Immunologic tools to decipher efficacy of BCG immunotherapy in advanced breast cancer: a one year follow up study

We report the clinical outcome of conventional therapy and BCG immunisation therapy for 40 patients with advanced breast carcinoma. The clinical outcome was better for the 20 patients receiving BCG immunisation therapy. All patients were assessed for cell mediated immunologic competence before starting treatment and after completion of treatment. Thereafter they were followed for one year. Those patients who showed good local response to BCG vaccination before starting therapy had better prognosis, and those for whom anergy to PPD and DNCB could be reversed by BCG immunotherapy showed clinical improvement. Another interesting finding was that IgA was the predominating immunoglobulin located in normal breast tissue and benign breast tumours while IgG was deposited in most of the malignant breast tumour. This indicated that malignant tumours of the breast jeopardise the secretory immune system of the mammary gland.     

Panic disorder in menopause: a case control study

OBJECTIVE: The course of panic disorder (PD) is often influenced by the different phases of the female reproductive cycle. The aim of this study is to assess PD in the climacteric stage and single out possible correlations between symptoms of PD and clinical and demographic variables in order to identify possible risk factors. METHOD: Forty-five women between 40 and 60 years of age was assessed through the SCL-90, the SCID, a "Climacteric Symptoms Questionnaire" (CSQ) devised to evaluate psychological symptoms typically associated with menopause, the Kupperman Index for the analysis of climacteric symptoms, and plasma level of allopregnanolone (ALLO). RESULTS: PD results in eight patients (18%). This group does not differ from the controls as far as socio-demographic data is concerned, but exhibits significantly higher values in the Kupperman Index, the SCL-90 total, and the CSQ. The plasma levels of ALLO correlate significantly inversely with the total of CSQ and, in any case, negatively with the other variables analysed. CONCLUSIONS: PD may arise and worsen with menopause, in correlation with greater severity of the climacteric syndrome in its physical and psychological symptoms.     

Hepatitis C virus related hepatocellular carcinoma: a case control study from India

Infection with hepatitis C virus (HCV) is a major risk factor for hepatocellular carcinoma (HCC) in India. The study was designed to investigate the clinical and molecular profiles of HCV related HCC cases in Indian patients. In a prospective study, 68 HCV related HCC, 55 HCV related chronic hepatitis, and 68 HCV related patients with cirrhosis were included. Glutathione S‐transferase gene polymorphism was analyzed in all the cases. The sex ratios were 5.18:1, 1.39:1, and 0.83:1 with mean age of 50.57 ± 12.47, 39.41 ± 13.34, and 46.08 ± 15.06 years, respectively, in three groups. Amongst the HCV related HCC cases seen in India, 49.2% (30 out of 68) were with Okuda stage I while 34.4% (21 out of 68) cases were classified as stage II. Older age, poor standards of living, HCV genotype 4, smoking, and null genotypes of GST were the risk factors associated significantly with the development of HCC. In 55.9% cases (38 out of 68) the size of the tumor was ≥5 cm while in 38.2% cases (26 out of 68) the size was between 2 and 5 cm, indicating an advanced stage of the disease at presentation. J. Med. Virol. 84: 1009–1017, 2012. © 2012 Wiley Periodicals, Inc.     

Phytoestrogens and breast cancer in postmenopausal women: a case control study

OBJECTIVE: To examine the association between isoflavones, androgens, and dietary composition and the risk of breast cancer in Australian postmenopausal women. DESIGN: Eighteen women with recently diagnosed breast cancer before surgery and 20 controls were recruited over a 12-month period. Both cases and controls were similarly assessed for urinary isoflavones, serum and urinary sex steroids, and dietary intake. RESULTS: Women with breast cancer had lower 24-h urinary daidzein compared with controls (cases: 31 [95% CI: 4, 234] nmol/day; controls: 427 [95% CI: 4, 234] nmol/day; p = 0.03), and there was a trend to lower urinary genistein excretion (cases: 25 [95% CI: 5, 132] nmol/day; controls: 155 [95% CI: 43, 550] nmol/day; p = 0.08). Total testosterone was higher in women with breast cancer compared with controls (cases: 1.3 [95% CI: 1.1, 1.5] nmol/L; controls: 1.0 [95% CI: 0.8, 1.11 nmol/L; p = 0.05). No significant differences were found for serum sex hormone binding globulin, free androgen index, dehydroepiandrosterone sulphate, estradiol and progesterone, or in urinary androgen metabolites, or in dietary intake with regard to fat, carbohydrate, protein, or fiber consumption between cases and controls. CONCLUSIONS: This preliminary study is the first report of low urinary daidzein and genistein in postmenopausal women with breast cancer. These findings are in keeping with the increasing observational data demonstrating a protective effect from phytoestrogens on breast cancer risk.     

