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Early hyperglycemia in extreme prematurity is associated with pulmonary and pancreatic dysfunction. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00600-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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2
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Improving survival without bronchopulmonary dysplasia in extremely preterm infants. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00727-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Abstract
BACKGROUND Fine-needle aspiration cytology (FNAC) is an integral part of thyroid nodule assessment. Nodules with an indeterminate cytology (THY3a-f) require formal histological assessment to confirm benign or malignant pathology. This study aimed to provide data for an evidence-based approach for management of patients with THY3f nodules. METHODS Retrospective review of patients who had a thyroid FNAC reported as suspicious of follicular neoplasm (THY3f) or showing atypia (THY3a) were identified, and clinical, operative and outcomes data were analysed. RESULTS Between 2018 and 2020, 200 patients (167F:33M, median age 51 years (range:18-86 years)) had a THY3f cytology. Most presented with a palpable nodule (n=104; 68.4%). Overall, 152 (76.0%;130F:23M) underwent surgery and 31 (20.4%) were found to have a thyroid carcinoma (22 follicular carcinomas, 7 papillary carcinomas, 1 medullary thyroid carcinoma and 1 metastatic renal carcinoma). An additional incidental carcinoma (size: 0.7-13mm) was found in seven (4.6%). Among those with cancer, a completion thyroidectomy and radioactive iodine treatment was indicated in nine (<6% of the entire cohort). Previously suggested risk factors for malignancy, eg male gender, large tumour size (>4cm) or age, were not found to be associated with increased risk. During the same period, THY3a cytology was reported in 53 patients, of whom 29 underwent diagnostic surgery and 4 patients were found to have a thyroid cancer (follicular, n=3 and medullary, n=1). CONCLUSION One in five patients with features suspicious of a follicular neoplasm (THY3f) has a thyroid carcinoma. This risk is much lower for THY3a. This study reinforces the current recommendation for thyroid surgery in all patients with a reliable THY3f cytology, as no further stratifying risk factors could be identified.
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P15.08 Phase I Trial of in situ Vaccination With Autologous CCL21-Modified Dendritic Cells (CCL21-DC) Combined With Pembrolizumab for Advanced NSCLC. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Plectin dysfunction in neurons leads to tau accumulation on microtubules affecting neuritogenesis, organelle trafficking, pain sensitivity and memory. Neuropathol Appl Neurobiol 2021; 47:73-95. [PMID: 32484610 PMCID: PMC7891324 DOI: 10.1111/nan.12635] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 05/19/2020] [Indexed: 12/26/2022]
Abstract
AIMS Plectin, a universally expressed multi-functional cytolinker protein, is crucial for intermediate filament networking, including crosstalk with actomyosin and microtubules. In addition to its involvement in a number of diseases affecting skin, skeletal muscle, heart, and other stress-exposed tissues, indications for a neuropathological role of plectin have emerged. Having identified P1c as the major isoform expressed in neural tissues in previous studies, our aim for the present work was to investigate whether, and by which mechanism(s), the targeted deletion of this isoform affects neuritogenesis and proper nerve cell functioning. METHODS For ex vivo phenotyping, we used dorsal root ganglion and hippocampal neurons derived from isoform P1c-deficient and plectin-null mice, complemented by in vitro experiments using purified proteins and cell fractions. To assess the physiological significance of the phenotypic alterations observed in P1c-deficient neurons, P1c-deficient and wild-type littermate mice were subjected to standard behavioural tests. RESULTS We demonstrate that P1c affects axonal microtubule dynamics by isoform-specific interaction with tubulin. P1c deficiency in neurons leads to altered dynamics of microtubules and excessive association with tau protein, affecting neuritogenesis, neurite branching, growth cone morphology, and translocation and directionality of movement of vesicles and mitochondria. On the organismal level, we found P1c deficiency manifesting as impaired pain sensitivity, diminished learning capabilities and reduced long-term memory of mice. CONCLUSIONS Revealing a regulatory role of plectin scaffolds in microtubule-dependent nerve cell functions, our results have potential implications for cytoskeleton-related neuropathies.
