Complex-analyticity of harmonic maps and strong rigidity of compact Kähler manifolds

A harmonic map f between two compact Kähler manifolds is shown to be either holomorphic or conjugate holomorphic under a suitable negativity condition on the curvature of the image manifold and a condition on the rank of df. As a consequence, a compact Kähler manifold of dimension ≥2 that is of the same homotopy type as a compact Kähler manifold with suitable negative curvature condition or as a compact quotient of an irreducible classical bounded symmetric domain must be either biholomorphic or conjugate biholomorphic to it.     

Reduced ovarian follicular development as a consequence of low body condition in ewes

The effect of body condition on ovarian follicular development was investigated in Scottish Blackface ewes in high and low body condition. Follicles were dissected from ovaries on days 11 and 12 of the luteal phase and 24 h after prostaglandin-induced luteal regression. Ewes in low body condition had a lower ovulation rate (low: 0.9; high: 1.8 P less than 0.05) and lower mean plasma levels of FSH during both the luteal (low: 54; high: 72 micrograms/l) and follicular (low: 34; high: 43 micrograms/l) phases of the cycle. Low body condition was associated with a reduced number of large (greater than or equal to 4 mm) follicles in both the luteal and follicular phases, and in low condition a lower proportion of these follicles was oestrogenic and potentially ovulatory as assessed by follicular fluid levels of oestradiol. However, within the different oestrogenic classifications of these large follicles there were no significant differences in the steroidogenic capacity as assessed by the concentrations of either oestradiol or testosterone in follicular fluid, basal and hCG-stimulated testosterone production, thecal 125I hCG binding or basal and testosterone-stimulated oestradiol production by granulosa cells in relation to body condition. These results suggest that body condition influences ovulation rate by altering the concentration of FSH in blood, which in turn affects the number of potentially ovulatory follicles growing beyond 4 mm.     

Principes,caractéristiques et interprétation des tests de diagnostic et de dépistage

In daily practice, the physician uses tests to confirm a diagnosis or to identify a group of individuals at risk for a certain condition; he/she carries out diagnostic and screening tests. The aim of these tests is to confirm or to disprove the existence of a condition, in giving the most precise response possible; they can be positive (identifying the individual as being sick) or negative (identifying the individual as being well). However, tests are rarely completely reliable, errors are observed, and there are false negative and false positive results. Sensitivity and specificity are important test features; they measure the proportion of test-positive persons who truly have the condition being examined and the proportion of test-negative persons who truly do not have the condition being considered. The positive predictive value (i.e. the proportion of individuals who really have the condition among those who are test-positive) and the negative predictive value (the proportion of individuals who really do not have the condition among those who are test-negative) have the particularity of being sensitive to the prevalence of the condition. In contrast to sensitivity and specificity, predictive values provide an estimation of the risk of having the condition when the test is positive and the likelihood of not having the condition when the test is negative. The objective of a screening test is to identify a subpopulation that has an elevated risk for developing the condition compared to the general population, thereby allowing them to be integrated into appropriate health care channels. Even when a test is positive, it is not certain that the individual has the condition. For that reason, a diagnostic procedure (including other diagnostic tests) may need to be done. Knowledge of these characteristics (sensitivity, specificity and predictive values) permits one to decide when additional measures should be carried out, to select those that are the most appropriate, and to be able to interpret the results correctly. It must be understood that such tests do not replace clinical findings; rather, they are complementary. Moreover, they are no more than a support, to be integrated into the framework of the diagnostic strategy.     

The metabolic syndrome,diabetes, and subclinical atherosclerosis assessed by coronary calcium

OBJECTIVES: We compared the prevalence and extent of coronary artery calcium (CAC) among persons with the metabolic syndrome (MetS), diabetes, and neither condition. BACKGROUND: The prevalence and extent of CAC has not been compared among those with MetS, diabetes, or neither condition. METHODS: Of 1,823 persons (36% female) age 20 to 79 years who had screening for CAC by computed tomography, 279 had MetS, 150 had diabetes, and the remainder (n = 1,394) had neither condition. Metabolic syndrome was defined with >or=3 of the following: body mass index >or=30 kg/m(2); high-density lipoprotein cholesterol <40 mg/dl if male or <50 mg/dl if female; triglycerides >or=150 mg/dl; blood pressure >or=130/85 mm Hg or on treatment; or fasting glucose 110 to 125 mg/dl. The prevalence and odds of any and significant (>or=75th percentile) CAC among these groups and by number of MetS risk factors were determined. RESULTS: Those with neither MetS nor diabetes, MetS, or diabetes had a prevalence of CAC of 53.5%, 58.8%, and 75.3% (p < 0.001), respectively, among men and 37.6%, 50.8%, and 52.6% (p < 0.001), respectively, among women. Coronary artery calcium increased by the number (0 to 5) of MetS risk factors (from 34.0% to 58.3%) (p < 0.001). Forty-one percent of subjects with MetS had either a >20% 10-year risk of CHD or CAC >or=75th percentile for age and gender. Risk factor-adjusted odds for the presence of CAC were 1.40 (95% confidence interval [CI] 1.05 to 1.87) among those with MetS and 1.67 (95% CI 1.12 to 2.50) among those with diabetes, versus those with neither condition. CONCLUSIONS: Those with MetS or diabetes have an increased likelihood of CAC compared with those having neither condition.     

