml to 760 pg/ml, mean 148.75 pg/ml, SD = 204.4 and in controls 0 pg/ml--164 pg/ml, mean 31.5, SD = 23.3; p < 0.05. The mean VEGF level in recently diagnosed patients was higher than in progression of the disease, mean 188.6 pg/ml, SD = 230.6 and mean 110.9 pg/ml, SD = 177.9; respectively, but the difference was not statistically significant. The patients with stage III had significantly (p < 0.05) higher VEGF level than those in stage II (mean 303.1 pg/ml, SD = 302.2 and mean 89.0 pg/ml SD = 121.6) respectively. The group of MM patients with renal failure (creatinine level > 2 mg%) had higher VEGF level than those with normal renal function: mean 199.9 pg/ml, SD = 235, and mean 46.9 SD = 47 respectively, p < 0.01. Elevated VEGF level was also present in comatic and precomatic patients when compared with hyperviscosity patients without these symptoms (p < 0.05). In multiple myeloma patients no correlation was found between the serum VEGF level and percentage of bone marrow plasma cells, serum beta-2-m and monoclonal Ig levels, levels of Hb, albumine and LDH. Median survival time (M-ST) of patients with VEGF higher than 71, 0 pg/ml was 32 months, M-ST of patients with VEGF below 71 pg/ml was 52 months. In summary: serum level of VEGF in advanced state of multiple myeloma was elevated and correlated with clinical state. An elevated serum level of VEGF is associated with a poor prognosis. PMID:14682206

  8. The Polymorphisms in LNK Gene Correlated to the Clinical Type of Myeloproliferative Neoplasms

    PubMed Central

    Hu, Yang; Liu, Qian; Bu, Dingfang; Tan, Mei; Wu, Liusong; Zhu, Ping

    2016-01-01

    Objective LNK is an adapter protein negatively regulating the JAK/STAT cell signaling pathway. In this study, we observed the correlation between variation in LNK gene and the clinical type of myeloproliferative neoplasms (MPN). Methods A total of 285 MPN cases were recruited, including essential thrombocythemia (ET) 154 cases, polycythemia vera (PV) 76 cases, primary myelofibrosis (PMF) 19 cases, and chronic myeloid leukemia (CML) 36 cases. Ninety-three healthy individuals were used as normal controls. V617F mutation in JAK2 was identified by allele-specific PCR method, RT-PCR was used for the detection of BCR/ABL1 fusion gene, and mutations and variations in coding exons and their flanking sequences of LNK gene were examined by PCR-sequencing. Results Missense mutations of A300V, V402M, and R415H in LNK were found in 8 patients including ET (4 cases, all combined with JAK2-V617F mutation), PV (2 cases, one combined with JAK2-V617F mutation), PMF (one case, combined with JAK2-V617F mutation) and CML (one case, combined with BCR/ABL1 fusion gene). The genotype and allele frequencies of the three SNPs (rs3184504, rs111340708 and rs78894077) in LNK were significantly different between MPN patients and controls. For rs3184504 (T/C, in exon2), the T allele (p.262W) and TT genotype were frequently seen in ET, PV and PMF (P<0.01), and C allele (p.262R) and CC genotype were frequently seen in CML (P<0.01). For rs78894077 (T/C, in exon1), the T allele (p.242S) was frequently found in ET (P<0.05). For rs111340708 (TGGGGx5/TGGGGx4, in intron 5), the TGGGG x4 allele was infrequently found in ET, PMF and CML(P<0.01). Conclusion Mutations in LNK could be found in some of MPN patients in the presence or absence of JAK2-V617F mutation. Several polymorphisms in LNK gene may affect the clinical type or the genetic predisposition of MPN. PMID:27111338

  9. Stereomicroscopic study of the human tooth caries: clinical and morphological correlations

    NASA Astrophysics Data System (ADS)

    Oancea, Roxana; Vasile, Liliana; Marchese, Cristian; Sava-Rosianu, Ruxandra

    2012-06-01

    Objectives: Stereomicroscopy allows a three-dimensional study of the images and of laterality at superior quality in comparison with other methods. Those advantages are given by the large examination fields and the wide work distances. The adding of the clinical and morphological data at the results gathered with stereomicroscopy and the stereo micrometry is useful in order to appreciate the deepness and the widening of the carious process, and the necessity to reconsider the therapeutically strategy. Materials and methods: During 2009-2011 the study material was represented by 10 surgically removed impacted third molars, and by 20 premolars extracted for orthodontic purposes, with closed and macroscopically apparently integer surfaces. 13 premolars with different degrees of carious affectation and periodontal lesions, which were surgically extracted without trauma, were also selected. The in situ measurements at the occlusal site were realized through the utilization of a fluorescent laser device - DIAGNOdent. The basic principles in stereomicroscopy stood at the base of the obliquely and circularly coaxial illumination techniques, one with optical alignment adjustment of the optical microscope and mechanical adjustment for the optimal illumination and micrometry. The Olympus Microscope SZ ×7 and an Olympus camera with 2,5 × digital zoom and a 3× optical zoom has been used to study the samples in stereomicroscopy and through polarized light it. Results: The DiagnoDent measured the following data: out of 43 apparently healthy teeth, 18 presented values between 2 and 13 (D1), 13 showed values between 14 and 24 (D2), 12 measured values over 24 (D3). After the histological examination in stereomicroscopy and in the polarized light: 25 teeth were healthy, 10 presented caries extended in dental enamel and 8 presented dentinal caries. Stereomicroscopy has allowed the morphological study, the color absorption, the appreciation of the lesions' deepness and substance loss that is very useful in grading the progression of the carious lesion. Conclusions: The stereomicroscopic study correlated with clinical and morphological data allowed to appreciate the extent of tissue involved in the carious process, but also the understanding of the enamel, dentine and cement matrix demineralization process, in proximity with the morpho-embryological markings of the human tooth structure.

  10. Self-Cannulation for Haemodialysis: Patient Attributes, Clinical Correlates and Self-Cannulation Predilection Models

    PubMed Central

    Jayanti, Anuradha; Foden, Philip; Wearden, Alison; Morris, Julie; Brenchley, Paul; Mitra, Sandip

    2015-01-01

    Background and Objectives With emerging evidence in support of home haemodialysis (HHD), patient factors which determine uptake of the modality need to be better understood. Self-cannulation (SC) is a major step towards enabling self-care ‘in-centre’ and at home and remains the foremost barrier to its uptake. Human factors governing this aspect of HD practice are poorly understood. The aim of this study is to better understand self-cannulation preferences and factors which define them in end stage renal disease (ESRD). Design In this multicentre study, 508 of 535 patients from predialysis (Group A: n = 222), in-centre (Group B: n = 213), and home HD (Group C: n = 100) responded to a questionnaire with 3 self-cannulation questions. Simultaneously, data on clinical, cognitive and psychosocial variables were ascertained. The primary outcome measure was ‘perceived ability to self-cannulate AV access’. Predictive models were developed using logistic regression analysis. Results 36.6% of predialysis patients (A) and 29.1% of the ‘in-centre’ haemodialysis patients (B) felt able to consider SC for HD. Technical-skills related apprehension was highest in Group B (14.4%) patients. Response to routine venepuncture and the types of SC concerns were significant predictors of perceived ability to self-cannulate. There was no significant difference in concern for pain across the groups. In multivariable regression analysis, age, education level, 3MS score, hypoalbuminemia in Groups B & C and additionally, attitude to routine phlebotomy and the nature of specific concern for self-cannulation in Groups A, B and C, are significant predictors of SC preference. The unadjusted c-statistics of models 1 (derived from Group A and validated on A) and 2 (derived from B+C and validated on B), are 0.76(95% CI 0.69, 0.83) and 0.80 (95% CI 0.74, 0.87) respectively. Conclusions There is high prevalence of perceived ability to self-cannulate. Modifiable SC concerns exist in ESRD. The use of predictive models to objectively define and target education and training strategies could potentially impact on HD self-management and future uptake of home HD. PMID:25992775

  11. Emotional Lability in Children and Adolescents with Attention Deficit/Hyperactivity Disorder (ADHD): Clinical Correlates and Familial Prevalence

    ERIC Educational Resources Information Center

    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.

    2010-01-01

    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…

  12. Correlation of Clinical and Dosimetric Factors With Adverse Pulmonary Outcomes in Children After Lung Irradiation

    SciTech Connect

    Venkatramani, Rajkumar; Kamath, Sunil; Wong, Kenneth; Malvar, Jemily; Sposto, Richard; Goodarzian, Fariba; Freyer, David R.; Keens, Thomas G.; and others

    2013-08-01

    Purpose: To identify the incidence and the risk factors for pulmonary toxicity in children treated for cancer with contemporary lung irradiation. Methods and Materials: We analyzed clinical features, radiographic findings, pulmonary function tests, and dosimetric parameters of children receiving irradiation to the lung fields over a 10-year period. Results: We identified 109 patients (75 male patients). The median age at irradiation was 13.8 years (range, 0.04-20.9 years). The median follow-up period was 3.4 years. The median prescribed radiation dose was 21 Gy (range, 0.4-64.8 Gy). Pulmonary toxic chemotherapy included bleomycin in 58.7% of patients and cyclophosphamide in 83.5%. The following pulmonary outcomes were identified and the 5-year cumulative incidence after irradiation was determined: pneumonitis, 6%; chronic cough, 10%; pneumonia, 35%; dyspnea, 11%; supplemental oxygen requirement, 2%; radiographic interstitial lung disease, 40%; and chest wall deformity, 12%. One patient died of progressive respiratory failure. Post-irradiation pulmonary function tests available from 44 patients showed evidence of obstructive lung disease (25%), restrictive disease (11%), hyperinflation (32%), and abnormal diffusion capacity (12%). Thoracic surgery, bleomycin, age, mean lung irradiation dose (MLD), maximum lung dose, prescribed dose, and dosimetric parameters between V{sub 22} (volume of lung exposed to a radiation dose ≥22 Gy) and V{sub 30} (volume of lung exposed to a radiation dose ≥30 Gy) were significant for the development of adverse pulmonary outcomes on univariate analysis. MLD, maximum lung dose, and V{sub dose} (percentage of volume of lung receiving the threshold dose or greater) were highly correlated. On multivariate analysis, MLD was the sole significant predictor of adverse pulmonary outcome (P=.01). Conclusions: Significant pulmonary dysfunction occurs in children receiving lung irradiation by contemporary techniques. MLD rather than prescribed dose should be used to perform risk stratification of patients receiving lung irradiation.

  13. School-Located Vaccination Clinics for Adolescents: Correlates of Acceptance Among Parents.

    PubMed

    Gargano, Lisa M; Weiss, Paul; Underwood, Natasha L; Seib, Katherine; Sales, Jessica M; Vogt, Tara M; Rask, Kimberly; Morfaw, Christopher; Murray, Dennis L; DiClemente, Ralph J; Hughes, James M

    2015-08-01

    Four vaccines are recommended by The Advisory Committee for Immunization Practices for adolescents: tetanus, diphtheria, acellular pertussis vaccine (Tdap), meningococcal conjugate vaccine (MCV4), human papillomavirus vaccine (HPV), and annual seasonal influenza vaccine. However, coverage among adolescents is suboptimal. School-located vaccination clinics (SLVCs) offer vaccines to students at school, increasing access. This study seeks to determine the relationship between attitudes of parents of middle- and high-school students and acceptance of SLVCs for all four adolescent recommended vaccines. We conducted a telephone and web-based survey among parents of students enrolled in six middle and five high schools in Georgia. Analyses were conducted to examine associations between parental attitudes and willingness to allow their child to be vaccinated at school. Tdap and influenza vaccine had the highest rates of parental SLVC acceptance while HPV vaccine had the lowest. Parents who accepted SLVCs had higher perceived severity of influenza, meningococcal, and HPV illnesses compared to parents who did not accept SLVC. Intention to vaccinate was associated with SLVC acceptance for Tdap [Adjusted OR (AOR) 7.38; 95% confidence interval (CI) 2.44-22.31], MCV4 (AOR 2.97; 95% CI 1.67-5.28), and HPV vaccines (AOR 7.61; 95% CI 3.43-16.89). Social norms were associated with acceptance of SLVCs for influenza vaccine (AOR 1.44; 95% CI 1.12-1.84). These findings suggest parents of adolescents are generally supportive of SLVCs for recommended adolescent vaccines. Perceived severity of illness and intention to get their adolescent vaccinated were the most consistent correlates of parental SLVC acceptance for all vaccines. Future SLVC planning should focus on perceptions of disease severity and benefits of vaccination. PMID:25528325

  14. Oxidative Stress and Erythrocyte Membrane Alterations in Children with Autism: Correlation with Clinical Features

    PubMed Central

    Visconti, Paola; Bolotta, Alessandra; Ferreri, Carla; Gobbi, Giuseppe; Malisardi, Gemma; Manfredini, Stefano; Marini, Marina; Nanetti, Laura; Pipitone, Emanuela; Raffaelli, Francesca; Resca, Federica; Mazzanti, Laura

    2013-01-01

    It has been suggested that oxidative stress may play a role in the pathogenesis of Autism Spectrum Disorders (ASD), but the literature reports somewhat contradictory results. To further investigate the issue, we evaluated a high number of peripheral oxidative stress parameters, and some related issues such as erythrocyte membrane functional features and lipid composition. Twenty-one autistic children (Au) aged 5 to 12 years, were gender and age-matched with 20 typically developing children (TD). Erythrocyte thiobarbituric acid reactive substances, urinary isoprostane and hexanoyl-lysine adduct levels were elevated in Au, thus confirming the occurrence of an imbalance of the redox status of Au, whilst other oxidative stress markers or associated parameters (urinary 8-oxo-dG, plasma radical absorbance capacity and carbonyl groups, erythrocyte superoxide dismutase and catalase activities) were unchanged. A very significant reduction of Na+/K+-ATPase activity (−66%, p<0.0001), a reduction of erythrocyte membrane fluidity and alteration in erythrocyte fatty acid membrane profile (increase in monounsaturated fatty acids, decrease in EPA and DHA-ω3 with a consequent increase in ω6/ω3 ratio) were found in Au compared to TD, without change in membrane sialic acid content. Some Au clinical features appear to be correlated with these findings; in particular, hyperactivity score appears to be related with some parameters of the lipidomic profile and membrane fluidity. Oxidative stress and erythrocyte membrane alterations may play a role in the pathogenesis of ASD and prompt the development of palliative therapeutic protocols. Moreover, the marked decrease in NKA could be potentially utilized as a peripheral biomarker of ASD. PMID:23840462

  15. Pathogenic properties of Campylobacter jejuni: assay and correlation with clinical manifestations.

    PubMed Central

    Klipstein, F A; Engert, R F; Short, H; Schenk, E A

    1985-01-01

    The pathogenic properties of 20 strains of Campylobacter jejuni isolated from persons with clearly defined clinical manifestations were determined. Cell-free broth filtrates were examined for (i) enterotoxin production by Chinese hamster tissue culture assay and an enzyme-linked immunosorbent assay (ELISA) employing GM1 ganglioside and affinity-purified antiserum to Escherichia coli heat-labile toxin, (ii) cytotoxin production by Vero and HeLa cell tissue culture lines, and (iii) their ability to cause fluid secretion in rat ligated ileal loops. Viable bacteria were examined for invasive properties by an ELISA with the immunoglobulin fraction of antiserum to Formalin-killed bacteria of an invasive strain, and by their effect on fluid secretion and morphology in rat ligated ileal loops. None of the eight isolates obtained from asymptomatic carriers had any detectable pathogenic properties. All six strains isolated from persons with bloody invasive-type diarrhea elaborated a cytotoxin; their viable bacteria had high titers in the ELISA for invasive properties and caused fluid secretion in ligated ileal loops, although consistent morphologic abnormalities and evidence of mucosal invasion, examined by immunofluorescence techniques, were not detected. All six strains isolated from persons with watery secretory-type diarrhea produced an enterotoxin, one elaborated a cytotoxin, and broth filtrates of all strains caused fluid secretion in ligated ileal loops; viable bacteria had low titers in the ELISA for invasive properties and evoked fluid secretion in ligated loops by means of enterotoxin production. These observations show (i) that a correlation exists between the pathogenic properties of the infective C. jejuni strain and gastrointestinal manifestations in the infected host, and (ii) that these pathogenic properties can be identified by in vitro assays, including ELISAs. Images PMID:3899937

  16. Paradoxical Lung Function Response to Beta2-agonists: Radiologic Correlates and Clinical Implications

    PubMed Central

    Bhatt, Surya P.; Wells, James M.; Kim, Victor; Criner, Gerard J.; Hersh, Craig P.; Hardin, Megan; Bailey, William C.; Nath, Hrudaya; il-Kim, Young; Foreman, Marilyn G.; Stinson, Douglas S.; Wilson, Carla G.; Rennard, Stephen I.; Silverman, Edwin K.; Make, Barry J.; Dransfield, Mark T.

    2014-01-01

    Background Bronchodilator response is seen in a significant proportion of patients with chronic obstructive pulmonary disease (COPD). However, there are also reports of a paradoxical response (PR) to beta2-agonists, resulting in bronchoconstriction. Asymptomatic bronchoconstriction is likely far more common but there has been no systematic study of this phenomenon.We assessed theprevalence of PR in current and former smokers with and without COPD, and its radiologic correlates and clinical implications. Methods Subjects from a large multicenter study (COPDGene) were categorized into two groups based on PR defined as at least a 12% and 200mLreduction in FEV1 and/or FVC after administration of a short-acting beta2-agonist (180ucg albuterol). Predictors of PR and associations with respiratory morbidity and computed tomographic measures of emphysema and airway disease were assessed. Findings 9986 subjects were included. PR was seen in 4.54% and the frequency was similar in those with COPD and smokers without airflow obstruction. Compared to Caucasians, PR was twice as common in African-Americans (6.9% vs. 3.4%;p <0.001). On multivariate analyses, African- American race (adjusted OR 1.89, 95%CI 1.50 to 2.39), lesspercent emphysema (OR 0.96, 95%CI 0.92 to 0.99) and increased wall-area% of segmental airways (OR 1.04,95%CI 1.01 to 1.08) were independently associated with PR.PR was independently associated with worse dyspnea, lower six-minute-walk distance, higher BODE index, and a greater frequency of exacerbations(increased by a factor of 1.35, 95%CI 1.003 to 1.81). Interpretation Paradoxical response to beta2-agonists is associated with respiratory morbidity and is more common in African Americans. PMID:25217076

  17. Prevalence and Correlates of Erectile Dysfunction among Primary Care Clinic Attendees in Nigeria

    PubMed Central

    Adebusoye, Lawrence A.; Olapade-olaopa, Olubunmi E.; Ladipo, Modupe M.; Owoaje, Eme T.

    2012-01-01

    Introduction: Erectile dysfunction (ED) has become a public health issue in Nigeria because of its increasing magnitude, association with chronic medical conditions and negative impact on sexual life. Materials and Methods: Cross-sectional study of 450 male patients aged 18-70years who presented with non-ED related complaints. Main outcome measurements were prevalence and severity of ED which was assessed with International Index of Erectile Function (IIEF-5) and single-item sexual function questionnaire. Also assessed were socio-demographic characteristics, physical activities, sexual satisfaction and morbidities. Results: The prevalence of ED was 55.1% (mild, moderate and severe were 32.6%, 17.8% and 4.7% respectively). Prevalence of ED was significantly associated with age (p < 0.0001), marital status (p = 0.032), income (p = 0.001), social class (p = 0.004), physical activities (p = 0.006) and BMI (p = 0.012). Prevalence of ED was significantly high among men with diabetes mellitus (72.7%), hypertension (70.7%), peptic ulcer disease (70.4%) and previous prostate surgery (76.2%). Logistic regression showed dissatisfaction with sexual life (OR = 0.689, CI = 1.233-5.866; p = 0.013) and having sexual activities less than desired (OR = 3.331, CI = 1.416-7.839; p = 0.006) to be the most significant factors associated with ED. There was a strong positive correlation between the IIEF-5 and single-item sexual function questionnaire (r = 0.747, p < 0.0001). Conclusion: The prevalence of ED is high among males attending a primary care clinic in Nigeria with non-ED related complaints. ED was more prevalent in men with chronic medical illnesses and sedentary lifestyle. Family physicians should inquire about this condition in these men and refer them early for specialist consultation. PMID:22980347

  18. The correlation between organizational justice and trust among employees of rehabilitation clinics in hospitals of Ahvaz, Iran

    PubMed Central

    Khiavi, Farzad Faraji; Shakhi, Kamal; Dehghani, Roohallah; Zahiri, Mansour

    2016-01-01

    Introduction Organizational justice is an intricate concept that refers to fair and ethical conduct of individuals within organizations. No research has been conducted on the variables associated with organizational justice in rehabilitation clinics. Thus, the aim of this research was to determine the correlation between organizational justice and organizational trust among the employees of rehabilitation clinics in hospitals of Ahvaz, Iran. Methods This was a cross-sectional research, and it was conducted on 140 rehabilitation staff members of hospital clinics in Ahvaz. The data were gathered using organizational justice and trust questionnaires. The data were analyzed using the independent-samples t-test, ANOVA, and Pearson’s product-moment correlation SPSS software. Results Significant correlations between procedure and interaction justice and organizational trust were identified (p < 0.001). Distributive justice showed small correlation with trust (r = 0.25, p < 0.021). Organizational justice was significantly associated with organizational trust (r = 0.42, p < 0.001). Organizational justice was not significantly related to any demographic variable (p > 0.05). Conclusion There was a positive, medium, and significant correlation between organizational justice and trust. It is suggested that rehabilitation clinics’ managers develop plans to increase their organizational justice subscales in order to develop organizational trust among their employees. PMID:27053997

  19. Serum thymidine kinase 1 levels correlate with clinical characteristics of esophageal squamous cell carcinoma

    PubMed Central

    Ji, Yong; Wu, Xiao-Bo; Chen, Jing-Yu; Hu, Bin; Zhu, Qian-Kun; Zhu, Xing-Feng; Zheng, Min-Feng

    2015-01-01

    Patients with esophageal cancer are often diagnosed at advanced stages, leading to poor prognosis. Biomarkers are needed to enable earlier detection as well as to aid in the prediction of prognosis, but to date these tools remain scarce. Thymidine kinase (TK1) has been shown to exhibit altered expression levels in esophageal tumor cells, therefore this study sought to determine whether serum TK1 levels are also altered and, if so, to assess the utility of TK1 as a biomarker in esophageal squamous cell carcinoma. Eighty patients with esophageal squamous cell carcinoma were included as the case group and 80 healthy persons were selected as the control group. Serum TK1 levels, postoperatively for cancer patients, were detected by chemiluminescence. Follow-up was performed for cancer patients to determine the progression free survival (PFS) and overall survival (OS). Serum TK1 levels were significantly higher in cases of esophageal cancer than in healthy control individuals (t=7.235, P<0.05). When cancer cases were sub-divided into lower and higher serum TK1 levels, based on the mean level of 3.38 pmol/L, statistically significant differences in TNM stage, tumor differentiation, and lymph node metastasis were observed between patients with ≥3.38 pmol/L and <3.38 pmol/L (χ2=28.134, 3.187, 7.234, P<0.05). The average OS of all esophageal cancer patients was 30.13 months, and the average PFS was 24.73 months. However, when the cases were divided by serum TK1 level, average OS of those with higher serum TK1 (≥3.38 pmol/L) was significantly lower (23.98 mo) than those with lower serum TK1 (32.96 mo) (χ2=5.439, P<0.05). Similarly, average PFS was significantly lower in patients with higher serum TK1 (17.65 mo versus 27.62) (χ2=4.640, P<0.05). OS was correlated with TNM stage (hazard ratio, HR=3.116), degree of tumor differentiation (HR=0.427), lymph node metastasis (HR=0.535), and serum TK1 level (HR=1.913) (Wald χ2=6.782, 6.228, 4.562, 5.681, P<0.05). Similarly, PFS was correlated with TMN stage (HR=2.153), degree of tumor differentiation (HR=0.627), and serum TK1 level (HR=1.632) (Wald χ2=7.035, 5.335, 4.887, P<0.05). Thus, patients with esophageal squamous cell carcinoma exhibit higher circulating TK1 levels, consistent with findings of increased TK1 expression in tumor cells. Further, the correlation of serum TK1 levels with clinical features of esophageal cancer and with patient survival suggest that serum TK1 may serve as a valuable biomarker for predicting patient prognosis. PMID:26550200

  20. Correlation between clinical findings and magnetic resonance imaging for the assessment of local response after standard treatment in cervical cancer☆

    PubMed Central

    Valduvieco, Izaskun; Biete, Albert; Rios, Iván; Llorente, Ricardo; Rovirosa, Angels; Pahisa, Jaume; Vidal, Laura; Farrús, Blanca; Samper, Pilar

    2013-01-01

    Background The aim of our study is to evaluate the correlation between gynecological examination and magnetic resonance (MRI) findings for the assessment of local response in cervical cancer patients treated with radiotherapy/chemotherapy (RT/ChT). Patients and methods This study is a retrospective review of 75 consecutive cervical cancer patients from April 2004 to November 2009 treated with RT/ChT. Clinical and radiological data were subsequently analyzed. Patient's median age was 51 with a FIGO stage from Ib to IVb. Individualized RT/ChT was administered with a median dose of 45 Gy. Sixty-three patients received a complementary brachytherapy. Seventy-one patients received chemotherapy on a weekly basis. Gynecological exam was performed 3 months and 6 months after treatment and these findings were compared to MRI results at the same time. Statistic analysis We used the Spearman's Rho test to determine the correlation level between the clinical and radiological methods. Results A correlation of 0.68 (60%) was observed between the clinical and MRI findings at 3 months with a further increase of up to 0.86 (82.6%) at 6 months. In the few cases with a poor correlation, the subsequent assessment and the natural history of the disease showed a greater value of the clinical exam as compared with the MRI findings. Conclusions Physical exam remains an essential tool to evaluate the local response to RT/ChT for cervical cancer. The optimal clinical radiological correlation found at 6 months after treatment suggests that the combination of gynecological examination and MRI are probably adequate in patient monitoring. PMID:24416556

  1. Disease quantification in dermatology: in vivo near-infrared spectroscopy measures correlate strongly with the clinical assessment of psoriasis severity

    NASA Astrophysics Data System (ADS)

    Greve, Tanja Maria; Kamp, Søren; Jemec, Gregor B. E.

