Identifying cut-off scores with neural networks for interpretation of the incontinence impact questionnaire

We propose to determine cut-off scores for the Incontinence Impact Questionnaire (IIQ) based on the neural network (NN) approach. These cut-off scores should discriminate between patients having poor, moderate, or good quality of life (QoL) secondary to their incontinence problems. Data from two prospectively completed QoL questionnaires, the IIQ (n = 237) and the MOS 36-Item Short-Form Health Survey (SF-36) (n = 237), were analyzed using NN and conventional statistical tools. Kohonen networks identified three distinct clusters of IIQ scores. The three clusters represent the full spectrum of possible scores on the IIQ. We interpreted these clusters as reflecting good, moderate, and poor QoL. We estimated that a score of less than 50 on the IIQ would be representative of good QoL, between 50 and 70 would be moderate QoL, and greater than 70 would be indicative of poor QoL. Validation with the SF-36 data confirmed these categories. The present study demonstrated that the NN approach is opening new areas in the interpretation and clinical usefulness of QoL questionnaires. NN allowed the identification of three levels of QoL and should be useful in clinical decision making.     

Efficacy and tolerability profile of etoricoxib in patients with osteoarthritis: A randomized,double-blind,placebo and active-comparator controlled 12-week efficacy trial

OBJECTIVE: To evaluate the efficacy of 12 weeks of treatment with etoricoxib, a selective COX-2 inhibitor, in patients with osteoarthritis (OA) of the knee or hip. METHODS: In the 12-week placebo- and active comparator-controlled period of a randomized, double-blind study, eligible patients were treated with etoricoxib 60 mg once daily (n = 224), naproxen 500 mg twice daily (n = 221), or placebo (n = 56). Western Ontario McMaster's Osteoarthritis Index (WOMAC) pain and physical function subscales and patient's global assessment of disease status were primary end points. Key secondary and other end points were patient's and investigator's global assessment of response to therapy, WOMAC stiffness subscale, investigator's global assessment of disease status, rescue paracetamol use, proportion of patients discontinuing due to lack of efficacy, and study joint tenderness. RESULTS: Etoricoxib 60 mg demonstrated efficacy significantly superior to placebo (p < or = 0.005) and comparable to naproxen 500 mg twice daily as assessed by the primary efficacy end points. Secondary and other end points confirmed these results. Treatment effects were evident by day 2, maximal by week 2, and sustained over the entire 12 weeks. Etoricoxib was well tolerated for 12 weeks. CONCLUSIONS: Etoricoxib showed rapid and durable treatment effects in patients with OA of the knee or hip. Etoricoxib was generally well tolerated.     

Quality of life assessment in men and women with urinary incontinence

PURPOSE: The literature on assessment of quality of life from 1993 to 2001 was reviewed to evaluate and compare existing measures through their psychometric value and make adequate recommendations on their clinical use and future research. MATERIALS AND METHODS: We selected quality of life articles and abstracts from Current Content 1996 to 1997 and MEDLINE 1993 to 1996 for our first report presented at the first consultation on incontinence in Monaco in 1998. This report was then updated up to September 2001 using the same strategy. We made our recommendations based on our clinical and research experience with these tools. RESULTS: Several quality of life generic or disease specific questionnaires have been published for male and female urinary incontinence. However, their psychometric value is far from uniform and for most of them responsiveness is weak or has never been reported. CONCLUSIONS: Few quality of life questionnaires are at an advanced enough stage of development to be applied in clinical practice. However, even with these questionnaires more study remains to be done to make them shorter, sometimes even more specific and easier to use in different populations.     