An Emotional Mediation Theory of Differential Age Effects in Episodic and Semantic Memories

Abstract

Perceivers were assigned to one of two decision conditions. In an absolute decision condition, perceivers rated how likely they would be to allow a young or old highly forgetful, slightly forgetful, or nonforgetful target to perform a challenging task. In a comparison decision condition, perceivers rated two targets, one young and one old, who had a similar level of forgetfulness. Separate Decision Type x Target Forgetfulness analyses of variance were conducted on ratings of the two target age groups. Young targets received higher ratings in the comparison than in the absolute condition, whereas old targets were rated the same in the two conditions. There was some preference for young targets in a comparison situation, but it was concluded that forgetfulness was a more important factor than age in perceivers' ratings.     

Serum amylase, isoamylase, and lipase in the acute abdomen. Their diagnostic value for acute pancreatitis

We evaluated the diagnostic value of serum amylase, isoamylase, and lipase for the diagnosis of acute pancreatitis from sera of patients with acute abdominal pain. Comparison was first made in condition A between 32 patients with image-proven pancreatitis and 414 patients with nonpancreatic acute abdomen (the control group), then in condition B, between 62 pancreatitis patients with or without image proof and the control group. We found (a) that patients with image-proven pancreatitis suffer a more severe clinical course than those without; (b) that the sensitivity, positive predictive value, and accuracy in condition B are higher than in condition A at any cutoff level; (c) that none of the enzyme assays is specific at the upper reference limit, but their diagnostic yields are much improved by raising cutoff levels to about three or four times the upper limit; and (d) that at these selected cutoff levels, amylase had a diagnostic value similar to p-isoamylase or lipase in both conditions (sensitivity 84% and 92% for amylase in conditions A and B, respectively; specificity 98% and 98%; positive predictive value 75% and 90%; negative predictive value 99% and 99%; accuracy 91% and 97%). In conclusion, at an appropriately selected cutoff level, amylase can be effectively used as the first-line test and isoamylase or lipase as adjunct tests for acute abdominal conditions.     

New and worsening conditions and change in physical and cognitive performance during weekly evaluations over 6 months: the Women's Health and Aging Study.

BACKGROUND: Despite the large burden of chronic disease in older persons, especially those with disability, little research has documented changes in symptomatology over short periods of time. Additionally, although it has been demonstrated that medical conditions strongly affect functional level, short-term worsening in condition status has not been investigated for its impact on functional change. METHODS: In a substudy of the Women's Health and Aging Study, 102 women with mild to severe disability received weekly home visits over a 6-month period. Each week they were queried as to the onset of 14 acute, generally self-limited conditions and the worsening or new diagnosis of 12 chronic conditions (condition reporting). They also received a battery of physical and cognitive performance tests. RESULTS: There was a high rate of condition reporting over 24 weekly interviews. Nearly all women reported acute and episodic conditions; the average number of weeks of reporting one or more conditions was 11.8 per woman. For chronic conditions, the average number of weeks of reporting worsening of one or more conditions was 5.2 per woman. Multiple reports of onset or worsening of specific conditions were common, especially for arthritis of the hands, hips, knees, or feet; urinary problems; dizziness or unsteadiness on feet; and back pain. The total number of condition reports and number of weeks of condition reporting were generally not associated with an individual's slope of change in performance tests. For specific conditions, there were generally small and nonsignificant changes in performance in those who reported onset or worsening after 3 or more weeks of not reporting this. CONCLUSIONS: Older disabled women frequently report the onset or worsening of acute and chronic conditions. In weekly observations, these conditions are not related to changes in physical and cognitive performance measures. Possible reasons for this are that (a) condition reporting may not be valid, (b) changes or severity of conditions were of insufficient magnitude to affect functioning, or (c) performance measures are not sensitive to the kinds of changes in chronic and acute conditions that affect people from week to week. We concluded that performance measures are not useful in monitoring modest, short-term changes in health status, but may still be valuable for assessing more major changes in health and functioning over time.     