    2013-03-01

    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.

  2. Clinical correlates of complicated grief among individuals with acute coronary syndromes

    PubMed Central

    Pini, Stefano; Gesi, Camilla; Abelli, Marianna; Cardini, Alessandra; Lari, Lisa; Felice, Francesca; Di Stefano, Rossella; Mazzotta, Gianfranco; Bovenzi, Francesco; Bertoli, Daniele; Borelli, Lucia; Michi, Paola; Oligeri, Claudia; Balbarini, Alberto; Manicavasagar, Vijaya

    2015-01-01

    Objective The study aimed at exploring bereavement and complicated grief (CG) symptoms among subjects without a history of coronary heart disease (CHD) at the time of a first acute coronary syndrome (ACS) and to evaluate the relationship of CG symptoms and ACS. Method Overall, 149 subjects with ACS (namely, acute myocardial infarct with or without ST-segment elevation or unstable angina), with no previous history of CHD, admitted to three cardiac intensive care units were included and evaluated by the Structured Clinical Interview for Complicated Grief (SCI-CG), Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, and the 36-item Short-Form Health Survey (MOS-SF-36). Results Of the total sample of 149 subjects with ACS, 118 (79.2%) met criteria for DSM-5 persistent complex bereavement disorder. Among these, subjects who lost a partner, child, or sibling were older (P=0.008), less likely to be working (P=0.032), and more likely to be suffering from hypertension (P=0.021), returned higher scores on the SCI-CG (P=0.001) and developed the index ACS more frequently between 12 and 48 months after the death than those who lost a parent or another relative (P≤0.0001). The occurrence of ACS 12–48 months (P=0.019) after the loss was positively correlated with SCI-CG scores. An inverse relationship with SCI-CG scores was observed for patients who experienced ACS more than 48 months after the loss (P=0.005). The SCI-CG scores significantly predicted lower scores on the “general health” domain of MOS-SF-36 (P=0.030), as well as lower scores on “emotional well-being” domain (P=0.010). Conclusion A great proportion of subjects with ACS report the loss of a loved one. Among these, the loss of a close relative and the severity of CG symptoms are associated with poorer health status. Our data corroborate previous data indicating a strong relationship between CG symptoms and severe cardiac problems. PMID:26504390

  3. Idiopathic normal‐pressure hydrocephalus: clinical comorbidity correlated with cerebral biopsy findings and outcome of cerebrospinal fluid shunting

    PubMed Central

    Bech‐Azeddine, R; Høgh, P; Juhler, M; Gjerris, F; Waldemar, G

    2007-01-01

    Objectives To elucidate the importance of clinically diagnosed cerebral comorbidity in idiopathic normal‐pressure hydrocephalus (INPH) and its effect on improvement after shunt surgery as well as concordance with parenchymal pathological changes described in frontal cerebral biopsy specimens. Methods In 28 consecutive patients diagnosed with INPH and shunted according to clinical, radiological and cerebrospinal fluid dynamic criteria, concomitant disorders were carefully registered, with special emphasis on cerebrovascular disease (CVD) and possible Alzheimer's disease. During shunt surgery, a frontal cerebral biopsy specimen was obtained and subsequently analysed for pathological changes. Results One or several concurrent disorders were present in 89% of the patients, most often CVD (n = 17) and possible Alzheimer's disease (n = 12), of which eight patients presented both, diagnosed according to the criteria of the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders Association. The shunt success rate was 33%. A clear tendency towards increasing prevalence of CVD or Alzheimer's disease was found in the subgroups with no improvement or clinical deterioration compared with the patients improving after shunt surgery. The presence of CVD tended towards an unfavourable shunt outcome. The pathological parenchymal changes reflected the clinical diagnoses of comorbidity, and were described in about half of the biopsy specimens, with Alzheimer's disease (n = 7) and vascular changes (n = 7) being the most common findings. However, no significant correlation was found with the clinical diagnoses of Alzheimer's disease and CVD. The presence of cerebral comorbidity, whether diagnosed clinically or by brain biopsy, did not preclude clinical improvement after shunt operation. Conclusions A high prevalence of CVD and Alzheimer's disease was found in patients shunted for INPH, which was reflected, although less commonly, by similar neuropathological biopsy findings. No significant correlation was found between the presence of comorbidity and shunt outcome. The findings support the perception of INPH as a multiaetiological clinical entity, possibly overlapping pathophysiologically with CVD and Alzheimer's disease. PMID:17012342

  4. Clinical and clinical laboratory correlates in sea otters dying unexpectedly in rehabilitation centers following the Exxon Valdez oil spill.

    PubMed

    Rebar, A H; Lipscomb, T P; Harris, R K; Ballachey, B E

    1995-07-01

    Following the Exxon Valdez oil spill, 347 oiled sea otters (Enhydra lutris) were treated in rehabilitation centers. Of these, 116 died, 94 within 10 days of presentation. Clinical records of 21 otters dying during the first 10 days of rehabilitation were reviewed to define the laboratory abnormalities and clinical syndromes associated with these unexpected deaths. The most common terminal syndrome was shock characterized by hypothermia, lethargy, and often hemorrhagic diarrhea. In heavily and moderately oiled otters, shock developed within 48 hours of initial presentation, whereas in lightly oiled otters shock generally occurred during the second week of captivity. Accompanying laboratory abnormalities included leukopenia with increased numbers of immature neutrophils (degenerative left shift), lymphopenia, anemia, azotemia (primarily prerenal), hyperkalemia, hypoproteinemia/hypoalbuminemia, elevations of serum transaminases, and hypoglycemia. Shock associated with hemorrhagic diarrhea probably occurred either as a direct primary effect of oiling or as an indirect effect secondary to confinement and handling in the rehabilitation centers. Lightly oiled otters were less likely to die from shock than were heavily oiled otters (22% vs. 72%, respectively). Heavily oiled otters developed shock more rapidly and had greater numbers of laboratory abnormalities, suggesting that exposure to oil was an important contributing factor. PMID:7483208

  5. Peer Evaluation in a Clinical Clerkship: Students' Attitudes, Experiences, and Correlations with Traditional Assessments

    ERIC Educational Resources Information Center

    Levine, Ruth E.; Kelly, P. Adam; Karakoc, Tayfun; Haidet, Paul

    2007-01-01

    Objective: The authors performed this study to determine whether clerkship peer evaluations, initiated as part of our "team-based learning" curriculum in 2002, correlated with other student performance measures, and to determine what qualities students rate in their peer evaluations. Method: The authors correlated peer evaluation scores with other…

  6. Clinical-Pathologic Correlation Between Transperineal Mapping Biopsies of the Prostate and Three-Dimensional Reconstruction of Prostatectomy Specimens

    PubMed Central

    Crawford, E. David; Rove, Kyle O.; Barqawi, Al B.; Maroni, Paul D.; Werahera, Priya N.; Baer, Craig A.; Koul, Hari K.; Rove, Cory A.; Lucia, M. Scott; La Rosa, Francisco G.

    2015-01-01

    Background Extended transrectal ultrasound guided biopsies (TRUSB) of the prostate may not accurately convey true morphometric information and Gleason score (GS) of prostate cancer (PCa) and the clinical use of template-guided (5-mm grid) transperineal mapping biopsies (TPMBs) remains controversial. Methods We correlated the clinical-pathologic results of 1,403 TPMB cores obtained from 25 men diagnosed with PCa with 64 cancer lesions found in their corresponding radical prostatectomy (RP) specimens. Special computer models of three-dimensional, whole-mounted radical prostatectomy (3D-WMRP) specimens were generated and used as gold standard to determine tumor morphometric data. Between-sample rates of upgrade and downgrade (highest GS and a novel cumulative GS) and upstage and downstage (laterality) were determined. Lesions ≥ 0.5 cm3 or GS ≥ 7 were considered clinically significant. Results From 64 separate 3D-WMRP lesions, 25 had significant volume (mean 1.13 cm3) and 39 were insignificant (mean 0.09 cm3) (P < 0.0001); 18/64 lesions were missed by TPMB, but only one was clinically significant with GS-8 (0.02 cm3). When comparing the cumulative GS of TPMB versus RP, 72% (n = 18) had identical scores, 12% (n = 3) were upgraded, and only 16% (n = 4) were downgraded. Laterality of TPMB and RP was strongly correlated, 80% same laterality, 4% were up-staged, and 16% down-staged. Conclusions Our clinical-pathology correlation showed very high accuracy of TPMB with a 5-mm grid template to detect clinically significant PCa lesions as compared with 3D-WMRP, providing physicians and patients with a reliable assessment of grade and stage of disease and the opportunity to choose the most appropriate therapeutic options. PMID:23169245

  7. Examining the Clinical Correlates of Autism Spectrum Disorder in Youth by Ascertainment Source

    ERIC Educational Resources Information Center

    Joshi, Gagan; Faraone, Stephen V.; Wozniak, Janet; Petty, Carter; Fried, Ronna; Galdo, Maribel; Furtak, Stephannie L.; McDermott, Katie; Epstien, Cecily; Walker, Rosemary; Caron, Ashley; Feinberg, Leah; Biederman, Joseph

    2014-01-01

    To examine whether presentation of autism spectrum disorder (ASD) and associated patterns of psychiatric comorbidity and dysfunction vary by referral source. ASD youth referred to a specialized ambulatory program for ASD (N = 143) were compared to ASD youth referred to a general child psychiatry clinic (N = 217). More ASD clinic youth met criteria…

  8. Empirical Correlates and Expanded Interpretation of the MMPI-2-RF Restructured Clinical Scale 3 (Cynicism)

    ERIC Educational Resources Information Center

    Ingram, Paul B.; Kelso, Kristy M.; McCord, David M.

    2011-01-01

    The recent release of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has received much attention from the clinical psychology community. Particular concerns have focused on Restructured Clinical Scale 3 (RC3; Cynicism). This article briefly reviews the major criticisms and responses regarding the restructuring of

  9. Examining the Clinical Correlates of Autism Spectrum Disorder in Youth by Ascertainment Source

    ERIC Educational Resources Information Center

    Joshi, Gagan; Faraone, Stephen V.; Wozniak, Janet; Petty, Carter; Fried, Ronna; Galdo, Maribel; Furtak, Stephannie L.; McDermott, Katie; Epstien, Cecily; Walker, Rosemary; Caron, Ashley; Feinberg, Leah; Biederman, Joseph

    2014-01-01

    To examine whether presentation of autism spectrum disorder (ASD) and associated patterns of psychiatric comorbidity and dysfunction vary by referral source. ASD youth referred to a specialized ambulatory program for ASD (N=143) were compared to ASD youth referred to a general child psychiatry clinic (N=217). More ASD clinic youth met criteria

  10. Empirical Correlates and Expanded Interpretation of the MMPI-2-RF Restructured Clinical Scale 3 (Cynicism)

    ERIC Educational Resources Information Center

    Ingram, Paul B.; Kelso, Kristy M.; McCord, David M.

    2011-01-01

    The recent release of the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has received much attention from the clinical psychology community. Particular concerns have focused on Restructured Clinical Scale 3 (RC3; Cynicism). This article briefly reviews the major criticisms and responses regarding the restructuring of…

  11. Examining the Clinical Correlates of Autism Spectrum Disorder in Youth by Ascertainment Source

    PubMed Central

    Joshi, Gagan; Faraone, Stephen V; Wozniak, Janet; Petty, Carter; Fried, Ronna; Galdo, Maribel; Furtak, Stephannie L.; McDermott, Katie; Epstien, Cecily; Walker, Rosemary; Caron, Ashley; Feinberg, Leah; Biederman, Joseph

    2014-01-01

    Objective To examine whether presentation of autism spectrum disorder (ASD) and associated patterns of psychiatric comorbidity and dysfunction vary by referral source. Methods ASD youth referred to a specialized ambulatory program for ASD (N=143) were compared to ASD youth referred to a general child psychiatry clinic (N=217). Results More ASD clinic youth met criteria for a more robust form of ASD (autistic disorder); more youth referred to the psychiatry clinic met criteria for broader spectrum ASD (PDD-NOS). General psychiatry clinic youth with ASD suffered from a greater burden of psychopathologies and higher levels of dysfunction. Conclusion The presentation of ASD in psychiatrically referred youth differs between general and ASD-specialized clinics, though both referral populations have high levels of comorbidity and dysfunction. PMID:24566937

  12. Myocardial uptake of indium-111-labeled antimyosin in acute subendocardial infarction: Clinical, histochemical, and autoradiographic correlation of myocardial necrosis

    SciTech Connect

    Hendel, R.C.; McSherry, B.A.; Leppo, J.A. )

    1990-11-01

    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.

  13. Obsessive-compulsive disorder--A question of conscience? An fMRI study of behavioural and neurofunctional correlates of shame and guilt.

    PubMed

    Hennig-Fast, Kristina; Michl, Petra; Müller, Johann; Niedermeier, Nico; Coates, Ute; Müller, Norbert; Engel, Rolf R; Möller, Hans-Jürgen; Reiser, Maximilian; Meindl, Thomas

    2015-09-01

    Shame and guilt can be described as 'self-conscious emotions' and are an essential part of the psychopathology in obsessive-compulsive disorder (OCD). Our primary aim was to explore whether individuals with OCD are processing shame and guilt differently from healthy individuals (N = 20 in both groups; 50% female; age: 20-40 years) on the behavioural and neurobiological level. For the experimental task, participants were scanned with functional magnetic resonance tomography (functional magnetic resonance imaging, 3 T) while imagining neutral, shame inducing and guilt inducing scenarios. In addition to clinical questionnaires, participants were asked to complete questionnaires measuring shame and guilt. The functional data indicate an increased activity in OCD patients in the shame condition in the limbic, temporal and sub-lobar (hypothalamus) areas, in the guilt condition inter alia in frontal, limbic and temporal areas. In summary we found activity in OCD patients in neural networks which are responsible for stimulus filtering, emotion regulation, impulse control and memory. The results from our study may contribute to a better understanding of the origins and maintenance of OCD in association with the pathological processing of shame and guilt on different functional levels. PMID:26028547

  14. How well do whole exome sequencing results correlate with medical findings? A study of 89 Mayo Clinic Biobank samples

    PubMed Central

    Middha, Sumit; Lindor, Noralane M.; McDonnell, Shannon K.; Olson, Janet E.; Johnson, Kiley J.; Wieben, Eric D.; Farrugia, Gianrico; Cerhan, James R.; Thibodeau, Stephen N.

    2015-01-01

    Whole exome sequencing (WES) is increasingly being used for diagnosis without adequate information on predictive characteristics of reportable variants typically found on any given individual and correlation with clinical phenotype. In this study, we performed WES on 89 deceased individuals (mean age at death 74 years, range 28–93) from the Mayo Clinic Biobank. Significant clinical diagnoses were abstracted from electronic medical record via chart review. Variants [Single Nucleotide Variant (SNV) and insertion/deletion] were filtered based on quality (accuracy >99%, read-depth >20, alternate-allele read-depth >5, minor-allele-frequency <0.1) and available HGMD/OMIM phenotype information. Variants were defined as Tier-1 (nonsense, splice or frame-shifting) and Tier-2 (missense, predicted-damaging) and evaluated in 56 ACMG-reportable genes, 57 cancer-predisposition genes, along with examining overall genotype–phenotype correlations. Following variant filtering, 7046 total variants were identified (~79/person, 644 Tier-1, 6402 Tier-2), 161 among 56 ACMG-reportable genes (~1.8/person, 13 Tier-1, 148 Tier-2), and 115 among 57 cancer-predisposition genes (~1.3/person, 3 Tier-1, 112 Tier-2). The number of variants across 57 cancer-predisposition genes did not differentiate individuals with/without invasive cancer history (P > 0.19). Evaluating genotype–phenotype correlations across the exome, 202(3%) of 7046 filtered variants had some evidence for phenotypic correlation in medical records, while 3710(53%) variants had no phenotypic correlation. The phenotype associated with the remaining 44% could not be assessed from a typical medical record review. These data highlight significant continued challenges in the ability to extract medically meaningful predictive results from WES. PMID:26257771

  15. The impact of cranioplasty on cerebral blood flow and its correlation with clinical outcome in patients underwent decompressive craniectomy

    PubMed Central

    Mah, Jon Kooi; Kass, Rosman Azmin

    2016-01-01

    Context: Decompressive craniectomy is commonly use as the treatment for medically refractory intracranial hypertension. Unexpected improvement in patient's neurological status has been observed among patients that underwent cranioplasty. Restoration of cerebral blood flow (CBF) hemodynamics is one of the contributing factors. This study was conducted to determine the impact of cranioplasty on CBF and its correlation with clinical outcome. Aims: This study was done to evaluate the effect of cranioplasty on CBF with computed tomography perfusion (CTP). It also aimed to determine the correlation between postcranioplasty CBF and clinical outcome. Settings and Design: Prospective observational study. Subjects and Methods: All patients had CTP done to determine precranioplasty CBF. CTP was repeated at 6 weeks postcranioplasty and clinical assessment at 6 and 24 weeks postcranioplasty. Statistical Analysis Used: Data analysis was done using Statistical Package for Social Sciences version 12.0.1. Results: The median value of the ipsilateral CBF was 48.87 and 61.10 ml/min/100 g at precranioplasty and 6 weeks postcranioplasty (P < 0.001). Contralateral CBF also showed improvement from 60.55 to 71.84 ml/min/100 g (P < 0.001). Median value for mini mental state examination showed a significant difference with value of 22, 25, and 25.5 at precranioplasty, 6 and 24 weeks postcranioplasty (P = 0.001 and P < 0.001). Median value for frontal assessment battery was 12, 14.5, and 15 (P = 0.002 and P = 0.001). Conclusions: Cranioplasty can remarkably improve cortical perfusion for both ipsilateral and contralateral hemisphere. Though we are unable to establish strong correlation, between CBF and clinical outcome, cranioplasty was observed to have a therapeutic role in terms of clinical outcome improvement. PMID:26889273

  16. Clinical-radiographic correlation of the femoral insertion point of the graft in reconstruction of the medial patellofemoral ligament☆

    PubMed Central

    Pinheiro Júnior, Lúcio Flávio Biondi; Cenni, Marcos Henrique Frauendorf; Nicolai, Oscar Pinheiro; Carneiro, Guilherme Galvão Barreto; de Andrade, Rodrigo Cristiano; de Moraes, Vinícius Vidigal

    2015-01-01

    Objective To analyze the radiographic positioning of the femoral tunnel and correlate this with the postoperative clinical results among patients undergoing reconstruction of the medial patellofemoral ligament (MPFL) alone. Method This was a retrospective study in which 30 knees of 26 patients with recurrent dislocation of the patella that underwent MPFL reconstruction were evaluated. The femoral insertion point of the graft and the postoperative clinical condition were analyzed and correlated using the Kujala and Lysholm scales. Results 22 knees presented a femoral tunnel in the anatomical area (group A) and 8 outside of this location (group B). In group A, the mean score on the Kujala scale was 89.68 points and on the Lysholm scale was 92.45 points. In group B, the mean score on the Kujala scale was 84.75 points and on the Lysholm scale was 92 points. The difference between the means was not significant on either of the two scales. Conclusion Correlation with the clinical results did not show any difference in relation to the positioning of the femoral insertion of the graft.

  17. Effort-Based Decision-Making Paradigms for Clinical Trials in Schizophrenia: Part 2—External Validity and Correlates.

    PubMed

    Horan, William P; Reddy, L Felice; Barch, Deanna M; Buchanan, Robert W; Dunayevich, Eduardo; Gold, James M; Marder, Steven R; Wynn, Jonathan K; Young, Jared W; Green, Michael F

    2015-09-01

    Effort-based decision making has strong conceptual links to the motivational disturbances that define a key subdomain of negative symptoms. However, the extent to which effort-based decision-making performance relates to negative symptoms, and other clinical and functionally important variables has yet to be systematically investigated. In 94 clinically stable outpatients with schizophrenia, we examined the external validity of 5 effort-based paradigms, including the Effort Expenditure for Rewards, Balloon Effort, Grip Strength Effort, Deck Choice Effort, and Perceptual Effort tasks. These tasks covered 3 types of effort: physical, cognitive, and perceptual. Correlations between effort related performance and 6 classes of variables were examined, including: (1) negative symptoms, (2) clinically rated motivation and community role functioning, (3) self-reported motivational traits, (4) neurocognition, (5) other psychiatric symptoms and clinical/demographic characteristics, and (6) subjective valuation of monetary rewards. Effort paradigms showed small to medium relationships to clinical ratings of negative symptoms, motivation, and functioning, with the pattern more consistent for some measures than others. They also showed small to medium relations with neurocognitive functioning, but were generally unrelated to other psychiatric symptoms, self-reported traits, antipsychotic medications, side effects, and subjective valuation of money. There were relatively strong interrelationships among the effort measures. In conjunction with findings from a companion psychometric article, all the paradigms warrant further consideration and development, and 2 show the strongest potential for clinical trial use at this juncture. PMID:26209546

  18. Correlation between Magnetic Resonance Imaging Characteristics of the Patellar Tendon and Clinical Scores in Osgood-Schlatter Disease

    PubMed Central

    Lee, Dhong Won; Kim, Min Jeong; Kim, Woo Jong; Ha, Jeong Ku

    2016-01-01

    Purpose This study aims to evaluate magnetic resonance imaging (MRI) findings in young adults with symptomatic Osgood-Schlatter disease (OSD) and compare those in young adults without OSD. Materials and Methods We compared MRI findings between young adults with OSD (OS group, n=30) and the equivalent number of young adults without OSD (control group). Visual analog scale scores and Kujala scores were evaluated and correlation analysis was performed in the OS group. Results In the OS group, MRI revealed that the patellar tendon was attached to the tibia more widely, resulting in a reduced free tendon portion, and more proximally to the articular surface (p<0.001). The correlation analysis between MRI findings and clinical scores showed statistically significant correlations (p<0.01). In the OS group, 43% presented with patellar tendinopathy or bone marrow edema at the distal attachments. Conclusions Compared to the control group, the relatively small free portion and relatively proximal attachment of the patellar tendon were observed with MRI in the OS group. The free portion of the patellar tendon was positively correlated with the clinical scores. Patellar tendinopathy was also frequently encountered in the OS group. PMID:26955614

  19. Clinical Correlates of Co-occurring Psychiatric and Autism Spectrum Disorder (ASD) Symptom-Induced Impairment in Children with ASD.

    PubMed

    Gadow, Kenneth D; Perlman, Greg; Ramdhany, Lianne; de Ruiter, Janneke

    2016-01-01

    Although psychiatric symptom severity and impairment are overlapping but nevertheless distinct illness parameters, little research has examined whether variables found to be associated with the severity are also correlated with symptom-induced impairment. Parents and teachers completed ratings of symptom-induced impairment for DSM-IV-referenced syndromes, and parents completed a background questionnaire for a consecutively referred sample of primarily male (81%) 6-to-12 year olds with autism spectrum disorder (ASD) (N = 221). Some clinical correlates (e.g., IQ < 70, maternal level of education, pregnancy complications, current use of psychotropic medication, season of birth) were associated with impairment for several disorders, whereas others were correlated with only a few syndromes (e.g., gender, co-morbid medical conditions) or were not related to impairment in any disorder (e.g., family psychopathology). There was little convergence in findings for parents' versus teachers' ratings. Some clinical correlates (e.g., season of birth, current psychotropic medication, maternal education) were unique predictors of three or more disorders. Pregnancy complications were uniquely associated with social anxiety and schizoid personality symptom-induced impairment. IQ was a unique predictor of schizophrenia, ASD, oppositional defiant disorder symptom-induced impairment. Children whose mothers had relatively fewer years of education had greater odds for symptom-induced impairment in social anxiety, depression, aggression, and mania and greater number of impairing conditions. Season of birth was the most robust correlate of symptom-induced impairment as rated by teachers but not by parents. Children born in fall evidenced higher rates of co-occurring psychiatric and ASD symptom-induced impairment and total number of impairing conditions. Many variables previously linked with symptom severity are also correlated with impairment. PMID:25640910

  20. Socio-demographic and clinical correlates of subjective quality of life among Nigerian outpatients with schizophrenia.

