Degree of cervical carotid artery stenosis and hemispheric stroke: duplex US findings

Duplex ultrasound (US) scans of 110 carotid arteries ipsilateral to hemispheric strokes were compared with scans of 90 asymptomatic vessels in the same patients to determine the relative prevalence of stenotic lesions. In addition, scans of paired carotid arteries in patients with stroke involving only one cerebral hemisphere were compared to determine whether the incriminated side demonstrated a greater degree of stenosis than the asymptomatic side. The duplex US findings demonstrated a positive correlation between stenosis and hemispheric stroke. However, only 20% of carotid arteries ipsilateral to hemispheric stroke showed a reduction in diameter greater than 70%, compared with 5% of asymptomatic vessels. A minimal difference was demonstrated between the symptomatic and asymptomatic groups with respect to lesser degrees of stenosis. In paired carotid arteries, the degree of stenosis of the symptomatic vessel exceeded that of the asymptomatic vessel in only 43% of cases. These results suggest that the prevalence of severe carotid stenosis in stroke patients has been previously overestimated. The findings also emphasize the need for further investigation of other plaque-related risk factors that may enhance stroke prevention through improved selection of surgical or medical therapy. Factors currently under investigation include plaque ulceration, intraplaque hemorrhage, plaque echogenicity, and the effects of sequential stenoses.     

TCR Vβ gene expression in lesional T lymphocyte cell lines in oral lichen planus

OBJECTIVE: To study Vβ gene expression in oral lichen planus (OLP) lesional T lymphocyte cell lines.
MATERIALS AND METHODS: Lesional T lymphocytes were isolated from eight OLP patients and cell lines established. The total RNA was extracted from these lymphocyte cell lines and reverse transcribed. cDNA was amplified by the polymerase chain reaction (PCR) using a panel of 26 Vβ-specific oligonucleotide primers followed by qualitative analysis of the electrophoresed reaction products.
RESULTS: Vβ 1, 2, 3, 5.1, 6.1–3, 7, 8, 9, 22. 23, and 24 were represented consistently in all of the OLP samples, Vβ11, 12, and 17 were consistently negative, while the other Vβ families (Vβ4, 5.2–3, 10, 13.1, 13.2, 14, 15, 16, 18, 19, 20, and 21) were variable. Vβ22 and 23 were the most strongly expressed in all patients.
CONCLUSIONS A limited T cell receptor (TCR) gene usage indicates a degree of oligoclonality within these lesional T lymphocyte cell lines from OLP. This implies that OLP may be an antigen-specific disease or linked to a limited number of superantigens.     

National Trends in Food Insecurity and Congregation-Based Food Provision between 1998 and 2012

Food insecurity has been a persistent problem in the U.S., and yet over the past three decades, federally funded food programs have become more restrictive. Scholars and policymakers have inquired whether the nonprofit sector is increasing its food provision activities to address this unmet need. This study analyzes data from the U.S. Census and a nationally representative survey of religious congregations in the U.S. to examine trends in food insecurity and congregation-based food provision between 1998 and 2012. The objective of the study is to investigate the extent to which congregation-based food provision fluctuated with national food insecurity prevalence for the overall population, and for subgroups vulnerable to this condition. Results show an over-time correspondence between the prevalence of food-insecure households and the prevalence of congregations that provide food. Parallel patterns are observed between food insecurity in disproportionately affected subpopulations (e.g., African-Americans and immigrants) and food provision in the congregations likely to serve those households. These findings indicate that congregations are helping meet the needs of food-insecure households. However, research suggests that congregations and nonprofits are not an adequate substitute for federally funded programs. Policy recommendations include expanding access to federally funded programs like the Supplemental Nutrition Assistance Program (SNAP) to more immigrants and other groups vulnerable to food insecurity, as well as providing more systematic financial or federal support and quality control of congregation-based efforts.     

Risk-adjusted analysis of early mortality after ruptured abdominal aortic aneurysm repair

PURPOSE: Ruptured abdominal aortic aneurysms (RAAAs) continue to result in early mortality in up to 50% of patients. Additionally, it remains difficult to compare outcomes given the variability in patient comorbidities and presentation. The purpose of this study was to describe an instrument that permits the prospective analysis of outcomes after RAAA repair while adjusting for the variability in preoperative risk. METHODS: Consecutive patients undergoing attempted open RAAA repair over a 5-year period (1999 to 2003) at our center were reviewed. Thirty-day or in-hospital mortality was the main outcome variable. Preoperative mortality risk was estimated for each patient by using a validated modification of the POSSUM scoring system (V-POSSUM). A risk-adjusted cumulative sum method (RA-CUSUM) was used to compare observed versus predicted outcomes by assigning a risk-adjusted score, based on log-likelihood ratios, to each patient. These scores were sequentially plotted with preset control limits to allow for "signaling" when results were substantially different from expected (doubling or halving of odds ratios). RESULTS: A total of 136 patients were reviewed, with an early mortality rate of 45.6%. V-POSSUM scores were accurate in predicting mortality for the entire cohort, with an observed-to-predicted mortality ratio of 0.92 (P = .80). Each patient's risk-adjusted score was plotted sequentially. In one segment of the resulting plot, the graph adopted a negative slope and crossed the lower control limit, indicating improved results compared with predicted. CONCLUSIONS: V-POSSUM scores in this series accurately predicted early mortality after RAAA surgery. The RA-CUSUM method allows for the prospective evaluation of outcomes, while taking into account patient variability. In the current study, this resulted in the identification of a series of patients who had improved outcomes compared with predicted.     

Study of distribution and factors affecting syphilis epidemic among inner-city minorities of Baltimore

Disparities in health and medical conditions among ethnic and racial groups have been repeatedly documented. These inequalities, which have been noted in the recent past, include health outcomes such as quality of life and mortality, process, accessibility and appropriateness of care, and the prevalence of certain degenerative conditions and infectious diseases. Syphilis, a sexually transmitted disease (STD) which seemed to have disappeared or had been controlled over the years, has now re-emerged as a major public health problem in many rural, urban and suburban communities. Progression of the current rate of syphilis, which erupted in Baltimore during the later part of 1994, has continued unabated, most especially among the ethnic minorities, despite efforts of the Baltimore City Health Department and Maryland Department of Health and Mental Hygiene to control the epidemic. With the current incidence rates of 270 per 100 000 live births for congenital syphilis and 99.3 per 100 000 population for primary, secondary and latent syphilis (96% of the cases being in the non-white population), Baltimore becomes the city with the highest number of syphilis cases in the nation, surpassing the national average of 2.6 cases per 100 000 population. This study, which utilizes a combination of retrospective and questionnaire-oriented approach, was designed to assess factors that influenced the high incidence of syphilis among Baltimore inner-city dwellers between 1994 and 1998. Data for the study included syphilis reports from private physicians, the Baltimore City Health Department, STD clinics, the Center for Disease Control (CDC), and ethnographic interviews. Factors favoring the distribution and infectivity of the disease among the inner-city dwellers include greater poverty, high level of communication gaps between providers and a cross-section of minority inner-city dwellers, exchange of sex for crack cocaine, lower educational background, and inadequate and inappropriate health education/health promotion programs for the ethnic minorities.The paper calls for, among other things, culturally-sensitive and competent syphilis elimination/prevention health education and health promotion programs for the ethnic minority inner-city dwellers of Baltimore.     

Cachexia in patients with rheumatoid arthritis: a cohort study

Clinical Rheumatology - Rheumatoid arthritis (RA) is an inflammatory disease that leads to altered body composition. The loss of lean mass with a preservation or increase in fat mass has been...