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Synergistic PXT3003 therapy uncouples neuromuscular function from dysmyelination in male Charcot-Marie-Tooth disease type 1A (CMT1A) rats. J Neurosci Res 2020; 98:1933-1952. [PMID: 32588471 DOI: 10.1002/jnr.24679] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 05/13/2020] [Accepted: 05/31/2020] [Indexed: 12/11/2022]
Abstract
Charcot-Marie-Tooth disease 1 A (CMT1A) is caused by an intrachromosomal duplication of the gene encoding for PMP22 leading to peripheral nerve dysmyelination, axonal loss, and progressive muscle weakness. No therapy is available. PXT3003 is a low-dose combination of baclofen, naltrexone, and sorbitol which has been shown to improve disease symptoms in Pmp22 transgenic rats, a bona fide model of CMT1A disease. However, the superiority of PXT3003 over its single components or dual combinations have not been tested. Here, we show that in a dorsal root ganglion (DRG) co-culture system derived from transgenic rats, PXT3003 induced myelination when compared to its single and dual components. Applying a clinically relevant ("translational") study design in adult male CMT1A rats for 3 months, PXT3003, but not its dual components, resulted in improved performance in behavioral motor and sensory endpoints when compared to placebo. Unexpectedly, we observed only a marginally increased number of myelinated axons in nerves from PXT3003-treated CMT1A rats. However, in electrophysiology, motor latencies correlated with increased grip strength indicating a possible effect of PXT3003 on neuromuscular junctions (NMJs) and muscle fiber pathology. Indeed, PXT3003-treated CMT1A rats displayed an increased perimeter of individual NMJs and a larger number of functional NMJs. Moreover, muscles of PXT3003 CMT1A rats displayed less neurogenic atrophy and a shift toward fast contracting muscle fibers. We suggest that ameliorated motor function in PXT3003-treated CMT1A rats result from restored NMJ function and muscle innervation, independent from myelination.
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Can we meet patients’ energy and nitrogen requirements with standard peripheral parenteral nutrition bags? Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2019.12.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Boot camps in neonatal-perinatal medicine fellowship programs: A national survey. J Neonatal Perinatal Med 2020; 12:231-237. [PMID: 30829620 DOI: 10.3233/npm-18117] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Simulation is widely used in graduate medical education. A prior survey showed that 80% of Neonatal-Perinatal Medicine (NPM) fellowship programs in the U.S. use simulation. There are multiple ways to provide simulation-based education. One such method is through intensive simulation-based education sessions held at the beginning of a training program, common called 'boot camps'. The aim of this study was to describe the use of simulation-based boot camps in NPM fellowship programs. METHODS Survey study of Accreditation Council for Graduate Medical Education (ACGME) accredited NPM fellowships in the U.S. RESULTS Fifty-nine of 98 programs (60%) responded. Thirty six (61%) participated in 1st year fellow boot camps, which focused on procedural skills and newborn resuscitation. Nearly half of programs participated in regional boot camps. Most boot camps were one or two days long. Eleven programs (19%) held 2nd or 3rd year fellow boot camps, which focused on advanced resuscitation and communication. Barriers included lack of faculty protected time (57%), funding (39%), and lack of faculty experience (31%). CONCLUSIONS A majority of ACGME accredited NPM fellowships participate in 1st year fellows' boot camps. Many participate in regional boot camps. A few programs have 2nd or 3rd year fellow boot camps. Lack of time, funding, and faculty experience were common barriers.
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P.80Imbalances in protein homeostasis caused by mutant desmin. Neuromuscul Disord 2019. [DOI: 10.1016/j.nmd.2019.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Imbalances in protein homeostasis caused by mutant desmin. Neuropathol Appl Neurobiol 2018; 45:476-494. [PMID: 30179276 DOI: 10.1111/nan.12516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/17/2018] [Indexed: 12/19/2022]
Abstract
AIMS We investigated newly generated immortalized heterozygous and homozygous R349P desmin knock-in myoblasts in conjunction with the corresponding desminopathy mice as models for desminopathies to analyse major protein quality control processes in response to the presence of R349P mutant desmin. METHODS We used hetero- and homozygous R349P desmin knock-in mice for analyses and for crossbreeding with p53 knock-out mice to generate immortalized R349P desmin knock-in skeletal muscle myoblasts and myotubes. Skeletal muscle sections and cultured muscle cells were investigated by indirect immunofluorescence microscopy, proteasomal activity measurements and immunoblotting addressing autophagy rate, chaperone-assisted selective autophagy and heat shock protein levels. Muscle sections were further analysed by transmission and immunogold electron microscopy. RESULTS We demonstrate that mutant desmin (i) increases proteasomal activity, (ii) stimulates macroautophagy, (iii) dysregulates the chaperone assisted selective autophagy and (iv) elevates the protein levels of αB-crystallin and Hsp27. Both αB-crystallin and Hsp27 as well as Hsp90 displayed translocation patterns from Z-discs as well as Z-I junctions, respectively, to the level of sarcomeric I-bands in dominant and recessive desminopathies. CONCLUSIONS Our findings demonstrate that the presence of R349P mutant desmin causes a general imbalance in skeletal muscle protein homeostasis via aberrant activity of all major protein quality control systems. The augmented activity of these systems and the subcellular shift of essential heat shock proteins may deleteriously contribute to the previously observed increased turnover of desmin itself and desmin-binding partners, which triggers progressive dysfunction of the extrasarcomeric cytoskeleton and the myofibrillar apparatus in the course of the development of desminopathies.