    PubMed

    Adelufosi, A O; Ogunwale, A; Abayomi, O; Mosanya, J T

    2013-10-30

    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

  1. Correlation between clinical performance and degree of conversion of resin cements: a literature review

    PubMed Central

    DE SOUZA, Grace; BRAGA, Roberto Ruggiero; CESAR, Paulo Francisco; LOPES, Guilherme Carpena

    2015-01-01

    Resin-based cements have been frequently employed in clinical practice to lute indirect restorations. However, there are numerous factors that may compromise the clinical performance of those cements. The aim of this literature review is to present and discuss some of the clinical factors that may affect the performance of current resin-based luting systems. Resin cements may have three different curing mechanisms: chemical curing, photo curing or a combination of both. Chemically cured systems are recommended to be used under opaque or thick restorations, due to the reduced access of the light. Photo-cured cements are mainly indicated for translucent veneers, due to the possibility of light transmission through the restoration. Dual-cured are more versatile systems and, theoretically, can be used in either situation, since the presence of both curing mechanisms might guarantee a high degree of conversion (DC) under every condition. However, it has been demonstrated that clinical procedures and characteristics of the materials may have many different implications in the DC of currently available resin cements, affecting their mechanical properties, bond strength to the substrate and the esthetic results of the restoration. Factors such as curing mechanism, choice of adhesive system, indirect restorative material and light-curing device may affect the degree of conversion of the cement and, therefore, have an effect on the clinical performance of resin-based cements. Specific measures are to be taken to ensure a higher DC of the luting system to be used. PMID:26398507

  2. Physical activities and correlates of clinical nurses in Taipei municipal hospitals.

    PubMed

    Lee, Yuh-Shwu; Huang, Yi-Ching; Kao, Yu-Hsiu

    2005-12-01

    The purpose of this study was to investigate the physical activity profiles of clinical nurses in Taipei municipal hospitals. This study also explored the factors that influence physical activity, including personal background and social psychological factors. A total of 400 Taipei municipal hospital clinical nurses were selected using a randomized procedure to participate in a 3-day physical activity record assignment and fill in a structured questionnaire. Study results indicate that energy expenditure for clinical nurses on working days are higher than that on non-working days. Non-working days of clinical nurses are characterized by a lack of physical activity. Nurses who were required to take turns working in three shift rotation cycles, those with education at the junior college level or below, and those who were married tended to spend more energy on physical activity. Social psychological factors affecting the physical activities of clinical nurses include mainly exercise self-efficacy. Heavy work loading, poor health conditions, laziness, and lack of time tended to lower exercise self-efficacy. On non-working days, perceived barriers to exercise are the main issue area affecting moderate-to-vigorous physical activity. Nurses with greater perceived barriers to exercise spend less energy on physical activity. The main influencing factors for perceived barriers to exercise include laziness and lack of time. PMID:16372239

  3. Correlation of serum IgE levels and clinical manifestations in patients with actinic prurigo*

    PubMed Central

    Cuevas-Gonzalez, Juan Carlos; Lievanos-Estrada, Zahide; Vega-Memije, Maria Elisa; Hojyo-Tomoka, Maria Teresa; Dominguez-Soto, Luciano

    2016-01-01

    BACKGROUND: Actinic prurigo is an idiopathic photodermatosis, the pathophysiology of which has been hypothesized to involve subtype IV type b (Th2) hypersensitive response, whereby IL4, IL5, and IL13 are secreted and mediate the production of B cells, IgE, and IgG4. OBJECTIVES: To examine the association of serum IgE levels and the clinical severity of injuries. METHODS: This case-control study comprised patients with a clinical and histopathological diagnosis of actinic prurigo, as well as clinically healthy subjects, from whom 3cc of peripheral blood was taken for immunoassay. Cases were classified by lesion severity as mild, moderate, and severe. Descriptive statistics were analyzed, and chi-square test was performed. RESULTS: We included 21 actinic prurigo patients and 21 subjects without disease; 11 patients with actinic prurigo had elevated serum IgE levels, and 10 had low serum levels. Six actinic prurigo (AP) patients with elevated serum levels of IgE had moderate injuries, 4 had severe injuries, and 1 had minor injuries. Eight out of 10 patients with normal IgE levels presented with minor injuries in the clinical evaluation. The 21 controls did not have increased serum IgE levels. CONCLUSIONS: Elevated IgE levels are associated with moderate to severe clinical lesions, suggesting that actinic prurigo entails a type IV subtype b hypersensitivity response in which Th2 cells predominate. PMID:26982774

  4. Prevalence and clinical correlates of obsessive-compulsive disorder in schizophrenia.

    PubMed

    Devi, Sugnyani; Rao, Naren P; Badamath, Suresh; Chandrashekhar, C R; Janardhan Reddy, Y C

    2015-01-01

    Obsessive compulsive symptoms frequently occur in a substantial proportion of patients with schizophrenia. The term schizoobsessive has been proposed to delineate this subgroup of schizophrenia patients who present with obsessive-compulsive symptoms/disorder. However, whether this co-occurrence is more than just co-morbidity and represents a distinct subgroup remains controversial. A striking variation is noted across studies examining prevalence of obsessive-compulsive symptoms/disorder in schizophrenia patients and their impact on clinical profile of schizophrenia. Hence, in this study, we examined the prevalence of obsessive-compulsive symptoms/disorder in a large sample of consecutively hospitalized schizophrenia patients and compared the clinical and functional characteristics of schizophrenia patients with and without obsessive-compulsive symptoms/disorder. We evaluated 200 consecutive subjects with the DSM-IV diagnosis of schizophrenia using the Structured Clinical Interview for DSM-IV Axis I disorders, Positive and Negative Syndrome Scale, Yale-Brown Obsessive-Compulsive Scale, Brown Assessment of Beliefs Scale, Clinical Global Impression-Severity scale, Global Assessment of Functioning Scale, Family Interview for Genetic Studies and World Health Organization Quality of Life scale. The prevalence of obsessive-compulsive symptoms in patients with schizophrenia was 24% (n=48); 37 of them had obsessive-compulsive disorder (OCD) and 11 had obsessive-compulsive symptoms not amounting to a clinical diagnosis of OCD (OCS). Schizophrenia patients with OCS/OCD had an earlier age at onset of schizophrenia symptoms, lower positive symptoms score, higher co-morbidity with Axis II disorders, higher occurrence of OCD in family and better quality of life. Findings of the study indicate a higher prevalence of OCS/OCD in schizophrenia. Schizophrenia patients with and without OCS/OCD have comparable clinical profile with few exceptions. High rates of OCD in first degree relatives suggest possible genetic contributions and differences in neurobiology. Finally, evidence to consider schizoobsessive as a distinct diagnostic entity is inconclusive and warrants further studies. PMID:25308405

  5. HLA-B51 subtypes in Turkish patients with Behçet's disease and their correlation with clinical manifestations.

    PubMed

    Demirseren, D D; Ceylan, G G; Akoglu, G; Emre, S; Erten, S; Arman, A; Metin, A

    2014-01-01

    Behçet's disease (BD) is a multisystemic inflammatory disease believed to be triggered by microbial or environmental factors on a genetic platform. Clinically, it may have an impact on many body systems, including the mucocutaneous, ocular, articular, vascular, and neurological systems. In this study, we aimed to determine the HLA-B51 subtypes and their correlations with the clinical findings of BD. Fifty-one patients with BD and 44 gender- and age-matched healthy subjects were included in this study. The HLA-B51 subtypes of all participants were determined, and the correlations of the clinical manifestations of the disease with the HLA-B51 subtypes were analyzed. HLA-B51 positivity was found to be significantly higher in the patient group (P < 0.001, RR = 15.20), which had significantly more frequent HLA-B5101, HLA-B5102(01), HLA-B5109, and HLA-B5122 subtypes than the healthy subjects (all P < 0.05). Furthermore, considering the correlation between the genetic makeup and clinical findings, the HLA-B5109 subtype was found to be less frequent in patients with papulopustular skin lesions (P = 0.042). The frequency of HLA-B5103 was significantly higher in patients with central nervous system involvement (P = 0.015). There may be a relationship between HLA-B5102(01), HLA-B5109, and HLA-B5122 in addition to HLA-B51 and HLA-B5101(01) in Turkish patients with BD. The HLA-B5109 subtype can be protective against papulopustular lesion development; however, the HLA-B5103 subtype may pose a risk for neuro-Behçet development in BD. PMID:25062414

  6. Early Onset Recurrent Subtype of Adolescent Depression: Clinical and Psychosocial Correlates

    ERIC Educational Resources Information Center

    Hammen, Constance; Brennan, Patricia A.; Keenan-Miller, Danielle; Herr, Nathaniel R.

    2008-01-01

    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.…

  7. 21 CFR 320.28 - Correlation of bioavailability with an acute pharmacological effect or clinical evidence.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 5 2013-04-01 2013-04-01 false Correlation of bioavailability with an acute..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE BIOAVAILABILITY AND BIOEQUIVALENCE REQUIREMENTS Procedures for Determining the Bioavailability or Bioequivalence of Drug Products §...

  8. 21 CFR 320.28 - Correlation of bioavailability with an acute pharmacological effect or clinical evidence.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 5 2014-04-01 2014-04-01 false Correlation of bioavailability with an acute..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE BIOAVAILABILITY AND BIOEQUIVALENCE REQUIREMENTS Procedures for Determining the Bioavailability or Bioequivalence of Drug Products §...

  9. 21 CFR 320.28 - Correlation of bioavailability with an acute pharmacological effect or clinical evidence.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 5 2012-04-01 2012-04-01 false Correlation of bioavailability with an acute..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) DRUGS FOR HUMAN USE BIOAVAILABILITY AND BIOEQUIVALENCE REQUIREMENTS Procedures for Determining the Bioavailability or Bioequivalence of Drug Products §...

  10. Cerebral Dysfunctions Related to Perinatal Organic Damage: Clinical-Neuropathologic Correlations.

    ERIC Educational Resources Information Center

    Towbin, Abraham

    1978-01-01

    Recent neuropathology studies identify hypoxia as the main cause of perinatal cerebral damage. Cerebral lesions present at birth, with transition to chronic scar lesions, are correlated to mental retardation, cerebral palsy, epilepsy, and minimal brain dysfunction. Gestation age and severity of hypoxic exposure essentially determine the cerebral…

  11. Overdiagnosing of femoroacetabular impingement: correlation between clinical presentation and computed tomography in symptomatic patients☆

    PubMed Central

    Canella, Richard Prazeres; Adam, Guilherme Pradi; de Castillo, Roberto André Ulhôa; Codonho, Daniel; Ganev, Gerson Gandhi; de Vicenzi, Luiz Fernando

    2016-01-01

    Objective To correlate the angles between the acetabulum and the proximal femur in symptomatic patients with femoroacetabular impingement (FAI), using computed tomography (CT). Methods We retrospectively evaluated 103 hips from 103 patients, using multislice CT to measure the acetabular age, acetabular version (in its supraequatorial portion and in its middle third), femoral neck version, cervical-diaphyseal and alpha angles and the acetabular depth. For the statistical analysis, we used the Pearson correlation coefficient. Results There were inverse correlations between the following angles: (1) acetabular coverage versus alpha angle (p = 0.019); (2) acetabular version (supraequatorial) versus alpha angle (p = 0.049). For patients with femoral anteversion lower than 15 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.026); (2) acetabular version (middle third) versus alpha angle (p = 0.02). For patients with acetabular version (supraequatorial) lower than 10 degrees: (1) acetabular version (supraequatorial) versus alpha angle (p = 0.004); (2) acetabular version (middle third) versus alpha angle (p = 0.009). Conclusion There was a statistically significant inverse correlation between the acetabular version and alpha angles (the smaller the acetabular anteversion angle was, the larger the alpha angle was) in symptomatic patients, thus supporting the hypothesis that FAI occurs when cam and pincer findings due to acetabular retroversion are seen simultaneously, and that the latter alone does not cause FAI, which leads to overdiagnosis in these cases. PMID:27069890

  12. Clinical and Cognitive Correlates of Depressive Symptoms among Youth with Obsessive Compulsive Disorder

    ERIC Educational Resources Information Center

    Peris, Tara S.; Bergman, R. Lindsey; Asarnow, Joan R.; Langley, Audra; McCracken, James T.; Piacentini, John

    2010-01-01

    Depression is the most common comorbidity among adults with obsessive compulsive disorder (OCD), yet little is known about depressive symptoms in childhood OCD. This study examined clinical and cognitive variables associated with depressive symptomatology in 71 youths (62% male, M age = 12.7 years) with primary OCD. Youths presented with a range…

  13. Annual Research Review: Attachment Disorders in Early Childhood--Clinical Presentation, Causes, Correlates, and Treatment

    ERIC Educational Resources Information Center

    Zeanah, Charles H.; Gleason, Mary Margaret

    2015-01-01

    Background: Though noted in the clinical literature for more than 50 years, attachment disorders have been studied systematically only recently. In part because of the ubiquity of attachments in humans, determining when aberrant behavior is best explained as an attachment disorder as opposed to insecure attachment has led to some confusion. In…

  14. Cognitive Deficits in Geriatric Depression: Clinical Correlates and Implications for Current and Future Treatment

    PubMed Central

    Morimoto, Sarah Shizuko; Alexopoulos, George S.

    2013-01-01

    Synopsis The purpose of this article is to identify the cognitive deficits commonly associated with geriatric depression, and describe their clinical significance. We then summarize the complex relationship between geriatric depression and dementia and discuss possible shared mechanisms. Last, we present evidence regarding whether the cognitive deficits in depression may be mitigated with medication or with computerized cognitive remediation. PMID:24229654

  15. Clinical and Cognitive Correlates of Depressive Symptoms among Youth with Obsessive Compulsive Disorder

    ERIC Educational Resources Information Center

    Peris, Tara S.; Bergman, R. Lindsey; Asarnow, Joan R.; Langley, Audra; McCracken, James T.; Piacentini, John

    2010-01-01

    Depression is the most common comorbidity among adults with obsessive compulsive disorder (OCD), yet little is known about depressive symptoms in childhood OCD. This study examined clinical and cognitive variables associated with depressive symptomatology in 71 youths (62% male, M age = 12.7 years) with primary OCD. Youths presented with a range

  16. A Comparative Study of Clinical Correlates in Schizophrenia with Onset in Childhood, Adolescence and Adulthood

    ERIC Educational Resources Information Center

    Biswas, Parthasarathy; Malhotra, Savita; Malhotra, Anil; Gupta, Nitin

    2006-01-01

    Background: Childhood onset schizophrenia (COS) is a rare disorder. Comparative data on the effect of differential age of onset on clinical profile in schizophrenia are very few. Method: Subjects with COS (n = 15), adolescence onset schizophrenia (AdOS, n = 20) and adulthood onset schizophrenia (AOS, n = 20) were compared on socio-demographic,…

  17. Examining Psychosocial Correlates of Drug Involvement among Drug Clinic-Referred Youth.

    ERIC Educational Resources Information Center

    Winters, Ken C.; Latimer, William W.; Stinchfield, Randy D.; Henly, George A.

    1999-01-01

    Examines the validity of the conduct disorder hypothesis of adolescent drug involvement on a large drug clinic-referred sample (N=2,582). It was hypothesized that factors of delinquency would account for the most variance in drug use compared to three competing factors (psychological distress, nonconventional values, and family distress). Analyses…

  18. Correlation of findings in clinical and high resolution ultrasonography examinations of the painful shoulder

    PubMed Central

    Kyburz, Diego; Ciurea, Adrian; Dubs, Beat; Toniolo, Martin; Bisig, Samuel Pascal; Tamborrini, Giorgio

    2015-01-01

    Objective High resolution ultrasonography is a non-painful and non-invasive imaging technique which is useful for the assessment of shoulder pain causes, as clinical examination often does not allow an exact diagnosis. The aim of this study was to compare the findings of clinical examination and high resolution ultrasonography in patients presenting with painful shoulder. Methods Non-interventional observational study of 100 adult patients suffering from unilateral shoulder pain. Exclusion criteria were shoulder fractures, prior shoulder joint surgery and shoulder injections in the past month. The physicians performing the most common clinical shoulder examinations were blinded to the results of the high resolution ultrasonography and vice versa. Results In order to detect pathology of the m. supraspinatus tendon, the Hawkins and Kennedy impingement test showed the highest sensitivity (0.86) whereas the Jobe supraspinatus test showed the highest specificity (0.55). To identify m. subscapularis tendon pathology the Gerber lift off test showed a sensitivity of 1, whereas the belly press test showed the higher specificity (0.72). The infraspinatus test showed a high sensitivity (0.90) and specificity (0.74). All AC tests (painful arc IIa, AC joint tendernessb, cross body adduction stress testc) showed high specificities (a0.96, b0.99, c0.96). Evaluating the long biceps tendon, the palm up test showed the highest sensitivity (0.47) and the Yergason test the highest specificity (0.88). Conclusion Knowledge of sensitivity and specificity of various clinical tests is important for the interpretation of clinical examination test results. High resolution ultrasonography is needed in most cases to establish a clear diagnosis. PMID:26674725

  19. Level of Oxidative Stress Markers in Peri-Implant Crevicular Fluid and Their Correlation with Clinical Parameters

    PubMed Central

    Mousavi Jazi, Mahvash; Sadeghi Pour Rodsari, Hamid Reza

    2015-01-01

    Objectives: Increased levels of oxidative stress markers in periodontitis have been reported by recent studies. Malondialdehyde (MDA) and superoxide dismutase (SOD) are both increased during oxidative stress. The aim of this study was to detect and measure the level of oxidative stress markers in peri-implant crevicular fluid (PICF). Their correlation with peri-implant clinical parameters was investigated as well. Materials and Methods: PICF samples of 50 dental implants were collected in 31 patients. Peri-implant clinical parameters including probing pocket depth (PPD), gingival index (GI) and bleeding on probing (BOP) were recorded. Levels of oxidative stress markers including MDA, SOD and total antioxidant capacity (TAC) in PICF were determined. Results: Twenty four implants showed signs of inflammation and 26 implants had healthy peri-implant tissues. MDA and TAC were detected in all samples, but SOD was not detected around 31 implants. The differences between the two groups with respect to the levels of MDA, TAC and SOD in PICF were not statistically significant (P> 0.05). In addition, significant correlations were observed between PPD and TAC and MDA level (P<0.05). Conclusion: Significant correlations exist between PPD and level of MDA and TAC. Moreover, level of oxidative stress markers (MDA, SOD and TAC) in PICF does not significantly change in peri-implantitis compared to healthy implants. Measuring these markers in PICF does not seem to be helpful for discrimination of peri-implant health and disease status. PMID:26877729

  20. Clinical Correlates of the Weight Bias Internalization Scale in a Sample of Obese Adolescents Seeking Bariatric Surgery

    PubMed Central

    Roberto, Christina A.; Sysko, Robyn; Bush, Jennifer; Pearl, Rebecca; Puhl, Rebecca M.; Schvey, Natasha A.; Dovidio, John F.

    2012-01-01

    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 α = .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. PMID:21593805

  1. Gallium-67 scanning to stage the alveolitis of sarcoidosis: correlation with clinical studies, pulmonary function studies, and bronchoalveolar lavage

    SciTech Connect

    Line, B.R.; Hunninghake, G.W.; Keogh, B.A.; Jones, A.E.; Johnston, G.S.; Crystal, R.G.

    1981-04-01

    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.

  2. Gallium-67 scanning to stage the alveolitis of sarcoidosis: correlation with clinical studies, pulmonary function studies, and bronchoalveolar lavage

    SciTech Connect

    Line, B.R.; Hunninghake, G.W.; Keogh, B.A.; Jones, A.E.; Johnston, G.S.; Crystal, R.G.

    1981-04-01

    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.

  3. Evaluation of Humoral Immunity to Mycobacterium tuberculosis-Specific Antigens for Correlation with Clinical Status and Effective Vaccine Development

    PubMed Central

    Niki, Mamiko; Suzukawa, Maho; Akashi, Shunsuke; Nagai, Hideaki; Ohta, Ken; Inoue, Manabu; Niki, Makoto; Kaneko, Yukihiro; Morimoto, Kozo; Kurashima, Atsuyuki; Kitada, Seigo; Matsumoto, Sohkichi; Suzuki, Koichi; Hoshino, Yoshihiko

    2015-01-01

    Although tuberculosis remains a major global health problem, Bacille Calmette-Guérin (BCG) is the only available vaccine. However, BCG has limited applications, and a more effective vaccine is needed. Cellular mediated immunity (CMI) is thought to be the most important immune response for protection against Mycobacterium tuberculosis (Mtb). However, the recent failure of a clinical trial for a booster BCG vaccine and increasing evidence of antibody-mediated immunity prompted us to evaluate humoral immunity to Mtb-specific antigens. Using Enzyme-Linked ImmunoSpot and Enzyme-Linked ImmunoSorbent Assays, we observed less correlation of both CMI and IgG titers with patient clinical status, including serum concentration of C reactive protein. However, IgA titers against Mtb were significantly correlated with clinical status, suggesting that specific IgA antibodies protect against Mtb proliferation. In addition, in some cases, IgA antibody titers were significantly associated with the serum concentration of total albumin, which supports the idea that humoral immunity can be influenced by the nutritional status. Based on these observations, we propose that the induction of humoral immunity should be included as an option in TB vaccine development strategies. PMID:26568961

  4. Monitoring the response of lymphoma patients to therapy: correlation of abdominal CT findings with clinical course and histologic cell type

    SciTech Connect

    Oliver, T.W. Jr.; Bernardino, M.E.; Sones, P.J. Jr.

    1983-10-01

    A review was made of 365 abdominal computed tomographic (CT) examinations in 125 patients with a histologic diagnosis of lymphoma who had undergone CT before and after therapy. Clinical correlation immediately preceding the follow-up CT examination was obtained in 100 patients. In these 100 patients, five distinct subgroups emerged: (a) reduction in extent of disease without changes in internal nodal characteristics; (b) reduction in extent of disease with change in internal nodal characteristics; (c) no change in extent of disease and no change in internal nodal characteristics; (d) no change in extent of disease but change in internal nodal charateristics; and (e) disease progression. Changes in internal nodal architecture consisted of diminished attenuation or mesenteric stranding. A 91% correlation existed between the CT findings and the clinical course. Of those patients with a worsening clinical course, and follow-up CT studies suggesting a stable or improved response to therapy, relapse in the majority (57%) involved the central nervous system. The authors conclude that limited abdominal CT examination is satisfactory in the posttherapy follow-up of lymphoma patients.

  5. A clear correlation between WT1-specific Th response and clinical response in WT1 CTL epitope vaccination.

    PubMed

    Fujiki, Fumihiro; Oka, Yoshihiro; Kawakatsu, Mai; Tsuboi, Akihiro; Tanaka-Harada, Yukie; Hosen, Naoki; Nishida, Sumiyuki; Shirakata, Toshiaki; Nakajima, Hiroko; Tatsumi, Naoya; Hashimoto, Naoya; Taguchi, Tetsuya; Ueda, Satsuki; Nonomura, Norio; Takeda, Yutaka; Ito, Toshinori; Myoui, Akira; Izumoto, Shuichi; Maruno, Motohiko; Yoshimine, Toshiki; Noguchi, Shinzaburo; Okuyama, Akihiko; Kawase, Ichiro; Oji, Yusuke; Sugiyama, Haruo

    2010-06-01

    Clinical studies of WT1-targeted cancer vaccine are being performed. However, WT1-specific Th response in cancer patients remains unclear. Using quantitative real-time RT-PCR, we investigated IFN-gamma and IL-10 mRNA expression from Th cells by stimulation with helper peptide WT1(332). Seventeen patients, of whom 10 had achieved stable disease and the remaining 7 had progressive disease, were weekly vaccinated with WT1 CTL epitope (modified WT1(235)) and examined for WT1(332)-specific Th response. A clear correlation between WT1(332)-specific Th response and clinical response was observed at 4 weeks post-vaccination. In patients who responded, a clear inverse correlation between IL-10-type and IFN-gamma-type WT1(332)-specific Th response was detected at pre- and 4 weeks post-vaccination, and the shift of the Th response from IL-10-type dominancy at early phase to IFN-gamma-type dominancy at late phase was observed. From this study we concluded that occurrence of WT1(332)-specific Th response could predict good clinical response of WT1 CTL epitope vaccination. PMID:20651376

  6. Evaluation of Humoral Immunity to Mycobacterium tuberculosis-Specific Antigens for Correlation with Clinical Status and Effective Vaccine Development.

    PubMed

    Niki, Mamiko; Suzukawa, Maho; Akashi, Shunsuke; Nagai, Hideaki; Ohta, Ken; Inoue, Manabu; Niki, Makoto; Kaneko, Yukihiro; Morimoto, Kozo; Kurashima, Atsuyuki; Kitada, Seigo; Matsumoto, Sohkichi; Suzuki, Koichi; Hoshino, Yoshihiko

    2015-01-01

    Although tuberculosis remains a major global health problem, Bacille Calmette-Guérin (BCG) is the only available vaccine. However, BCG has limited applications, and a more effective vaccine is needed. Cellular mediated immunity (CMI) is thought to be the most important immune response for protection against Mycobacterium tuberculosis (Mtb). However, the recent failure of a clinical trial for a booster BCG vaccine and increasing evidence of antibody-mediated immunity prompted us to evaluate humoral immunity to Mtb-specific antigens. Using Enzyme-Linked ImmunoSpot and Enzyme-Linked ImmunoSorbent Assays, we observed less correlation of both CMI and IgG titers with patient clinical status, including serum concentration of C reactive protein. However, IgA titers against Mtb were significantly correlated with clinical status, suggesting that specific IgA antibodies protect against Mtb proliferation. In addition, in some cases, IgA antibody titers were significantly associated with the serum concentration of total albumin, which supports the idea that humoral immunity can be influenced by the nutritional status. Based on these observations, we propose that the induction of humoral immunity should be included as an option in TB vaccine development strategies. PMID:26568961

  7. Correlations between statistical models of robotically collected kinematics and clinical measures of upper extremity function.

