Cluster Subtypes in the Standardization Sample of the California Verbal Learning Test-Children's Version

Representative profile subtypes, based on 5 key z-score variables, were examined in the standardization sample of the California Verbal Learning Test-Children's Version (CVLT-C; Delis, Kramer, Kaplan, & Ober, 1994). Two-stage cluster analysis identified 5 reliable subtypes. Both level and pattern of performance differences contributed to differentiation of the subtypes. The clusters did not differ significantly in age, but educational background of the children and of their parents, as well as level of performance on an independent measure of problem solving (Children's Category Test; Boll, 1993), did covary directly with CVLT-C performance. Guidelines for determining the relative uniqueness of clinically obtained CVLT-C patterns are presented.     

Prediction of neurobehavioral outcome 1-5 years post pediatric traumatic head injury.

OBJECTIVE: To examine the neurobehavioral status of children with traumatic head injury (THI) and to identify variables that predict outcome. DESIGN: Retrospective chart review, with follow-up 1-5 years after injury. Outcome predictor variables were identified through stepwise regression analysis. SETTING: Level one trauma center and pediatric rehabilitation program. PATIENTS: 71 Children with THI, selected from a four-year series of consecutive admissions. Measure: Vineland Adaptive Behavior Scales-Survey Edition. RESULTS: Significant predictors of better neurobehavioral status at follow-up included absence of a premorbid learning problem (p <.01), older age at injury (p <.01), and normal pupillary response (p <.001) and higher cerebral perfusion pressure (p <.0001) during critical care management. CONCLUSIONS: Neurobehavioral outcome after THI is influenced by premorbid psychosocial variables as well as by critical care management.     

Anomalous ABO inheritance explained by ovum transplantation

BACKGROUND: Modern fertilization techniques can lead to unexpected ABO phenotypes in newborn infants and can raise questions as to maternity, paternity, and infant misidentification. Ovum transplantation can result in an infant with an ABO phenotype that is unexpected, given the birth mother's ABO type. STUDY DESIGN AND METHODS: A group AB, Rh- positive female infant was born to a group O, Rh-positive woman as a result of ovum transplantation. The case report is provided. RESULTS: The birth mother typed group O, Rh-positive both before and after delivery. The infant typed group AB, Rh-positive on cord blood and heelstick specimens. CONCLUSION: Ovum transplantation can result in newborns whose ABO phenotypes are unexpected, in relation to the birth mother's ABO type. To ensure patient privacy, such fertilization techniques may not be clearly documented in the delivery room chart. A complete obstetric history helps prevent repeat phlebotomies, expensive and unnecessary typing studies, and concern of the clinical staff with possible sample or infant misidentification.     

Cytokines in inflammatory malignant fibrous histiocytoma presenting with leukemoid reaction

Inflammatory malignant fibrous histiocytomas (IMFH) are rare tumors and are frequently associated with leukocytosis. In rare cases, leukemoid reactions were attributed to tumor production of unidentified hematopoietic factors. In this study, we used immunohistochemical techniques to show cytokine immunoreactivity in the malignant cells of two cases of IMFH presenting with leukemoid reactions and compared them with two malignant fibrous histocytomas, noninflammatory type. All four tumors stained positively for stem cell factor (SCF), granulocyte colony-stimulating factor (G-CSF), interleukin-2 (IL-2), IL-4, IL-5, interferon-alpha (IFN-alpha), and insulin-like growth factor-I. Other cytokines detected only in the two IMFH included IL-6, IL-7, IL-8, IFN- gamma, and keratinocyte growth factor. Granulocyte-macrophage-CSF, IL- 3, and transforming growth factor-beta staining was present in one of the two IMFH tumors and was not present in the noninflammatory tumors. The immunohistochemical staining was localized to the malignant cells, suggesting deregulated cytokine expression consistent with their monocytic/histocytic origin. Expression of certain cytokines in the IMFH may account for the local inflammatory infiltrate, tumor fibrosis, and the aggressive nature of the malignant cells. We also detected elevated serum levels of SCF, G-CSF, IL-6, and tumor necrosis factor in one or both of the IMFH patients. These latter observations may explain the bone marrow hypercellularity and other paraneoplastic symptoms, including fever, malaise, and weight loss, observed in both patients. Different cytokines present in the two IMFH tumors appear to be responsible for the eosinophilic leukemoid reaction observed in one case and for the granulocytic leukemoid reaction observed in the other patient. They may also be responsible for expansion of the tumor-cell population, fibroblast proliferation, and enhanced secretion of extracellular collagen.     