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Physical and Mental Recovery after Aortic Valve Repair. Thorac Cardiovasc Surg 2017. [DOI: 10.1055/s-0037-1598966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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DesR349P Mutation Results in Ultrastructural Disruptions and Compromise of Skeletal Muscle Biomechanics Already at Preclinical Stages in Young Mice before the Onset of Protein Aggregation. Biophys J 2016. [DOI: 10.1016/j.bpj.2015.11.1629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Physical and Mental Recovery after Conventional Aortic Valve Surgery. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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PB.45. Correlation of perilesional tissue stiffness measured by ultrasound strain elastography with breast density. Breast Cancer Res 2014. [PMCID: PMC4243770 DOI: 10.1186/bcr3742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Intragenic duplication of EHMT1 gene results in Kleefstra syndrome. Mol Cytogenet 2014; 7:74. [PMID: 25349628 PMCID: PMC4209064 DOI: 10.1186/s13039-014-0074-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/14/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kleefstra syndrome is characterized by intellectual disability, muscular hypotonia in childhood and typical facial features. It results from either a microdeletion of or a deleterious sequence variant in the gene euchromatic histone-lysine N-methyltransferase 1 (EHMT1) on chromosome 9q34. RESULTS We report on a 3-year-old girl with characteristic symptoms of Kleefstra syndrome. Array comparative genomic hybridization analysis revealed a 145 kilobases duplication spanning exons 2 to 10 of EHMT1. Sequence analysis characterized it as an intragenic tandem duplication leading to a frame shift with a premature stop codon in EHMT1. CONCLUSIONS This is the first description of an intragenic duplication of EHMT1 resulting in Kleefstra syndrome.
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Psychiatric morbidity in adults with congenital heart disease: Rare disease or frequent problem? Thorac Cardiovasc Surg 2014. [DOI: 10.1055/s-0034-1394050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Treating Gastritis, Peptic Ulcer Disease, and Dyspepsia in the Emergency Department: The Feasibility and Patient Reported Outcomes of Testing and Treating for H. Pylori Infection. Ann Emerg Med 2013. [DOI: 10.1016/j.annemergmed.2013.07.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Peptide receptor radionuclide therapy of neuroendocrine tumors with (90)Y-DOTATOC: is treatment response predictable by pre-therapeutic uptake of (68)Ga-DOTATOC? Diagn Interv Imaging 2013; 95:289-300. [PMID: 24034971 DOI: 10.1016/j.diii.2013.07.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE PET with (68)Ga-DOTATOC allows for imaging and quantitative assessment of somatostatin receptor expression in neuroendocrine tumors (NET). The aim of this retrospective study was to analyze whether pre-therapeutic (68)Ga-DOTATOC PET/CT is able to predict response to Peptide Receptor Radionuclide Therapy (PRRT). PATIENTS AND METHODS Forty patients with advanced stage NET were treated with a fixed dose of (90)Y-DOTATOC (5550 or 3700MBq). Prior to PRRT, each patient received (68)Ga-DOTATOC PET/CT. Treatment results were evaluated after 3months by CT, tumor marker levels and clinical course and correlated with (68)Ga-DOTATOC uptake (SUVmax) and the assumed uptake of (90)Y-DOTATOC in tumor manifestations (MBq/g). ROC analysis and pairwise comparison of area under the curve (AUC) were performed with pre-treatment uptake of (68)Ga-DOTATOC, assumed uptake of (90)Y-DOTATOC and treatment activity alone and in relation to body weight as continuous variables, and response/no response as classification variable. RESULTS According to conventional criteria (tumor shrinkage, decrease of tumor markers, improved or stable clinical condition), 20 patients were classified as responders, 16 as non-responders and in four patients findings were equivocal. Using a SUV more than 17.9 as cut-off for favorable outcome, PET was able to predict treatment response of all responders and 15 out of 16 non-responders. All four patients with equivocal findings showed SUV less than or equal to 17.9 and soon experienced tumor progression. The assumed uptake of (90)Y-DOTATOC in tumor manifestations using a cut-off more than 1.26MBq/g as predictor of response was able to correctly classify 19 out of 20 responders, and 14 out of 16 non-responders. In all patients with equivocal findings, the assumed uptake of (90)Y-DOTATOC was below 1.26MBq/g. CONCLUSION Pre-therapeutic (68)Ga-DOTATOC tumor uptake as well as assumed uptake of (90)Y-DOTATOC are strongly associated with the results of subsequent PRRT. The defined cut-off values should be confirmed by prospective studies and may then provide the rationale for individual dosing and selecting patients with high likelihood of favorable treatment outcome.
