Small area estimation of receiver operating characteristic curves for ordinal data under stochastic ordering

There has been a recent increase in the diagnosis of diseases through radiographic images such as x-rays, magnetic resonance imaging, and computed tomography. The outcome of a radiological diagnostic test is often in the form of discrete ordinal data, and we usually summarize the performance of the diagnostic test using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The ROC curve will be concave and called proper when the outcomes of the diagnostic test in the actually positive subjects are higher than in the actually negative subjects. The diagnostic test for disease detection is clinically useful when a ROC curve is proper. In this study, we develop a hierarchical Bayesian model to estimate the proper ROC curve and AUC using stochastic ordering in several domains when the outcome of the diagnostic test is discrete ordinal data and compare it with the model without stochastic ordering. The model without stochastic ordering can estimate the improper ROC curve with a nonconcave shape or a hook when the true ROC curve of the population is a proper ROC curve. Therefore, the model with stochastic ordering is preferable over the model without stochastic ordering to estimate the proper ROC curve with clinical usefulness for ordinal data.     

Functional Localization of the Supplementary Motor Area

The supplementary motor area (SMA) is a key structure involved in behavioral planning and execution. Although many reports have indicated that SMA is organized somatotopically, its exact organization remains still unclear. This study aimed to functionally map SMA using functional magnetic resonance imaging (fMRI) and validate the fMRI-SMA by electrocortical stimulation (ECS) and postsurgical symptoms. Total 32 healthy volunteers and 24 patients participated in this study. Motor tasks were right and left finger tapping and language tasks included simple reading, lexical decision for presented words, and verb generating tasks. SPM8 was used to conduct individual and group analyses. In all subjects, the lexical decision task induced the greatest number of active fMRI pixels in SMA. fMRI during the language tasks showed anterior part of SMA compared to finger tapping tasks. We found an overlap spot with all different tasks in posterior part of SMA, which we termed SMA core. Six patients underwent awake craniotomy for ECS mapping for primary regions and SMA. During awake craniotomy, ECS to posterior part of SMA, which might involve the possible SMA core consistently, evoked both speech arrest and flaccid hemiparesis. The SMA mapping suggested posterior part of SMA might play more important roles in any executions, which might involve the SMA core.     

本院丙泊酚注射液致不良反应58例分析

目的探讨丙泊酚所致不良反应特点及相关因素，为临床合理用药提供参考。方法在本院2008年3月11日至2013年3月11日间上报的不良反应报表中，检索由丙泊酚引起的不良反应，对患者性别、年龄、用药情况、不良反应等方面进行统计分析。结果检索到丙泊酚引起的不良反应58例，女性多于男性；15～44岁的人群发生率为60．34％；用药30min内不良反应发生率较高为78％；不良反应主要为皮疹。结论临床应重视丙泊酚发生的不良反应，用药时注意患者的临床表现。     

孕期运动对孕妇及胎儿影响的研究进展

综述了近年来国内外对孕期运动的研究,认为孕妇孕期适度地运动,可以促进孕妇的血液循环,减轻妊娠反应所致的不适,增强腹肌力量,帮助孕妇适应身体重心的转移和控制体重.这不仅可以增强体质,加强自身免疫力减少疾病的发生,还可以积蓄力量,有利于顺利分娩,而且对母体和胎儿都无不良影响.     

Prevalence of orthorexia nervosa in resident medical doctors in the faculty of medicine (Ankara, Turkey)

This study has been carried out to "identify highly sensitive behavior on healthy nutrition (orthorexia nervosa-ON)" in residence medical doctors (MD) in the Faculty of Medicine. Diagnoses of ON was based on the presence of a disorder with obsessive-compulsive personality. The study is a cross-sectional research, which reached out to the entire 318 MD. The ORTO-15 test was used to propose a diagnostic proceeding and to try verify the prevalence of ON. Those subjects who were classified below 40 from the ORTO-15 test are accepted to have ON. Chi-square test, ANOVA (univariate) analysis and logistic regression were used for analyses of the data. Mean score of the participants from the ORTO-15 test is 39.8+/-0.22, and there is no statistical difference between women and men. A total of 45.5% of the residence MD involved in the research scored below 40 in the ORTO-15 test. Those who do their food shopping themselves, skip a meal with a salad/fruit, care about the quality of the things they eat, think that eating outside is healthy, look at the content of what they eat and the content of food is important in selection of a product score lower in their average marks in ORTO-15 and the difference among the groups is statistically significant. Food selection of 20.1% of the male participants and 38.9% of the female participants among the residence MD is influenced by the programs on nutrition/health in mass-media. The difference between the groups is statistically significant (p<0.05). Female medical doctors are more careful than men of their physical appearance and weight control and consume less caloric food, which is statistically significant. Since those who exhibit "healthy fanatic" eating habits may have a risk of ON in the future, it would be useful to conduct studies that identify the prevalence of ON in the public.     