    PubMed

    Rohafza, Maryam; Fluet, Gerard G; Qiu, Qinyin; Adamovich, Sergei

    2012-01-01

    One of the obstacles in the development of rehabilitation robotics has been inadequacy in the measurement of treatment effects due to interventions. A measurement tool that will efficiently produce a large reliable sample of measurements collected during a single session that can also produce a rich set of data which reflects a subject's ability to perform meaningful functional activities has not been developed. This paper presents three linear regression models generated from seven kinematic measures collected during the performance of virtually simulated rehabilitation activities that were integrated with haptic robots by 19 persons with upper extremity hemiparesis due to chronic stroke. One of these models demonstrated a statistically significant correlation with the subjects' scores on the Jebsen Test of Hand Function (JTHF), a battery of six standardized upper extremity functional activities. The second and third models demonstrated a statistically significant correlation with the subjects' change scores on the JTHF. PMID:23366834

  8. CYP24A1 Expression Inversely Correlates with Melanoma Progression: Clinic-Pathological Studies

    PubMed Central

    Brożyna, Anna A.; Jochymski, Cezary; Janjetovic, Zorica; Jóźwicki, Wojciech; Tuckey, Robert C.; Slominski, Andrzej T.

    2014-01-01

    The major role of 24-hydroxylase (CYP24A1) is to maintain 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) homeostasis. Recently, it has been discovered that CYP24A1 also catalyses the hydroxylation of 20(OH)D3, producing dihydroxy-derivatives that show very effective antitumorigenic activities. Previously we showed a negative correlation of vitamin D receptor (VDR) and CYP27B1 expression with progression, aggressiveness and overall or disease-free survivals of skin melanomas. Therefore, we analyzed CYP24A1 expression in relation to clinicopathomorphological features of nevi, skin melanomas and metastases. In melanocytic tumors, the level of CYP24A1 was higher than in the normal epidermis. The statistically highest mean CYP24A1 level was found in nevi and early stage melanomas. With melanoma progression, CYP24A1 levels decreased and in advanced stages were comparable to the normal epidermis and metastases. Furthermore, the CYP24A1 expression positively correlated with VDR and CYP27B1, and negatively correlated with mitotic activity. Lower CYP24A1 levels correlated with the presence of ulceration, necrosis, nodular type and amelanotic phenotypes. Moreover, a lack of detectable CYP24A1 expression was related to shorter overall and disease-free survival. In conclusion, the local vitamin D endocrine system affects melanoma behavior and an elevated level of CYP24A1 appears to have an important impact on the formation of melanocytic nevi and melanomagenesis, or progression, at early stages of tumor development. PMID:25334067

  9. Oestrogen receptor-alpha and -beta expression in breast implant capsules: experimental findings and clinical correlates.

    PubMed

    Persichetti, Paolo; Segreto, Francesco; Carotti, Simone; Marangi, Giovanni Francesco; Tosi, Daniele; Morini, Sergio

    2014-03-01

    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

  10. Neuroanatomical correlates of individual differences in social anxiety in a non-clinical population.

    PubMed

    Tian, Xue; Hou, Xin; Wang, Kangcheng; Wei, Dongtao; Qiu, Jiang

    2016-08-01

    Socially anxious individuals are characterized as those with distorted negative self-beliefs (NSBs), which are thought to enhance reactions of social distress (emotional reactivity) and social avoidance (social functioning). However, it remains unclear whether individual differences in social distress and social avoidance are represented by differences in brain morphometry. To probe into these neural correlates, we analyzed magnetic resonance images of a sample of 130 healthy subjects and used the Connectome Computation System (CCS) to evaluate these factors. The results showed that social distress was correlated with the cortical volume of the right orbitofrontal cortex (OFC) and the subcortical volume of the left amygdala, while social avoidance was correlated with the cortical volume of the right dorsolateral prefrontal cortex (DLPFC). Additionally, loneliness might mediate the relationship between the amygdala volume and the social distress score. Our results demonstrated that social distress and social avoidance were represented by segregated cortical regions in the healthy individuals. These findings might provide a valuable basis for understanding the stable brain structures underlying individual differences in social anxiety. PMID:26442578

  11. Ileostomy obstruction by ingested apricot stone with clinical-radiological-pathological correlation.

    PubMed

    George, A J; Fallaize, R C; Bennett, J; Shabbir, J

    2015-01-01

    Patients with stomas often present with bowel obstruction, often secondary to adhesions. This case describes the presentation, investigation and management of a 62-year-old woman with an end ileostomy, who presented to hospital with acute abdominal pain and subacute bowel obstruction. Further questioning revealed the recent ingestion of an apricot stone and this was identified by multimodality imaging as the cause of the luminal obstruction in the distal ileum, just proximal to the stoma. After a failed period of conservative management, examination under anaesthesia was performed and digital extraction attempted, but this was unsuccessful. Rather than surgical stoma revision, endoscopic removal was achieved. The patient improved and was discharged the following day. However, her small bowel obstruction relapsed within 48 h. She was readmitted and underwent stoma revision with no further problems. PMID:26374775

  12. Correlating magnetic resonance findings with neuropathology and clinical signs in dogs and cats

    PubMed Central

    Vite, Charles H.; Cross, Johnny R.

    2011-01-01

    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. PMID:21392153

  13. Kimura's disease revisited: report of a case with a clinical and cytohistological correlation.

    PubMed

    Chaudhary, Ramkaran; Elhence, Poonam; Porwal, Pankaj

    2016-01-01

    Kimura's disease (KD) is a rare chronic inflammatory disorder of unknown aetiology. The common mode of clinical presentation is in the form of painless subcutaneous nodules usually seen in the head and neck region and is associated with regional lymphadenopathy and occasional involvement of the major salivary glands. It is often accompanied by peripheral eosinophilia and markedly elevated serum IgE levels. Histologically, it is characterised by reactive lymphoid follicles with eosinophilic infiltration, sometimes forming eosinophilic abscesses and prominent postcapillary venules. There is no consensus about optimal treatment of this disease in the reported literature. This condition seldom resolves spontaneously but the prognosis is good. Malignant transformation has not been reported. Early diagnosis of KD could spare the patient unnecessary and potentially harmful diagnostic procedures. A high index of clinical suspicion can help in diagnosing this disease and aid in better management. PMID:27009194

  14. Prenatal genetic diagnosis of retinoblastoma – clinical correlates on follow-up

    PubMed Central

    Neriyanuri, Srividya; Raman, Rajiv; Rishi, Pukhraj; Govindasamy, Kumaramanickavel; Ramprasad, V L; Sharma, Tarun

    2015-01-01

    Retinoblastoma is the most common malignant intraocular tumor in pediatric age group if undetected leads to ocular mortality. Prenatal diagnosis is an emerging technology to detect fatal diseases in utero such that subsequent management is planned to reduce the ocular morbidity. We describe a case demonstrating the importance of prenatal diagnosis in a child with a strong family history of retinoblastoma and importance of a long-term clinical follow-up in these cases. PMID:26632134

  15. Retrospective study of colorectal cancer in Zimbabwe: Colonoscopic and clinical correlates

    PubMed Central

    Katsidzira, Leolin; Gangaidzo, Innocent Tichaona; Mapingure, Munyaradzi Paul; Matenga, Jonathan Arthur

    2015-01-01

    AIM: To compare differences in the frequency of colorectal cancer at colonoscopy in Zimbabwe according to ethnicity. METHODS: All lower gastrointestinal endoscopic procedures performed between January 2006 and December 2011 at a gastroenterology clinic in Harare, Zimbabwe were reviewed. The demographic characteristics, clinical indications, differences in bowel preparation and the endoscopic and histological diagnoses were compared between different ethnic groups with emphasis on colorectal cancer. The clinical and demographic characteristics and the endoscopic findings were compared using the student t-test and the χ2 test, while the clinical indications associated with a diagnosis of colorectal cancer were determined by logistic regression. RESULTS: All colonoscopies and sigmoidoscopies performed in 1236 Caucasians, 460 black Africans and 109 Asians were analysed. Colorectal cancer was diagnosed more frequently in the black African patients compared to Caucasians or Asians (10% vs 3%, 10% vs 2%, P < 0.001). However, polyps were less common among black Africans (5%) compared to both Caucasians (8%) and Asians (9%) (P = 0.03). Among patients with colorectal cancer, black Africans tended to be younger than Caucasians, who were over-represented in the oldest age category; 32 % vs 2% were less than 50 years and 41% vs 78% were older than 60 years (P < 0.001). Anaemia and weight loss were associated with colorectal cancer in both black African [odds ratio (OR): 2.73 (95%CI: 1.33-5.61) and 3.09 (1.35-7.07)] and Caucasian patients [OR: 6.65 (95%CI: 2.93-15.09) and 3.47 (1.52-7.94)]. CONCLUSION: The likelihood of diagnosing colorectal cancer in patients referred for colonoscopy in Zimbabwe is at least as likely among black Africans as it is among Caucasians. PMID:25741144

  16. Hemophilus influenzae pneumonia in the adult: radiographic appearance with clinical correlation

    SciTech Connect

    Pearlberg, J.; Haggar, A.M.; Saravolatz, L.; Beute, G.H.; Popovich, J.

    1984-04-01

    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 were no signs of lobar expansion, bulging fissures, or cavitation. In general, predisposing factors such as alcoholism and chemotherapy place patients at risk. Radiographic response to therapy is variable but often lags behind clinical improvement.

  17. Correlations between Clinical Features and Mortality in Patients with Vibrio vulnificus Infection

    PubMed Central

    Zhao, Hong; Xu, Lichen; Dong, Huihui; Hu, Jianhua; Gao, Hainv; Yang, Meifang; Zhang, Xuan; Chen, Xiaoming; Fan, Jun; Ma, Weihang

    2015-01-01

    Vibrio vulnificus is a common gram-negative bacterium, which might cause morbidity and mortality in patients following consumption of seafood or exposure to seawater in Southeast China. We retrospectively analyzed clinical data of patients with laboratory confirmed V. vulnificus infection. Twenty one patients were divided into a survival group and a non-surviving (or death) group according to their clinical outcome. Clinical data and measurements were statistically analyzed. Four patients (19.05%) died and five patients gave positive cultures from bile fluid, and 16 other patients gave positive culture from blood or blisters. Ten patients (47.62%) had an underlying liver disease and marine-related events were found in sixteen patients (76.2%). Patients with heavy drinking habits might be at increased mortality (p = 0.028). Clinical manifestations of cellulitis (47.6%), septic shock (42.9%) and multiple organ failure (28.6%) were statistically significant when comparing survivors and non-survivors (p = 0.035, p = 0.021 and p = 0.003, respectively). The laboratory results, including hemoglobin < 9.0 g/L (p = 0.012), platelets < 2.0×109 /L, prothrombin time activity (PTA) <20%, decreased serum creatinine and increased urea nitrogen were statistically significant (p = 0.012, p = 0.003, p = 0.028 and p = 0.028, respectively). Patients may be at a higher risk of mortality under situations where they have a history of habitual heavy alcoholic drink consumption (p = 0.028, OR = 22.5, 95%CI 1.5–335.3), accompanied with cellulitis, shock, multiple organ failure, and laboratory examinations that are complicated by decreased platelets, hemoglobin and significantly prolonged prothrombin time (PT). PMID:26274504

  18. Multiparametric MRI of the anterior prostate gland: clinical-radiological-histopathological correlation.

    PubMed

    Moosavi, B; Flood, T A; Al-Dandan, O; Breau, R H; Cagiannos, I; Morash, C; Malone, S C; Schieda, N

    2016-05-01

    Anterior prostate cancer (APC) is defined as a tumour in which more than half of malignant tissue is located anterior to the urethra. APCs are increasingly recognized as clinically important, particularly in patients undergoing active surveillance and for patients with negative non-targeted systematic transrectal ultrasound (TRUS)-guided biopsies but with persistent clinical suspicion of cancer. Multiparametric (mp) MRI has a crucial role for the diagnosis of anterior tumours, eventual histological sampling of suspicious lesions using image-guided targeted biopsy techniques, and potentially, to improve local staging of disease. mpMRI is accurate for the detection of APC and for differentiation of tumour from other anterior prostatic structures including benign prostatic hyperplasia (BPH) and the anterior fibromuscular stroma (AFMS). Characterization and reporting of APC should rely on the recently revised Prostate Imaging and Data Reporting System (PI-RADS) version 2.0 document. T2-weighted (T2W) imaging is emphasized as the determining sequence for assessment of the anterior prostate and specific features for APC on T2W imaging include: ill-defined/spiculated margin, lenticular shape, anterior/inferior location, and growth pattern (invasion of urethra or AFMS and crossing midline). Functional imaging, mainly with diffusion-weighted imaging, is also contributory and improves the sensitivity for detection of APC compared to T2W imaging alone. APCs commonly show positive surgical margins after radical prostatectomy and staging of disease extent using conventional clinical parameters is limited. mpMRI may have a future role to improve local staging of APC. This review illustrates the importance of mpMRI in APC using a clinical-radiological-histopathological approach. PMID:26888762

  19. Social and clinical correlates of the persistence of psychotic experiences in the general population.

    PubMed

    DeVylder, Jordan E; Lehmann, Meshan; Chen, Fang-pei

    2015-12-01

    Recent epidemiological evidence suggests that sub-threshold psychotic experiences commonly occur in the general population. When these experiences persist over time, they may increase risk for psychotic disorder or lead to other clinical or functional impairments. The aims of this study were to distinguish the relative importance of sociodemographic factors and clinical factors, including characteristics of the psychotic experiences themselves, in determining the course of psychotic symptoms over time. Participants were drawn from the Collaborative Psychiatric Epidemiology Surveys. We tested for retrospectively-reported predictors of current psychotic experiences among individuals who reported lifetime psychotic experiences, with onset prior to the past year (n=921), using logistic regression. Persistence was primarily related to demographic variables, with lower odds associated with being married and having at least a college education. Individuals reporting prior to the past year auditory hallucinations were more likely to have persistent psychotic experiences than those reporting other types of psychotic experiences. Interventions aiming at strengthening family support and social skills may reduce the likelihood of persistence among individuals with psychotic experiences, thereby reducing risk for psychotic disorders and other related outcomes. Future studies should continue to identify predictors of persistence versus remission and further explore clinical services for those with persistent psychotic experiences. PMID:26386897

  20. Clinical-physiologic correlates of Alzheimer's disease and frontal lobe dementia

    SciTech Connect

    Jagust, W.J.; Reed, B.R.; Seab, J.P.; Kramer, J.H.; Budinger, T.F. )

    1989-01-01

    Thirty patients with degenerative dementia underwent clinical evaluation, neuropsychological testing, and single photon emission computed tomography (SPECT) with the blood flow tracer ({sup 123}I)-N-isopropyl-p-iodoamphetamine. Five of these patients were clinically and psychologically different from the others, demonstrating predominant behavioral disturbances with relative preservation of memory function. These five patients, who were felt to have a frontal lobe dementia (FLD), showed SPECT perfusion patterns which differed from the remaining 25 patients, who were diagnosed as having Alzheimer's disease (AD), and from 16 healthy control subjects. The FLD patients showed diminished perfusion in orbitofrontal, dorsolateral frontal, and temporal cortex relative to controls, while the AD patients showed lower perfusion in temporal and parietal cortex than controls. The FLD patients also showed hypoperfusion in both frontal cortical regions relative to AD patients. The pattern of performance on neuropsychological testing paralleled these differences in regional perfusion. These results suggest that clinical evaluation and physiological imaging may enable the differentiation of groups of degenerative dementia patients during life.

  1. Magnetic resonance imaging of periventricular leukomalacia and its clinical correlation in children.

    PubMed

    Olsén, P; Pääkkö, E; Vainionpää, L; Pyhtinen, J; Järvelin, M R

    1997-06-01

    The prevalence of periventricular leukomalacia and its association with clinical neurological signs in school-age preterm children are unknown. We matched 42 eight-year-old children who were born before term with birth weights lower than 1,750 gm (mean, 1,410 gm; gestational age, 31 weeks) with 42 children who were born at term and of normal birth weight, to compare clinical neurological status and magnetic resonance imaging findings. Of the children born prematurely, 9.5% had cerebral palsy and 31% had minor neurological dysfunction whereas 9% of the children born at term had minor neurological dysfunction and none had cerebral palsy. Deviations in tongue movements, heel walking. Fogs test results, and finger opposition, as well as behavioral disturbances, differentiated the preterm from the full-teem group. The prevalence of periventricular leukomalacia among all children born prematurely was 32%. It was observed in all children with cerebral palsy, in 25% with minor neurological dysfunction, and in 25% of the clinically healthy preterm children. None of the children born at term had evidence of periventricular leukomalacia. Children with periventricular leukomalacia especially demonstrated poor performance on heel walking and Fogs test. Though commonly found in preterm children, periventricular leukomalacia is not uniformly associated with abnormal neurological findings. A thorough neurological examination is a better predictor of later developmental problems than is magnetic resonance imaging. PMID:9189036

  2. The inflammatory phenotype of the fibrous plate is distinct from the liver and correlates with clinical outcome in biliary atresia.

    PubMed

    Arva, Nicoleta C; Russo, Pierre A; Erlichman, Jessi; Hancock, Wayne W; Haber, Barbara A; Bhatti, Tricia R

    2015-03-01

    Biliary atresia is an inflammatory cholangiopathy of still undetermined etiology. Correlations between histologic findings and clinical outcome in this disease have largely been based on evaluation of liver parenchyma. This study aimed to characterize the pattern of inflammation within the biliary remnant and identify associations between the type and degree of inflammation and clinical outcome as reflected by the transplant-free interval. The inflammation within the fibrous plates and livers of 41 patients with biliary atresia was characterized using immunohistochemical markers and the cell populations were digitally quantified. The type and quantity of cells within the infiltrate were then correlated with length of time from Kasai portoenterostomy until transplant. Histologic and immunohistochemical features of the biliary remnant allowed stratification of patients into "inflammatory plate" and "fibrotic plate" groups. Overall there was no significant difference in transplant-free interval between the two cohorts; however, there was a trend towards a longer time to transplant among patients in the "fibrotic plate" group. In addition, the composition of the inflammatory infiltrate in the fibrous plate was distinctly different from that present in the liver and only the characteristics of the inflammation in the fibrous plate, in particular the number of Foxp3+ T regulatory lymphocytes correlated with clinical outcome. The results of this study support the view of the extra-hepatic biliary tree as the primary site of injury in BA with the changes seen in the liver as secondary manifestations of outflow obstruction. The association between specific inflammatory cell subtypes within the fibrous plate and the length of transplant-free interval also supports the role of the immune system in the initial process of bile duct damage in biliary atresia. PMID:25624184

  3. Some youths have a gloomy side: correlates of the dark triad personality traits in non-clinical adolescents.

    PubMed

    Muris, Peter; Meesters, Cor; Timmermans, Anke

    2013-10-01

    This cross-sectional study examined the Dark Triad personality traits and their correlates in non-clinical youths aged 12-18 years (N = 117). Child- and parent-report data were obtained on Machiavellianism, narcissism, and psychopathy as well as on Big Five personality factors and symptoms of aggression and delinquency. Results indicated that especially Machiavellianism and psychopathy were in a theoretically meaningful way related to Big Five factors: that is, both traits were associated with lower levels of agreeableness, conscientiousness, and openness/intellect, and higher levels of emotional instability. Further, Machiavellianism and psychopathy also emerged as significant and unique correlates of symptoms of aggression and delinquency, which further underlines the importance of these Dark Triad traits in the pathogenesis of disruptive behavior problems in youths. PMID:23334267

  4. Acquired hepatocerebral degeneration and hepatic encephalopathy: correlations and variety of clinical presentations in overt and subclinical liver disease.

    PubMed

    Romeiro, Fernando G; Américo, Madileine F; Yamashiro, Fábio S; Caramori, Carlos A; Schelp, Arthur O; Santos, Antonio C; Silva, Giovanni F

    2011-06-01

    Acquired hepatocerebral degeneration (AHD) and hepatolenticular degeneration can have similar clinical presentations, but when a chronic liver disease and atypical motor findings coexist, the distinction between AHD and hepatic encephalopathy (HE) can be even more complicated. We describe three cases of AHD (two having HE) with different neuroimaging findings, distinct hepatic diseases and similar motor presentations, all presenting chronic arterial hypertension and weight loss before the disease manifestations. The diagnosis and physiopathology are commented upon and compared with previous reports. In conclusion, there are many correlations among HE, hepatolenticular degeneration and AHD, but the overlapping of AHD and HE could be more common depending on the clinical knowledge and diagnostic criteria adopted for each condition. Since AHD is not considered a priority that affects the liver transplant list, the prognosis in AHD patients remains poor, and flow interruption in portosystemic shunts must always be taken into account. PMID:21755129

  5. Current views on the etiopathogenesis, clinical manifestation, diagnostics, treatment and correlation with other nosological entities of SIBO.

    PubMed

    Miazga, Angelika; Osiński, Maciej; Cichy, Wojciech; Żaba, Ryszard

    2015-03-01

    Small intestinal bacterial overgrowth (SIBO) is a disease of great clinical and socioeconomic importance caused by an excessive amount of bacteria in the upper alimentary tract. Physiological microbiota are replaced by pathogenic bacteria mainly from large intestine, which is called dysbacteriosis. SIBO disturbs digestion and absorption in the alimentary tract, which seems to cause inflammation. SIBO affects the morphology and function of the digestive system and causes systemic complications (e.g. osteoporosis, macrocytic anemia). Inflammation interferes with gene expression responsible for producing and secreting mucus, therefore, a correlation between SIBO and cystic fibrosis, irritable bowel syndrome and chronic abdominal pain are postulated. All conditions leading to bacterial growth such as congenital and anatomical abnormalities in the digestive tract, motility disorder or immunological deficits are risk factors of SIBO. A typical clinical manifestation of SIBO comprises meteorism, enterectasia, abdominal discomfort and diarrhea. Diagnostic procedures such as glucose, lactulose, methane, 13C mixed triglyceride breath tests are being used in diagnosing SIBO. PMID:25657082

  6. Clinical and histopathological correlations of fecal calprotectin release in colorectal carcinoma

    PubMed Central

    Lehmann, Frank Serge; Trapani, Francesca; Fueglistaler, Ida; Terracciano, Luigi Maria; von Flüe, Markus; Cathomas, Gieri; Zettl, Andreas; Benkert, Pascal; Oertli, Daniel; Beglinger, Christoph

    2014-01-01

    AIM: To determine calprotectin release before and after colorectal cancer operation and compare it to tumor and histopathological parameters. METHODS: The study was performed on patients with diagnosed colorectal cancer admitted for operation. Calprotectin was measured in a single stool sample before and three months after the operation using an enzyme-linked immunosorbent assay (ELISA). Calprotectin levels greater than or equal to 50 μg/g were considered positive. The compliance for collecting stool samples was assessed and the value of calprotectin was correlated to tumor and histopathological parameters of intra- and peri-tumoral inflammation. Surgical specimens were fixed in neutral buffered formalin and stained with hematoxylin and eosin. Staging was performed according to the Dukes classification system and the 7th edition tumor node metastasis classification system. Intra- and peri-tumoral inflammation was graded according to the Klintrup criteria. Immunohistochemical quantification was performed for MPO, CD45R0, TIA-1, CD3, CD4, CD8, CD57, and granzyme B. Statistical significance was measured using Wilcoxon signed rank test, Kruskal Wallis test and Spearman’s rank correlation coefficient as appropriate. RESULTS: Between March 2009 and May 2011, 80 patients with colorectal cancer (46 men and 34 women, with mean age of 71 ± 11.7 years old) were enrolled in the study. Twenty-six patients had rectal carcinoma, 29 had left-side tumors, 23 had right-side tumors, and 2 had bilateral carcinoma. In total, 71.2% of the patients had increased levels of calprotectin before the operation (median 205 μg/g, range 50-2405 μg/g) and experienced a significant decrease three months after the operation (46 μg/g, range 10-384 μg/g, P < 0001). The compliance for collecting stool samples was 89.5%. Patients with T3 and T4 tumors had significantly higher values than those with T1 and T2 cancers (P = 0.022). For all other tumor parameters (N, M, G, L, V, Pn) and location, no significant difference in calprotectin concentration was found. Furthermore, the calprotectin levels and histological grading of both peri- and intra-tumoral inflammation was not correlated. Additional testing with specific markers for lymphocytes and neutrophils also revealed no statistically significant correlation. CONCLUSION: Fecal calprotectin decreases significantly after colorectal cancer operation. Its value depends exclusively on the individual T-stage, but not on other tumor or histopathological parameters. PMID:24803811

  7. Wisconsin Card Sorting Test scores and clinical and sociodemographic correlates in Schizophrenia: multiple logistic regression analysis

    PubMed Central

    Banno, Masahiro; Koide, Takayoshi; Aleksic, Branko; Okada, Takashi; Kikuchi, Tsutomu; Kohmura, Kunihiro; Adachi, Yasunori; Kawano, Naoko; Iidaka, Tetsuya; Ozaki, Norio

    2012-01-01

    Objectives This study investigated what clinical and sociodemographic factors affected Wisconsin Card Sorting Test (WCST) factor scores of patients with schizophrenia to evaluate parameters or items of the WCST. Design Cross-sectional study. Setting Patients with schizophrenia from three hospitals participated. Participants Participants were recruited from July 2009 to August 2011. 131 Japanese patients with schizophrenia (84 men and 47 women, 43.5±13.8 years (mean±SD)) entered and completed the study. Participants were recruited in the study if they (1) met DSM-IV criteria for schizophrenia; (2) were physically healthy and (3) had no mood disorders, substance abuse, neurodevelopmental disorders, epilepsy or mental retardation. We examined their basic clinical and sociodemographic factors (sex, age, education years, age of onset, duration of illness, chlorpromazine equivalent doses and the positive and negative syndrome scale (PANSS) scores). Primary and secondary outcome measures All patients carried out the WCST Keio version. Five indicators were calculated, including categories achieved (CA), perseverative errors in Milner (PEM) and Nelson (PEN), total errors (TE) and difficulties of maintaining set (DMS). From the principal component analysis, we identified two factors (1 and 2). We assessed the relationship between these factor scores and clinical and sociodemographic factors, using multiple logistic regression analysis. Results Factor 1 was mainly composed of CA, PEM, PEN and TE. Factor 2 was mainly composed of DMS. The factor 1 score was affected by age, education years and the PANSS negative scale score. The factor 2 score was affected by duration of illness. Conclusions Age, education years, PANSS negative scale score and duration of illness affected WCST factor scores in patients with schizophrenia. Using WCST factor scores may reduce the possibility of type I errors due to multiple comparisons. PMID:23135537

  8. Lymphomatoid granulomatosis, a single institute experience: pathologic findings and clinical correlations

    PubMed Central

    Song, Joo Y.; Pittaluga, Stefania; Dunleavy, Kieron; Grant, Nicole; White, Therese; Jiang, Liuyan; Davies-Hill, Theresa; Raffeld, Mark; Wilson, Wyndham H.; Jaffe, Elaine S.