Influence of contraceptive choice on vaginal bacterial and fungal microflora

The influence of contraception on vaginal microflora can have a major impact on the risk of developing acute or recurrent vaginal infections, but also may influence the risk of acquiring sexually transmissible infections (STI) such as HIV. A cohort of 248 women presenting for levonorgestrel-releasing intrauterine system (LNG-IUS) insertion or reinsertion were stratified according to their current contraceptive method. Information concerning their menstrual pattern and data about the medical history were collected. The composition of their vaginal microflora was studied by detailed phase contrast microscopy of fresh vaginal fluid, and aerobic cultures were taken to detect enteric bacterial growth and fungal colonisation. LNG-IUS and progesterone-only-pill (POP) users had significantly lower blood loss (p?<?0.001) than other women. Regardless of the type of contraception used, all women reported similar rates of symptomatic lower genital tract infection during the preceding year. Women using combined oral contraception (COC) and long-term LNG-IUS had the same bacterial composition of vaginal microflora as non-contraceptive users, even when infections were combined. Both hormonal and non-hormonal intrauterine device users had an increased tendency to have more vaginal colonisation with Candida. Women on POPs or subcutaneous implants had a tendency towards increased vaginal atrophy, but had a lower Candida carriage rate compared to IUCD users (LNG-IUS and Copper-IUCD, p?=?0.037). Women with an increased risk of acquiring STIs or recurrent BV could benefit from LNG-IUS or COC due to a well-preserved vaginal bacterial flora. Women with a susceptibility for RVVC should prefer POPs, and avoid intrauterine contraception.     

Risk factors for depressive symptoms after mild-to-moderate traumatic brain injury

PRIMARY OBJECTIVE: To determine the extent to which pre-injury psychosocial factors, injury-related variables and post-injury litigation, perceived stress, fatigue, pain and information processing speed contributed to depressive symptoms after traumatic brain injury (TBI). RESEARCH DESIGN: Cross-sectional outpatient follow-up at 1-36 months post-injury. Methods and procedures: Eighty-four adults recruited from outpatient clinics completed measures of depressive symptoms, measured with the Neurobehavioural Functioning Inventory, chronic stress and other symptoms. Hierarchical linear regression analysis was used to identify statistically significant covariates. Logistic regression analysis determined classification accuracy of these variables with regard to the presence or absence of borderline depression levels. MAIN OUTCOMES: Perceived stress, pain and litigation status made independent contributions to the level of depressive symptoms, with perceived stress explaining the bulk of the variance and mediating the effect of milder injury severity. These variables had a classification accuracy of 77% with regard to post-injury depressive symptoms, with a sensitivity of 84% and a specificity of 69%. CONCLUSIONS: Perceived stress, one indicator of allostatic load, explains a considerable amount of the variance in depressive symptoms after mild-moderate TBI. The findings suggest a need for earlier identification of, as well as preventative education with, those who are stress-vulnerable.     

Correlates of invalid neuropsychological test performance after traumatic brain injury

Primary objective: To investigate external correlates of invalid test performance after traumatic brain injury, as assessed by the California Verbal Learning Test - Second Edition (CVLT-II) and Word Memory Test (WMT).

Research design: Consecutive 2-year series of rehabilitation referrals with a diagnosis of traumatic brain injury (n = 87).

Methods and procedures: Logistic regression analysis was used to determine which demographic and neurological variables best differentiated those with vs. without actuarial CVLT-II or WMT evidence for invalid responding.

Main outcomes and results: Twenty-one participants (about 24%) performed in the invalid range. The combination of a premorbid psychiatric history with minimal or no coma was associated with an approximately four-fold increase in the likelihood of invalid performance.

Conclusions: Premorbid psychosocial complicating factors constitute a significant threat to validity of neuropsychological test results after (especially mild) traumatic brain injury. At the same time, care should be taken to not routinely assume that all persons with mild traumatic brain injury and premorbid psychiatric histories are simply malingering. The WMT appears to be a promising instrument for the purpose of identifying those cases where neuropsychological test results are confounded by factors not directly related to acquired cerebral impairment.     

Proof-of-concept study on the suitability of 13C-urea as a marker substance for assessment of in vivo behaviour of oral colon-targeted dosage forms

Background and purpose:

¹³C-urea may be a suitable marker to assess the in vivo fate of colon-targeted dosage forms given by mouth. We postulated that release in the colon (urease-rich segment) of ¹³C-urea from colon-targeted capsules would lead to fermentation of ¹³C-urea by bacterial ureases into ¹³CO₂. Subsequent absorption into the blood and circulation would lead to detectable ¹³C (as ¹³CO₂) in breath. If, however, release of ¹³C-urea occurred in the small intestine (urease-poor segment), we expected detectable ¹³C (as ¹³C-urea) in blood but no breath ¹³C (as ¹³CO₂). The differential kinetics of ¹³C-urea could thus potentially describe both release kinetics and indicate the gastrointestinal segment of release.

Experimental approach:

The in vivo study consisted of three experiments, during which the same group of four volunteers participated.

Key results:

The kinetic model was internally valid. The appearance of ¹³C-in breath CO₂ (F_fermented) and the appearance of ¹³C in blood as ¹³C-urea (F_{not fermented}) show a high inverse correlation (Pearson''s r=−0.981, P= 0.06). The total recovery of ¹³C (F_fermented+F_{not fermented}) averaged 99%, indicating complete recovery of the administered ¹³C via breath and blood. ¹³CO₂ exhalation was observed in all subjects. This indicates that ¹³C-urea was available in urease-rich segments, such as the caecum or colon.

Conclusions and implications:

In this proof-of-concept study, ¹³C-urea was able to provide information on both the release kinetics of a colon-targeted oral dosage form and the gastrointestinal segment where it was released.