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1045Blood/myocardium contrast-to-noise ratio for cardiac
morphology and function imaging increases with field strength. Eur Heart J Cardiovasc Imaging 2013. [DOI: 10.1093/ehjci/jet070bl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Sodium imaging of the heart at 7T: design, evaluation and application of a four-channel transmit/receive surface coil array. J Cardiovasc Magn Reson 2013. [PMCID: PMC3560029 DOI: 10.1186/1532-429x-15-s1-w14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Comparison of three multichannel TX/RX coils for anatomic and functional CMR at 7.0T. J Cardiovasc Magn Reson 2013. [PMCID: PMC3560092 DOI: 10.1186/1532-429x-15-s1-w24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Use of ultrasound elasticity imaging to monitor the response of a primary breast cancer to neoadjuvant chemotherapy in one patient in a pilot study. Breast Cancer Res 2011. [PMCID: PMC3238280 DOI: 10.1186/bcr2995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Die Dritte Welle der Verhaltenstherapie. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2011; 79:330-9. [DOI: 10.1055/s-0029-1245963] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Type 3 Von Willebrand disease (VWD) is a rare, severe, autosomal recessive bleeding disorder. In our institution, we follow 17 children with type 3 VWD. We have observed a high prevalence of dental disease in these patients prompting us to undertake a retrospective review of our cohort of patients with type 3 VWD to catalogue the extent of their dental disease. Sixteen of these patients have been assessed by our dentistry department. Five children have undergone minor dental procedures (e.g. restorations, stainless steel crowns) and seven major procedures (e.g. dental extractions, pulpotomies and root canal treatments). These patients have collectively used 85,400 (ristocetin cofactor) IU of Humate-P on dental procedures alone. In addition to the considerable costs of factor are the cost of operating room time, dentists' costs, and the cost of other topical haemostatic agents (e.g. Tisseel) used during their dental procedures. As such there is considerable morbidity and cost from dental disease in these patients that is much higher than what is seen in patients with haemophilia or in the normal paediatric population. We speculate that the combination of these patients having a significant mucosal bleeding disorder together with various socioeconomic factors contribute to the significant degree of dental disease seen in this group of patients. We would suggest that better preventive dental care needs to be provided to these patients to avoid the considerable morbidity and very high burden of dental disease in type 3 VWD.
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Computertomografische Diagnostik einer Gallenblasenperforation Typ II/III. ROFO-FORTSCHR RONTG 2010; 182:527-9. [DOI: 10.1055/s-0029-1245276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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[Endomyocardial fibrosis in chronic eosinophilic leukemia]. ROFO-FORTSCHR RONTG 2009; 181:691-3. [PMID: 19401974 DOI: 10.1055/s-0028-1109295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Parenting knowledge and its role in the prediction of dysfunctional parenting and disruptive child behaviour. Child Care Health Dev 2009; 35:217-26. [PMID: 19134009 DOI: 10.1111/j.1365-2214.2008.00929.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a paucity of research on the relationship between parental knowledge, parenting and parenting self-efficacy, and some inconsistencies have been reported in the literature. METHOD Parent knowledge of effective parenting strategies was assessed among 68 parents from a non-clinic sample, who also completed questionnaires relating to parenting confidence, quality of parenting and child behaviour. RESULTS Parents with greater knowledge tended to be less dysfunctional, and reported significantly higher education and income levels. Parenting confidence explained a significant proportion of the variance in reported frequency of disruptive child behaviour while knowledge did not independently contribute to the prediction. However, the relationship between parenting confidence and dysfunctional parenting was moderated by the level of knowledge. There was a stronger negative relationship between confidence and dysfunctional parenting when knowledge level was low than when it was high. Post hoc analyses indicated that the relationship between parenting knowledge and disruptive child behaviour was moderated by the level of parenting dysfunction. Parenting knowledge and reported frequency of disruptive behaviour were positively related when the level of dysfunction was low, but were unrelated when it was high. CONCLUSIONS Parents with low levels of knowledge and confidence in their parenting may be at greater risk of dysfunctional parenting and might benefit from interventions designed to enhance both knowledge and confidence. Results are interpreted in relation to inconsistencies with previous research and implications for future methodologies.
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Pegfilgrastim for treatment of chemotherapy associated myelosuppression in pediatric patients with solid tumor malignancies. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.10022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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[Really drunk?]. PRAXIS 2007; 96:1767-1771. [PMID: 18050602 DOI: 10.1024/1661-8157.96.45.1767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
We report about a 42-year-old patient who was admitted to the emergency department because of suspected alcohol abuse. He declared himself to be drunk. He stated in his case history that he had suffered from right sided neck and facial pain for several days. The clinical examination revealed a left sided hemiparesis. Together with the demonstrated right hemispherical brain ischemia by computed tomography, a presumptive diagnosis of a dissection of the right internal carotid artery was made. This diagnosis was finally confirmed by ultrasound and magnetic resonance imaging. A therapy with full dose heparin was begun and oral anticoagulation was subsequently initiated. After two weeks of follow-up, the neurological deficiencies were partially regredient.