    2014-01-01

    Lymphomatoid granulomatosis (LYG) is a rare angiocentric and angiodestructive EBV-associated B-cell lymphoproliferative disorder. It is hypothesized that these patients have dysregulated immune surveillance of EBV. We reviewed the biopsies of 55 patients with LYG who were referred for a prospective trial at the NCI (19952010) and evaluated the histologic, immunohistochemical, in situ hybridization, and molecular findings of these biopsies in conjunction with clinical information. Grading of the lesions was based on morphologic features and the number of EBV-positive B cells. The median age was 46 years (M:F 2.2:1). Clinically, all patients had lung involvement (100%) with the next most common site being the central nervous system (38%). No patient had nodal or bone marrow disease. All patients had past EBV exposure by serology but with a low median EBV viral load. We reviewed 122 biopsies; the most common site was lung (73%) followed by skin/subcutaneous tissue (17%); other sites included kidney, nasal cavity, gastrointestinal tract, conjunctiva, liver, and adrenal gland. Histologically the lesions showed angiocentricity, were rich in T cells, had large atypical B cells, and were positive for EBV. Grading was performed predominantly on the lung biopsy at diagnosis; they were distributed as follows: LYG grade 1 (30%), grade 2 (22%), and grade 3 (48%). Necrosis was seen in all grades with a greater degree in high-grade lesions. Immunoglobulin gene rearrangement studies were performed and a higher percentage of clonal rearrangements were seen in LYG grade 2 (50%) and grade 3 (69%) as compared to grade 1 (8%). LYG is a distinct entity that can usually be differentiated from other EBV-associated B-cell lymphoproliferative disorders based on the combination of clinical presentation, histology, and EBV studies. Grading of these lesions is important because it dictates the treatment choice. PMID:25321327

  9. Clinical and sociodemographic correlates of suicidality in patients with major depressive disorder from six Asian countries

    PubMed Central

    2014-01-01

    Background East Asian countries have high suicide rates. However, little is known about clinical and sociodemographic factors associated with suicidality in Asian populations. The aim of this study was to evaluate the factors associated with suicidality in patients with major depressive disorder (MDD) from six Asian countries. Methods The study cohort consisted of 547 outpatients with MDD. Patients presented to study sites in China (n = 114), South Korea (n = 101), Malaysia (n = 90), Singapore (n = 40), Thailand (n = 103), and Taiwan (n = 99). All patients completed the Mini-International Neuropsychiatric Interview (MINI), the Montgomery–Asberg Depression Rating Scale (MADRS), the Global Severity Index(SCL-90R), the Fatigue Severity Scale, the 36-item short-form health survey, the Sheehan Disability Scale, and the Multidimensional Scale of Perceived Social Support (MSPSS). Patients were classified as showing high suicidality if they scored ≥6 on the MINI suicidality module. Multivariate logistic regression analysis was used to examine sociodemographic and clinical factors related to high suicidality. Results One hundred and twenty-five patients were classed as high suicidality. Unemployed status (adjusted odds ratio [OR] 2.43, p < 0.01), MADRS score (adjusted OR 1.08), p < 0.001, and GSI (SCL-90R) score (adjusted OR 1.06, p < 0.01) were positively related to high suicidality. Hindu (adjusted OR 0.09, p < 0.05) or Muslim (adjusted OR 0.21, p < 0.001) religion and MSPSS score (adjusted OR 0.82, p < 0.05) were protective against high suicidality. Conclusions A variety of sociodemographic and clinical factors were associated with high suicidality in Asian patients with MDD. These factors may facilitate the identification of MDD patients at risk of suicide. PMID:24524225

  10. Ultrasound Findings in Hand Joints Involvement in Patients with Psoriatic Arthritis and Its Correlation with Clinical DAS28 Score

    PubMed Central

    Naranje, Priyanka; Prakash, Mahesh; Sharma, Aman; Dogra, Sunil; Khandelwal, Niranjan

    2015-01-01

    Objective. To determine the frequency of the various ultrasound findings in hand joints in patients with psoriatic arthritis and correlate grayscale and Power Doppler ultrasonography findings with Disease Activity Score 28. Methods. This prospective study was performed in 30 patients. Ultrasound evaluation of 28 joints of both hands was undertaken and various findings were recorded including synovial hypertrophy, Power Doppler abnormality, soft tissue thickening, tendonitis, joint effusion, periosteal reaction, and erosions. Composite ultrasound scores and Disease Activity Score 28 were calculated and compared. Spearman correlation was used to see relationship between the ultrasound and DAS28 scores. Results. Ultrasound detected more abnormalities in the hand joints than did clinical examination. The frequency of various ultrasound abnormalities was as follows: Synovial hypertrophy was seen in 100%, Power Doppler abnormality suggesting hypervascularity was seen in 36.7%, soft tissue thickening was seen in 66.7%, periosteal reaction was seen in 33.3%, erosions were seen in 30% (mostly in DIP and PIP joints), and flexor tendonitis was seen in 6.7% of patients. Significant correlation was found between Disease Activity Score 28 and grayscale joint score (GSJS) (Spearman's ρ: 0.499; P: 0.005), grayscale joint count (GSJC) (ρ: 0.398; P: 0.029), and Power Doppler joint score (PDJS) (ρ: 0.367; P: 0.046). There was a statistically significant difference between remission and low disease activity group and moderate disease activity group in terms of GSJC, GSJS, PDJC, and PDJS (P < 0.05). These ultrasound measures were higher in moderate disease activity zone patients. Conclusion. Ultrasound is a useful modality for the objective assessment of psoriatic arthritis. Ultrasound including Power Doppler can be used as a modality for assessment of severity of psoriatic arthritis as it correlates with the clinical scoring. PMID:26858846

  11. Reversible paralysis with status asthmaticus, steroids, and pancuronium: clinical electrophysiological correlates.

    PubMed

    Road, J; Mackie, G; Jiang, T X; Stewart, H; Eisen, A

    1997-12-01

    Prolonged neuromuscular weakness has been identified after neuromuscular blockade in intensive care unit patients on mechanical ventilation. Previously reported electromyographic studies in these patients documented both neurogenic features and features consistent with a myopathy. We recorded sequential electrophysiological parameters during recovery from neuromuscular blockade in 5 patients with clinical weakness. An evolving pattern was identified. The early features were in keeping with previous reports of neurogenic changes, and this evolved into features consistent with a primary myopathy. Several potential underlying mechanisms are discussed. PMID:9390673

  12. Using base rates and correlational data to supplement clinical risk assessments.

    PubMed

    Davis, Jaya; Sorensen, Jon R

    2013-01-01

    The current study is a partial replication of previous studies designed to estimate the level of risk posed by capital murder defendants. The study draws on data describing the behavior of nearly 2,000 incarcerated capital murderers to forecast violence propensity among defendants sentenced to life imprisonment. Logistic regression is used to model various violence outcomes, relying on the following predictors: age, educational attainment, prior imprisonment, and gang affiliation. This exercise is designed to illustrate how actuarial data may be used to anchor individualized clinical assessments of risk in capital murder trials. PMID:24051592

  13. Alterations in Platelet Functions During Aging: Clinical Correlations with Thrombo-Inflammatory Disease in Older Adults

    PubMed Central

    Mohebali, Donya; Kaplan, David; Carlisle, McKenzie; Supiano, Mark A.; Rondina, Matthew T.

    2014-01-01

    Platelets possess a dynamic functional repertoire that mediates hemostatic and inflammatory responses. Many of these functions are altered in older adults, promoting a pro-thrombotic and pro-inflammatory milieu and contributing to an increased risk of adverse clinical events. This review summarizes, drawing primarily from human studies, key aspects of aging-related changes in platelets. The relationship between altered platelet functions and thrombotic and inflammatory disorders in older adults is highlighted. Established and developing anti-platelet therapies for the treatment of thrombotic and inflammatory disorders are also discussed in light of these data. PMID:24512275

  14. Inflammatory infiltration into placentas of Neospora caninum challenged cattle correlates with clinical outcome of pregnancy

    PubMed Central

    2014-01-01

    Infection with Neospora caninum stimulates host cell-mediated immune responses, which may be responsible for placental damage leading to bovine abortion. The aim of this study was to compare immune responses in the bovine placenta, following experimental infection in different stages of pregnancy. Placentomes were examined by immunohistochemistry and inflammation in early gestation was generally moderate to severe, particularly in the placentas carrying non-viable foetuses, whereas it was milder in later stages, mainly characterised by the presence of CD3+, CD4+ and γδ T-cells. This distinctive cellular immune response may explain the milder clinical outcome observed when animals are infected in later gestation. PMID:24484200

  15. Inflammatory infiltration into placentas of Neospora caninum challenged cattle correlates with clinical outcome of pregnancy.

    PubMed

    Cantón, Germán J; Katzer, Frank; Maley, Stephen W; Bartley, Paul M; Benavides-Silván, Julio; Palarea-Albaladejo, Javier; Pang, Yvonne; Smith, Sionagh H; Rocchi, Mara S; Buxton, David; Innes, Elisabeth A; Chianini, Francesca

    2014-01-01

    Infection with Neospora caninum stimulates host cell-mediated immune responses, which may be responsible for placental damage leading to bovine abortion. The aim of this study was to compare immune responses in the bovine placenta, following experimental infection in different stages of pregnancy. Placentomes were examined by immunohistochemistry and inflammation in early gestation was generally moderate to severe, particularly in the placentas carrying non-viable foetuses, whereas it was milder in later stages, mainly characterised by the presence of CD3+, CD4+ and γδ T-cells. This distinctive cellular immune response may explain the milder clinical outcome observed when animals are infected in later gestation. PMID:24484200

  16. Neuropsychological Profiles Correlated with Clinical and Behavioral Impairments in a Sample of Brazilian Children with Attention-Deficit Hyperactivity Disorder

    PubMed Central

    Rizzutti, Sueli; Schuch, Viviane; Augusto, Bruno Muszkat; Coimbra, Caio Colturato; Pereira, João Pedro Cabrera; Bueno, Orlando Francisco Amodeo

    2015-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD. PMID:26635638

  17. Neuropsychological Profiles Correlated with Clinical and Behavioral Impairments in a Sample of Brazilian Children with Attention-Deficit Hyperactivity Disorder.

    PubMed

    Rizzutti, Sueli; Schuch, Viviane; Augusto, Bruno Muszkat; Coimbra, Caio Colturato; Pereira, João Pedro Cabrera; Bueno, Orlando Francisco Amodeo

    2015-01-01

    Attention-deficit hyperactivity disorder (ADHD) is a complex neurodevelopmental disorder that implies several-step process, and there is no single test to diagnose both ADHD and associated comorbidities, such as oppositional-defiant disorder (ODD), anxiety disorder, depression, and certain types of learning disabilities. The purpose of the present study was to examine correlations between behavioral and clinical symptoms by administering an extensive neuropsychological battery to a sample of children and adolescents from a developing country. The sample was divided into three groups: non-ADHD, ADHD-non-comorbid, and ADHD + comorbidity. A full neuropsychological battery and clinical assessment found that 105 children met DSM-5 criteria, of whom 46.6% had the predominantly inattentive presentation, 37.3% had combined presentation, and 16% were predominantly hyperactive/impulsive presentation. The internal correlation between neuropsychological tests did not reach statistical significance in the comparison between ADHD and non-ADHD cases (p < 0.17). Clinical ADHD cases, including both + comorbidity and non-comorbid groups, performed substantially worse on continuous performance test (CPT), working memory. Comparing ADHD-non-comorbid and ADHD + comorbidity groups, the latter did significantly worse on inhibitory control, time processing, and the level of perseveration response on CPT indexes, as well as on working memory performance and child behavior checklist (CBCL) tests particularly the CBCL-deficient emotional self-regulation test in the ADHD + comorbidity group. Children diagnosed as ODD or with conduct disorder showed close correlations between clinical CBCL profiles and externalized symptoms. Our findings suggest that ADHD + comorbidity and ADHD non-comorbid cases may be differentiated by a number of neuropsychological measures, such as processing speed, inhibitory control, and working memory, that may reflect different levels of involvement of the hot and cool executive domains, which are more impaired in cases of severe symptomatic-externalized behavior and emotional regulation problems. Therefore, profiles based on clinical and behavioral findings can help clinicians select better strategies for detecting neuropsychological impairment in Brazilian children with ADHD. PMID:26635638

  18. Aphasia and unilateral spatial neglect due to acute thalamic hemorrhage: clinical correlations and outcomes.

    PubMed

    Osawa, Aiko; Maeshima, Shinichiro

    2016-04-01

    Thalamic hemorrhages are associated with a variety of cognitive dysfunctions, and it is well known that such cognitive changes constitute a limiting factor of recovery of the activities of daily living (ADL). The relationship between cognitive dysfunction and hematomas is unclear. In this study, we investigated the relationship between aphasia/neglect and hematoma volume, hematoma type, and the ADL. One hundred fifteen patients with thalamic hemorrhage (70 men and 45 women) were studied. Their mean age was 68.9 ± 10.3 years, and patients with both left and right lesions were included. We calculated hematoma volume and examined the presence or absence of aphasia/neglect and the relationships between these dysfunctions and hematoma volume, hematoma type, and the ADL. Fifty-nine patients were found to have aphasia and 35 were found to have neglect. Although there was no relationship between hematoma type and cognitive dysfunction, hematoma volume showed a correlation with the severity of cognitive dysfunction. The ADL score and ratio of patient discharge for patients with aphasia/neglect were lower than those for patients without aphasia/neglect. We observed a correlation between the hematoma volume in thalamic hemorrhage and cognitive dysfunction. Aphasia/neglect is found frequently in patients with acute thalamic hemorrhage and may influence the ADL. PMID:26796359

  19. Subcellular Spatial Correlation of Particle Traversal and Biological Response in Clinical Ion Beams

    SciTech Connect

    Niklas, Martin; Abdollahi, Amir; Akselrod, Mark S.; Debus, Jürgen; Jäkel, Oliver; and others

    2013-12-01

    Purpose: To report on the spatial correlation of physical track information (fluorescent nuclear track detectors, FNTDs) and cellular DNA damage response by using a novel hybrid detector (Cell-Fit-HD). Methods and Materials: The FNTDs were coated with a monolayer of human non-small cell lung carcinoma (A549) cells and irradiated with carbon ions (270.55 MeV u{sup −1}, rising flank of the Bragg peak). Phosphorylated histone variant H2AX accumulating at the irradiation-induced double-strand break site was labeled (RIF). The position and direction of ion tracks in the FNTD were registered with the location of the RIF sequence as an ion track surrogate in the cell layer. Results: All RIF sequences could be related to their corresponding ion tracks, with mean deviations of 1.09 μm and −1.72 μm in position and of 2.38° in slope. The mean perpendicular between ion track and RIF sequence was 1.58 μm. The mean spacing of neighboring RIFs exhibited a regular rather than random spacing. Conclusions: Cell-Fit-HD allows for unambiguous spatial correlation studies of cell damage with respect to the intracellular ion traversal under therapeutic beam conditions.

  20. CLINICAL CORRELATES OF PERIODIC LIMB MOVEMENTS IN SLEEP IN PARKINSONS DISEASE

    PubMed Central

    Covassin, Naima; Neikrug, Ariel B.; Liu, Lianqi; Corey-Bloom, Jody; Loredo, Jose S.; Palmer, Barton W.; Maglione, Jeanne; Ancoli-Israel, Sonia

    2012-01-01

    Objective The aim of the current study was to investigate the frequency of periodic limb movements in sleep (PLMS) in Parkinsons disease (PD) and their impact on nocturnal sleep and daytime functioning. Methods Forty-five PD patients (mean age 68.58.7 years; 32 males) underwent one night of polysomnography (PSG). Clinical assessment and questionnaires evaluating sleep disturbance and quality of life (QoL) were completed. Patients were divided into two groups based on their PLMS index (PLMSI): PLMSI ?15 (PLMS+) and PLMSI <15 (PLMS?). Results There were 26 (57.8%) PD patients in the PLMS+ group and 19 (42.2%) patients in the PLMS? group. Subjective assessment revealed an association between PLMS+ status and greater PD symptom severity, more subjective sleep disturbance, and decreased QoL. All patients showed poor sleep, and no significant group differences were detected on PSG measures. Conclusion We observed that PLMS occurred frequently in PD and increased with more severe PD. Although PLMS did not affect objective sleep, it was associated with increased sleep complaints and reduced QoL. Overall, our findings support the association between PLMS and PD as well as the clinical relevance of sleep disturbances in PD. PMID:22277375

  1. Pro-inflammatory cytokine levels in human apical periodontitis: Correlation with clinical and histological findings.

    PubMed

    Jakovljevic, Aleksandar; Knezevic, Aleksandra; Karalic, Danijela; Soldatovic, Ivan; Popovic, Branka; Milasin, Jelena; Andric, Miroslav

    2015-08-01

    This study aimed to compare the levels of tumour necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1β) and interleukin-6 (IL-6) between apical periodontitis lesions with different clinical and histological features. Based on clinical data and history of disease, 100 human apical periodontitis lesions were categorised as either asymptomatic or symptomatic lesions. According to histological examination, lesions were divided into periapical granulomas and radicular cysts. Pulp tissues of 25 impacted wisdom teeth were used as controls. Homogenised tissue samples were centrifuged and supernatants were used for the determination of cytokine levels by enzyme-linked immunosorbent assay. Significantly higher levels of IL-1β and IL-6 were found in symptomatic lesions compared with asymptomatic lesions and control tissues (P < 0.001, P < 0.001, respectively). The concentration of IL-1β was significantly higher in radicular cysts compared with periapical granulomas (P = 0.003). Symptomatic lesions, as judged by high local production of IL-1β and IL-6, represent an immunologically active stage of the disease. PMID:25163634

  2. Correlation between cell-mediated immunity and clinical forms of paracoccidioidomycosis.

    PubMed

    Mota, N G; Rezkallah-Iwasso, M T; Peraçoli, M T; Audi, R C; Mendes, R P; Marcondes, J; Marques, S A; Dillon, N L; Franco, M F

    1985-01-01

    Cellular immune response to specific and non-specific stimulants was investigated, both in vivo and in vitro, in 29 healthy controls and in 53 previously untreated patients with the chronic isolated organic form (CIOF), the chronic mixed form (CMF) and the acute progressive form (APF) of paracoccidioidomycosis. The study included skin tests to Paracoccidioides brasiliensis antigen (PbAg) and phytohaemagglutinin (PHA), DNCB sensitization, determination of T lymphocytes and complement rosette-forming cells, lymphocyte transformation and leucocyte migration inhibition tests using PbAg and PHA. Patients displayed staggered cutaneous response to PHA and to PbAg, with marked decrease in intensity in the APF group. DNCB sensitization test and proliferative response of lymphocytes to PHA and PbAg were severely depressed in most of the patients. Leucocyte migration inhibition indices to PbAg were highly positive, while response to PHA was slightly decreased regardless of the clinical form. The number of T lymphocytes was reduced in most of patients and in them the number of complement-rosette forming cells was normal. The distribution of patients according to a suppression index, based in the results of the tests employed, revealed a tendency towards an increased degree of cellular immunosuppression from the least severe (CIOF) to the most severe (APF) clinical form of the disease. On the whole, the present study demonstrated a gamut of immunological reactivity in paracoccidioidomycosis. PMID:3832489

  3. Nocardia caviae: a Report of 13 New Isolations with Clinical Correlation

    PubMed Central

    Causey, William A.

    1974-01-01

    Thirteen isolates of Nocardia caviae from 12 different clinical sources were received and identified over a 5½-year period by the Mycology Division of the Center for Disease Control. The results of morphological, biochemical, and physiological studies on these isolates were compared with those obtained with four reference cultures of N. caviae received from the Institute of Microbiology, Rutgers University. Comparison showed that N. caviae isolates form a homogeneous group that is usually easily distinguished from N. asteroides, N. brasiliensis, and other pathogenic aerobic actinomycetes. The clinical sources included nine human and two animal infections and one human isolate apparently not associated with disease. Previous reports of N. caviae infections in man have been limited to rare cases of actinomycotic mycetoma. Among the human infections reported in this series are one case of mycetoma, one case of “mycotic” keratitis, one case of skin abscess, two cases of osteomyelitis, and four cases of serious pulmonary infection caused by N. caviae. PMID:4604822

  4. Phenotype/genotype correlations in Gaucher disease type 1: Clinical and therapeutic implications

    SciTech Connect

    Sibille, A.; Eng, C.M.; Kim, S.J.; Pastores, G. ); Grabowski, G.A. Univ. of Cincinnati, OH )

    1993-06-01

    Gaucher disease is the most frequent lysosomal storage disease and the most prevalent genetic disease among Ashkenazi Jews. Gaucher disease type 1 is characterized by marked variability of the phenotype and by the absence of neuronopathic involvement. To test the hypothesis that this phenotypic variability was due to genetic compounds of several different mutant alleles, 161 symptomatic patients with Gaucher disease type 1 (> 90% Ashkenazi Jewish) were analyzed for clinical involvement, and their genotypes were determined. Qualitative and quantitative measures of disease involvement included age at onset of the disease manifestations, hepatic and splenic volumes, age at splenectomy, and severity of bony disease. High statistically significant differences (P < .005) were found in each clinical parameter in patients with the N370S/N370S genotype compared with those patients with the N370S/84GG, N370S/L444P, and N370/ genotypes. The symptomatic N370S homozygotes had onset of their disease two to three decades later than patients with the other genotypes. In addition, patients with the latter genotypes have much more severely involved livers, spleens, and bones and had a higher incidence of splenectomy at an earlier age. These predictive genotype analyses provide the basis for genetic care delivery and therapeutic recommendations in patients affected with Gaucher disease type 1. 38 refs., 1 fig., 4 tabs.

  5. Idiopathic normal pressure hydrocephalus: correlating magnetic resonance imaging biomarkers with clinical response.

    PubMed

    Ng, Samuel E S; Low, Angela M S; Tang, Kok Kee; Lim, Winston E H; Kwok, Robert K

    2009-09-01

    Idiopathic Normal Pressure Hydrocephalus (NPH) is a debilitating condition of the elderly. The patient is typically "wet, wobbly and wonky", to different degrees of the triad. The diagnosis is supported by the radiologic finding of dilated ventricles, determined by an elevated Evan's Index (EI) without a demonstrable cause. Patients with newly diagnosed NPH typically respond to ventriculo-peritoneal shunting (VPS). NPH-related dementia is possibly the only surgically reversible dementia. An elevated cerebrospinal fluid (CSF) fl ow rate (FR) is associated with a positive response to shunting. However, post-shunting EI and FRs are unpredictable. Of late, intracranial apparent diffusion coefficient (ADC) quantification via Diffusion Weighted Imaging (DWI) has been emerging as a possible marker in NPH diagnosis. A local study, conducted on a national level, to study the relationship of EI, FR and ADC to pre- and post-shunt clinical measurements has just ended. This review seeks to reconcile the current thinking of NPH, magnetic resonance imaging (MRI) quantification and clinical evaluation, and in the process shed some light on major pathophysiological determinants of the disease. PMID:19816640

  6. Endemic chronic kidney disease of unknown etiology in Sri Lanka: Correlation of pathology with clinical stages

    PubMed Central

    Wijetunge, S.; Ratnatunga, N. V. I.; Abeysekera, T. D. J.; Wazil, A. W. M.; Selvarajah, M.