Acute Aortic Dissection With Tear in Ascending Aorta Not Diagnosed Until Necropsy or Operation (for Another Condition) and Comparison to Similar Cases Receiving Proper Operative Therapy

Acute aortic dissection (AD) with a tear in ascending aorta (AA) is recognized to masquerade occasionally as another condition, and therefore the proper diagnosis is never made or made too late. During a recent 3-year period (2009 to 2011) at Baylor University Medical Center at Dallas, 30 patients with acute AD with tear in AA were diagnosed: 23 (77%) were diagnosed clinically and underwent proper urgent operative therapy; the remaining 7 (23%) with AD with tear in AA were not diagnosed until operation (for another condition) or necropsy or retrospectively by review of antemortem computed tomographic scan after death. The number of patients with AD from tear in AA whose cardiac condition was not diagnosed clinically and who died in the hospital but did not have an autopsy is unclear. Because the autopsy rate in most United States hospitals, including Baylor University Medical Center, is now <5%, many cases of AD are probably not diagnosed and thus its frequency is being underestimated. In conclusion, ≥7 of 30 patients (23%) with acute AD with a tear in AA were not diagnosed until necropsy or operation (for another condition) or retrospectively by computed tomography during a 3-year period at a large tertiary medical center showing that this condition continues to be underdiagnosed, and when not diagnosed correctly is usually rapidly fatal. Because the autopsy rate today is so low, the percentage not diagnosed clinically is probably >23%.     

Acute bilateral emphysematous pyelonephritis successfully managed by medical therapy alone: A case report and review of the literature

Background  

Bilateral emphysematous pyelonephritis is a life threatening condition usually occurring in diabetics. Management of this condition has traditionally been aggressive and surgery is considered mandatory. However, this is itself a hazardous intervention in a septic, unstable patient with circulatory or liver failure. When bilateral disease is present, the need for long-term dialysis is obviously unavoidable.     

Platypnea-Orthodeoxia Syndrome Caused by an Intracardiac Shunt

Platypnea-orthodeoxia syndrome, a rare condition characterized by posture-related dyspnea, is usually caused by an intracardiac shunt, hepatopulmonary syndrome, or shunting resulting from severe pulmonary disease.We report the case of a 33-year-old woman who presented with increasing dyspnea and oxygen desaturation when she sat up or arose. Our diagnosis was platypnea-orthodeoxia syndrome. A lead of a previously implanted pacemaker exacerbated a severe tricuspid regurgitant jet that was directed toward the patient''s intra-atrial septum. Percutaneous closure of a small secundum atrial septal defect eliminated right-to-left shunting and substantially improved the patient''s functional status. In addition to this case, we discuss this unusual condition.     

The Role of Instructional Set on Alcoholic Performance

This study was conducted to determine whether alcoholic and control subjects respond differently to manipulations that either enhance personal involvement (PI) or reduce negative affect (R, relaxation) on tests of neuropsychological function. In Phase 1, 48 male alcoholics and 36 male control subjects completed neuropsychological tasks under standard instructional sets. In Phase 2, subjects completed equivalent forms of these tests under one of three randomly assigned conditions; the PI condition in which subjects were encouraged to identify specific ways of improving their performance, the R condition in which subjects participated in a short relaxation exercise designed to reduce anxiety, or a No Treatment (NT) condition in which no attempt to manipulate the subjects' involvement or affect was made. Alcoholics were inferior to controls in both Phase 1 and Phase 2 [Fs (1,82) > 5.03, ps < 0.03]. The experimental manipulation differentially affected measures of negative affect and effort in the predicted direction. There were no group x condition interactions. Alcoholic and control subjects responded comparably to the experimental manipulations. This investigation, in combination with others using related manipulations, reinforces the hypothesis that alcohol-related cognitives dysfunction reflects an underlying deficit in brain states.     

Pseudo-obstruction of the colon (Ogilvie's syndrome), a genuine clinical condition?

Conclusion The so-called “Ogilvie's syndrome” seems not to be a genuine clinical condition. It appears to be associated with generalized disease(s) or systemic derangement in nearly all cases. The five patients whose cases are reported in this paper were all admitted to one hospital within a few months of each other. The condition, though uncommon, is by no means a rarity, and warrants attention.     

