Dietary aflatoxins, intelligence and school performance in southern Georgia

In a region of southern Georgia known for poor school performance, the mothers of the mentally retarded children had diets that differed from the average in terms of foods, but did not differ in terms of critical nutrients. The consumption of large amounts of corn, rice, peanuts and milk (foods potentially high in aflatoxins) was significantly related to mental retardation of children in one county having high levels of aflatoxins in the food supply. However, no such relationship was found in a county having trivial levels of aflatoxins in the diet.     

Pubertal growth spurt in the female rhesus monkey: Relation to menarche and skeletal maturation

Three-monthly measurements of tibia length, crown-rump length (CRL), and body wieght have been made on nine indoor-housed and six outdoor-housed female rhesus monkeys (Macaca mulatta) from ages 17 to 41 months. In the indoor-housed there were clear pubertal growth spurts, identifiable in individual curves, with average peaks at 22.5 months for tibia length, 23.5 months for CRL, and 24.5 for weight. Menarche occurred on average at 26.0 months. In both skeletal dimensions the amount of acceleration exceeded that which occurs in man. The relative timing of the spurts and of menarche was similar to that in man. The outdoor-housed monkeys showed a similar spurt in tibia length, although a less easily identifiable one in crown-rump length. The peak velocity of tibia length in these monkeys occurred on average at 30.5 months, with menarche at 32.5 months. We conclude that the pubertal growth spurt in female rhesus is very little different from that in man.     

A polymorphism in the dopamine β-hydroxylase gene is associated with “paranoid ideation” in patients with major depression

Background: Increased dopaminergic activity may play a primary role in psychotic depression. Dopamine β-hydroxylase (DβH) catalyses the key step in biosynthesis of the neurotransmitter noradrenaline from dopamine, and low DβH activity is a possible risk factor for developing psychotic depression. An exon 2 polymorphism (DBH∗444 g/a) of the DβH gene (DBH) is significantly associated with both serum and cerebrospinal fluid levels of DβH.Methods: We determined the genotype of the DBH∗444g/a polymorphism in a cohort of 164 patients with major depression and examined the association of this polymorphism with paranoid ideation, interpersonal sensitivity, and psychoticism on the Hopkins Symptom Checklist.Results: Patients who possessed the A allele were significantly more likely to have higher scores for interpersonal sensitivity and paranoia than patients without the A allele (p = .004 and p = .048, respectively), suggesting that this allele may predispose patients to paranoia in major depression. In addition, we found an association between prolactin levels in men and DBH∗444 g/a genotype such that homozygous G individuals displayed significantly higher levels than homozygous A or heterozygote individuals.Conclusions: Depressed patients with the GG genotype of DβH have lower scores for interpersonal sensitivity and paranoid ideation. The GG genotype may be protective against the development of psychosis in the presence of a major depressive episode.     

Pre-processed image reconstruction applied to breast and brain MR imaging

Magnetic resonance imaging (MRI) has emerged as a powerful tool in medical diagnosis and research. Although high spatial resolution images are essential in medical diagnosis and image analysis, high temporal resolution is equally important in applications of dynamic contrast-enhanced MRI or functional brain MRI. In particular, in breast MRI the ability to differentiate between benign and malignant lesions depends, in part, on the temporal resolution of the dynamic image acquisition. New applications of MRI such as multi-feature analysis of image time series data and full 3D functional MRI or event-related functional MRI require high spatial and high temporal resolution for accurate image analysis on a voxel-by-voxel basis. Currently available partial Fourier reconstruction techniques. which effectively improve the time resolution, suffer from a reduced signal to noise ratio in the reconstructed image, a decrease in spatial resolution or reconstruction artefacts, making numerical image analysis difficult. In this work we present an image reconstruction algorithm based on image recovery theory which effectively doubles the temporal resolution and results in an image quality sufficient for further numerical analysis. The developed algorithm requires a full Fourier space acquisition of a pre-contrast or baseline image prior to the reconstruction procedure of the time series partial Fourier data.     

Immunotherapy for thoracic malignancies

Purpose

Historically, thoracic malignancies, such as non-small cell lung cancer and malignant pleural mesothelioma, have been marked by poor prognosis. Current standard of care for these diseases results in limited improvements in survival benefit. This has prompted researchers to explore new and innovative treatment alternatives. Immunotherapy is an emerging therapeutic modality that harnesses the power of the human immune system against cancer cells. Herein, we summarize the concepts and current status of immunotherapy for the treatment of thoracic malignancies.