    2015-01-01

    Chronic kidney disease of unknown etiology (CKDU) is endemic among the rural farming communities in several localities in and around the North Central region of Sri Lanka. This is an interstitial type renal disease and typically has an insidious onset and slow progression. This study was conducted to identify the pathological features in the different clinical stages of CKDU. This is a retrospective study of 251 renal biopsies identified to have a primary interstitial disease from regions endemic for CKDU. Pathological features were assessed and graded in relation to the clinical stage. The mean age of those affected by endemic CKDU was 37.3 12.5 years and the male to female ratio was 3.3:1. The predominant feature of stage I disease was mild and moderate interstitial fibrosis; most did not have interstitial inflammation. The typical stage II disease had moderate interstitial fibrosis with or without mild interstitial inflammation. Stage III disease had moderate and severe interstitial fibrosis, moderate interstitial inflammation, tubular atrophy and some glomerulosclerosis. Stage IV disease typically had severe interstitial fibrosis and inflammation, tubular atrophy and glomerulosclerosis. The mean age of patients with stage I disease (27 10.8 years) was significantly lower than those of the other stages. About 79.2%, 55%, 49.1% and 50% in stage I, II, III and IV disease respectively were asymptomatic at the time of biopsy. PMID:26628792

  7. RMI study and clinical correlations of ankle retinacula damage and outcomes of ankle sprain.

    PubMed

    Stecco, Antonio; Stecco, Carla; Macchi, Veronica; Porzionato, Andrea; Ferraro, Claudio; Masiero, Stefano; De Caro, Raffaele

    2011-12-01

    Recent studies reveal the role of the ankle retinacula in proprioception and functional stability of the ankle, but there is no clear evidence of their role in the outcomes of ankle sprain. 25 patients with outcomes of ankle sprain were evaluated by MRI to analyze possible damage to the ankle retinacula. Patients with damage were subdivided into two groups: group A comprised cases with ankle retinacula damage only, and group B those also with anterior talofibular ligament rupture or bone marrow edema. Both groups were examined by VAS, CRTA and static posturography and underwent three treatments of deep connective tissue massage (Fascial Manipulation technique). All evaluations were repeated after the end of treatment and at 1, 3 and 6 months. At MRI, alteration of at least one of the ankle retinacula was evident in 21 subjects, and a further lesion was also identified in 7 subjects. After treatment, VAS and CRTA evaluations showed a statistically significant decrease in values with respect to those before treatment (p < 0.0001). There were also significant improvements (p < 0.05) in stabilometric platform results. No significant difference was found between groups A and B. The initial benefit was generally maintained at follow-up. The alteration of retinacula at MRI clearly corresponds to the proprioceptive damage revealed by static posturography and clinical examination. Treatment focused on the retinacula may improve clinical outcomes and stabilometric data. PMID:21305286

  8. Lifetime Obesity in Patients with Eating Disorders: Increasing Prevalence, Clinical and Personality Correlates

    PubMed Central

    Villarejo, Cynthia; Fernández-Aranda, Fernando; Jiménez-Murcia, Susana; Peñas-Lledó, Eva; Granero, Roser; Penelo, Eva; Tinahones, Francisco J; Sancho, Carolina; Vilarrasa, Nuria; Montserrat-Gil de Bernabé, Mónica; Casanueva, Felipe F; Fernández-Real, Jose Manuel; Frühbeck, Gema; De la Torre, Rafael; Treasure, Janet; Botella, Cristina; Menchón, José Manuel

    2012-01-01

    Objectives : The aims of our study were to examine the lifetime prevalence of obesity rate in eating disorders (ED) subtypes and to examine whether there have been temporal changes among the last 10 years and to explore clinical differences between ED with and without lifetime obesity. Methods : Participants were 1383 ED female patients (DSM-IV criteria) consecutively admitted, between 2001 and 2010, to Bellvitge University Hospital. They were assessed by means of the Eating Disorders Inventory-2, the Symptom Checklist-90—Revised, the Bulimic Investigatory Test Edinburgh and the Temperament and Character Inventory—Revised. Results : The prevalence of lifetime obesity in ED cases was 28.8% (ranging from 5% in anorexia nervosa to 87% in binge-eating disorders). Over the last 10 years, there has been a threefold increase in lifetime obesity in ED patients (p < .001). People with an ED and obesity had higher levels of childhood and family obesity (p < .001), a later age of onset and longer ED duration; and had higher levels of eating, general and personality symptomatology. Conclusions : Over the last 10 years, the prevalence of obesity associated with disorders characterized by the presence of binge episodes, namely bulimic disorders, is increasing, and this is linked with greater clinical severity and a poorer prognosis. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. PMID:22383308

  9. A Review of Biomarkers in Mood and Psychotic Disorders: A Dissection of Clinical vs. Preclinical Correlates

    PubMed Central

    Brand, Sarel J.; Möller, Marisa; Harvey, Brian H.

    2015-01-01

    Despite significant research efforts aimed at understanding the neurobiological underpinnings of mood (depression, bipolar disorder) and psychotic disorders, the diagnosis and evaluation of treatment of these disorders are still based solely on relatively subjective assessment of symptoms as well as psychometric evaluations. Therefore, biological markers aimed at improving the current classification of psychotic and mood-related disorders, and that will enable patients to be stratified on a biological basis into more homogeneous clinically distinct subgroups, are urgently needed. The attainment of this goal can be facilitated by identifying biomarkers that accurately reflect pathophysiologic processes in these disorders. This review postulates that the field of psychotic and mood disorder research has advanced sufficiently to develop biochemical hypotheses of the etiopathology of the particular illness and to target the same for more effective disease modifying therapy. This implies that a “one-size fits all” paradigm in the treatment of psychotic and mood disorders is not a viable approach, but that a customized regime based on individual biological abnormalities would pave the way forward to more effective treatment. In reviewing the clinical and preclinical literature, this paper discusses the most highly regarded pathophysiologic processes in mood and psychotic disorders, thereby providing a scaffold for the selection of suitable biomarkers for future studies in this field, to develope biomarker panels, as well as to improve diagnosis and to customize treatment regimens for better therapeutic outcomes. PMID:26411964

  10. Toxoplasma encephalitis in Haitian adults with acquired immunodeficiency syndrome: a clinical-pathologic-CT correlation

    SciTech Connect

    Post, M.J.D.; Chan, J.C.; Hensley, G.T.; Hoffman, T.A.; Moskowitz, L.B.; Lippmann, S.

    1983-05-01

    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 or less, had severe idiopathic immunodeficiency syndrome. All were lymphopenic and six were on treatment for tuberculosis when the toxoplasma encephalitis developed. All patients were studied with CT when they developed an altered mental status and fever associated with seizures and/or focal neurologic deficits. Scans before treatment showed multiple intraparenchymal lesions in seven and a single lesion in the thalamus in one. Ring and/or nodular enhancement of the lesions was found in six and hypodense areas in two. Progressions of abnormalities occurred on serial studies. These CT findings that were best shown on axial and coronal thin-section double-dose contrast studies were useful but not diagnostically pathognomonic. In patients with similar clinical presentation CT is recommended to identify focal areas of involvement and to guide brain biopsy or excision so that prompt medical thereapy of this often lethal infection can be instituted.

  11. Distinct lymphocytes subsets in IgM-related neuropathy: clinical-immunological correlations.

    PubMed

    Iorio, Raffaele; Sabatelli, Mario; Del Grande, Alessandra; Bisogni, Giulia; Damato, Valentina; Plantone, Domenico; Marti, Alessandro; Frisullo, Giovanni; Romano, Angela; Rossini, Paolo Maria; Luigetti, Marco

    2015-02-01

    IgM-related neuropathy generally presents as a late-onset demyelinating polyneuropathy with predominant sensory loss and ataxia. However, we recently reported the clinical, neurophysiological and pathological findings from our cohort and identified in about a third of patients an atypical phenotype. We analyzed by flow cytometry the different lymphocytes subsets in the peripheral blood of patients affected by IgM-related neuropathy, chronic inflammatory demyelinating polyneuropathy (CIDP), monoclonal gammopathy of undetermined significance and healthy subjects, to investigate whether different immunological patterns may differentiate the classical phenotype from atypical forms. IFN-gamma producing CD4+ and CD8+ T lymphocytes, as well as CD4+ and CD8+ T cells expressing T-bet (T-helper type 1, Th1) were increased in CIDP patients. The percentage of circulating CD4+ and CD8+ T cells producing IL-10 as well as the percentage of CD19+ cells expressing Blimp-1 were higher in patients with IgM-neuropathy. We did not find any significant differences in the different lymphocytes subsets in the IgM-related neuropathy between patients with classical and atypical phenotype. Th1 cells are increased in CIDP patients while a T helper type 2-phenotype seems to prevail in patients with IgM-neuropathy. Further studies involving a larger patient population are needed to evaluate if different lymphocytes subset may be involved in different clinical phenotypes of IgM-related neuropathy. PMID:25192662

  12. Mental health and other clinical correlates of euthanasia attitudes in an Australian outpatient cancer population.

    PubMed

    Carter, G L; Clover, K A; Parkinson, L; Rainbird, K; Kerridge, I; Ravenscroft, P; Cavenagh, J; McPhee, J

    2007-04-01

    A majority of patients with cancer have been reported to endorse euthanasia and physician assisted suicide (PAS) in general and a substantial proportion endorse these for themselves. However, the potential influence of mental health and other clinical variables on these decisions is not well understood. This study of 228 outpatients attending an oncology clinic in Newcastle, Australia used a cross-sectional design and logistic regression modelling to examine the relationship of demographic, disease status, mental health and quality of life variables to attitudes toward euthanasia and PAS. The majority reported support for euthanasia (79%, n=179), for PAS (69%, n=158) and personal support for euthanasia/PAS (68%, n=156). However, few reported having asked their doctor for euthanasia (2%, n=5) or PAS (2%, n=5). Three outcomes were modelled: support for euthanasia was associated with active religious belief (adjusted odds ratio (AOR) 0.21, 95% CI: 0.10-0.46); support for PAS was associated with active religious belief (AOR 0.35, 95% CI: 18-0.70) and recent pain (AOR 0.87, 95% CI: 0.0.76-0.99); and personal support for euthanasia/PAS was associated with active religious belief (AOR 0.26, 95% CI: 0.14-0.48). Depression, anxiety, recent suicidal ideation, and lifetime suicide attempt were not independently associated with any of the three outcomes modelled. PMID:16921477

  13. Colour Doppler Evaluation of Extracranial Carotid Arteries: A Clinical and Radiological Correlation

    PubMed Central

    Kashikar, Shivali V.; Phatak, Suresh

    2016-01-01

    Introduction Atherosclerosis (i.e. hardening and thickening of arteries) causes vascular remodeling, obstruction of lumen, abnormalities of blood flow and reduced oxygenation of target tissues. Manifestation of atherosclerosis in the form of either Myocardial Infarction or Stroke is the major cause of morbidity and mortality. This study evaluated extracranial carotid arteries of patients (>60 years) who presented with risk factors of atherosclerosis and determined the association of risk factors with carotid abnormalities. Aim To evaluate the prevalence of atherosclerosis, haemodynamic and morphological changes that take place in extra cranial portion of carotid arteries in patients with risk factors of atherosclerosis (Diabetes Mellitus, Hypertension, Smoking, Stroke, Coronary Artery Disease, Hypercholesterolaemia) and determine the association of risk factors with carotid abnormalities. Materials and Methods The prospective cross-sectional analytical study included the examination of Extracranial carotid arteries of 1043 patients over a period of 2 years (2013-2015) using duplex ultrasound. Assessment of CCA-IMT, ICA-IMT and percent stenosis was done using a linear probe of 8-12 MHz. Statistical Analysis Correlation between risk factors of atherosclerosis, wall thickness of common carotid (CCA-IMT), internal carotid arteries (ICA-IMT) and stenosis was studied using statistical tools like multiple logistic regression analysis and analysis of variance (p<0.05) using SPSS 17.0. Results Maximum percent stenosis increased with increase in age. Prevalence of severe stenosis (>70%) was low while the prevalence of mild stenosis (<50%) was quite high. In all age groups, stenosis was more prevalent and more severe in men as compared to women. Hypertension showed the strongest positive correlation with all three measures of interest CCA-IMT, ICA-IMT and maximum percent stenosis. Stroke history showed strong positive correlation with CCA-IMT and stenosis. Smoking, Diabetes Mellitus, Hypercholesterolaemia, Heart disease showed strong association with all three measures as well. Atherosclerotic plaques were mostly found at the site of carotid bifurcation. Conclusion CCA-IMT was strongly associated with hypertension, smoking and diabetes mellitus. ICA-IMT was strongly associated with hypertension and history of heart disease. Percent stenosis was strongly associated with smoking and history of heart disease. PMID:26894141

  14. Clinical correlation of oral-dental findings with radiographs and with total body bone scans.

    PubMed

    Laga, E A; Toth, B B; Podoloff, D A; Keene, H J

    1993-02-01

    Bone scans are frequently used to detect osteoblastic areas in bone, including bony metastases in patients with existing tumors. Various dental conditions have been found to cause areas in the jaws to have increased uptake of radiopharmaceuticals. We studied 30 patients with an existing cancer or previous history of cancer with the use of total body bone scans, panoramic radiographs, and dental examinations, and we found no correlation between the intensity of radionuclide uptake in the jaws on the bone scans and the number of teeth in each jaw, the age of the patient, the degree of periodontal disease, or the number of dental pathoses per jaw. The frequency and intensity of positive scan results were related to the presence or absence of intrabony lesions in the jaws. Dental disease therefore does not appear to mask metastatic disease in the jaws; however, when metastasis is suspected, a dental examination with radiographs is recommended. PMID:8426726

  15. A benchmark for evaluation of algorithms for identification of cellular correlates of clinical outcomes.

    PubMed

    Aghaeepour, Nima; Chattopadhyay, Pratip; Chikina, Maria; Dhaene, Tom; Van Gassen, Sofie; Kursa, Miron; Lambrecht, Bart N; Malek, Mehrnoush; McLachlan, G J; Qian, Yu; Qiu, Peng; Saeys, Yvan; Stanton, Rick; Tong, Dong; Vens, Celine; Walkowiak, Sławomir; Wang, Kui; Finak, Greg; Gottardo, Raphael; Mosmann, Tim; Nolan, Garry P; Scheuermann, Richard H; Brinkman, Ryan R

    2016-01-01

    The Flow Cytometry: Critical Assessment of Population Identification Methods (FlowCAP) challenges were established to compare the performance of computational methods for identifying cell populations in multidimensional flow cytometry data. Here we report the results of FlowCAP-IV where algorithms from seven different research groups predicted the time to progression to AIDS among a cohort of 384 HIV+ subjects, using antigen-stimulated peripheral blood mononuclear cell (PBMC) samples analyzed with a 14-color staining panel. Two approaches (FlowReMi.1 and flowDensity-flowType-RchyOptimyx) provided statistically significant predictive value in the blinded test set. Manual validation of submitted results indicated that unbiased analysis of single cell phenotypes could reveal unexpected cell types that correlated with outcomes of interest in high dimensional flow cytometry datasets. © 2015 International Society for Advancement of Cytometry. PMID:26447924

  16. Lack of correlation between clinical data and growth hormone concentrations in cord blood.

    PubMed

    von Mühlendahl, K E; Pachaly, J; Schmidt-Gollwitzer, M

    1976-01-01

    Growth hormone concentrations were measured in 182 umbilical cord blood samples taken at the time of birth. The mean value in 165 full-term, normal weight infants was 31.5 +/- 25.9 ng/ml SD. 14 prematures had significantly higher levels (50.0 +/- 38.4 p less than 0.01). There were no statistically significant correlations to any of the following parameters: complication of pregnancy by toxaemia, duration of labour, presence of umbilical cord contortion, perinatal distress, Apgar index, mode of delivery, body weight, body length, ratio of weight to length, and blood glucose. There was a wide scatter of individual values in this study as well as in previous investigations. We think it unlikely that those variations are purely accidental. Hence, yet undefined factors must play a major role in the regulation of GH secretion in the perinatal period. PMID:974186

  17. Judgments of Omitted BE and DO in Questions as Extended Finiteness Clinical Markers of Specific Language Impairment (SLI) to 15 Years: A Study of Growth and Asymptote

    ERIC Educational Resources Information Center

    Rice, Mabel L.; Hoffman, Lesa; Wexler, Ken

    2009-01-01

    Purpose: Clinical grammar markers are needed for children with SLI older than 8 years. This study followed children who were previously studied 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…

  18. Preliminary comparison of the Essie and PubMed search engines for answering clinical questions using MD on Tap, a PDA-based program for accessing biomedical literature.

    PubMed

    Sutton, Victoria R; Hauser, Susan E

    2005-01-01

    MD on Tap, a PDA application that searches and retrieves biomedical literature, is specifically designed for use by mobile healthcare professionals. With the goal of improving the usability of the application, a preliminary comparison was made of two search engines (PubMed and Essie) to determine which provided most efficient path to the desired clinically-relevant information. PMID:16779415

  19. Preliminary comparison of the Essie and PubMed search engines for answering clinical questions using MD on Tap, a PDA-based program for accessing biomedical literature

    PubMed Central

    Sutton, Victoria R.; Hauser, Susan E.

    2005-01-01

    MD on Tap, a PDA application that searches and retrieves biomedical literature, is specifically designed for use by mobile healthcare professionals. With the goal of improving the usability of the application, a preliminary comparison was made of two search engines (PubMed and Essie) to determine which provided most efficient path to the desired clinically-relevant information. PMID:16779415

  20. Questions, Questioning Techniques, and Effective Teaching.

    ERIC Educational Resources Information Center

    Wilen, William W., Ed.

    This book focuses on questioning techniques and strategies teachers may employ to make the difference between active and passive learning in the classroom. There are nine chapters: (1) Why Questions? (Ambrose A. Clegg, Jr.); (2) Review of Research on Questioning Techniques (Meredith D. Gall and Tom Rhody); (3) The Multidisciplinary World of…

  1. Cathepsin B Expression and the Correlation with Clinical Aspects of Oral Squamous Cell Carcinoma

    PubMed Central

    Yang, Wei-En; Ho, Chuan-Chen; Yang, Shun-Fa; Lin, Shu-Hui; Yeh, Kun-Tu; Lin, Chiao-Wen; Chen, Mu-Kuan

    2016-01-01

    Background Cathepsin B (CTSB), a member of the cathepsin family, is a cysteine protease that is widely distributed in the lysosomes of cells in various tissues. It is overexpressed in several human cancers and may be related to tumorigenesis. The main purpose of this study was to analyze CTSB expression in oral squamous cell carcinoma (OSCC) and its correlation with patient prognosis. Methodology/Principal Findings Tissue microarrays were used to detect CTSB expression in 280 patients and to examine the association between CTSB expression and clinicopathological parameters. In addition, the metastatic effects of the CTSB knockdown on two oral cancer cell lines were investigated by transwell migration assay. Cytoplasmic CTSB expression was detected in 34.6% (97/280) of patients. CTSB expression was correlated with positive lymph node metastasis (p = 0.007) and higher tumor grade (p = 0.008) but not with tumor size and distant metastasis. In addition, multivariate analysis using a Cox proportional hazards model revealed a higher hazard ratio, demonstrating that CTSB expression was an independent unfavorable prognostic factor in buccal mucosa carcinoma patients. Furthermore, the Kaplan–Meier curve revealed that buccal mucosa OSCC patients with positive CTSB expression had significantly shorter overall survival. Moreover, treatment with the CTSB siRNA exerted an inhibitory effect on migration in OC2 and CAL27 oral cancer cells. Conclusions We conclude that CTSB expression may be useful for determining OSCC prognosis, particularly for patients with lymph node metastasis, and may function as a biomarker of the survival of OSCC patients in Taiwan. PMID:27031837

  2. Prediction scores do not correlate with clinically adjudicated categories of pulmonary embolism in critically ill patients

    PubMed Central

    Katsios, CM; Donadini, M; Meade, M; Mehta, S; Hall, R; Granton, J; Kutsiogiannis, J; Dodek, P; Heels-Ansdell, D; McIntyre, L; Vlahakis, N; Muscedere, J; Friedrich, J; Fowler, R; Skrobik, Y; Albert, M; Cox, M; Klinger, J; Nates, J; Bersten, A; Doig, C; Zytaruk, N; Crowther, M; Cook, DJ

    2014-01-01

    BACKGROUND: Prediction scores for pretest probability of pulmonary embolism (PE) validated in outpatient settings are occasionally used in the intensive care unit (ICU). OBJECTIVE: To evaluate the correlation of Geneva and Wells scores with adjudicated categories of PE in ICU patients. METHODS: In a randomized trial of thromboprophylaxis, patients with suspected PE were adjudicated as possible, probable or definite PE. Data were then retrospectively abstracted for the Geneva Diagnostic PE score, Wells, Modified Wells and Simplified Wells Diagnostic scores. The chance-corrected agreement between adjudicated categories and each score was calculated. ANOVA was used to compare values across the three adjudicated PE categories. RESULTS: Among 70 patients with suspected PE, agreement was poor between adjudicated categories and Geneva pretest probabilities (kappa 0.01 [95% CI −0.0643 to 0.0941]) or Wells pretest probabilities (kappa −0.03 [95% CI −0.1462 to 0.0914]). Among four possible, 16 probable and 50 definite PEs, there were no significant differences in Geneva scores (possible = 4.0, probable = 4.7, definite = 4.5; P=0.90), Wells scores (possible = 2.8, probable = 4.9, definite = 4.1; P=0.37), Modified Wells (possible = 2.0, probable = 3.4, definite = 2.9; P=0.34) or Simplified Wells (possible = 1.8, probable = 2.8, definite = 2.4; P=0.30). CONCLUSIONS: Pretest probability scores developed outside the ICU do not correlate with adjudicated PE categories in critically ill patients. Research is needed to develop prediction scores for this population. PMID:24083302

  3. X-ray crystallographic and kinetic correlation of a clinically observed human fumarase mutation.

    PubMed

    Estévez, Marcel; Skarda, Jeremy; Spencer, Josh; Banaszak, Leonard; Weaver, Todd M

    2002-06-01

    Fumarase catalyzes the reversible conversion of fumarate to S- malate during the operation of the ubiquitous Kreb's cycle. Previous studies have shown that the active site includes side chains from three of the four subunits within the tetrameric enzyme. We used a clinically observed human mutation to narrow our search for potential catalytic groups within the fumarase active site. Offspring homozygous for the missense mutation, a G-955-C transversion in the fumarase gene, results in the substitution of a glutamine at amino acid 319 for the normal glutamic acid. To more fully understand the implications of this mutation, a single-step site-directed mutagenesis method was used to generate the homologous substitution at position 315 within fumarase C from Escherichia coli. Subsequent kinetic and X-ray crystal structure analyses show changes in the turnover number and the cocrystal structure with bound citrate. PMID:12021453

  4. A study of the clinical profile of acute pancreatitis and its correlation with severity indices

    PubMed Central

    Vengadakrishnan, K.; Koushik, A. K.

    2015-01-01

    Background Acute pancreatitis is a common disease with wide clinical variation and its incidence is increasing. Acute pancreatitis may vary in severity, from mild self-limiting pancreatic inflammation to pancreatic necrosis with life-threatening sequelae. Severity of acute pancreatitis is linked to the presence of systemic organ dysfunctions and/or necrotizing pancreatitis. Aim and objectives The present study was aimed to assess the clinical profile of acute pancreatitis and to assess the efficacy of various severity indices in predicting the outcome of patients. Methodology This was a prospective study done in Sri Ramachandra Medical College and Hospital from April 2012–September 2014. All patients with a diagnosis of acute pancreatitis were included in this study. Along with routine lab parameters, serum amylase, lipase, lipid profile, calcium, CRP, LDH, CT abdomen, CXR and 2D Echo was done for all patients. Results A total of 110 patients were analysed. 50 patients required Intensive care, among them 9 patients (18%) died. 20 patients (18.2%) had MODS, 15 patients (13.6%) had pleural effusion, 9 patients (8.2%) had pseudocyst, 2 patients(1.8%) had hypotension, 2 patients(1.8%) had ARDS and 2 patients(1.8%) had DKA. In relation to various severity indices, high score of CRP, LDH and CT severity index was associated with increased morbidity and mortality. 15 patients (13.6%) underwent open necrosectomy surgery, 3 patients (2.7%) underwent laparoscopic necrosectomy and 7 patients (6.4%) were tried step up approach but could not avoid surgery. Step up approach and surgery did not have a significant reduction in the mortality. Conclusion Initial assessment of severity by CRP, LDH and lipase could be reliable indicators of outcome in acute pancreatitis PMID:26715920

  5. Snoring and risk for obstructive sleep apnea among nigerians with heart failure: Prevalence and clinical correlates

    PubMed Central

    Akintunde, Adeseye A.