Documentation of Psychiatric Disorders and Related Factors in a Large Sample Population of HIV-Positive Patients in California

This retrospective cohort study examined electronic medical records of HIV-positive patients in California (N = 7,834) to find the prevalence of any psychiatric condition and the associations between several factors and the likelihood of these disorders. Approximately 53 % of the patients in this study had a documented psychiatric condition, including 23 % who had a mood disorder, 19 % who had a substance-related disorder, and 16 % who had an anxiety disorder. After controlling for potential confounders, significant positive associations (p < 0.001) were found between female gender and the presence of any mood disorder (adjusted odds ratio [95 % confidence interval, 95 %CI] = 1.58 [1.26–1.99]) or anxiety disorder (AOR = 1.54 [1.18–2.02]) and between homosexual orientation and the presence of any psychiatric condition (AOR = 1.33 [1.15–1.55]), mood disorder (AOR = 1.71 [1.42–2.07]), or anxiety disorder (AOR = 1.41 [1.22–1.88]). There were also significant negative associations between African-American race and the presence of any psychiatric condition (AOR = 0.68 [0.60–0.77]), mood disorder (AOR = 0.74 [0.64–0.86]), anxiety disorder (AOR = 0.43 [0.36–0.52]), or substance-related disorder (AOR = 0.78 [0.67–0.91]) and between state/federal insurance and the presence of any psychiatric condition (AOR = 0.70 [0.62–0.79]), mood disorder (AOR = 0.71 [0.62–0.80]), or anxiety disorder (AOR = 0.77 [0.66–0.89]).     

Effect of PTSD Diagnosis and Contingency Management Procedures on Cocaine Use in Dually Cocaine‐ and Opioid‐Dependent Individuals Maintained on LAAM: A Retrospective Analysis

This randomized clinical trial retrospectively examined the effect of post‐traumatic stress disorder (PTSD) and contingency management (CM) on cocaine use in opioid and cocaine dependent individuals maintained on high or low‐dose LAAM randomly assigned to CM or a yoked‐control condition. Cocaine‐positive urines decreased more rapidly over time in those without PTSD versus those with PTSD in the noncontingency condition. In participants with PTSD, CM resulted in fewer cocaine‐positive urines compared to the noncontingent condition. This suggests that CM may help improve the potentially worse outcomes in opioid‐ and cocaine‐dependent individuals with PTSD compared to those without PTSD. (Am J Addict 2010;00:1–9)     

Interacting Effects of Preoperative Information and Patient Choice in Adaptation to Colonoscopy

PURPOSE The aim of this study was to match patient information requirements by determining whether giving patients a choice for additional preprocedural audiovisual information modifies the effectiveness of this information on anxiety, worry, knowledge, and patient satisfaction. METHODS Patients scheduled to undergo colonoscopy were approached one week before their procedure. All patients received an information leaflet during their standard preanesthetic clinic visit. Patients were randomly assigned to a choice or no-choice condition. Patients in the choice condition were free to watch or not watch the video, people in the no-choice condition were further randomized to watch or not watch the video. Measures of anxiety and worry were completed before watching the video. Anxiety, worry, knowledge, and satisfaction were measured one week later just before the colonoscopy. RESULTS One hundred sixty-six patients completed the study. Of those patients randomized to the choice condition, 69 percent wanted to watch the video. Those who chose not to watch the video were significantly more worried on the day of their procedure. Consistent with current evidence, watching the video was associated with improvements in short-term knowledge (F (1,161) = 4.8, P = 0.03). There was, however, no significant effect of the choice or video conditions on anxiety or patient satisfaction. CONCLUSIONS There appears to be no additional benefits in terms of patient outcomes by allowing patients to choose whether they want additional audiovisual information. We suggest that all patients undergoing colonoscopy would benefit from watching such an educational video in the week before their procedure. Sue Pearson is a recipient of a Royal Australasian College of Surgeons Scholarship in Surgical Ethics. Presented at the Royal Australasian College of Surgeons Annual Scientific Congress, Perth, Australia, May 9 to 13, 2005. Reprints are not available.     

脑卒中后精神障碍与社会家庭环境的相关性研究

目的：探讨脑卒中后精神障碍与社会、家庭环境的相关性。方法：对脑卒中病人同时进行精神障碍的诊断，并全部采用自拟有关社会、家庭环境项目调查表进行调查，将调查结果进行分析。结果：脑卒中后抑郁症发病率为44．1％，焦虑症为7．9％，躁狂症为1．6％，总发病率为53．5％。脑力劳动者、文化程度较高者抑郁症发病率较高；经济状况较差者焦虑症发病率较高；家庭环境差者各种类型均高。结论：脑卒中后精神障碍发病率及类型与社会、家庭环境有一定程度的相关性。     

High glucose-induced upregulation of Rho/Rho-kinase via platelet-derived growth factor receptor-beta increases migration of aortic smooth muscle cells