Behavioral aspects of Angelman syndrome: a case control study

Angelman syndrome (AS) is a rare congenital disorder characterized by impairments in intellectual, neurological and motor functioning and a postulated behavioral profile. This study compared behavioral characteristics of 62 individuals with genetically confirmed AS and 29 individuals with presumed AS from clinical features, with a control group of young persons with intellectual disability (ID) derived from an Australian epidemiological register. Twelve behavioral items from the developmental behavior checklist (DBC) were used for this comparison. The groups were matched for chronological age, gender, and level of ID. In the AS group, significant differences were found for 10 behaviors, with poor attention span and impulsivity being less common, and overactivity/restlessness, chewing or mouthing objects, eating non-food items, gorging food, food fads, fascination for water, hand flapping and sleep disturbance being more common. Interestingly, there was no difference in prevalence of unprovoked laughter. Comparison of the results of the genetically confirmed with the genetically unconfirmed AS cases showed no significant differences between individual behavior prevalence. These findings show that a "behavioral phenotype" of AS can be distinguished from others of similar level of ID, but it is different from that hitherto published. Abnormal food related behaviors, hyperactivity, fascination for water, hand flapping, and sleep disturbance should be included in a "behavioral phenotype" for AS. Apart from hyperactivity, "ADHD-type" behaviors are not more characteristic of AS than in ID generally. Therefore, the Consensus Criteria for the diagnosis of AS need to be reviewed.     

The outcome of menorrhagia: a retrospective case control study

One hundred and three women who were known to have complained of menorrhagia at some time in their lives were compared with a control group drawn from the practice's age-sex index.

The results indicated that the women in the menorrhagia group were more likely to have had antidepressant medication prescribed for them at some time in their lives than the women in the control group. Furthermore, their case folders were thicker than those of the controls. The age at which menorrhagia was first reported was the only factor studied which was associated with increased likelihood of hysterectomy.

     

Developmental surface dyslexia: a case study of the efficacy of a remediation programme

Abstract

A remedial training programme was devised and implemented in a single case of developmental dyslexia. Extensive pre-therapy psycholinguistic assessment determined the developmental stage at which the acquisition of reading skills had arrested. Subject DF had failed to develop orthographic skills; his pattern of performance resembled that of surface dyslexics. Remediation focused on development of the strategy DF had failed to acquire. The efficacy of remediation was investigated employing a single subject case study incorporating a crossover design with multiple baseline and repeated pre- and post-therapy measures. DF indicated significant positive effects of therapy, which could only be ascribed to the treatment. Theoretical explanations and practical implications of the results are discussed.     

Fetuin-A is related to syndesmophytes in patients with ankylosing spondylitis: a case control study

OBJECTIVES:

New bone formation is one of the hallmark characteristics of ankylosing spondylitis, which is thereby associated with syndesmophytes. Fetuin-A is a molecule that is abundantly found in calcified tissues and it shows high affinity for calcium phosphate minerals and related compounds. Considering the role of fetuin-A in the regulation of calcified matrix metabolism, we compared the fetuin-A levels in ankylosing spondylitis patients with syndesmophytes with those in patients without syndesmophytes and in healthy controls. We also studied other biomarkers that are thought to be related to syndesmophytes.