Methods

Using ClinicalTrials.gov, we conducted a literature review using the terms “immunotherapy” and “immune therapy,” and combined them with the conditions “pleural mesothelioma” and “carcinoma, non-small cell lung.” The search results yielded 452 trials, among which 122 trials met our specific criteria.

Results

Our search identified immune checkpoint blockade, immunotoxin therapy, anticancer vaccines, and adoptive cell therapy as the most common and relevant immunotherapies that are currently being assessed in clinical trials.

Conclusion

We have highlighted the successes, as well as the limitations, of immunotherapy for non-small cell lung cancer and malignant pleural mesothelioma. We have identified early phase clinical trials that assess immunotherapy as first-line, second-line, and maintenance therapy, and compared these drugs as monotherapeutics or in combination with chemotherapy or other types of immunotherapy.

     

Effects of fluconazole and clarithromycin on rifabutin and 25-O-desacetylrifabutin pharmacokinetics

Ten human immunodeficiency virus-infected patients were given rifabutin in addition to fluconazole and clarithromycin. There was a 76% increase in the area under the concentration-time curve of rifabutin when either fluconazole or clarithromycin was given alone and a 152% increase when both drugs were given together with rifabutin. Patients should be monitored for adverse effects of rifabutin administered concomitantly with clarithromycin and/or fluconazole.     

Measuring the population impact of knee pain and disability with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)

This study has used the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) in an unsolicited postal questionnaire to investigate the impact of knee pain and disability in the general older population. The study provides WOMAC population data for those aged over 50 and demographic and psychosocial associations with severity of WOMAC scores. A pilot survey (n=240) and repeatability study (n=80) were undertaken to test completion of the WOMAC in this new setting. The main questionnaire was mailed to 8,995 men and women aged over 50 registered with three general practices in North Staffordshire, UK. Completion rates for WOMAC items were high. Substantial reliability was found for pain and physical function scales (both >0.80). Fourteen percent of the over 50 population in this study had severe knee pain, 20% had severe difficulty with at least one area of physical functioning, 12% had both. The strongest link with severe difficulty with physical functioning was chronicity (odds ratio (OR)=6.49, 95% CI 4.65, 9.04). Other independent links were age over 75 years (odds ratio (OR)=4.11, 95% confidence interval (CI) 3.03, 5.58), depression (OR=2.80, 95% CI 2.22, 3.54), bilateral knee injury (OR=2.23, 95% CI 1.63, 3.06) and body mass index>30 (OR=2.00, 95% CI 1.51, 2.64). Similar associations were found for severe pain. The findings suggest that the WOMAC is a reliable measure for use in postal surveys. It has advantages over other instruments when measuring pain and physical function difficulty related to the knee. Chronicity, older age, injury, obesity and depression were all linked with higher WOMAC scores for knee pain severity and disability among knee pain sufferers in the general older population.     

Digital photography: a technique to optimize reimbursement.

Insurance companies may reject claims because of inadequate documentation. Dictated notes or an electronic medical record provide an accurate and complete documentation of services. In a paper-based medical record system, significant amounts of professional fees are lost because the insurance companies reject claims without copies of the note. It is onerous to provide copies of the daily progress notes and bedside procedure notes to the billing service. Retrospective review of billing records for a 12-month period was performed. One partner took daily digital photos of all progress notes and made these available to be submitted with the claim. The other partner did not use this technique. Both partners dictated procedure notes which were available to the billing service for submission. The Wilcoxon's rank-sum test compared the reimbursement rates which were stratified for dictated procedures vs daily notes and insurance type between the two partners. More than 5000 billing submissions were analyzed. The reimbursement rate for procedures was similar for each surgeon (mean 18-19%). The reimbursement rate for daily progress notes was significantly higher for the surgeon using digital photography (mean 38% vs 29%, P < .05 by Wilcoxon's rank-sum test). Digital photography provides an easy means of documenting services. This provides proof of service to insurance companies and improves reimbursement. The same result could be provided by an electronic medical record, or by onsite billing personnel copying the medical record.