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Magnetic resonance imaging in suspected rectal cancer: determining tumor localization, stage, and sphincter-saving resectability at 3-Tesla-sustained high resolution. Acta Radiol 2007; 48:379-87. [PMID: 17453515 DOI: 10.1080/02841850701196914] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE To assess image quality and overall accuracy of 3-Tesla (3T)-sustained high-resolution magnetic resonance (MR) imaging for diagnostic preoperative workup in suspected rectal carcinoma. MATERIAL AND METHODS Twenty-three patients with suspected rectal cancer underwent unenhanced and contrast-enhanced fat-suppressed pelvic high-resolution MR imaging using a four-channel phased-array pelvic coil at 3T. Image quality, tumor stage, distance from the anorectal margin, and sphincter-saving resectability were prospectively assessed by two blinded readers. The results were correlated with clinical, surgical, and histopathologic findings. RESULTS In all 23 patients, MR images were of diagnostic quality, and malignancy was correctly identified in 21 patients. The accuracy for determining sphincter-saving resectability was 100% (19/19). T stage and N stage were correctly diagnosed in 95% and 91%, respectively. MRI allowed correct identification of tumor extension and its relation to surgically relevant pelvic structures including the anorectal margin and mesorectal fascia. Transverse T2-weighted fast spin-echo images compared superiorly to all other sequences for the diagnosis of mesorectal infiltration and lymph node involvement. Moreover, transverse fat-suppressed contrast-enhanced T1-weighted images were valuable for identifying tumor infiltration, while sagittal sections were useful for the detection of longitudinal tumor extension. CONCLUSION MR imaging with phased-array receiver coils at 3T facilitated both visualization of different pathologic conditions of the rectum and accurate determination of tumor stage in rectal carcinomas. Thus, this noninvasive diagnostic approach appeared highly suitable for the assessment of patients with suspected rectal carcinoma.
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Atrial myxoma presenting as transient ischaemic attack and acute coronary syndrome in an octogenarian. Age Ageing 2006; 35:644. [PMID: 16951262 DOI: 10.1093/ageing/afl097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Oral out-patient chemotherapy medication errors in children with acute lymphoblastic leukemia. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.9028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
9028 Background: Oral out-patient chemotherapy medications (OOCMs) compromise the majority of therapy for children with acute lymphoblastic leukemia (ALL). OOCM are administered at the patient’s home, usually by parents with limited medical training. The frequency of errors in OOCM dose or schedule is unknown in children with ALL. Methods: We conducted a prospective case series. After providing informed consent, parents were interviewed during an ambulatory clinic visit to determine the dose and frequency of OOCMs administered since the last ambulatory clinic visit or hospitalization. Parents also completed a questionnaire regarding their understanding of the child’s OOCMs. Patient medical records were reviewed to determine the appropriate OOCM doses and schedules and then compared to the parent report. Pharmacy records were reviewed to determine how OOCMs were prescribed. OOCM errors included omission of any OOCM, use of an incorrect OOCM, > 10% deviation from the intended OOCM dose, or incorrect OOCM schedule. Results: 69 children (median age 6.4 years, range 1.3–17.9 years) participated, with a total of 171 OOCMs assessed. Fifteen (8.7%) OOCMs were given incorrectly, including 10 OOCMs administered incorrectly by parents, and five prescribed incorrectly. Eight errors involved under- or over-dosing within 10–20% of the intended OOCM dose. There were no errors in pharmacy dispensing. Errors were more common with glucocorticoids (9/60 OOCMs evaluated) than anti-metabolites (6/111 OOCMs evaluated). Conclusions: OOCM errors are unusual in children with ALL. Both administration and prescription errors were observed. Efforts to improve optimal use of OOCMs should include prevention of errors, potentially by identifying patients at higher risk for OOCM errors. No significant financial relationships to disclose.