METHODS:

Ninety-four patients (49 patients without syndesmophytes, 67.3% male, 40.7±8.7 years; 45 patients with syndesmophytes, 71.1% M, 43.9±9.9 years) and 68 healthy controls (44.2±10.6 years and 70.6% male) were included in this study. Syndesmophytes were assessed on the lateral radiographs of the cervical and lumbar spine. The serum levels of fetuin-A, dickkopf-1, sclerostin, IL-6, high-sensitivity C-reactive protein and bone morphogenetic protein-7 were measured with an enzyme-linked immunosorbent assay.

RESULTS:

Patients with syndesmophytes had significantly higher levels of fetuin-A compared with patients without syndesmophytes and controls (1.16±0.13, 1.05±0.09 and 1.08±0.13 mg/ml, respectively). However, fetuin-A was not different between the patients without syndesmophytes and controls. Bone morphogenetic protein-7 was significantly lower; dickkopf-1 was significantly higher in patients with ankylosing spondylitis compared with controls. The sclerostin concentrations were not different between the groups. In regression analysis, fetuin-A was an independent, significant predictor of syndesmophytes.

CONCLUSION:

Our results suggest that fetuin-A may a role in the pathogenesis of bony proliferation in ankylosing spondylitis.     

Management and control of clinical engineering productivity: a case study.

This paper describes, in chronological order, the steps taken to install productivity measurements and controls within the Clinical Engineering Department of a large teaching hospital. Motivation for this project involved both preparation for going "for profit" and the need to resolve an over-budget condition of labor cost. The project steps included current hospital management reports, database adequacy, supervisors' time logs, computerized budget spread sheets, testing changes on a financial simulation model, developing labor task standards, and departmental labor performance reporting. The project yielded significant positive results for the department's performance versus budget and also led to growth in supervisory and management skills.     

Apocrine carcinoma of the breast presenting as a solitary cyst: cytological and histopathological study of a case

Apocrine carcinoma is a rare, unique and morphologically distinct type of invasive breast carcinoma. This tumor has predilection for elderly females (6th and 7th decade). This report is of apocrine carcinoma of the breast arising in a 27 year old female, a rare occurrence in this age group, with only a few cases on record.     

Attention bias to faces in Asperger Syndrome: a pictorial emotion Stroop study

BACKGROUND: Emotional Stroop tasks have shown attention biases of clinical populations towards stimuli related to their condition. Asperger Syndrome (AS) is a neuropsychiatric condition with social and communication deficits, repetitive behaviours and narrow interests. Social deficits are particularly striking, including difficulties in understanding others. METHOD: We investigated colour-naming latencies of adults with and without AS to name colours of pictures containing angry facial expressions, neutral expressions or non-social objects. We tested three hypotheses: whether (1) controls show longer colour-naming latencies for angry versus neutral facial expressions with male actors, (2) people with AS show differential latencies across picture types, and (3) differential response latencies persist when photographs contain females. RESULTS: Controls had longer latencies to pictures of male faces with angry compared to neutral expressions. The AS group did not show longer latencies to angry versus neutral expressions in male faces, instead showing slower latencies to pictures containing any facial expression compared to objects. When pictures contained females, controls no longer showed longer latencies for angry versus neutral expressions. However, the AS group still showed longer latencies to all facial picture types, compared to objects, providing further evidence that faces produce interference effects for this clinical group. CONCLUSIONS: The pictorial emotional Stroop paradigm reveals normal attention biases towards threatening emotional faces. The AS group showed Stroop interference effects to all facial stimuli regardless of expression or sex, suggesting that faces cause disproportionate interference in AS.     