The effect of theory of mind impairment on language: Referring after right-hemisphere damage

Background: Some patients after right-hemisphere damage show difficulty in Theory of Mind (TOM) tasks, namely, in the ability to attribute and reason about mental states of others and of themselves.

Aims: We explored how such TOM impairment (aTOMia) following brain damage affects language abilities that are related to TOM. Specifically, we explored the ability of individuals with aTOMia to use and comprehend various referring expressions (e.g., definite and indefinite noun phrases, proper names, and pronouns) according to the speaker’s assessment of the addressee’s knowledge state about the referent.

Methods & Procedures: We compared linguistic abilities that depend on the evaluation of shared knowledge, and hence might be affected by TOM impairment, to purely syntactic tasks, unrelated to TOM. TOM-related abilities were assessed using 6 tasks that test the comprehension, production, and judgment of various types of referring expressions. Non-TOM, syntactic, abilities were assessed using 4 tasks of comprehension and production.

The participants were 21 Hebrew speakers with right-hemisphere damage aged 25–65 years (mean 52;2), 6 women and 15 men. Twenty of them had a right cerebrovascular accident, and one patient was surgically treated for the removal of a tumour. Fourteen of them were aTOMic, whereas 7 showed normal TOM. We compared the TOM-dependent linguistic abilities of the aTOMic patients to the brain-damaged patients with normal TOM, and to an age-matched control group.

Outcomes & Results: The participants with aTOMia performed consistently worse on the TOM-related linguistic tasks than the right-hemisphere-damaged participants with intact-TOM and the healthy control group. They failed to take into account the mental state of the interlocutors and the knowledge that they share in selecting a referring expression. In contrast, their syntactic abilities, which are not dependent on TOM, were intact. Their comprehension of relative clauses, Wh-questions, and object pronouns was normal, and their production of embedded sentences was similar to the controls. The aTOMic and non-aTOMic participants performed similarly to controls on the TOM-independent syntactic tasks.

Conclusions: Individuals who have aTOMia following right-hemisphere damage might show specific impairments in language, when the comprehension and production require TOM. An important implication of this study is, thus, that although these individuals do not suffer damage to the language areas in the brain, they should be considered for language evaluation and treatment.     

改良小指固有伸肌腱移位重建拇对掌功能：5年21例随访

摘要：改良小指固有伸肌腱移位重建拇对掌功能是治疗陈旧性正中神经损伤致拇对掌功能障碍的很多方法之一,为了解该治疗方法的远期效果是否优良,实验回顾性分析了2003-01/2007-12北华大学附属医院手外科接受过利用改良小指固有伸肌腱移位重建拇对掌功能患者97例,进行随访21例。应用《手功能评定标准的改定》的标准进行术后拇对掌功能的功能评定,测量患手拇指的长度T、拇指对掌活动中向掌心移动(mo)与离掌心移动(Mo)：即手掌及４指在冠状面处于伸直位,拇指向掌侧尽量外展并与示指处于同一个矢状面内,测量拇指掌侧指间横纹中点(简称E点)至中指掌指关节掌侧横纹中点(简称F点)之间的的连线距离(简称该距离为Mo)。拇指对掌功能重建后,测量患手拇指的长度及向掌心活动、离掌心活动拇指掌侧指间横纹中点至中指掌指关节掌侧横纹中点的距离,并分别计算它们间的比值。本组病例随访时间为1~14年,平均7.5年,可见利用改良小指固有伸肌腱移位术是重建拇对掌功能的良好治疗方法。     

Primate models of dystonia

Several models of dystonia have emerged from clinical studies providing a comprehensive explanation for the pathophysiology of this movement disorder. However, several points remain unclear notably concerning the specific role of brainstem, basal ganglia nuclei and premotor cortex. We review data collected in sub-human primate to see whether they might provide new insights into the pathophysiology of dystonia. As in human patients, lesions of the putamen induce dystonia, as well as pharmacological manipulations of the dopaminergic system. In addition, primate studies revealed that lesions in brain stem areas involved in the control of muscular tone and GABAergic manipulations in various basal ganglia nuclei or thalamus also lead to dystonia. Moreover, there is a dramatic disruption in the processing of proprioceptive information with abnormal large receptive fields in the basal ganglia, thalamus, primary somesthetic cortex and premotor cortex of dystonic monkeys. These data highlight the idea that dystonia is associated with aberrant sensory representations interfering with motor control. Considering that the supplementary motor area (SMAp) is the target of basal ganglia projections within the motor loop, we propose a model of dystonia in which abnormal excitability, associated with alteration in sensory receptive fields within the SMAp, leads to an abnormal synchronization between primary motor cortex columns. Such a phenomenon might account for the co-contractions of antagonist muscles favored by action and the abnormal postures observed in dystonia.