Tissue Doppler echocardiography--already of clinical significance?

Tissue Doppler echocardiography has already been available on clinical ultrasound machines for 8 years. Although this echo modality offers important information on regional myocardial function, it has not found widespread clinical application. A major difficulty has been the necessity for time-consuming off-line postprocessing as no clinical information on regional function can be obtained by visual assessment of complex color 2-D Doppler data. In recent years new modalities based on color tissue Doppler have been introduced such as strain/strain rate imaging, tissue tracking, Q-stress-echocardiography. While strain/strain rate imaging offers very precise analysis of regional left ventricular function, it also requires intensive postprocessing, is limited by an unfavorable signal to noise ratio and a major angle dependency. It is therefore unlikely to have a major clinical role in its currently available form. Tissue tracking and Q-stress echocardiography already incorporate data processing into a visually analyzable format. They offer only semi-quantitative data. However, their ease of use will increase the likelihood of more frequent use in clinical practices. Considering the important information which can be derived about regional function at rest and under stress conditions regarding systolic and diastolic function for different disease entities, it is expected that the use of tissue Doppler echocardiography in clinical practice will increase in the future with the availability of easier to use imaging techniques.     

Is HBV genotyping of clinical relevance?

The hepatitis B virus, as is the case of the hepatitis C virus, can be categorized in several genotypes. The genotyping of HBV is based on the nucleotide sequence divergence encoding the amino acids constituting the HBV surface proteins. Since the genotype of the hepatitis C virus is shown to be related to epidemiology and response to interferon therapy, one wonders whether this also holds for the hepatitis B virus. HBV genotypes clearly are found to be different in various geographical areas of infection. In Europe, genotypes A and D are predominant, whereas in Asian patients genotypes B and C are more frequent, and in the Middle-East the genotype D. Data concerning the clinical relevance are less clear but it seems that in Europe, the genotype A has a higher HBeAg clearance rate and a better outcome. In Asia, genotype B (and especially the genotype Bj) is associated with a higher HBeAg clearance and with less development of cirrhosis and HCC. The impact on spontaneous or therapy induced viral resolution is not yet clearly identified. Further evaluation in different countries is needed to delineate the impact of the genotype relative to other factors such as age at infection, level of serum transaminases and viral load, on the course of infection, complication, outcome of treatment and prognosis.     

Short-term clinical outcome of drug-eluting coronary stent

Objective To evaluate short-term outcome of coronary drug-eluting stent (DES) in patients with coronary artery disease (CAD) by comparing with standard bare stents.     

Wide clinical implementation of insulin resistance syndrome?

The aim of this paper is to review the literature regarding the metabolic syndrome and the single factor that links all its core components. That single factor seems to be partial insulin deficiency (PID), which is responsible for varying degrees of atherosclerotic vascular damage. In conclusion, we found that the diagnosis of insulin resistance syndrome (IRS) may allow clinicians to diagnose and treat atherosclerosis at an early stage-to stop or reverse vascular damage.     

How reliable are assessments of clinical teaching?

BACKGROUND:  Learner feedback is the primary method for evaluating clinical faculty, despite few existing standards for measuring learner assessments.
OBJECTIVE:  To review the published literature on instruments for evaluating clinical teachers and to summarize themes that will aid in developing universally appealing tools.
DESIGN:  Searching 5 electronic databases revealed over 330 articles. Excluded were reviews, editorials, and qualitative studies. Twenty-one articles describing instruments designed for evaluating clinical faculty by learners were found. Three investigators studied these papers and tabulated characteristics of the learning environments and validation methods. Salient themes among the evaluation studies were determined.
MAIN RESULTS:  Many studies combined evaluations from both outpatient and inpatient settings and some authors combined evaluations from different learner levels. Wide ranges in numbers of teachers, evaluators, evaluations, and scale items were observed. The most frequently encountered statistical methods were factor analysis and determining internal consistency reliability with Cronbach's α. Less common methods were the use of test-retest reliability, interrater reliability, and convergent validity between validated instruments. Fourteen domains of teaching were identified and the most frequently studied domains were interpersonal and clinical-teaching skills.
CONCLUSIONS:  Characteristics of teacher evaluations vary between educational settings and between different learner levels, indicating that future studies should utilize more narrowly defined study populations. A variety of validation methods including temporal stability, interrater reliability, and convergent validity should be considered. Finally, existing data support the validation of instruments comprised solely of interpersonal and clinical-teaching domains.     

Is this the end of clinical research?

SIR, Research by NHS consultants and their juniors has beena tradition of the Health Service since its inception. It hasamused the participants and added to the data available. Ithas been regarded as meritorious both by appointments committeesand the merit award system. I now feel that our ability to performthis research is under serious threat from all angles such thatit may become impractical. I write as a full-time NHS consultantwho has averaged three original papers a year in refereed journalssince my first publication in 1985. The ethics committee Once upon a time you only applied for ethical approval if youwere intervening in a patient's care, or you had ethical issuesthat you perceived and     

The clinical spectrum of bruton’s agammaglobulinemia

X-linked, or Bruton’s, agammaglobulinemia (XLA) was described in 1952 as the congenital inability to form antibodies. Patients were typically infants or young children with recurrent, severe bacterial infections. Other, milder cases of hypogammaglobulinemia were considered "acquired," and often presented later in life. Since the discovery of the defective gene in XLA in 1993, it has been shown that a significant number of male patients with sporadic or acquired hypogammaglobulinemia actually have XLA. We present here a case of atypical XLA and discuss similar cases in the literature. We conclude that any male with hypogammaglobulinemia, regardless of age of presentation, might have XLA. Males with low B-cell numbers are particularly likely to have XLA and should have Bruton’s tyrosine kinase levels assessed.     