    2013-01-01

    Background: Heart failure is an important cause of morbidity and mortality in developing nations like Nigeria. Sleep apnea and snoring has recently been recognized to be a cardiovascular risk factor. Sleep apnea is yet to be well studied among Africans with heart failure. We aimed to determine the prevalence of snoring and high risk for obstructive sleep apnea among Nigerians with stable heart failure. Materials and Methods: We studied 103 subjects that included 62 patients with heart failure and 41 control subjects. Demographic parameters and clinical examination were performed on the participants. The Berlin score and the Epworth Sleepiness Scale were administered for each participant. Echocardiography was done on all participants. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) 17.0. Results: Snoring was reported in 48.4% of subjects with heart failure compared to 22.0% of control subjects ( P < 0.005). High risk for obstructive sleep apnea using the Berlin score was documented in 51.6% of heart failure subjects compared to 7.31% of controls. Excessive daytime somnolence occurred more in heart failure patients (51.6% vs. 9.8%, P < 0.05). Snorers tended to be older and were more likely to be obese than nonsnorers. Systolic blood pressure and fasting blood sugar were significantly higher among heart failure subjects with snoring than those without snoring (131.9 ± 19.2 vs. 119.2 ± 15.7 and 6.0 ± 0.8 vs. 5.4 ± 2.7, P < 0.005). Conclusion: Heart failure seems to be associated with snoring and a high risk for obstructive sleep apnea among Africans with heart failure. Assessment for sleep disordered breathing should be incorporated into their routine clinical workup. PMID:23580920

  6. Correlation of Real Time PCR Cycle Threshold Cut-Off with Bordetella pertussis Clinical Severity

    PubMed Central

    Bolotin, Shelly; Deeks, Shelley L.; Marchand-Austin, Alex; Rilkoff, Heather; Dang, Vica; Walton, Ryan; Hashim, Ahmed; Farrell, David; Crowcroft, Natasha S.

    2015-01-01

    Bordetella pertussis testing performed using real-time polymerase chain reaction (RT-PCR) is interpreted based on a cycle threshold (Ct) value. At Public Health Ontario Laboratories (PHOL), a Ct value <36 is reported as positive, and Ct values ≥36 and <40 are reported as indeterminate. PHOL reported indeterminate results to physicians and public health units until May 2012, after which these results were only reported to physicians. We investigated the association between Ct value and disease symptom and severity to examine the significance of indeterminate results clinically, epidemiologically and for public health reporting. B. pertussis positive and indeterminate RT-PCR results were linked to pertussis cases reported in the provincial Integrated Public Health Information System (iPHIS), using deterministic linkage. Patients with positive RT-PCR results had a lower median age of 10.8 years compared to 12.0 years for patients with indeterminate results (p = 0.24). Hospitalized patients had significantly lower Ct values than non-hospitalized patients (median Ct values of 20.7 vs. 31.6, p<0.001). The proportion of patients reporting the most indicative symptoms of pertussis did not differ between patients with positive vs. indeterminate RT-PCR results. Taking the most indicative symptoms of pertussis as the gold-standard, the positive predictive value of the RT-PCR test was 68.1%. RT-PCR test results should be interpreted in the context of the clinical symptoms, age, vaccination status, prevalence, and other factors. Further information on interpretation of indeterminate RT-PCR results may be needed, and the utility of reporting to public health practitioners should be re-evaluated. PMID:26186564

  7. A comparison of nerve conduction velocities and current perception thresholds as correlates of clinical severity of diabetic sensory neuropathy.

    PubMed Central

    Rendell, M S; Katims, J J; Richter, R; Rowland, F

    1989-01-01

    Nerve conduction velocities (NCVs) are the standard measurements used to confirm the presence or absence of diabetic neuropathy. NCVs were contrasted with the newer technique of measurement of alternating current perception thresholds (CPTs) in assessing the quantitative level of correlation with severity of diabetic sensory neuropathy. A very detailed, scored neurological history (symptoms) and physical examination, emphasising sensory assessment, was conducted on 71 individuals with diabetic neuropathy of varying degrees of severity. Sensory and motor NCVs and CPTs at 5, 250, and 2000 Hz of the upper and lower extremities were determined for these individuals. In addition, vibration thresholds (VTs) were measured as a third modality. Twenty eight individuals underwent repeated evaluations at 2, 6, 10 and 12 months after the initial procedures. Using the results of 169 complete evaluations, correlations were determined between physical scores (PS) and symptoms scores (SS) and NCVs. NCV correlations with the SS were weaker than with the PS. The strongest of the correlations were found between the PS and motor NCVs of the median nerve (rho = 0.29) and the tibial nerve (rho = 0.38). Normal NCVs were present in the face of very significant historical and physical abnormality. Correlations of the SS and PS with both VTs and CPTs were higher than with the NCVs. CPTs proved the more effective as predictors of both symptomatic and physical impairment. NCVs appear to lack the resolving power necessary to evaluate subtle differences in clinical state of diabetic sensory neuropathy. The supplementary use of current perception testing may improve the quantitative assessment of this condition. PMID:2738593

  8. Testing homogeneity of proportion ratios for stratified correlated bilateral data in two-arm randomized clinical trials.

    PubMed

    Pei, Yanbo; Tian, Guo-Liang; Tang, Man-Lai

    2014-11-10

    Stratified data analysis is an important research topic in many biomedical studies and clinical trials. In this article, we develop five test statistics for testing the homogeneity of proportion ratios for stratified correlated bilateral binary data based on an equal correlation model assumption. Bootstrap procedures based on these test statistics are also considered. To evaluate the performance of these statistics and procedures, we conduct Monte Carlo simulations to study their empirical sizes and powers under various scenarios. Our results suggest that the procedure based on score statistic performs well generally and is highly recommended. When the sample size is large, procedures based on the commonly used weighted least square estimate and logarithmic transformation with Mantel-Haenszel estimate are recommended as they do not involve any computation of maximum likelihood estimates requiring iterative algorithms. We also derive approximate sample size formulas based on the recommended test procedures. Finally, we apply the proposed methods to analyze a multi-center randomized clinical trial for scleroderma patients. PMID:24974954

  9. Correlates of Stress and Coping among Jordanian Nursing Students during Clinical Practice in Psychiatric/Mental Health Course.

    PubMed

    Alzayyat, Abdulkarim; Al-Gamal, Ekhlas

    2014-10-13

    Training in psychiatric settings is stressful for nursing students. The purpose of this study was to examine the correlations between the students' characteristics, their stress degrees, stressors and types of coping strategies they experience during training in psychiatric course. A descriptive, correlational, longitudinal design was used. Sixty-five undergraduate nursing students were recruited randomly from five Jordanian universities. Self-report questionnaires were administered at the second semester of the 2012-2013 academic year. The findings showed that students who utilized avoidance or transference strategies reported high stress degrees. Moreover, the results showed that those students who were in the fourth year, with a low family income, who avoid extracurricular activities, with a low academic grade or who registered in other clinical course(s) reported high stress degrees. These findings present a worthy data for the clinical instructors that facilitate students training in psychiatric settings and promote their psychosocial well-being. Copyright © 2014 John Wiley & Sons, Ltd. PMID:25308304

  10. Empirically-Derived Subtypes of Lifetime Anxiety Disorders: Developmental and Clinical Correlates in U.S. Adolescents

    PubMed Central

    Burstein, Marcy; Georgiades, Katholiki; Lamers, Femke; Swanson, Sonja A.; Cui, Lihong; He, Jian-Ping; Avenevoli, Shelli; Merikangas, Kathleen R.

    2011-01-01

    Objective The current study examined the sex- and age-specific structure and comorbidity of lifetime anxiety disorders among U.S. adolescents. Method The sample consisted of 2,539 adolescents (1,505 females and 1,034 males) from the National Comorbidity Survey-Adolescent Supplement who met criteria for DSM-IV lifetime anxiety disorders. Adolescents ranged in age from 13-18 years (M = 15.2 years, SE = 0.08 years) and were 39% non-White. Multiple-group latent class analysis (LCA) was conducted by adolescent sex and age to identify subgroups of adolescents with similar anxiety disorder profiles. Developmental and clinical correlates of empirically-derived classes were also examined to assess the nomological validity of identified subgroups. Results A seven-class solution provided the best fit to the data, with classes defined primarily by one rather than multiple anxiety disorders. Results also indicated that classes displayed similar diagnostic profiles across age, but varied by sex. Classes characterized by multiple anxiety disorders were consistently associated with a greater degree of persistence, clinical severity, impairment, and comorbidity with other DSM-IV psychiatric disorders. Conclusions The presentation of lifetime anxiety disorders among adolescents and the observation of unique correlates of specific classes provide initial evidence for the utility of individual DSM-IV anxiety disorder categories. Although findings of the present study should be considered preliminary, results emphasize the potential value of early intervention and gender-specific conceptualization and treatment of anxiety disorders. PMID:22081863

  11. Altered Autophagy-Associated Genes Expression in T Cells of Oral Lichen Planus Correlated with Clinical Features

    PubMed Central

    Tan, Ya-Qin; Zhang, Jing; Du, Ge-Fei; Lu, Rui; Chen, Guan-Ying; Zhou, Gang

    2016-01-01

    Oral lichen planus (OLP) is a T cell-mediated inflammatory autoimmune disease. Autophagy has emerged as a fundamental trafficking event in mediating T cell response, which plays crucial roles in innate and adaptive immunity. The present study mainly investigated the mRNA expression of autophagy-associated genes in peripheral blood T cells of OLP patients and evaluated correlations between their expression and the clinical features of OLP. Five differentially expressed autophagy-associated genes were identified by autophagy array. Quantitative real-time RT-PCR results confirmed that IGF1 expression in the peripheral blood T cells of OLP patients was significantly higher than that in controls, especially in female and middle-aged (30–50 years old) OLP patients. In addition, ATG9B mRNA levels were significantly lower in nonerosive OLP patients. However, no significant differences were found in the expression of HGS, ESR1, and SNCA between OLP patients and controls. Taken together, dysregulation of T cell autophagy may be involved in immune response of OLP and may be correlated with clinical patterns. PMID:26980945

  12. Levels of serum fibronectin as a biomarker in gastric cancer patients: Correlation with clinical diagnosis and outcome

    PubMed Central

    TAS, FARUK; BILGIN, ELIF; KARABULUT, SENEM; TASTEKIN, DIDEM; DURANYILDIZ, DERYA

    2016-01-01

    Fibronectin is an important component of the extracellular matrix and serves a role in the pathogenesis of multiple malignancies. The expression of fibronectin also affects the outcome for patients with cancer. The objective of the present study was to determine the clinical significance of the serum fibronectin levels in patients with gastric cancer. A total of 63 patients with a pathologically confirmed diagnosis of gastric cancer were enrolled into the present study. Serum fibronectin concentrations were determined by the solid-phase sandwich enzyme-linked immunosorbent assay method. Age and sex matched healthy controls (n=30) were included in the analysis. The median age at diagnosis was 62 years (range 28–82 years). The baseline serum fibronectin levels of the patients with gastric cancer were significantly higher compared with those in the control group (median values, 606, vs. 193 ng/ml; P<0.001). The known clinical variables, including the age of the patient, gender, site of lesion, histology, histological grade, stage of disease and serum tumor markers, including lactate dehydrogenase, carcinoembryonic antigen and cancer antigen 19.9, were not found to be correlated with serum fibronectin concentrations (P>0.05). In addition, no correlation was observed in serum fibronectin level and response to chemotherapy (P=0.12). Serum fibronectin concentration demonstrated no prognostic role on survival (P=0.43). In conclusion, the serum levels of fibronectin may have a good diagnostic marker in patients with gastric cancer. However, its predictive and prognostic values remain to be elucidated.

  13. Abdominal Ultrasound With Scintigraphic and Clinical Correlates in Infants With Sickle Cell Anemia: Baseline Data From the BABY HUG Trial

    PubMed Central

    McCarville, M. Beth; Luo, Zhaoyu; Huang, Xiangke; Rees, Renee C.; Rogers, Zora R.; Miller, Scott T.; Thompson, Bruce; Kalpatthi, Ram; Wang, Winfred C.

    2015-01-01

    OBJECTIVE The purpose of this study is to perform and evaluate baseline abdominal ultrasound in infants with sickle cell anemia who participated in the BABY HUG multiinstitutional randomized placebo-controlled trial of hydroxyurea therapy and to examine the potential relationships among ultrasound results and clinical, nuclear medicine, and laboratory data. SUBJECTS AND METHODS After local institutional review board approval and with informed guardian consent, 116 girls and 87 boys (age range, 7.5–18 months) with sickle cell anemia underwent standardized abdominal sonography at 14 institutions. Imaging was centrally reviewed by one radiologist who assessed and measured the spleen, kidneys, gallbladder, and common bile duct. Baseline physical assessment of spleen size, serum alanine aminotransferase and bilirubin levels, 99mTc sulfur colloid liver-spleen scans, and 99mTc diethylenetriaminepentaacetic acid clearance glomerular filtration rates (GFRs) were obtained. Analysis of variance and the Student test were performed to compare sonographic findings to published results in healthy children and to clinical and laboratory findings. RESULTS The mean (± SD) spleen volume (108 ± 47 mL) was significantly greater than published normal control values (30 ± 14 mL; p < 0.0001). There was no correlation between spleen volume and function assessed by liver-spleen scan. The mean GFR (125 ± 34 mL/min/1.73 m2) was elevated compared with control GFRs (92 ± 18 mL/min/1.73 m2). Renal volumes (right kidney, 29 ± 8 mL; left kidney, 31 ± 9 mL) were significantly greater than control volumes (right kidney, 27 ± 3 mL; left kidney, 27 ± 3 mL; p < 0.0001) and were positively correlated with GFR (p = 0.0009). Five percent of patients had sonographic biliary abnormalities (sludge, n = 6; dilated common bile duct, n = 2; and cholelithiasis and thickened gallbladder wall, n = 1 each). There was no correlation between biliary sonographic findings and laboratory results. CONCLUSION In infants with sickle cell anemia, sonographic spleen volume does not reflect function, but increased renal volume correlates with GFR and is consistent with hyperfiltration. Sonographic biliary abnormalities can occur early in life, while remaining clinically silent. PMID:21606305

  14. Muscle Synergies in Cycling after Incomplete Spinal Cord Injury: Correlation with Clinical Measures of Motor Function and Spasticity

    PubMed Central

    Barroso, Filipe O.; Torricelli, Diego; Bravo-Esteban, Elisabeth; Taylor, Julian; Gómez-Soriano, Julio; Santos, Cristina; Moreno, Juan C.; Pons, José L.

    2016-01-01

    Background: After incomplete spinal cord injury (iSCI), patients suffer important sensorimotor impairments, such as abnormal locomotion patterns and spasticity. Complementary to current clinical diagnostic procedures, the analysis of muscle synergies has emerged as a promising tool to study muscle coordination, which plays a major role in the control of multi-limb functional movements. Objective: Based on recent findings suggesting that walking and cycling share similar synergistic control, the analysis of muscle synergies during cycling might be explored as an early descriptor of gait-related impaired control. This idea was split into the following two hypotheses: (a) iSCI patients present a synergistic control of muscles during cycling; (b) muscle synergies outcomes extracted during cycling correlate with clinical measurements of gait performance and/or spasticity. Methods: Electromyographic (EMG) activity of 13 unilateral lower limb muscles was recorded in a group of 10 healthy individuals and 10 iSCI subjects during cycling at four different cadences. A non-negative matrix factorization (NNMF) algorithm was applied to identify synergistic components (i.e., activation coefficients and muscle synergy vectors). Reconstruction goodness scores (VAF and r2) were used to evaluate the ability of a given number of synergies to reconstruct the EMG signals. A set of metrics based on the similarity between pathologic and healthy synergies were correlated with clinical scales of gait performance and spasticity. Results: iSCI patients preserved a synergistic control of muscles during cycling. The similarity with the healthy reference was consistent with the degree of the impairment, i.e., less impaired patients showed higher similarities with the healthy reference. There was a strong correlation between reconstruction goodness scores at 42 rpm and motor performance scales (TUG, 10-m test and WISCI II). On the other hand, the similarity between the healthy and affected synergies presented correlation with some spasticity symptoms measured by Penn, Modified Ashworth and SCATS scales. Conclusion: Overall, the results of this study support the hypothesis that the analysis of muscle synergies during cycling can provide detailed quantitative assessment of functional motor impairments and symptoms of spasticity caused by abnormal spatiotemporal muscle co-activation following iSCI. PMID:26793088

  15. Sexual dysfunction in pre-menopausal diabetic women: clinical, metabolic, psychological, cardiovascular, and neurophysiologic correlates.

    PubMed

    Cortelazzi, Donatella; Marconi, Annamaria; Guazzi, Marco; Cristina, Maurizio; Zecchini, Barbara; Veronelli, Annamaria; Cattalini, Claudio; Innocenti, Alessandro; Bosco, Giovanna; Pontiroli, Antonio E

    2013-12-01

    An increased prevalence of female sexual dysfunction (FSD) has been reported in women with diabetes mellitus (DM). Our aim was to evaluate correlates (psychological, cardiovascular, and neurophysiologic) of FSD in DM women without chronic diabetic complications. Female Sexual Function Index (FSFI), Beck Depression Inventory (BDI), Michigan Diabetic Neuropathy Index (DNI), and the symptoms of diabetic neuropathy (SDN) questionnaires, metabolic variables, endothelial vascular function (flow-mediated dilation, FMD), echocardiography, and electromyography were studied. 109 pre-menopausal women (18-50 years) [48 with DM (14 type 1 DM, 34 type 2 DM, duration 12.6 ± 1.91 years), and 61 healthy women] received the above questionnaires; physical activity, smoking habits, parity, BMI, waist circumference, HOMA-IR index, fibrinogen, cholesterol (total, HDL, LDL), triglycerides, HbA1c, high-sensitivity C-reactive protein, total testosterone, and estradiol were measured; echocardiography, assessment of intima-media thickness (IMT), FMD, ECG (heart rate and Qtc, indexes of sympathetic activity), and electromyography were performed. FSFI total score and score for arousal, lubrication, and orgasm domains were lower in DM women than in controls (P < 0.05); DM women had higher BDI, Doppler A wave peak velocity, DNI, and SDN score (P < 0.001 to P < 0.04). Doppler E wave peak velocity, peroneal, posterior tibial and sural nerves conduction velocity and amplitude were lower in diabetic women than in controls (P < 0.05 to P < 0.001). FSFI score was positively correlated with physical activity, Doppler E wave peak velocity, and peroneal nerve amplitude and negatively with BDI, parity, IMT, SDN, and HbA1c (P < 0.05 to P < 0.001). At stepwise regression, SDN score (negatively) and Doppler E wave peak velocity (positively) predicted FSFI score (r = 507, P < 0.001). In conclusion, cardiovascular and neurological impairments are associated with FSD in diabetic women. Follow-up studies are required to evaluate sexual dysfunction as a risk factor for future cardiovascular or neurological events. PMID:23677545

  16. Clinical correlates of human leucocyte antigen (HLA)-G in systemic sclerosis.

    PubMed

    Favoino, E; Favia, I E; Vettori, S; Vicenti, C; Prete, M; Valentini, G; Perosa, F

    2015-07-01

    Human leucocyte antigen (HLA)-G has a tolerogenic function and could play a role in the pathogenesis of immune-mediated diseases, including systemic sclerosis (SSc). The aim of this study was to evaluate HLA-G serum expression (sHLA-G) and the HLA-G gene 14 base pairs (bp) insertion/deletion (del(-)/del(+)) polymorphism in patients with Ssc, to search for possible associations with clinical and laboratory variables. sHLA-G was measured by enzyme-linked immunosorbent assay (ELISA) in sera from 77 patients with SSc and 32 healthy donors (HD); the 14 bp del(-)/del(+) polymorphism was evaluated by polymerase chain reaction (PCR) amplification of peripheral blood mononuclear cells (PBMC) genomic DNA. Receiver operating characteristics (ROC) analysis identified the HLA-G cut-off that best discriminated dichotomized clinical and serological variables, that was subsequently employed to subdivide SSc patients into HLA-G high (HLA-G(+)) and low (HLA-G(-)) profile groups. sHLA-G were not statistically different between SSc patients and HD, nor between distinct SSc autoantibody subsets. Subdividing SSc patients by HLA-G positivity or negativity yielded significant differences for the modified Rodnan skin score (mRss) (P = 0.032), 'general' (P = 0.031) and 'kidney' (P = 0.028) Medsger severity scores (MSS) and disease activity index, and especially ? heart/lung (P = 0.005). A worse 'general' MSS (P = 0.002) and ? heart/lung (P = 0.011) were more frequent in the low sHLA-G group. These two variables and mRss were associated with sHLA-G levels at logistic regression analysis. Treatment had no influence on sHLA-G. Moreover, a higher frequency of scleredema was detected in the del(+)/del(+) than the del(-)/del(+) group (P = 0.04). These data suggest modulatory effects of sHLA-G on SSc. Prospective studies are needed to investigate a role in predicting the disease course. PMID:25847615

  17. Correlations Between the EGFR Mutation Status and Clinicopathological Features of Clinical Stage I Lung Adenocarcinoma.

    PubMed

    Isaka, Tetsuya; Yokose, Tomoyuki; Ito, Hiroyuki; Nagata, Masashi; Furumoto, Hideyuki; Nishii, Teppei; Katayama, Kayoko; Yamada, Kouzo; Nakayama, Haruhiko; Masuda, Munetaka

    2015-10-01

    Advanced lung cancers with epidermal growth factor receptor (EGFR) exon 19 deletions (Ex19s) and EGFR exon 21 L858R point mutations (Ex21s) exhibit different clinical behavior. However, these differences are unclear in resectable primary lung tumors.The clinicopathological features of 88 (20.9%) Ex19, 124 (29.4%) Ex21, and 198 (46.9%) EGFR wild-type (Wt) clinical stage I primary adenocarcinomas resected between January 1, 2012 and October 31, 2014 were compared by using Chi-square tests, residual error analysis, analysis of variance, and Tukey tests.Ex21 lesions occurred more frequently in women and never-smokers and had a higher tumor disappearance rate (TDR: 59.6% vs 43.9%; P < 0.001) and lower maximum standardized uptake value (maxSUV: 2.0 vs 3.5; P < 0.01) than Wt lesions; Ex19 lesions had intermediate values (52.8% and 2.6). There was a low frequency of vascular invasion in Ex21 lesions (12.1%; P < 0.05) and a high frequency in Wt lesions (22.7%; P < 0.05). Most Ex19 lesions were intermediate-grade adenocarcinoma (lepidic, acinar, and papillary predominant: 73.9%; P < 0.05). Wt and Ex21 lesions were predominately high-grade (micropapillary or solid predominant, mucinous variant) and low-grade (adenocarcinoma in situ and minimally invasive adenocarcinoma) adenocarcinoma, respectively. Wt lesions had smaller lepidic components (42.1% vs 56.3%; P < 0.001) and larger papillary and solid components (papillary: 15.5% vs 9.0%; P < 0.05; solid: 13.2% vs 3.2%; P < 0.001) than Ex21 lesions. Most Ex19 lesions had intermediate component rates.Most Ex21 lesions were low-grade adenocarcinoma with lepidic growth patterns. Wt high-grade adenocarcinomas included solid and papillary components with vascular invasion. Ex19 lesions were intermediate grade between Ex21 and Wt. PMID:26496308

  18. Correlations Between the EGFR Mutation Status and Clinicopathological Features of Clinical Stage I Lung Adenocarcinoma

    PubMed Central

    Isaka, Tetsuya; Yokose, Tomoyuki; Ito, Hiroyuki; Nagata, Masashi; Furumoto, Hideyuki; Nishii, Teppei; Katayama, Kayoko; Yamada, Kouzo; Nakayama, Haruhiko; Masuda, Munetaka

    2015-01-01

    Abstract Advanced lung cancers with epidermal growth factor receptor (EGFR) exon 19 deletions (Ex19s) and EGFR exon 21 L858R point mutations (Ex21s) exhibit different clinical behavior. However, these differences are unclear in resectable primary lung tumors. The clinicopathological features of 88 (20.9%) Ex19, 124 (29.4%) Ex21, and 198 (46.9%) EGFR wild-type (Wt) clinical stage I primary adenocarcinomas resected between January 1, 2012 and October 31, 2014 were compared by using Chi-square tests, residual error analysis, analysis of variance, and Tukey tests. Ex21 lesions occurred more frequently in women and never-smokers and had a higher tumor disappearance rate (TDR: 59.6% vs 43.9%; P < 0.001) and lower maximum standardized uptake value (maxSUV: 2.0 vs 3.5; P < 0.01) than Wt lesions; Ex19 lesions had intermediate values (52.8% and 2.6). There was a low frequency of vascular invasion in Ex21 lesions (12.1%; P < 0.05) and a high frequency in Wt lesions (22.7%; P < 0.05). Most Ex19 lesions were intermediate-grade adenocarcinoma (lepidic, acinar, and papillary predominant: 73.9%; P < 0.05). Wt and Ex21 lesions were predominately high-grade (micropapillary or solid predominant, mucinous variant) and low-grade (adenocarcinoma in situ and minimally invasive adenocarcinoma) adenocarcinoma, respectively. Wt lesions had smaller lepidic components (42.1% vs 56.3%; P < 0.001) and larger papillary and solid components (papillary: 15.5% vs 9.0%; P < 0.05; solid: 13.2% vs 3.2%; P < 0.001) than Ex21 lesions. Most Ex19 lesions had intermediate component rates. Most Ex21 lesions were low-grade adenocarcinoma with lepidic growth patterns. Wt high-grade adenocarcinomas included solid and papillary components with vascular invasion. Ex19 lesions were intermediate grade between Ex21 and Wt. PMID:26496308

  19. Diagnostic and prognostic role of steroidogenic factor 1 in adrenocortical carcinoma: a validation study focusing on clinical and pathologic correlates.

