Reading and phonological awareness in reading-disabled adults

Sixty-eight students with reading disabilities (RDs) and 55 non-reading-disabled university undergraduates composed the sample. Students with RDs met either low achievement (LA) or regression-based discrepancy (D) criteria. In addition to IQ and reading decoding measures, all participants received measures of phonological awareness (PA), confrontation naming, and verbal fluency. Consistent with expectations, the D and LA subgroups did not differ from one another, and both performed worse than students without RD on phonological measures. However, only the LA subgroup performed worse on measures of confrontation naming and verbal fluency. Subgroups of readers who had LA without an IQ-achievement discrepancy (LA-no D) and readers who had both LA and a discrepancy (LA + D), performed worse than readers who had a discrepancy but whose reading achievement was above the 16th percentile (D-no LA) on measures of PA, naming, and fluency; this subgroup did not differ from students without RDs. These results question the utility of determining RD in adults solely on the basis of IQ-achievement discrepancy criterion without regard to other linguistic skills or absolute reading level.     

Evidence-based orthopaedics: a primer

Evidence-based medicine has evolved from the need of solving clinical problems. In contrast to the traditional paradigm of clinical practice, evidence-based medicine acknowledges that intuition, clinical experience, and pathophysiologic rationale are not sufficient for making the best clinical decisions. Although evidence-based medicine recognizes the importance of clinical experience, it includes the evaluation of evidence from clinical research and the integration of patients' values, preferences, and actions for best clinical decision-making. To optimize this process, evidence-based medicine advocates that a formal set of rules must accompany training and clinicians' common sense to interpret and apply evidence from clinical research results effectively. We describe the critical appraisal of studies related to prognosis and therapy or prevention building on an example relevant for the clinical orthopaedist. Based on the example, the authors describe how clinicians can apply measures of association and of intervention effects to their practice and patient care. The authors conclude with describing the appraisal of systematic reviews, their application to the development of practice guidelines, and the process of guideline development and recommendations.     

Mammary intraepithelial neoplasia outgrowths (MINO): MINO and human ductal carcinoma <Emphasis Type="Italic">in situ</Emphasis>

Germ-line mutations in the BRCA1 tumour suppressor gene contribute to familial breast tumour formation, but there is no evidence for direct mutation of the BRCA1 gene in the sporadic form of the disease. In contrast, decreased expression of the BRCA1 gene has been shown to be common in sporadic tumours, and the magnitude of the decrease correlates with disease progression. BRCA1 expression is also tightly regulated during normal breast development. Determining how these developmental regulators of BRCA1 expression are co-opted during breast tumourigenesis could lead to a better understanding of sporadic breast cancer aetiology and the generation of novel therapeutic strategies aimed at preventing sporadic breast tumour progression.     

A randomised phase II study on neo-adjuvant chemotherapy for 'high-risk' adult soft-tissue sarcoma

The aim of this study was to examine the strategy, feasibility and outcome of neo-adjuvant chemotherapy, with doxorubicin and ifosfamide, in adult patients with 'high-risk' soft-tissue sarcomas. Patients with 'high-risk' soft-tissue sarcomas, defined as tumours > or =8 cm of any grade, or grade II/III tumours <8 cm, or grade II/III locally recurrent tumours, or grade II/III tumours with inadequate surgery performed in the previous 6 weeks and therefore requiring further surgery, were randomised between either surgery alone or three cycles of 3-weekly doxorubicin 50 mg/m(2) intravenous (i.v.) bolus and ifosfamide 5 g/m(2) (24 h infusion) before surgery. The type of surgery had to be planned at randomisation. Tumours were to be amenable to surgery by amputation, compartmental resection, wide or marginal excision. If chemotherapy was given, surgery had to be performed within 21 days after the last chemotherapy. Patients received postoperative radiotherapy in cases of marginal surgery, microscopically incomplete resection and no further possibility for surgery, and in cases of surgery because of local recurrence. 150 patients were entered into the study and 134 were eligible, 67 in each arm. The most frequent side-effects of chemotherapy were alopecia, nausea and vomiting (95%), and leucocytopenia (32%). One patient died of neutropenic fever after the first cycle of chemotherapy. Chemotherapy did not interfere with planned surgery and did not affect postoperative wound healing. Limb-salvage was achieved in 88%, amputation was necessary in 12% (all according to the plan at randomisation). The trial was closed after completion of phase II, since accrual was too slow to justify expanding the study into the scheduled phase III study. At a median follow-up of 7.3 years, the 5 year disease-free survival is estimated at 52% for the no chemotherapy and 56% for the chemotherapy arm (standard error: 7%) (P=0.3548). The 5 year overall survival for both arms is 64 and 65%, respectively (standard error 7%) (P=0.2204). Neo-adjuvant-chemotherapy with doxorubicin and ifosfamide at these doses and with this schedule was feasible and did not compromise subsequent treatment, surgery with or without radiotherapy. Although not powered to draw definitive conclusions on benefit, but with an at least 7 year median follow-up, the results render it less likely that major survival benefits will be achieved with this type of chemotherapy.     

Influence of caloric restriction on the development of atherosclerosis in nonhuman primates: progress to date

Caloric restriction (CR) has been observed to retard aging processes and extend the maximum life span in rodents. In an effort to evaluate the effect of this nutritional intervention on physiologic variables in higher species, several nonhuman primate trials are ongoing. In particular, a study evaluating the independent effect of CR on the extent of atherosclerosis was initiated in 1993 in 32 adult cynomolgus monkeys. Therefore, the trial was designed to achieve identical cholesterol intake after animals were randomized to a control group or a calorie-restricted group (30% reduction from baseline caloric intake). The animals were routinely evaluated for glycated proteins, plasma insulin and glucose levels, insulin sensitivity, and specific measures for abdominal fat distribution by CT scans over a 4-year interval. The results from 4 years of intervention demonstrate that CR improves cardiovascular risk factors (such as visceral fat accumulation) and improves insulin sensitivity. In contrast to other primate studies with normolipidemic animals, CR had no independent effects on plasma lipid levels and composition in the presence of equivalent amounts of dietary cholesterol intake. Preliminary analysis of atherosclerotic lesion extent in the abdominal aorta has failed to demonstrate differences between control animals and CR animals. Follow- up studies are being conducted to determine the effect of CR on atherosclerosis extent in coronary and carotid arteries.