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Magnetic resonance imaging including magnetic resonance cholangiopancreatography for tumor localization and therapy planning in malignant hilar obstructions. Acta Radiol 2005; 46:462-70. [PMID: 16224919 DOI: 10.1080/02841850510021625] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess image quality and overall accuracy of magnetic resonance imaging (MRI), including two magnetic cholangiopancreatography (MRCP) techniques, for the diagnostics and preoperative work-up of malignant hilar obstructions. MATERIAL AND METHODS Thirty-one patients with malignant hilar obstructions (hilar cholangiocarcinoma, n=30; hepatocellular carcinoma, n=1) received MRCP by two techniques (single-shot thick-slab and multisection thin-slice MRCP) and unenhanced and contrast material-enhanced MRI. MR assessment included the evaluation of image quality and visualization of bile ducts (5-point scale), and the classification of tumor status. MR results were subsequently correlated with the results from surgery and pathology. RESULTS The maximum intensity projections of multisection thin-slice MRCP had significantly more artifacts compared to MRCP in the single-shot thick-slab technique, and overall image quality of single-shot thick-slab MRCP was rated significantly superior compared to multisection thin-slice MRCP (4.4 +/- 0.7 and 4.1 +/- 0.9, respectively). Moreover, ductal visualization of different parts of the biliary system was rated superior with single-shot thick-slab MRCP. In contrast, the original data from multisection thin slice MRCP facilitated visualization of periductal lesions and adjacent structures. Overall MR accuracy for the assessment of tumor status, periductal infiltration, and lymph node metastases was 90%, 87%, and 66%, respectively. CONCLUSION For evaluation of malignant hilar obstructions, MRCP by the single-shot thick-slab technique had superior image quality and fewer artifacts; in contrast, besides sole biliary visualization, multisection MRCP depicted complementary adjacent parenchymal and periductal structures. We therefore recommend MRI, with a combination of both MRCP techniques, for the diagnostic work-up and therapy planning of malignant hilar obstructions.
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Prospective Evaluation of Preoperative 3 Tesla MRI in the Diagnosis of Rectal Carcinoma. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-865268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Auswirkung der Feldstärke bei der standardisierten Kernspintomographie des Gehirns am Beispiel der Darstellung von Hirnnerven und Gefäßen in den basalen Zisternen: Vergleich zwischen 1,5 und 3,0 Tesla. ROFO-FORTSCHR RONTG 2005; 177:530-5. [PMID: 15838758 DOI: 10.1055/s-2005-857958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Comparison of MR images acquired as routine examinations at a field strength of 3.0 T and 1.5 T to determine whether and to which degree the image quality improves at the higher field strength of 3.0 T. MATERIALS AND METHODS Routine MR images of 200 patients were examined retrospectively, with 100 images obtained at 1.5 T and 100 obtained at 3.0 T. The examinations were performed with a quadrature head coil and focused on the basal cisterns because of the abundance of small distinct structures in this region. We selected the T2-weighted 2D-FSE sequence in transverse direction for comparison. At both field strengths, the same section thickness of 5 mm and a matrix of 512 x 388 (FOV: 220 mm) were used. The quality of the images was evaluated with regard to depicting the cranial nerves N. III, V - X, the AICA and PICA. For comparison, image quality was rated with a score from 1 (well defined) to 5 (not depicted). RESULTS A score of 1 was obtained in 46 % of the anatomic structures examined at 3.0 T and in only 9.2 % at 1.5 T. A score of 2 was given in 27.6 % of the anatomic structures at 3.0 T vs. 23.5 % at 1.5 T, a score of 3 in 17.2 % vs. 28.1 %, a score of 4 in 8.6 % vs. 28.7 %, and a score of 5 in 0.4 % vs. 10.3 %, respectively. The Mann-Whitney U test showed significance at p < 0.001 for the comparison of images at 1.5 and 3.0 Tesla. CONCLUSION Routine magnetic resonance imaging using the same quadrature coil technique and similar acquisition times at 3.0 T and 1.5 T shows an improvement for T2-weighted images at the higher field strength.
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Well-being, appraisal, and coping in African-American and Caucasian dementia caregivers: findings from the REACH study. Aging Ment Health 2004; 8:316-29. [PMID: 15370048 DOI: 10.1080/13607860410001728998] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although there has been considerable interest in racial differences in family caregiving for persons with dementia, most research to date has either ignored racial diversity or based conclusions on small numbers of caregivers drawn primarily from single site studies. The current study utilized participants from four sites of the REACH (Resources for Enhancing Alzheimer's Caregiver Health) multi-site study to compare well-being, appraisal, and religious coping by race. African-American (n = 295) and Caucasian (n = 425) dementia caregivers from four cities (Birmingham, Memphis, Boston, and Philadelphia) were compared in their demographics, care recipient characteristics, mental and physical health, and psychosocial coping resources including appraisal and religious coping. African-American caregivers reported lower anxiety, better well-being, less use of psychotropic medications, more benign appraisals of stress and perceived benefits of caregiving, and greater religious coping and participation, than Caucasian caregivers. Self-rated health did not differ by race, but African-American caregivers reported more unhealthy behaviors than Caucasian caregivers. Some results were specific to site, possibly due to differences in recruitment strategies, inclusion/exclusion criteria, and regional differences. Adjustment for covariates, including caregiver relationship to the care recipient, gender, age, socioeconomic status, and care recipient behavioral problems, altered few of these differences. Results are discussed in terms of their relevance to psychosocial intervention programs for ethnically diverse caregivers.