    PubMed

    Duregon, Eleonora; Volante, Marco; Giorcelli, Jessica; Terzolo, Massimo; Lalli, Enzo; Papotti, Mauro

    2013-05-01

    The pathologic characterization of adrenocortical cancer is still problematic for several reasons, including the identification of novel markers of diagnostic or prognostic relevance. Among them, steroidogenic factor 1 deserves major interest because of its potential usefulness as a marker of adrenocortical derivation and of biological aggressiveness. Our aim was to validate its prognostic relevance in a large series of adrenocortical cancer, comparing the performance of 2 different commercial antibodies and investigating its expression in adrenocortical cancer variants and in comparison with clinical and pathologic features. Seventy-five (including 53 classical, 10 myxoid, and 12 oncocytic) adrenocortical cancer cases were included in tissue microarrays and analyzed for the immunohistochemical expression of steroidogenic factor 1 using 2 commercial antibodies, 1 polyclonal and 1 monoclonal (N1665). Nuclear steroidogenic factor 1 staining was assessed using a semiquantitative score and correlated with adrenocortical cancer type and clinical pathologic characteristics. A weak but significant correlation was found comparing the 2 antibodies with a positive rate of 88% and 58% using the monoclonal and polyclonal antibodies, respectively. High steroidogenic factor 1 expression with the N1665 antibody was positively correlated with high mitotic count, high Ki-67 index, and high European Network for the Study of Adrenal Tumors (ENSAT) stage and negatively associated with loss of functionality and presence of oncocytic features. Moreover, high steroidogenic factor 1 expression with this same antibody was significantly associated at univariate analysis with a decreased survival, together with high Ki-67 and mitotic indexes, with a trend to significance confirmed by multivariate analysis, thus supporting the detection of steroidogenic factor 1 using the N1665 antibody as a novel prognostic marker in adrenocortical cancer. PMID:23158211

  20. Lung ultrasound in systemic sclerosis: correlation with high-resolution computed tomography, pulmonary function tests and clinical variables of disease.

    PubMed

    Gigante, Antonietta; Rossi Fanelli, Filippo; Lucci, Silvio; Barilaro, Giuseppe; Quarta, Silvia; Barbano, Biagio; Giovannetti, Antonello; Amoroso, Antonio; Rosato, Edoardo

    2016-03-01

    Interstitial lung disease (ILD) is a hallmark of systemic sclerosis (SSc). Although high-resolution computed tomography (HRCT) is the gold standard to diagnose ILD, recently lung ultrasound (LUS) has emerged in SSc patients as a new promising technique for the ILD evaluation, noninvasive and radiation-free. The aim of this study was to evaluate if there is a correlation between LUS, chest HRCT, pulmonary function tests findings and clinical variables of the disease. Thirty-nine patients (33 women and 6 men; mean age 51 ± 15.2 years) underwent clinical examination, HRCT, pulmonary function tests and LUS for detection of B-lines. A positive correlation exists between the number of B-lines and the HRCT score (r = 0.81, p < 0.0001), conversely a negative correlation exists between the number of B-lines and diffusing capacity of the lung for carbon monoxide (DLCO) (r = -0.63, p < 0.0001). The number of B-lines increases along with the progression of the capillaroscopic damage. A statistically significant difference in the number of B-lines was found between patients with and without digital ulcers [42 (3-84) vs 16 (4-55)]. We found that the number of B-lines increased with the progression of both HRCT score and digital vascular damage. LUS may therefore, be a useful tool to determine the best timing for HRCT execution, thus, preventing for many patients a continuous and useless exposure to ionizing radiation. PMID:26494471

  1. Depression in acute and chronic aphasia: symptoms, pathoanatomical-clinical correlations and functional implications.

    PubMed Central

    Herrmann, M; Bartels, C; Wallesch, C W

    1993-01-01

    Depressive alterations were investigated in 21 acute and 21 chronic aphasic patients with single left sided strokes. The assessment of depression was based on a psychometrically evaluated German version of the Cornell Scale for Depression (CDS) and the Research Diagnostic Criteria (RDC). No significant difference was found concerning depression sum-scores between the two aphasic groups. The acute group, however, exhibited significantly higher ratings in items related to physical signs of depression and disturbances of cyclic functions. Patients corresponding to the RDC-syndrome of major depression were only found in the acute group. Neither age, sex nor degree of hemiparesis discriminated the patients on the severity of depressive symptoms. In the acute patient group, nonfluency of aphasia was the only parameter that could be identified which had an effect on the mood symptom scores. A CT scan analysis in the acute patient group showed an association between the severity of depression and anterior lesions. A significant correlation was found between CDS sum-scores and the proximity of the anterior border of the lesion to the frontal pole of the hemisphere whereas the volume of lesions seemed to have no effect on depressive alterations in acute aphasic patients. Superimposition of the lesions of the aphasic patients with major depressive disorders showed a common subcortical lesion area involving putaminal and external pallidal structures. Images PMID:8509782

  2. Plasma fatty acid composition in patients with pancreatic cancer: correlations to clinical parameters.

    PubMed

    Macek, Jaroslav; Vecka, Marek; k, Ale; Urbnek, Miroslav; Krechler, Tom; Petruelka, Lubo; Sta?kov, Barbora; Zeman, Miroslav

    2012-01-01

    Pancreatic cancer (PC) ranks as the fourth cause of cancer-related deaths in the Czech Republic. Evidence exists that deregulation of fatty acid (FA) metabolism is connected with some malignancies; therefore, we decided to analyze FA profile in plasma lipid classes in patients with PC with relation to tumor staging, nutritional status, and survival. The study included 84 patients (47 males, 37 females) with PC and 68 controls (36 males, 32 females). FA patterns were analyzed in plasma lipid classes by gas-chromatography. We observed increased proportion of total monounsaturated FA (MUFA) in PC group in all plasma lipid classes. These changes were connected with increased ?9-desaturase (SCD1) and ?5-desaturase indices. Correlations of dihomo-?-linolenic acid (DHGLA) with these variables were opposite. Longer survival of patients was connected with higher content of EPA, DHA, and with lower SCD1 index, respectively. Plasma phospholipid proportions of ?-linolenic acid, DHGLA, EPA, and n-3 polyunsaturated fatty acids displayed negative trend with tumor staging. Plasma lipid FA pattern in PC patients resulted from decreased dietary fat intake and increased de novo synthesis of FA with transformation into MUFA. Changes in FA profile implicated some pathophysiological mechanisms responsible for disturbed FA metabolism in PC and importance of appropriate nutritional support. PMID:23061902

  3. Correlation between the expression of DNA topoisomerases I and IIalpha and clinical parameters in kidney disease.

    PubMed

    Ivanova, L V; Rudolph, P; Shilov, Y M; Gieseler, F; Alm, P; Tareeva, I E; Proppe, D

    2001-11-01

    Multiple factors interact during the evolution of renal diseases. In the present study, we examined the expression of DNA topoisomerases type I and IIalpha, which reflect gene transcription and DNA replication, respectively. Enzyme content was assessed by immunohistochemistry using two specific monoclonal antibodies, C21 and Ki-S4, on 81 archival punch-biopsy specimens from patients with renal diseases, including minimal change disease (MCD; n = 10), focal segmental glomerular sclerosis (FSGS; n = 6), mesangial proliferative glomerulonephritis (MPGN; n = 11), membranous glomerulonephritis (MGN; n = 10), mesangial capillary glomerulonephritis (MCGN; n = 7), rapidly progressive glomerulonephritis (RPGN; n = 12), lupus nephritis (LN; n = 15), and tubulointerstitial nephritis (TIN; n = 10). Both enzymes were strongly expressed in diseases tending to rapid progression, notably RPGN and LN, whereas MCD and MGN showed low protein levels in both the glomerular and tubular compartments. Moreover, topoisomerase expression was significantly associated with the density of monocytogenic infiltrates (monitored by means of the monoclonal antibody Ki-M1p), such pathogenesis-associated factors as antinuclear antibodies and paranuclear antineutrophilic antibodies, and serum immunoglobulin levels. There also was a positive correlation with serum creatinine levels and an inverse association with proteinuria and nephrotic syndrome. We conclude that the expression of DNA topoisomerases may be linked to pathogenetic mechanisms and may provide prognostic information. Because of their comparatively low nephrotoxicity, topoisomerase inhibitors might prove to be useful therapeutic agents in the treatment of renal diseases. PMID:11684556

  4. Humoral Immunity to Smallpox Vaccines and Monkeypox Virus Challenge: Proteomic Assessment and Clinical Correlations

    PubMed Central

    Keckler, M. S.; Patel, N.; Davies, D. H.; Felgner, P.; Damon, I. K.; Karem, K. L.

    2013-01-01

    Despite the eradication of smallpox, orthopoxviruses (OPV) remain public health concerns. Efforts to develop new therapeutics and vaccines for smallpox continue through their evaluation in animal models despite limited understanding of the specific correlates of protective immunity. Recent monkeypox virus challenge studies have established the black-tailed prairie dog (Cynomys ludovicianus) as a model of human systemic OPV infections. In this study, we assess the induction of humoral immunity in humans and prairie dogs receiving Dryvax, Acam2000, or Imvamune vaccine and characterize the proteomic profile of immune recognition using enzyme-linked immunosorbent assays (ELISA), neutralization assays, and protein microarrays. We confirm anticipated similarities of antigenic protein targets of smallpox vaccine-induced responses in humans and prairie dogs and identify several differences. Subsequent monkeypox virus intranasal infection of vaccinated prairie dogs resulted in a significant boost in humoral immunity characterized by a shift in reactivity of increased intensity to a broader range of OPV proteins. This work provides evidence of similarities between the vaccine responses in prairie dogs and humans that enhance the value of the prairie dog model system as an OPV vaccination model and offers novel findings that form a framework for examining the humoral immune response induced by systemic orthopoxvirus infection. PMID:23135728

  5. Epilepsy in Prader-Willi syndrome: clinical characteristics and correlation to genotype.

    PubMed

    Vendrame, Martina; Maski, Kiran P; Chatterjee, Madhumouli; Heshmati, Arezou; Krishnamoorthy, Kalpathy; Tan, Wen-Hann; Kothare, Sanjeev V

    2010-11-01

    Prader-Willi syndrome (PWS) is a genomic imprinting disease secondary to the loss of a functional paternal copy of 15q11-q13. Unlike its related imprinting disorder, Angelman syndrome, PWS has not been regarded as a risk factor for epilepsy. A retrospective analysis of 92 patients with PWS identified 24 (26%) with seizures. Twenty-two of these (92%) were affected by focal epilepsy and only two (8%) had generalized epilepsy. The most common seizure type was staring spells (67%). Correlation to genotype analysis showed deletions were more common in patients with epilepsy than in patients without epilepsy. The epilepsy syndromes were easy to control with a single antiepileptic drug in most cases. Three patients (11%) had had febrile seizures. These findings suggest that PWS may be a risk factor for epilepsy, which can manifest with focal features. Patients with PWS with a deletion genotype showed a trend toward developing seizures compared with patients with other genotypes in our series, even though this difference did not achieve statistical significance. PMID:20727826

  6. Clinical biomechanic correlates for cervical function: Part III. Intermittent secondary movements.

    PubMed

    Vorro, J; Johnston, W L; Hubbard, R P

    1991-02-01

    Parts I and II of this study compared kinematic and myoelectric data for two groups of asymptomatic subjects classified as having symmetric or asymmetric motor response to a palpatory test for cervical sidebending. Kinematic data revealed that asymmetric subjects had limited mobility for primary and secondary motions. Myoelectric activity was slow to be initiated in the asymmetric subjects, and reduced in time and strength of contraction. Part III addresses additional specific kinematic data concerning three-dimensional orientations of the head; however, these data were accumulated throughout the paths of movement, not just at their end points as in our previous work. Although asymmetric subjects had demonstrated significantly reduced range of motion, paths of the more minor secondary axes did not differ significantly between groups. As with previous data (Part I and II), active and passive movements were undifferentiated; this degree of likeness in even minor aspects of the motor performance continues to indicate the remarkable similarities that can exist between primary movements directed and guided by trained physicians and those actively controlled by patients themselves. Part III completes a study of cervical motor behavior in which a passive gross motion test distinguished an asymmetric group with subclinical motor behavior that has measurable kinematic and myoelectric correlates. PMID:2013533

  7. Clinical and Pathological Features of Generalized Granuloma Annulare with Their Correlation: A Retrospective Multicenter Study in Korea

    PubMed Central

    Yun, Jeong Hyun; Lee, Ji Yeoun; Kim, Mi Kyeong; Seo, Young Joon; Kim, Myung Hwa; Cho, Kwang Hyun; Kim, Moon Bum; Lee, Won Soo; Lee, Kwang Hoon; Kim, You Chan; Lee, Seok Jong; Choi, Gwang Seong; Won, Young Ho; Ihm, Chull Wan

    2009-01-01

    Background Generalized granuloma annulare (GGA) is a benign skin disorder of an unknown etiology. Though some cases of GGA have been reported, few systemic reviews of the clinical and pathological features of GGA have been performed. Objective The purpose of this study is to analyze and correlate the clinical and pathological characteristics of GGA in Korean patients. Methods We conducted a retrospective study that included 54 biopsy specimens of Korean GGA patients, and the clinical and pathological features of GGA were reviewed and analyzed for their correlation. Results The cutaneous lesions could be divided into the annular (24, 44%) and nonannular types (30, 56%), and the lesions were more common in males than in females (29 males and 25 females). The incidence of GGA showed a bimodal age distribution. The number of patients who presented within the first decade was 24 cases (44%), and 24 cases (44%) were over the fifth decade. Eight patients (15%) had systemic diseases. Especially, diabetes mellitus (DM) occurred only in the adult GGA patients over forty years old. The pathological findings showed dermal granulomatous lesions that consisted of either a palisading pattern (28, 52%) or an interstitial pattern (26, 48%). Conclusion In contrast to the previously reported studies, the age of GGA onset showed a bimodal distribution, and GGA was observed more often in males. The prevalence of DM in the GGA affected individuals was higher than that found in the general Korean population. Therefore, it is recommended to perform a work-up for DM in the GGA affected patients who are over forty years old. PMID:20523767

  8. Correlation between clinical characteristics, spirometric indices and high resolution computed tomography findings in patients of chronic obstructive pulmonary disease

    PubMed Central

    Singh, Anubhuti; Kumar, Santosh; Mishra, Ashwini Kumar; Kumar, Manoj; Kant, Surya; Verma, S K; Kushwaha, R A S; Garg, Rajiv

    2016-01-01

    Introduction: Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease affecting the airways, leading to significant morbidity and mortality throughout the world. There is a need to have a holistic evaluation of COPD patients, other than just measuring the level of obstruction as performed by spirometry. High resolution computed tomography (HRCT) scan of thorax partly fulfills this requirement. Materials and Methods: Fifty patients of COPD (confirmed on spirometry as per the GOLD guidelines 2014 guidelines) were enrolled, out of which 35 patients got a HRCT done. Complete clinical evaluation was done. The Philips computer program for lung densitometry was used with these limits (−800/−1, 024 Hounsfield unit [HU]) to calculate densities, after validating densitometry values with phantoms. We established the area with a free hand drawing of the region of interest, then we established limits (in HUs) and the computer program calculated the attenuation as mean lung density (MLD) of the lower and upper lobes. Results: There was a significant correlation between smoking index and anteroposterior tracheal diameter (P = 0.036). Tracheal index was found to be decreasing with increasing disease severity which was statistically significant (P = 0.037). Mean upper lobe MLD was −839.27 HU, mean lower lobe MLD was −834.91 HU and the mean MLD was −837.08 HU. The lower lobes MLD were found to be decreasing with increasing disease severity. A mild linear correlation of pre forced expiratory volume in the first second (FEV1) was observed with lower lobe and total average MLD while a mild linear correlation of Post-FEV1 was observed with both coronal (P = 0.042) and sagittal (P = 0.001) lower lobes MLD. In addition, there was a linear correlation between both pre (P = 0.050) and post (P = 0.024) FEV1/forced vital capacity with sagittal lower lobe MLD. A predictive model can be derived to quantify obstruction severity (FEV1). Conclusion: HRCT may be an important additional tool in the holistic evaluation of COPD. HRCT can well be correlated with the spirometric and clinical features and the level of obstruction can be indirectly derived from it by measuring the MLD. PMID:26933306

  9. Hypertension Control and Its Correlates Among Adults Attending a Hypertension Clinic in Tanzania.

    PubMed

    Maginga, John; Guerrero, Mariana; Koh, Eileen; Holm Hansen, Christian; Shedafa, Rehema; Kalokola, Fredrick; Smart, Luke R; Peck, Robert N

    2016-03-01

    Hypertension control rates are low in sub-Saharan Africa. Population-specific determinants of blood pressure (BP) control have not been adequately described. The authors measured BP and conducted interviews to determine factors associated with BP control among adults attending a hypertension clinic in Tanzania. Three hundred adults were enrolled. BP was controlled in 47.7% of patients at the study visit but only 28.3% over three consecutive visits. Demographic and socioeconomic factors were not associated with control. Obesity and higher medication cost were associated with decreased control. Their effect was mediated through adherence. Good knowledge of (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.0-6.1; P=.047), attitudes towards (OR, 2.7; 95% CI, 1.0-7.1; P=.04), and practices concerning (OR, 5.4; 95% CI, 2.3-13.0; P<.001) hypertension were independently associated with increased control, even after adjusting for mediation through adherence. Good adherence had the strongest association with control (OR, 14.6; 95% CI, 5.8-37.0; P<.001). Strategies to reduce hypertension-related morbidity and mortality in sub-Saharan Africa should target these factors. Interventional studies of such strategies are needed. PMID:26279168

  10. Demographic, behavioral, biochemical, and dietary correlates of plasma triglycerides. Lipid Research Clinics Program Prevalence Study.

    PubMed

    Cowan, L D; Wilcosky, T; Criqui, M H; Barrett-Connor, E; Suchindran, C M; Wallace, R; Laskarzewski, P; Walden, C

    1985-01-01

    Few studies have simultaneously examined the relationship of triglyceride levels with a wide variety of potential covariates. Thus, the present study was designed to assess in a large, free-living population the association of fasting plasma triglyceride values with selected demographic, behavioral, biochemical, and dietary measures. These analyses were done using data obtained from 5189 white men and women aged 20 to 69 years who participated in the Lipid Research Clinics Program Prevalence Study. Of the eight nondietary factors examined, age, Quetelet Index, fasting plasma glucose, and cigarette smoking were strongly, positively associated (p less than 0.0001) with triglycerides in men and in women not using gonadal hormones. Among women using oral contraceptives or estrogens, only Quetelet Index (p less than 0.01) and cigarette smoking (p = 0.01) were significantly related to triglyceride values. Physical activity was inversely associated (p less than 0.0001) and use of diuretic medications was positively related (p less than 0.01) to triglycerides only in men. Results of analyses of triglycerides and six selected dietary measures varied by age, sex, and hormone-use subgroups. Although none of the dietary variables showed consistent associations with triglycerides across all of the subgroups, triglycerides tended to be inversely associated with total calories per kilogram of body weight and the percentage of calories as dietary fat. PMID:4038160

  11. Clinical Correlates of Non-Suicidal Self-Injury (NSSI) in an Outpatient Sample of Adolescents.

    PubMed

    Garca-Nieto, Rebeca; Carballo, Juan J; Daz de Neira Hernando, Mnica; de Len-Martinez, Victoria; Baca-Garca, Enrique

    2015-01-01

    Non-suicidal self-injury (NSSI) in adolescents is a major public health concern. The first goal of our study was to describe the characteristics and functions of NSSI and NSSI thoughts in an adolescent outpatient sample. The second goal was to examine which clinical factors discriminate between these two groups of patients. A group of 267 subjects was recruited from the Adolescent Outpatient Psychiatric Services, Jimnez Daz Foundation (Madrid, Spain) from November 2011 to October 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI). A total of 21.7% of patients reported having engaged in NSSI at least once in their lifetime. The most strongly endorsed function for NSSI was automatic negative reinforcement. In comparison with patients in the NSSI Thoughts group and the control group, patients in the NSSI group scored higher in Internalization of Anger and in all the scales comprising the Children's Depression Inventory. Our findings on the prevalence and functions of NSSI are consistent with the literature. NSSI was mainly performed for emotion regulation purposes; specifically, NSSI seems to be used to cope with anger and depression. In addition, internalization of anger might play a significant role in the maintenance of this behavior. PMID:25257184

  12. [Clinical, structural-functional and haemodynamic correlates of cerebral venous blood circulation disturbances].

    PubMed

    Todua, F I; Verulashvili, I V; Kortushvili, M G; Gachechiladze, D G

    2006-01-01

    Difficulties of liquor circulation as a result of cerebrospinal fluid absorption and venous drainage of the entire intracranial space, in particular in the presence of venous system abnormalities in the forms of hypoplasia or aplasia of venous sinuses, play an essentiale role in cerebral venous dyscirculation. The symmetric character of hydrocephaly in chronic insufficiency of cerebral blood circulation and strong dependence of chronic cerebrovascular insufficiency on passive congestion suggest that the latter is characteristic of the blood supply system in whole. The MPI analysis of 120 patients revealed signs of cerebral ischemic lesions in 72% of cases, i.e. dilatation of liquor-containing spaces, multiple lacunar infarctions, especially in deep brain regions, diffusive changes of the periventricular white matter etc. Low indices of the blood flow increase during antiorthostatic loading, a trend towards decreasing of PI parameters and difficulty of blood flow in conditional insonation of intracranial veins in cases of "pseudotumorous syndrome" in patients with clinical signs of passive congestion. Venous dilatation of convexital brain areas and intensification of contrasting of direct sinus and vein of Galen were observed in venous infarctions. PMID:18193577

  13. Primary Progressive Apraxia of Speech: Clinical Features and Acoustic and Neurologic Correlates

    PubMed Central

    Strand, Edythe A.; Clark, Heather; Machulda, Mary; Whitwell, Jennifer L.; Josephs, Keith A.

    2015-01-01

    Purpose This study summarizes 2 illustrative cases of a neurodegenerative speech disorder, primary progressive apraxia of speech (AOS), as a vehicle for providing an overview of the disorder and an approach to describing and quantifying its perceptual features and some of its temporal acoustic attributes. Method Two individuals with primary progressive AOS underwent speech-language and neurologic evaluations on 2 occasions, ranging from 2.0 to 7.5 years postonset. Performance on several tests, tasks, and rating scales, as well as several acoustic measures, were compared over time within and between cases. Acoustic measures were compared with performance of control speakers. Results Both patients initially presented with AOS as the only or predominant sign of disease and without aphasia or dysarthria. The presenting features and temporal progression were captured in an AOS Rating Scale, an Articulation Error Score, and temporal acoustic measures of utterance duration, syllable rates per second, rates of speechlike alternating motion and sequential motion, and a pairwise variability index measure. Conclusions AOS can be the predominant manifestation of neurodegenerative disease. Clinical ratings of its attributes and acoustic measures of some of its temporal characteristics can support its diagnosis and help quantify its salient characteristics and progression over time. PMID:25654422

  14. The widening spectrum of C9ORF72-related disease; genotype/phenotype correlations and potential modifiers of clinical phenotype.

    PubMed

    Cooper-Knock, Johnathan; Shaw, Pamela J; Kirby, Janine

    2014-03-01

    The GGGGCC (G4C2) repeat expansion in C9ORF72 is the most common cause of familial amyotrophic lateral sclerosis (ALS), frontotemporal lobar dementia (FTLD) and ALS-FTLD, as well as contributing to sporadic forms of these diseases. Screening of large cohorts of ALS and FTLD cohorts has identified that C9ORF72-ALS is represented throughout the clinical spectrum of ALS phenotypes, though in comparison with other genetic subtypes, C9ORF72 carriers have a higher incidence of bulbar onset disease. In contrast, C9ORF72-FTLD is predominantly associated with behavioural variant FTD, which often presents with psychosis, most commonly in the form of hallucinations and delusions. However, C9ORF72 expansions are not restricted to these clinical phenotypes. There is a higher than expected incidence of parkinsonism in ALS patients with C9ORF72 expansions, and the G4C2 repeat has also been reported in other motor phenotypes, such as primary lateral sclerosis, progressive muscular atrophy, corticobasal syndrome and Huntington-like disorders. In addition, the expansion has been identified in non-motor phenotypes including Alzheimer's disease and Lewy body dementia. It is not currently understood what is the basis of the clinical variation seen with the G4C2 repeat expansion. One potential explanation is repeat length. Sizing of the expansion by Southern blotting has established that there is somatic heterogeneity, with different expansion lengths in different tissues, even within the brain. To date, no correlation with expansion size and clinical phenotype has been established in ALS, whilst in FTLD only repeat size in the cerebellum was found to correlate with disease duration. Somatic heterogeneity suggests there is a degree of instability within the repeat and evidence of anticipation has been reported with reducing age of onset in subsequent generations. This variability/instability in expansion length, along with its interactions with environmental and genetic modifie