Bimodal cell populations are common in chronic lymphocytic leukemia but do not impact overall survival

Flow cytometric histograms were evaluated for bimodal antigen expression on samples from 246 patients diagnosed with chronic lymphocytic leukemia (CLL) at University Hospitals of Cleveland, Cleveland, OH. Survival data were obtained, and the clinical significance of bimodality was evaluated using the Kaplan-Meier method and the log-rank test. Bimodal antigen expression was found in 107 cases (43.5%). CD38 and CD13 were the most common antigens to demonstrate bimodality at 14.5% and 12.9%, respectively, and CD20, CD11c, CD5, FMC-7, and surface immunoglobulin also were frequently bimodal. Bimodal antigen expression, the number of bimodal antigens, and bimodality of a specific antigen were not associated with decreased survival in patients with CLL, although bimodality for CD38 trended toward worse overall survival. Therefore, although bimodal antigen expression is common in CLL, the presence of bimodality does not seem to have significant prognostic importance     

Effects of Sertoli cell transplants in a 3-nitropropionic acid model of early Huntington's disease: a preliminary study

Problems with immunosuppression and graft survival limit clinical applications of neurotransplantation protocols for neurodegenerative disease. Sertoli cells, testes-derived cells with immunosuppressive and trophic properties, may serve as an alternative cell source for transplantation. Sertoli cells were transplanted into the striatum of rats following two injections of 3-nitropropionic acid (3-NP) to determine whether they could ameliorate abnormalities in a model of early stage Huntington's disease. 3-NP-induced locomotor hyperactivity was significantly reduced in rats receiving Sertoli transplants compared to controls, with some behaviors returning to baseline. Sertoli cells survived in the striatum without systemic immunosuppression and some formed tubule-like structures. These results show that Sertoli transplants are able to ameliorate locomotor abnormalities in a 3-NP model of early HD. Thus, Sertoli cells should be further evaluated as a possible treatment strategy for the early stages of Huntington's disease.     

Impact of transmission dynamics on the cost-effectiveness of rotavirus vaccination

The objective of this study is to estimate the cost-effectiveness of mass vaccination of US infants with the recently available rotavirus vaccine, RotaTeq. We developed a dynamic transmission model of rotavirus to incorporate herd immunity into cost-effectiveness analysis. Our study indicates that a rotavirus vaccination program would prevent about 90% of rotavirus incidence, mortality, hospitalization and emergency department visits annually. We conclude that a universal rotavirus vaccine program in the US would cost $77.30 per case averted from the health care and give a net saving of $80.75 per case averted from the societal perspectives, respectively. The cost per QALY gained was found to be $104,610 when we considered child with one caregiver, making the rotavirus vaccination program a cost-effective intervention.     

Arterial and end-tidal carbon dioxide difference in pediatric intensive care

Background and Aim:

Arterial carbon dioxide tension (PaCO₂) is considered the gold standard for scrupulous monitoring in pediatric intensive care unit (PICU), but it is invasive, laborious, expensive, and intermittent. The study aims to explore when we can use end-tidal carbon dioxide tension (P_ETCO₂) as a reliable, continuous, and noninvasive monitor of arterial CO₂

Materials and Methods:

Concurrent P_ETCO₂, fraction of inspired oxygen, PaCO₂, and arterial oxygen tension values of clinically stable children on mechanical ventilation were recorded. Children with extra-pulmonary ventriculoatrial shunts were excluded. The P_ETCO₂ and PaCO₂ difference and its variability and reproducibility were studied.

Results:

A total of 624 concurrent readings were obtained from 105 children (mean age [SD] 5.53 [5.43] years) requiring invasive bi-level positive airway pressure ventilation in the PICU. All had continuous P_ETCO₂ monitoring and an arterial line for blood gas measurement. The mean (SD) number of concurrent readings obtained from each child, 4-6 h apart was 6.0 (4.05). The P_ETCO₂ values were higher than PaCO₂ in 142 observations (22.7%). The PaCO₂–P_ETCO₂ difference was individual admission specific (ANOVA, P < 0.001). The PaCO₂–P_ETCO₂ difference correlated positively with the alveolar-arterial oxygen tension [P(A-a)O₂] difference (ρ = 0.381 P < 0.0001). There was a fixed bias between the P_ETCO₂ and PaCO₂ measuring methods, difference +0.66 KPa (95% confidence interval: +0.57 to +0.76).