Rehabilitation and outcome following pediatric traumatic brain injury

The long-term outcome for a child who has sustained a traumatic brain injury must be viewed in the context of ongoing development and maturation. Although neuronal plasticity provides the potential for neuronal reorganization in a child's brain, it is the behavioral demands of the environment that allow the child to take advantage of this potential and to maximize recovery. Pediatric rehabilitation is the setting that provides the necessary experiences for stimulating neuronal reorganization following TBI. However, neuronal reorganization has a cost to long-term development. The ultimate long-term impact of a TBI sustained in childhood depends on the child's ability to achieve developmental milestones following injury. Although injury-related and treatment-related factors are critical during the early stages of recovery, patient-related factors such as age-at-injury, developmental achievement at time of injury, maturation, and family involvement and resources impact the later stages of recovery. The process of pediatric rehabilitation following TBI is to provide an enriched, stimulating environment tailored to the needs of the child and based on real-word experiences. Early in the recovery process, pediatric rehabilitation is the setting that maximizes the potential for neuronal reorganization. Early rehabilitation also prepares the family for the child's long-term recovery and developmental needs. Involvement and training of family members early in the recovery process is critical for successful long-term outcome. Family members are the individuals best equipped to ensure treatment compliance and follow through with treatment recommendations, in maintaining treatment gains, and in generalizing treatment effects beyond the medical settings. Despite the life-long ramifications of childhood TBI, pediatric rehabilitation is the necessary step in promoting recovery and successful long-term outcome.     

Participants' perception of impact of a workshop on their preventive practices

A 90-minute interactive workshop, offered to small groups on request, was developed to help physicians include evidence-based preventive interventions in their practices. Between 25 September 1996 and 10 December 1997, 593 family physicians throughout the Province of Quebec (Canada) participated in one of the 40 workshops presented in all the regions of Quebec. Almost all participants (98%) completed the self-administered questionnaire. Their opinion of the achievement of three workshop objectives were evaluated using a seven-point Likert scale (-3 to +3)as their perception of the direct impact of the workshop on their practice. The workshop objectives were reached to a high degree: 2.1 (sd 0.90) for prescribing a proper check-up for adults; 1.83(sd 1.02) for explaining to the patient the reasons motivating his/her choice to include or exclude certain tests; 2.09 (sd 0.93)for using concrete and useful tool facilitating the integration of preventive measures in his/her professional practice. Female physicians and those under 40 perceived that the objectives were reached to a greater degree. Participants indicate their intention to modify their practice according to the clinical practice guidelines presented in the workshop.     

Use of diffusion weighted MRI to predict the occurrence and severity of hemorrhagic transformation in a rabbit model of embolic stroke

Alpha-synuclein is a brain presynaptic protein that is linked to familiar early onset Parkinson's disease and it is also a major component of Lewy bodies in sporadic Parkinson's disease and other neurodegenerative disorders. Alpha-synuclein expression increases in substantia nigra of both MPTP-treated rodents and non-human primates, used as animal models of parkinsonism. Here we describe an increase in alpha-synuclein expression in a human neuroblastoma cell line, SH-SY5Y, caused by 5-100 microM MPP+, the active metabolite of MPTP, which induces apoptosis in SH-SY5Y cells after a 4-day treatment. We also analysed the activation of the MAPK family, which is involved in several cellular responses to toxins and stressing conditions. Parallel to the increase in alpha-synuclein expression we observed activation of MEK1,2 and ERK/MAPK but not of SAPK/JNK or p38 kinase. The inhibition of the ERK/MAPK pathway with U0126, however, did not affect the increase in alpha-synuclein. The highest increase in alpha-synuclein (more than threefold) in 4-day cultures was found in adherent cells treated with low concentrations of MPP+ (5 microM). Inhibition of ERK/MAPK reduced the damage caused by MPP+. We suggest that alpha-synuclein increase and ERK/MAPK activation have a prominent role in the cell mechanisms of rescue and damage, respectively, after MPP+ -treatment.     

Induction of peripherin expression in subsets of brain neurons after lesion injury or cerebral ischemia

Peripherin is a type III intermediate filament predominantly expressed in neurons having direct axonal projections toward peripheral structures. Here, we report that brain injuries can trigger expression of peripherin and the formation of peripherin accumulations in neurons that are normally silent for this gene. Stab lesions made with nitrocellulose implants induced within 4 days the formation of peripherin accumulations, devoid of neurofilament proteins, in thalamic neurites at the site of the lesion. The local administration of interleukin-6 or leukemia inhibitory factor at the site of the stab lesion extended the expression pattern of peripherin to other neuronal subsets in areas of the cortex and/or of the hippocampus adjacent to injury. We also show that transient focal ischemia in mice, a model of stroke, can trigger within 72 h the formation of neuronal peripherin accumulations in neurons of the cortex, thalamus and hippocampus. This new type of potentially noxious intermediate filament protein accumulations, composed of peripherin, may be of relevance to many brain degenerative disorders with occurrence of proinflammatory cytokines.     

