Is “fear of passive movement” a distinctive component of the Fear-Avoidance Model in whiplash?

Objectives:Modify the Tampa Scale for Kinesiophobia (TSK) for ‘fear of passive motion’ beliefs.Methods:With permission, a 14-item modification, the TSK-PM (passive movement), was created. Test-retest reliability was tested first. Construct validity was tested in chronic whiplash patients by comparing the TSK-PM with the TSK, the Neck Disability Index (NDI) and cervical ranges of motion.Results:The TSK-PM showed high test-retest reliability (r = 0.83) and high correlation with the original TSK (r = 0.84). Low, non-significant correlations were found with other variables. NDI scores were strongly correlated with ranges of motion.Conclusions:While having high test-retest reliability and a single factor structure, the TSK-PM failed to demonstrate distinctive construct validity vs the original TSK. The original TSK is likely to be sufficient to assess fear of being moved in neck pain patients in a clinical setting. Modifications to the current version of the TSK-PM might improve its construct validity in future studies.     

Multicenter evaluation of parametric response mapping as an indicator of bronchiolitis obliterans syndrome after hematopoietic stem cell transplantation

Parametric response mapping (PRM) is a novel computed tomography (CT) technology that has shown potential for assessment of bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation (HCT). The primary aim of this study was to evaluate whether variations in image acquisition under real‐world conditions affect the PRM measurements of clinically diagnosed BOS. CT scans were obtained retrospectively from 72 HCT recipients with BOS and graft‐versus‐host disease from Fred Hutchinson Cancer Research Center, Karolinska Institute, and the University of Michigan. Whole lung volumetric scans were performed at inspiration and expiration using site‐specific acquisition and reconstruction protocols. PRM and pulmonary function measurements were assessed. Patients with moderately severe BOS at diagnosis (median forced expiratory volume at 1 second [FEV1] 53.5% predicted) had similar characteristics between sites. Variations in site‐specific CT acquisition protocols had a negligible effect on the PRM‐derived small airways disease (SAD), that is, BOS measurements. PRM‐derived SAD was found to correlate with FEV1% predicted and FEV1/ forced vital capacity (R = ?0.236, P = .046; and R = ?0.689, P < .0001, respectively), which suggests that elevated levels in the PRM measurements are primarily affected by BOS airflow obstruction and not CT scan acquisition parameters. Based on these results, PRM may be applied broadly for post‐HCT diagnosis and monitoring of BOS.     

MRI and "tenderness guided" transvaginal ultrasonography in the diagnosis of recto-sigmoid endometriosis

Purpose:

To compare the diagnostic accuracy of MRI and “tenderness‐guided” transvaginal ultrasonography (tg‐TVUS) in the identification of recto‐sigmoid endometriosis.

Materials and Methods:

Institutional Review Board approval for this study was obtained, and written informed consent was given by all patients. This study is compliant with the STARD (Standards for Reporting of Diagnostic Accuracy) method. Fifty‐nine patients (mean age, 33 years; range, 21–44 years) with clinical suspicion of deep pelvic endometriosis were prospectively enrolled. They underwent tg‐TVUS and MRI before surgery. The characteristics of the MRI signal were analyzed. Mapping of recto‐sigmoid endometriosis was performed and tg‐TVUS and MR imaging results were compared with surgical and pathological findings. Sensitivity, specificity, and the positive and negative likelihood ratio (LR+ and LR?) were calculated. Inter‐technique concordance was assessed using the Cohen statistic, and receiver operating characteristic (ROC) curves were obtained. Logistic regression analysis was performed.

Results:

The prevalence of recto‐sigmoid endometriosis was 51%. The specificity, sensitivity, and LR+ and LR? were 90%, 73%, 7.089 and 0.297, respectively, for MRI and 86%, 73%, 5.317 and 0.309, respectively, for tg‐TVUS. The presence of a high T1 signal spot was an excellent specific finding (100%) but was associated with a low sensitivity (30%). Inter‐technique concordance using the Cohen statistic indicated a kappa value of 0.658 (± 0.098 SD). According to the logistic regression equation obtained, the use of both tg‐TVUS and MRI allows optimal diagnostic performance.