Anti-Ku antibodies. Study of prévalence and of clinical meaning

PURPOSE: Auto-immunity against Ku nuclear antigens is rare and clinical meaning remains badly estimated. Our study is for purposes: to appreciate the prévalence of antibodies anti-Ku within the framework of the search for antinuclear antibodies and to clarify clinical and biological relations associated to this auto-immunity. METHODS: A retrospective study of a series of 10,000 searches for antinuclear antibodies studies the prévalence of the auto-immunity anti-Ku and a retrospective analysis of the data found at the patients bearers of an anti-Ku identifies clinical and biological signs associated with this antibody. RESULTS: Prévalence anti-Ku is low (1/3493 case of antinuclear antibodies) and association is possible with in a myositic process through variable auto-immune contexts (overlap syndrome) of relative good preview. CONCLUSION: Auto-immunity anti-Ku is so characterized with its weak prévalence, a possible observation during different auto-immune diseases with an obvious frequency of the overlap syndrome often concerning a process myositic. Finally a weak évolutivité seems to characterize the auto-immune diseases of the patients with anti-Ku antibodies.     

Carcinoid of the ampulla of Vater： Morphologic features and clinical implications

INTRODUCTION Carcinoid tumors belong to the family of neuroendocrine tumors, which usually grow slowly with distinct biologi- cal and clinical characteristics. The incidence of these tumors is approximately 2.5 in 100 000 people per year. The appendix is …     

Physicians’ reports of focused expertise in clinical practice

Little is known about the prevalence of focused expertise (special areas of expertise within a clinical field) among physicians, yet such expertise may influence how care is delivered. We surveyed general internists, pediatricians, cardiologists, infectious disease specialists, and orthopedic surgeons to describe the prevalence of focused expertise and identify associated physician and practice characteristics. About one quarter of generalists and three quarters of specialists reported a focused expertise within their primary specialty. Hospital-based physicians more often reported such expertise, and physicians reimbursed by capitation less often reported expertise. Learning how focused expertise affects processes and outcomes of care will contribute to decisions about physician training and staffing of medical groups. Dr. Keating was the recipient of a National Research Service Award from the Agency for Healthcare Research and Quality, Rockville, MD, Dr. Ayanian was a Generalist Physician Faculty Scholar of the Robert Wood Johnson Foundation, Princeton, NJ. This study was supported by the Primary Care Research and Education Fund of Brigham and Women’s Hospital.     

Advances in clinical research of hepatocellular carcinoma in China

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Behçet disease: evolution of clinical manifestations

Clinical phenotypes of Beh?et disease (BD) vary among ethnic groups. We chronologically analyzed the clinical manifestations of BD in 412 patients meeting the Japanese criteria for BD seen at 2 Yokohama City University hospitals from July 1991 to December 2007. We examined the onset of individual symptoms in each patient. A single initial symptom appeared earlier than any other manifestation in 78% of the patients. Time from the initial symptom to diagnosis was 8.6 ± 10.1 years. Oral ulcer, the most common initial manifestation, preceded the diagnosis by 7.5 ± 10.2 years. Genital ulcer and eye and skin involvement appeared 1 or 2 years before diagnosis, whereas gastrointestinal, central nervous system, or vascular involvement developed later. The frequency of eye involvement was significantly higher in patients with neurologic lesions, but significantly lower in those with gastrointestinal or vascular involvement. However, no particular combination of major symptoms predicted the development of organ involvement. There has been a recent decrease in the rate of "complete" BD (patients having all 4 of the major symptoms of oral ulcers, genital ulcers, and eye and skin lesions), whereas the frequencies of arthritis, gastrointestinal, and vascular involvement have been increasing. Further assessment may allow the detection of early predictors of the more aggressive disease, which requires more intensive treatment.     

What is the clinical impact of macrolide resistance?

Respiratory tract infections are treated empirically. Treatment is based on the likely pathogens and their antibiotic susceptibility. The most common respiratory tract pathogen is Streptococcus pneumoniae. In the United States, approximately 25% to 30% of S. pneumoniae are resistant to erythromycin and other macrolides. There are two mechanisms of resistance: ribosomal methylation that causes high-level resistance, and an efflux pump that causes low-level resistance. Macrolides are ineffective in animal models that use pneumococcal isolates with the methylase- or efflux-mediated resistance mechanisms. There are many case reports that describe clinical failure and isolation of a macrolide-resistant pneumococcus while a patient receives macrolide treatment. Two recent studies that included macrolide-susceptible and macrolideresistant pneumococci showed that breakthrough bacteremia in patients receiving macrolide treatment occurred only with macrolide-resistant isolates. Study of bacteremic disease ensures the pathogenic role of the pneumococcus; however, it underestimates the true clinical impact of macrolide resistance.