Automated generation of curved planar reformations from volume data: method and evaluation

The authors developed and evaluated a method to automatically create interactive vascular curved planar reformations with computed tomographic (CT) angiographic data. The method decreased user interaction time by 86%, from 15 to 2 minutes. Expert reviewers were asked to indicate their confidence in differentiating automatically created images from clinical-quality manually produced images. The area under the receiver operating characteristic curve was 0.45 (95% CI: 0.39, 0.51), and a test of equivalency indicated that reviewers could not distinguish between images. They also graded image quality as equivalent to that with manual methods and found fewer artifacts on automatically created images. Automatic methods rapidly produce curved planar reformations of equivalent quality with reduced time and effort.     

Local staging of pancreatic carcinoma with multi-detector row CT: use of curved planar reformations initial experience

PURPOSE: To evaluate the utility of curved planar reformations compared with standard transverse images in the assessment of pancreatic tumors. MATERIALS AND METHODS: Forty-three patients suspected of having pancreatic tumors underwent contrast material-enhanced biphasic multi-detector row computed tomography (CT). Curved planar reformations were generated along the pancreatic duct, common bile duct, and major mesenteric vessels. Three blinded independent readers assessed the curved planar reformations and transverse images separately for the presence of tumor, resectability, and vascular involvement. The results were compared with those of a consensus panel who evaluated the curved planar reformations and transverse images together along with clinical data and surgical findings. RESULTS: Of 43 patients, 20 had pancreatic malignancies as judged by the consensus panel and proven at biopsy and/or clinical follow-up. For tumor detection, transverse images and curved planar reformations had an average sensitivity of 95.0% and 98.4% (P >.05), respectively, and an average specificity of 90.9% and 91.3% (P >.05), respectively. For tumor resectability, transverse images and curved planar reformations had an average sensitivity of 85.7% and 71.4% (P >.05), respectively, and an average specificity of 85.2% and 84.3% (P >.05), respectively. Average interpretation time was 6.4 minutes with transverse images and 4.1 minutes with curved planar reformations. CONCLUSION: Curved planar reformations are equivalent to transverse images in the detection of pancreatic tumors and determination of surgical resectability.     

Phonomyography of the corrugator supercilii muscle: signal characteristics, best recording site and comparison with acceleromyography

Background. This study investigated the acoustic signal characteristicsand best recording site of phonomyography at the corrugatorsupercilii muscle and compared phonomyography with acceleromyography. Methods. In 12 patients (group I), after induction of anaesthesiaand insertion of a laryngeal mask, a microphone (frequency range2.5 Hz to 10 kHz) was placed on six different areason the forehead and the peak-to-peak response after single-twitchstimulation of the facial nerve was measured. The microphonewas placed where the response was largest and mivacurium 0.2mg kg ^–1 was administered. Fast Fourier transformationwas applied to all signals to determine peak frequencies andthe power–frequency relationship at different stages ofneuromuscular block. In an additional 15 patients (group II),the same microphone and an acceleromyographic probe were placedabove the middle portion of the left and right eyebrows respectively.Onset and offset of neuromuscular block were determined aftermivacurium 0.2 mg kg^–1. Results. In all seven women and all five men in group I, thebest response was obtained just above the middle portion ofthe eyebrow. Peak frequency was 4.1 (SD 0.9) Hz withoutneuromuscular block and did not change significantly duringonset and offset of neuromuscular block. Ninety per cent ofthe total signal power was below 40 Hz. In group II, meanonset time and maximum effect measured were 104 (20) s and 76(10)% respectively using acceleromyography and 134 (30) s and92 (4)% using phonomyography (P<0.04). Mean time to reach25, 75 and 90% of control was 9.5 (2.8), 14 (5.1) and 15.1 (5.3)min respectively using acceleromyography and 6.9 (2.8), 12.5(5.9) and 13.6 (4.9) min using phonomyography (P<0.04). Bland-Altmantesting revealed significant bias (precision) for onset time,maximum effect and time to reach 25% of control (acceleromyographyminus phonomyography) at –30 (38) s, –16 (11)% and2.6 (2.8) min respectively. Conclusions. Phonomyography can be used to determine neuromuscularblock at the corrugator supercilii muscle. In comparison withacceleromyography, phonomyography tends to measure a longeronset with more pronounced maximum effect and shorter recoveryof neuromuscular block. Br J Anaesth 2002; 88: 389–93