Conclusions:

The PaCO₂–P_ETCO₂ difference was individual specific. It was not affected by the primary disorder leading to the ventilation.     

A pilot study of levonorgestrel concentrations and bleeding patterns in women with epilepsy using a levonorgestrel IUD and treated with antiepileptic drugs

Objectives

We explored levonorgestrel (LNG) concentrations, bleeding patterns and endometrial thickness in women with epilepsy (WWE) initiating an LNG-intrauterine device (IUD) co-administered with antiepileptic drugs (AEDs).

Second Trimester Insulin Resistance,Early Pregnancy Body Mass Index and Gestational Weight Gain

Objectives Because prior work suggests an association between high insulin concentrations in early pregnancy and excess gestational weight gain, we examined such associations in a prospective cohort. Methods Multivariate regression analysis of early pregnancy insulin homeostasis and gestational weight gain among 434 women enrolled in the MGH Obstetrical Maternal Study. Results We found that the association between insulin quartile and gestational weight gain varied depending on maternal body mass index (BMI) in early pregnancy (P for interaction <0.0001). Among women with a BMI of 20, high fasting insulin was associated with greater gestational weight gain (multivariate-adjusted predicted mean 39.6, 95% CI 30.9–40.3 lbs for Quartile 4 (Q4) vs. 31.3, 95% CI 28.6–34.1 lbs for Q1) and higher risk of excessive weight gain. By contrast, among women with a BMI of 35, higher fasting insulin was associated with lower total gain (multivariate-adjusted predicted mean 25.7, 95% CI 22.6–28.7 lbs for Q4 vs. 33.2, 95% CI 10.5–55.9 lbs for Q1) and lower risk of excessive gain. Conclusion In our cohort, early pregnancy BMI modified the association between insulin homeostasis and gestational weight gain. These associations suggest that the physiologic consequences of hyperinsulinemia differ between normal weight and obese women.     

Desipramine treatment for cocaine dependence in buprenorphine- or methadone-treated patients: baseline urine results as predictor of response

The prognostic importance of baseline urines for cocaine was examined in a randomized, placebo-controlled, twelve-week clinical trial in 165 opioid- and cocaine-dependent patients who were treated with desipramine (DMI) in combination with buprenorphine (BUP) or methadone (Meth). Patients with a cocaine-positive urine at baseline (CU+) had significantly fewer cocaine-free urines than those with a negative urine at baseline (CU-neg). The CU+ patients showed a treatment effect of DMI. This DMI effect was significant in patients maintained on BUP but not on Meth.     

Factors predicting patient perception of dysphonia caused by benign vocal fold lesions

OBJECTIVES/HYPOTHESIS: To assess factors that may be predictive of patient perception of dysphonia severity, as quantified by the Voice Handicap Index (VHI) score. We hypothesize that 1) level of vocal demand; 2) auditory-perceptual evaluation of dysphonia severity; and 3) vocal function, as defined by phonatory glottal closure and mucosal wave vibration, are the most significant predictors of VHI score. STUDY DESIGN:: Retrospective review of 100 patients with benign vocal fold lesions. METHODS: Variables assessed for predictive value to VHI score are level of vocal demands, auditory-perceptual evaluation of dysphonia severity, integrity of mucosal wave vibration and phonatory glottal closure, lesion type, duration of current complaint, smoking, age, and sex. Harmonic to noise ratio was assessed in a subset of 50 patients. RESULTS: Patients with routine voice use had significantly lower VHI scores than those with more intensive (nonsinging/acting) vocal demands. Patients who quit smoking had greater VHI scores than those who currently smoke or never started. Patients with long-standing dysphonia tended to have lower VHI scores than those with shorter duration vocal complaints. Auditory-perceptual assessment of dysphonia severity and harmonic to noise ratio were weak predictors of VHI score. Age, sex, lesion type, phonatory glottal closure, and mucosal wave vibration were not significant predictors of VHI score. CONCLUSIONS: Patient perception of dysphonia severity is independent of many factors commonly assessed during the evaluation of voice disorders. It appears to be an important independent element in the assessment of the effect of a benign vocal fold lesion and critical to therapeutic decision-making.