Conclusion:

MRI and tg‐TVUS show similar results in the identification of recto‐sigmoid endometriosis. The Cohen kappa value suggests that these methods may have complementary roles in the identification of recto‐sigmoid endometriosis, depending on the site affected. J. Magn. Reson. Imaging 2012;352‐360. © 2011 Wiley Periodicals, Inc.

     

Recurrent Pleural Effusion and Pulmonary Metastases from a Cutaneous Apocrine Tumour of the Axilla

Sweat gland carcinomas are very rare and they are differentiated between tumours of apocrine or eccrine origin. The axilla is the most common site for apocrine gland carcinoma for its great abundance of these glands. There are no recommendations in literature regarding appropriate treatment schedules for apocrine gland carcimonas in advanced stages. We report a case of recurrent left pleural effusion in a 76-year old man with metastatic cutaneous apocrine tumour of the right axilla. We describe the clinical and histological features, with management options and a review of the relevant literature on apocrine gland carcinoma.     

Stromal cell-derived factor 1alpha increases polyploidization of megakaryocytes generated by human hematopoietic progenitor cells

The alpha chemokine receptor CXCR4 has been shown to be expressed on human hematopoietic progenitor cells and during the megakaryocytic differentiation pathway. Stromal cell-derived factor 1 (SDF-1) is the ligand for CXCR4. In this study, the role of SDF-1alpha in megakaryocytopoiesis was investigated. CD34(+) progenitors purified from peripheral blood were grown in serum-free liquid suspension culture supplemented with thrombopoietin to obtain a virtually pure megakaryocytic progeny. In this condition, the addition of SDF-1alpha gives rise to megakaryocytes (MKs) showing an increased DNA content and a rise of lobated nuclei, as compared with untreated cells: at day 5, approximately 20% of the cells already showed the presence of more than one nuclear lobe versus fewer than 5% in the control cells; at day 12, approximately 85% of the cells were of large size and markedly polyploid, whereas approximately 60% of the control cells were polyploid, showed fewer lobes, and were a smaller size. This effect was dose-dependent and did not affect the megakaryocytic proliferation. Experiments with the mitogen-activated protein kinase (MAPK) inhibitor PD98059 suggested a role for MAPK pathway on SDF-1alpha-induced endomitosis. Furthermore, SDF-1alpha induced a significant increase in the number of proplatelet-bearing MKs and promoted the migration of megakaryocytic cells. Treatment with SDF-1alpha caused reduction in CXCR4 abundance on the plasma membrane, seemingly owing to receptor internalization. Furthermore, the presence of SDF-1alpha did not affect the expression of megakaryocytic markers, indicating that differentiation and polyploidization are independently regulated events.     

Repeated transient hypergonadotropic amenorrhea during pharmacologic induction of multiple follicular development with exogenous gonadotropins

Human gonadotropins are widely used for induction of ovulation in the treatment of anovulatory infertility and for induction of multiple follicular development (MFD) in in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT), and artificial insemination with husband's semen (AIH) programs. Reported is a patient with normal menstrual cycles, who had two episodes of gonadal unresponsiveness to human gonadotropin therapy, followed by transient hypergonadotropic amenorrhea ("resistant ovary" syndrome), during induction of MFD in conjunction with AIH as treatment for unexplained infertility. The first episode occurred during the sixth cycle of a first series of MFD induction with daily intramuscular injections of exogenous gonadotropins. The second episode occurred during the second cycle of a second series of MFD induction with intravenous pulsatile administration of FSH. On both occasions, normalization of endogenous gonadotropin levels and reappearance of ovulatory cycles occurred spontaneously, after two and three months, respectively. A similar mechanism could occur in the failures of MFD induction observed in IVF programs.