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Investigation of health perspectives of those with physical disabilities: the role of spirituality as a determinant of health. Disabil Rehabil 2004; 26:129-44. [PMID: 14754624 DOI: 10.1080/09638280310001636419] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To identify key determinants of health and the process of health attainment for people with musculoskeletal disabilities. METHOD Focus groups of people with musculoskeletal disorders, including 30 members and their five trained facilitators, provided data. Discussed were 'What is health for you?' and 'What has helped, or would help you achieve this health?' Delphi-structured analysis identified health themes and a health process model was developed with the facilitators comprising the expert panel. RESULTS Health was perceived as centred on relationships that required a spiritual awareness for a strong and resilient identity. The Self Attributes Model developed portrays the processes perceived to be required for health. CONCLUSIONS Although physical, social and psychological interventions are essential aspects of health intervention, by themselves they are not sufficient. Also required for health is a strong resilient self resulting from interaction and connection with other people and the natural world. Moreover, development of such an identity requires a spiritual world-view comprising an acknowledgement of the essence of self and focus upon the nature of the connection of this essence with all other aspects of life. Further research is required to advance understanding of the process by which this occurs for people with chronic disorders.
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Ortsaufgelöste H1-MR-Spektroskopie der Leber bei 3.0T: Etablierung eines klinisch praktikablen Protokolls zur Datenaufnahme und -auswertung. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-828018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Lokalisierte H1-Magnetresonanzspektroskopie der Leber und maligner Leberläsionen bei 3.0T. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kontrastmittelinduzierte Nephropathie im klinischen Alltag der Computertomographie. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Antinociceptive properties of neurosteroids: a comparison of alphadolone and alphaxalone in potentiation of opioid antinociception. Anesth Analg 2003; 97:798-805. [PMID: 12933405 DOI: 10.1213/01.ane.0000075835.73967.f3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this study, we investigated the antinociceptive and sedative effects of the opioids fentanyl, morphine, and oxycodone given alone and in combination with two neurosteroids: alphadolone and alphaxalone. An open-field activity monitor and rotarod apparatus were used to define the sedative effects caused by opioid and neurosteroid compounds given alone intraperitoneally to male Wistar rats. Dose-response curves for antinociception were constructed using only nonsedative doses of these drugs. At nonsedating doses, fentanyl, morphine, and oxycodone all caused dose-dependent tail flick latency (TFL) antinociceptive effects. Because neither neurosteroid altered TFL, electrical current was used as the test to determine doses of neurosteroid that caused antinociceptive effects at nonsedative doses. Alphadolone 10 mg/kg intraperitoneally caused significant antinociceptive effects in the electrical test but alphaxalone did not. All three opioid dose-response curves for TFL antinociception were shifted to the left by coadministration of alphadolone even though alphadolone alone had no effect on TFL. Alphaxalone given alone had no antinociceptive effects at nonsedative doses and it had no effect on opioid antinociception. Neither neurosteroid caused sedative effects when combined with opioids. We conclude that coadministration of alphadolone, but not alphaxalone, with morphine, fentanyl, or oxycodone potentiates antinociception and that this effect is not caused by an increase in sedation.
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How quality assurance facilitates decentralization in a primary health care system: the case of Niger. Q.A. BRIEF 2002; 5:22-4. [PMID: 12347469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Applying quality assurance to the primary health care service delivery system in Tahoua, Niger. Q.A. BRIEF 2002; 3:22-4. [PMID: 12319097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
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Evaluating home environments of persons with dementia: interrater reliability and validity of the Home Environmental Assessment Protocol (HEAP). Disabil Rehabil 2002; 24:59-71. [PMID: 11827156 DOI: 10.1080/09638280110066325] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE This article reports on an interrater reliability and preliminary validity study of an investigator-developed tool, the Home Environmental Assessment Protocol (HEAP) for use in homes of persons with dementia. METHOD The HEAP consists of 192 items that are summed into separate indices representing the number of hazards, adaptations, and level of clutter and comfort in eight areas of the home. Interrater reliability was examined among four raters, two environmental experts and two non-experts, who observed 22 dementia households. RESULTS The Kappa statistic was used to evaluate agreement level for each measured item and found that agreement ranged from slight to almost perfect. Intraclass correlations (ICCs), were used to evaluate agreement level for indices. The hazard index in each room ranged from fair (0.36) to moderate (0.66) for all raters. For the adaptation, clutter and comfort indices in each room, ICCs ranged from 0.51 to 0.90 for all raters. Agreement level between expert and non-expert raters differed minimally for all indices. Adaptations to dining rooms (r= -0.080, p = 0.001), kitchens (r = -0.52, p = 0.02) and bedrooms (r = -0.76, p = 0.001) were associated with patient deficits such that more adaptations were made in homes of dependent persons. Low Mini-Mental Status Examination scores were associated with fewer hazards, more adaptations, and less clutter. CONCLUSION Findings show that both experts and non-expert raters use the HEAP consistently. Also, measured attributes are related to cognitive and functional status in the expected direction.
