Adherence to antidepressant medications in black and Latino elderly patients.

OBJECTIVE: The purpose of this pilot study was to identify ethnic group differences in nonadherence and to determine predictors of nonadherence to antidepressant medications in older minority-group members. METHODS: Participants were 49 black and 52 Latino subjects over the age of 55 who had been prescribed antidepressant medications within the past 12 months. RESULTS: We found a distinction between intentional nonadherence (e.g., alteration of medication regimen to fit one's needs) and unintentional nonadherence (e.g., forgetfulness/difficulties keeping track of medication regimen). Results suggested that older Latino subjects reported significantly more unintentional nonadherence than older black subjects. However, once other predictors were entered into the model, ethnicity did not remain a significant predictor. No ethnic group differences in intentional nonadherence were suggested. After controlling for ethnicity and medication type, intentional nonadherence was associated with concerns about the side effects of antidepressant medications, the stigma associated with antidepressant medications, and the attribution of lesser importance to antidepressant medications than other medications. Unintentional nonadherence was associated with greater cognitive impairment. CONCLUSIONS: Results suggest that the two ethnic minority groups face similar barriers to adherence to antidepressant medications. Interventions to increase adherence should target the specific type of nonadherence presented by the elderly patients. Some may benefit from memory aids and the assistance of family and friends, others from specific educational interventions about the nature of depression and antidepressant medications.     

Multimodal approach to assess tumour vasculature and potential treatment effect with DCE‐US and DCE‐MRI quantification in CWR22 prostate tumour xenografts

The aim of this study was to compare intratumoural heterogeneity and longitudinal changes assessed by dynamic contrast‐enhanced ultrasound (DCE‐US) and dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) in prostate tumour xenografts. In vivo DCE‐US and DCE‐MRI were obtained 24 h pre‐ (day 0) and post‐ (day 2) radiation treatment with a single dose of 7.5 Gy. Characterization of the tumour vasculature was determined by Brix pharmacokinetic analysis of the time–intensity curves. Histogram analysis of voxels showed significant changes (p < 0.001) from day 0 to day 2 in both modalities for k_ep, the exchange rate constant from the extracellular extravascular space to the plasma, and k_el, the elimination rate constant of the contrast. In addition, k_ep and k_el values from DCE‐US were significantly higher than those derived from DCE‐MRI at day 0 (p < 0.0001) for both groups. At day 2, k_el followed the same tendency for both groups, whereas k_ep showed this tendency only for the treated group in intermediate‐enhancement regions. Regarding k_ep median values, longitudinal changes were not found for any modality. However, at day 2, k_ep linked to DCE‐US was correlated to MVD in high‐enhancement areas for the treated group (p = 0.05). In contrast, correlation to necrosis was detected for the control group in intermediate‐enhancement areas (p < 0.1). Intratumoural heterogeneity and longitudinal changes in tumour vasculature were assessed for both modalities. Microvascular parameters derived from DCE‐US seem to provide reliable biomarkers during radiotherapy as validated by histology. Furthermore, DCE‐US could be a stand‐alone or a complementary technique. Copyright © 2015 John Wiley & Sons, Ltd.     

Sandwich Thyroplasty: A Novel Technique for Simplifying Medialization of Vocal Fold Using Silicone Implant in Paralytic Dysphonia with Modification of Thyroplasty Window

A novel technique of thyroplasty—Sandwich thyroplasty—described, with modification of Isshiki’s thyroplasty window to overcome the problems of securing and stabilising the silicone implant in the window thus simplifying the medialization of the vocal fold. Seventy five patients diagnosed with paralytic dysphonia of varied etiology, attending Sri Sathya Sai Institute of ORL, Guntur, India from January 2005 to January 2012, were subjected to this new technique. Medialization of vocal fold was achieved by sandwiching and stabilising a silicone implant between a superiorly based cartilaginous hinged door and the inner perichondrium of the modified thyroplasty window. Results were analysed based upon pre and postoperative voice handicap index, maximum phonation time readings and video-stroboscopic findings. The results were statistically significant with no untoward complications. Sandwich thyroplasty technique facilitated easier fixation and stabilization of silicone implant avoiding difficult and time consuming, techniques involving flanges or sutures.     

Association of the salivary triggering receptor expressed on myeloid cells/its ligand peptidoglycan recognition protein 1 axis with oral inflammation in kidney disease

1 Background

Triggering receptor expressed on myeloid cells (TREM‐1) is a cell‐surface receptor involved in amplification of inflammatory response to bacterial infections, along with its ligand peptidoglycan recognition protein 1 (PGLYRP1). TREM‐1 is shed by matrix metalloproteinases (MMPs) to its soluble (s) form. The aim of the study is to investigate association of sTREM‐1 and PGLYRP1 with oral inflammatory burden among patients with chronic kidney disease (CKD) at predialysis and posttransplantation stages.