Sperm output of healthy men in Australia: magnitude of bias due to self- selected volunteers

Controversial claims, based on a meta-analysis aggregating 61 heterogeneous observational studies, have been made that human sperm output has decreased by 50% over the last six decades and that this trend may be due to global pollution. If true, such effects should be evident in all areas of the globe; however, longitudinal studies within single centres in Europe and America have produced conflicting results and there are no reports from the southern hemisphere. We therefore reviewed semen analyses obtained from 1980-1995 from 689 healthy men volunteering for screening either as potential sperm donors for a donor insemination programme (n = 509) or to participate in five male contraception research studies (studies no. 1-5, n = 180). All were recruited through the Andrology Unit of the Royal Prince Alfred Hospital, Sydney, by the same doctors using standard methods of recruiting, screening and laboratory examination throughout the period 1980-1995. Recruitment was by advertising without regard to marital or fertility status except in two contraceptive efficacy studies (no. 1 and no. 3) where participants had to be in a stable relationship requiring contraception. Analysing the first semen sample individually or when grouped by year of ejaculation, there was no significant difference in sperm concentration over time or between years or according to year of birth. During the second half of this period, 180 consecutive volunteers were recruited by the same doctors and staff for five male contraception studies. The median sperm concentration for studies no. 1 (103 x 10(6) ml) and no. 2 (142 x 10(6) ml) were significantly (P < 0.05) higher than for studies no. 3-5 (84, 67 and 63 x 10(6) ml, respectively) and for potential sperm donors (median 69 x 10(6) ml). The inconsistency of these estimates illustrates the magnitude of bias (up to 100%) in sperm output that may occur in recruiting groups of self-referred volunteers within a single centre. This highlights the invalidity of extrapolating similar findings on sperm output of self-selected volunteers to the general male community or in using such study groups to characterize sperm output in supposedly 'normal' men.      

Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease: a case control study from China

Patients with severe chronic obstructive pulmonary disease (COPD) are at higher risk of developing invasive pulmonary aspergillosis (IPA). However, there are limited data for this disease. To evaluate risk factors and the clinical characteristics of IPA in COPD patients, we conducted a hospital-based, retrospective case-control study of 30 COPD patients with IPA and 60 COPD control patients without IPA. Patients in the case group were significantly more likely to have concurrent co-morbidities than controls. Of the IPA patients, 65.4% had worsening radiological findings vs. 11.4% in the control group (p<0.001). IPA in COPD was associated with a higher proportion of mechanical ventilation (43.3% vs. 5%; p<0.001), a longer hospital stay duration (45.8±39.1 days vs. 18.4±11.8 days; p<0.001), and higher mortality (43.3% vs. 11.4%; p<0.001). Systemic use of steroids in the stable phase, treatment with three or more antibiotics during hospitalization and antibiotic treatment longer than 10 days were independent risk factors associated with IPA. COPD patients with obvious dyspnoea, antibiotic-resistant lower respiratory tract infection and repeated detection of Aspergillus in sputum should be considered for the possibility of IPA.     

Developmental phonological dyslexia: A case study of the efficacy of a remediation programme

Abstract

A remediation programme was devised and implemented in a case study of a developmental phonological dyslexic. Psycholinguistic assessment determined the developmental stage at which the subject's acquisition of reading skills had arrested. This was determined to be at the logographic stage of reading (Frith, 1985) so his pattern of performance resembled that of phonological dyslexics. Remediation focused on development of an alphabetic or phonological strategy for reading. The efficacy of remediation was investigated employing a single-subject case study incorporating a crossover design with multiple baseline and repeated pre- and post-therapy measures. The results of therapy indicated significant improvement in phonological reading skills as a consequence of the treatment. In addition, these effects generalised to untreated items and were accompanied by changes in reading strategy. Theoretical explanations and practical implications of the results are discussed.     

Measles immunity and response to revaccination of a young adult population in Israel