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A randomized, controlled trial of a home environmental intervention: effect on efficacy and upset in caregivers and on daily function of persons with dementia. THE GERONTOLOGIST 2001; 41:4-14. [PMID: 11220813 DOI: 10.1093/geront/41.1.4] [Citation(s) in RCA: 252] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
PURPOSE OF STUDY The authors determined short-term effects of a home environmental intervention on self-efficacy and upset in caregivers and daily function of dementia patients. They also determined if treatment effect varied by caregiver gender, race, and relationship to patient. DESIGN AND METHODS Families (N = 171) of dementia patients were randomized to intervention or usual care control group. The intervention involved 5 90-min home visits by occupational therapists who provided education and physical and social environmental modifications. RESULTS Compared with controls, intervention caregivers reported fewer declines in patients' instrumental activities of daily living (p = .030) and less decline in self-care and fewer behavior problems in patients at 3 months post-test. Also, intervention spouses reported reduced upset (p = .049), women reported enhanced self-efficacy in managing behaviors (p = .038), and women (p = .049) and minorities (p = .037) reported enhanced self-efficacy in managing functional dependency. IMPLICATIONS The environmental program appears to have a modest effect on dementia patients' IADL dependence. Also, among certain subgroups of caregivers the program improves self-efficacy and reduces upset in specific areas of caregiving.
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Abstract
OBJECTIVES The objective was to derive and test the psychometric characteristics of a scale to measure Valuation of Life (VOL). METHODS Four samples were used in successive phases of exploratory factor analysis, confirmatory factor analysis, reliability and validity testing, and exploration of response-error effects. Estimates of Years of Desired Life were obtained under a variety of hypothetical quality-of-life (QOL)-compromising conditions of poor health. RESULTS Confirmed 13-item (Positive VOL) and 6-item (Negative VOL) factors were obtained. A significant relationship between VOL and most Years of Desired Life estimates remained when demographic, health, quality of life, and mental health measures were controlled. Analysis of Negative VOL revealed that some respondents misunderstand the meaning of an agree response to negatively phrased items. DISCUSSION VOL is a cognitive-affective schema whose function as a mediator and moderator between health and end-of-life decisions deserves further research.
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Abstract
Long-term and moderately short-term effects of bereavement and marriage on psychological well-being (PWB) among older people were investigated. The aspect of PWB that was examined was the prevalence of six affects, rated in terms of their frequency during the past year. Affect frequency of four groups was tested: Recently widowed, recently married, and widowed and married elders unselected for length of time in those marital statuses. As predicted, both length of time in the marital status and congruence between the positive event (marriage) and positive affect and between congruence of the negative event (bereavement and negative affect) were associated with group differences. Depressive affect was greatest among the recently bereaved but the recently-married, long-married, and longer-bereaved groups did not differ in depression. Positive affect was greatest among the recently married and other groups did not differ in this respect. Hostility, anxiety, shyness, and contentment were not predicted to differ among groups; in fact, contentment was least in the bereaved; shyness was least among the recently-married, and hostility was lowest among the long-widowed. Results are discussed in terms of the joint influences of time since a life event and the differential relevance of positive and negative affect states to positive and negative events. Continued research attention to the covariation of these factors in relation to the affective aspects of PWB is needed to understand the conditions of stability and change.
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Abstract
OBJECTIVE To report the first example of an abnormal magnetic resonance imaging (MRI) test in a patient with migraine and olfactory hallucinations and to provide additional evidence for a possible role of the temporal lobe in migraine. BACKGROUND The relationship between the temporal lobe and migraine with or without hallucinations is unclear and continues to evolve. Clinical and functional neuroimaging studies (positron emission tomography/single photon emission computed tomography) have lent support to the possibility of a relationship. Anatomical neuroimaging with computed tomography has previously been normal. METHODS The history and findings of an adolescent with migraine and olfactory hallucinations is reported. RESULTS Brain MRI demonstrated a mass in the temporal lobe. CONCLUSIONS Magnetic resonance imaging should be considered in patients with olfactory hallucinations and migraine. In addition, the role of the temporal lobe in migraine warrants further study.
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