2 Methods

One hundred forty‐four patients with CKD were examined at predialysis, and oral infection foci were treated prior to kidney transplantation. Fifty‐three patients were available for follow‐up after transplantation. Oral inflammatory burden was assessed by the Periodontal Inflammatory Burden Index (PIBI) and Total Dental Index. sTREM‐1, PGLYRP1, and interleukin (IL)‐1β were measured in saliva by enzyme‐linked immunosorbent assay, and MMP‐8 was measured by immunofluorometric assay.

3 Results

In the predialysis stage, sTREM‐1 and PGLYRP1 were positively associated with IL‐1β, MMP‐8, and PIBI. More specifically, patients with deeper probing depth (PD) (at least two sites with ≥6 mm) had higher concentrations of salivary sTREM‐1 and PGLYRP1 compared with those with shallower PD. Higher concentrations of PGLYRP1 and IL‐1β were associated with a higher number of teeth (> 25). On follow‐up, higher PGLYRP1 and sTREM‐1 were associated with one or more sites with ≥4 mm PD.

4 Conclusions

sTREM‐1 and PGLYRP1 are elevated in patients with CKD with poor oral health and positively correlate with number of active periodontal pockets after oral infection therapy. Moreover, they positively correlate with MMP‐8 and IL‐1β. Hence, the salivary sTREM‐1/PGLYRP1 axis could be useful as a diagnostic marker for oral infection within patients with CKD.     

Biochemical lung, liver and kidney markers and early death among elderly following hip fracture

Introduction

In the elderly, hip fracture is a common injury associated with high early mortality dominated by cardiorespiratory and thromboembolic events. Identification of risk factors that can be modified by treatment has caught attention over the last years. This study was conducted to assess biological markers on perioperative organ dysfunction and its association with early mortality within 3?months after surgery.

Method

Blood samples were collected before, during and until 4?days after surgery. Analyses on PaO₂, alanine aminotransaminase (ALAT), gamma-glutamyl transpeptidase (g-GT) and creatinine were performed and used as markers on lung, liver and kidney functions.

Patients

Three hundred and two patients over 75?years of age with acute dislocated hip fracture were consecutively enrolled from two hospitals in Norway.

Results

We found a positive correlation between the plasma levels of ALAT, creatinine and death, and an inverse relationship between PaO₂ and death. After controlling for confounding factors such as sex, age and comorbidity, ALAT and creatinine levels were shown to be significantly and independently related to risk for fatal outcome.

Conclusion

Our results provide data on clinically important biomarkers in patients undergoing hip fracture surgery. We suggest a stronger emphasis on monitoring and correcting these biomarkers when possible.     

Carcinoid tumor in Meckel's diverticulum

The accidental finding of a carcinoid tumour in Meckel's diverticulum, a very uncommon event, triggered a physiopathological and clinical analysis of this very interesting but very rare association. The value of systematic identification and removal of the diverticulum during laparotomy is underlined.     

Type beta transforming growth factor and epidermal growth factor suppress the plasminogen activator activity in a human glioblastoma cell line

Summary In the human glioblastoma cell line, T-MG1, plasminogen activator activity (PA activity) was demonstrated by using the chromogenic substrate S-2251. Using monoclonal antibodies against human urokinase type PA (u-PA) and human tissue type PA (t-PA), only u-PA activity was found in T MG1, cell extracts. The u-PA activity in T-MG1, cells was suppressed in a dose-dependent manner by B TGF and EGF after 24 hours of exposure to these growth factors. Twenty units of B TGF caused a decrease in PA-activity of 80%, while 10 ng/ml EGF gave a decrease in PA-activity of 60%. The suppressive effects of B TGF and EGF were observed after 2 hours and 4 hours of incubation, respectively and sustained for at least 24 hours. The effects of B-TGF and EGF were not antienzymatic, but rather mediated through regulatory mechanisms. In view of the capacity of invasive growth of gliomas and the potential role of PA in invasive growth, the suppression of PA-activity in gliomas by B-TGF and EGF may be of importance.     

Childhood maltreatment in adult female psychiatric outpatients with eating disorders

To explore possible relations between maltreatment in childhood and subsequent eating disorders in adult life, 107 consecutive adult psychiatric female outpatients were screened for eating disorders. They also completed questionnaires about harassment by adults and bullying by peers in childhood. The Childhood Trauma Questionnaire measured childhood abuse by parents or other adults, and the Parental Bonding Instrument captured parental coldness and overprotection. Bullying by peers was measured by an inventory used in schools. Outpatients who met the criteria for bulimia nervosa reported far more bullying by peers, more coldness and overprotection from fathers, and more childhood emotional, physical and sexual abuse. The findings suggest associations between childhood maltreatment, especially bullying by peers, and bulimia nervosa.