Small GTPase Rho and Rho-kinase, the target protein of Rho, play an important role in atherosclerosis. In diabetic macroangiopathy, one of the major pathogenic changes is the migration of vascular smooth muscle cells (SMCs). Platelet-derived growth factor (PDGF) is known to stimulate the migration of SMCs. In the current study, we have investigated the involvement of the Rho/Rho-kinase pathway in the increased migration of cultured human aortic SMCs under a high glucose condition. PDGF stimulated the activation and the protein level of Rho. The protein level of PDGF receptor-β (PDGFR-β) was increased under the high glucose condition concomitant with the increased protein level and activation of Rho. The increased protein level and activity of Rho were suppressed by an anti-PDGF neutralizing antibody or a PDGFR-β inhibitor, AG1433, under the high glucose condition. Furthermore, high glucose significantly increased the migration of SMCs. A specific inhibitor of Rho-kinase, Y-27632, or anti-PDGF neutralizing antibody inhibited increased migration of SMCs under the high glucose condition. The protein levels of Rho were increased in aortae of diabetic rats, which were abolished by the treatment of Imatinib, the inhibitor of PDGFR. These observations indicate that the upregulation of the PDGFR-β / Rho / Rho-kinase pathway increases the migration of SMCs under the high glucose condition. The inhibition of Rho/Rho-kinase may be a new target for the treatment of diabetic macroangiopathy.     

Impact of nasal condition on self-assessed disease control and treatment satisfaction in patients with asthma complicated by allergic rhinitis.

BACKGROUND: Bodies of evidences have suggested that upper and lower airways are intricately interconnected with each other in patients with allergic airways diseases, however, few data are available concerning the impact of allergic rhinitis on self-assessed asthma condition and treatment satisfaction. The present study was conducted to clarify the association between nasal condition and self-assessment of asthma control and treatment satisfaction. METHODS: Adult patients with asthma were consecutively recruited for a systematic self-administered questionnaire to obtain information on nasal condition, self-perceived condition of asthma, and asthma treatment satisfaction. RESULTS: 3,140 adult patients with asthma completed the questionnaire, and of these 634 patients (mean age:53.1, 389 female) had physician-diagnosed allergic rhinitis. There were significant correlations between nasal symptoms (sneeze, rhinorrhea, nasal obstruction) and self-perceived asthma condition (limited daily activity, wheeze, dyspnea/chest tightness, cough, sputum, sleep disturbance, overall asthma condition). Patients who considered their overall nasal condition as unfavorable or bad were more likely than those who considered their condition as good or favorable to be dissatisfied with asthma treatment (p<0.01). CONCLUSIONS: Nasal condition is closely associated with self-assessed asthma condition and asthma treatment satisfaction. Controlling allergic rhinitis is critical to attain optimal management of asthma in patients complicated by allergic rhinitis.     

Increasing condom use by undermining perceived invulnerability to HIV.

An intervention to increase condom use by undermining perceptions of invulnerability to HIV was tested in a sample of 128 college students. Participants were randomly assigned to the invulnerability undermined (IU) condition or a demand characteristic control (DCC) condition. The IU condition used tasks that highlighted past failures to protect oneself and the failure of illusory protection strategies. Participants in the DCC condition watched a video on protecting oneself from HIV. Participants in the IU condition, relative to those in the DCC group, had lower perceptions of invulnerability to HIV and higher intentions to use condoms on the immediate postintervention measures; they reported more condom use at the 3-month follow-up. Contrary to prediction, perceptions of invulnerability did not mediate the effects of the intervention on condom use intentions or condom use. The advantage of indirect methods of reducing denial of vulnerability is discussed.     

Noninvasive Identification of ATTRwt Cardiac Amyloid: The Re-emergence of Nuclear Cardiology

More than half of all subjects with chronic heart failure are older adults with preserved ejection fraction (HFpEF). Effective therapy for this condition is yet to be delineated by clinical trials, suggesting that a greater understanding of underlying biologic mechanisms is needed, especially for the purpose of clinical intervention and future clinical trials. Amyloid infiltration of the myocardium is an underappreciated contributing factor to HFpEF that is often caused by misfolded monomers or oligomers of the protein transthyretin. While previously called senile cardiac amyloidosis and traditionally requiring endomyocardial biopsy for diagnosis, advances in our pathophysiologic understanding of this condition, coupled with nuclear imaging techniques using bone isotopes that can diagnose this condition noninvasively and the development of potential therapies, have resulted in a renewed interest in this previously considered “rare” condition. This reviewer focuses on the re-emergence of nuclear cardiology using pyrophosphate agents that hold promise for early, noninvasive identification of affected individuals.