In order to evaluate the true immune status and the effect of revaccination on a young adult population, we collected serum samples from 289 military recruits who were vaccinated during an outbreak in 1991. Most vaccinees, age 18–25 years, had apparently been immunized once before as infants. Sera collected just prior to the vaccination and 14 and 28 days afterwards were tested for measles antibodies by hemagglutination inhibition (HI) and enzyme-linked immunosorbent assay (ELISA)-IgM. Before vaccination, 46 (15.9%) of the subjects had no HI antibodies, (<1:4) and 48 (16.6%) had borderline (1:4) HI titer. Following vaccination, only ten (3.5%) remained negative and 19 (6.6%) had borderline titer. The increase in HI antibody titer was inversely proportional to the prevaccination titer, and 159 subjects (55.0%) showed no increase at all. The geometric mean titer (GMT) rose from 9.14 to 21.47. Among the prevaccination-negative subjects (HI <1:4) 28 (60.9%) reached a postvaccination titer of ≥ 1:8, and eight (17.4%) reached a titer of 1:4. Twelve (26.1%) of the negative subjects seroconverted and developed IgM, 16 (35%) seroconverted without IgM, and 18 (39%) remained negative and did not develop IgM. A group of eight vaccinees with prevaccination titer of ≥ 1:4 developed IgM. Some were probably infected by the circulating wild-type virus prior to the vaccination. Thus, a total number of 20 of the 289 subjects studied (6.9%) had true negative preimmune status as judged by the IgM test. However, the vaccination campaign prevented further measles cases, apparently by increasing the population's immunity, particularly in individuals with very low titers or without measles antibodies. © 1996 Wiley-Liss, Inc.     

Validity of Qualis database as a predictor of evidence hierarchy and risk of bias in randomized controlled trials: a case study in dentistry

OBJECTIVE:

To evaluate the validity of the Qualis database in identifying the levels of scientific evidence and the quality of randomized controlled trials indexed in the Lilacs database.

METHODS:

We selected 40 open‐access journals and performed a page‐by‐page hand search, to identify published articles according to the type of study during a period of six years. Classification of studies was performed by independent reviewers assessed for their reliability. Randomized controlled trials were identified for separate evaluation of risk of bias using four dimensions: generation of allocation sequence, allocation concealment, blinding, and incomplete outcome data. The Qualis classification was considered to be the outcome variable. The statistical tests used included Kappa, Spearman''s correlation, Kendall‐tau and ordinal regressions.

RESULTS:

Studies with low levels of scientific evidence received similar Qualis classifications when compared to studies with high levels of evidence. In addition, randomized controlled trials with a high risk of bias for the generation of allocation sequences and allocation concealment were more likely to be published in journals with higher Qualis levels.

DISCUSSION:

The hierarchy level of the scientific evidence as classified by type of research design, as well as by the validity of studies according to the bias control level, was not correlated or associated with Qualis stratification.

CONCLUSION:

Qualis classifications for journals are not an approximate or indirect predictor of the validity of randomized controlled trials published in these journals and are therefore not a legitimate or appropriate indicator of the validity of randomized controlled trials.     

Health locus of control and use of conventional and alternative care: a cohort study.

BACKGROUND: Health locus of control influences health-related behaviour, but its association with healthcare use is unclear. AIM: To investigate the association between individuals' health locus of control and the use of conventional and alternative health care. DESIGN OF STUDY: Prospective cohort study. SETTING: A nationally representative random sample of community-dwelling adult households in Japan. METHOD: Health locus of control, symptom-related visits to physicians, and the use of dietary and physical complementary and alternative medicine (CAM) was measured. Dietary CAM included supplements, such as herbs and vitamins. Physical CAM included manipulations, such as acupuncture and acupressure. RESULTS: Of the 2453 adult participants studied, 2103 (86%; 95% CI [confidence interval] = 84 to 88%) developed at least one symptom during the 31-day study period. Of these symptomatic adults, 639 visited physicians (30%; 95% CI = 28 to 32%), 480 used dietary CAM (23%; 95% CI = 21 to 25%), and 156 (7%; 95% CI = 6 to 9%) used physical CAM. The likelihood of visiting a physician was not related significantly to individuals' health locus of control. Increased use of dietary CAM was weakly associated with control by spiritual powers (P = 0.028), internal control (P = 0.013), and less control by professionals (P = 0.020). Increased use of physical CAM was significantly associated with control by spiritual powers (P = 0.009) indicating a belief that supernatural forces control individuals' health status. CONCLUSION: The likelihood of visiting a physician is not affected by individuals' health locus of control. Control by spiritual powers is involved with increased CAM use. Internal control is weakly associated with greater use of dietary CAM; professional control is weakly associated with less use of dietary CAM.