Children with cochlear implants who live in monolingual and bilingual homes.

OBJECTIVE: To determine if exposure to a second language impacts the ability of children with cochlear implants to develop spoken English skills. STUDY DESIGN: Matched-pairs comparison of postoperative speech perception and speech/language data of children from monolingual and bilingual homes with cochlear implants. SETTING: Tertiary medical facility. SUBJECTS: Twelve matched pairs of children with unilateral cochlear implants who reside in monolingual or in bilingual homes. Pairs were matched for age of implantation, cochlear anatomy, educational setting, and device type. All subjects received their implant before the age of 6 years. INTERVENTION: Subjects participated in routine speech perception and speech and language assessments at various postimplantation time intervals. MAIN OUTCOME MEASURES: Matched-pairs t tests and mixed-model analyses were used to evaluate and compare scores obtained by the 2 groups on the Peabody Picture Vocabulary Test, The MacArthur-Bates Communicative Development Inventory: Words and Gestures, The Oral and Written Language Scales, The Infant-Toddler Meaningful Auditory Integration Scale, and the Student Oral Language Observation Matrix. RESULTS: No significant differences were found between the scores of children living in bilingual homes when compared with the scores obtained by children living in monolingual homes at any interval tested. CONCLUSION: This study supports the belief that exposure to a second language at home does not impair primary language acquisition for some young children with cochlear implants. The study suggests that some children with cochlear implants can learn multiple spoken languages and that parents of such children do not need to avoid using a minority language with their child who has a cochlear implant.     

Cost-Utility Analysis of Rimonabant in the Treatment of Obesity

Objective:  To estimate the incremental cost-utility ratio (ICUR) of rimonabant 20 mg/day in the treatment of obesity from a third-party payer's perspective.
Methods:  Pooled data from three randomized clinical trials were used to develop a decision tree with five treatment alternatives: 1- and 2-year treatment with rimonabant, 2-year placebo, 1-year rimonabant followed by 1-year placebo, and no treatment. All alternatives, except no treatment, were accompanied by lifestyle interventions. Treatment benefits included gains in quality-adjusted life-years (QALYs) and reduced incidence of type-2 diabetes mellitus and coronary heart disease (CHD). Drug acquisition cost was based on the average wholesale price of a comparator drug minus 15%. One-way and probabilistic sensitivity analyses were conducted to assess the stability of the base-case results.
Results:  One-year rimonabant and 1-year rimonabant followed by placebo were extendedly dominated. Rimonabant for 2 years showed an average weight reduction of 8.49 kg, a body mass index reduction of 2.98 kg/m² and reduced waist circumference by 8.24 cm (placebo: 3.55 kg, 1.22 kg/m², 4.18 cm). Two-year rimonabant was associated with a relative reduction in the 5-year incidence of CHD by 7.15% and of diabetes by 9.28%. Incremental benefits (costs) were 0.0984 QALYs ($5209) compared to no treatment and 0.0581 QALYs ($4182) compared to placebo, producing ICURs of $52,936/QALY (95% confidence interval $39K–$69K) and $71,973/QALY ($51K–$98K), respectively.
Conclusions:  Rimonabant combined with lifestyle interventions has the potential to decrease the rate of obesity-related comorbidities and improve health-related quality of life, albeit at considerable cost.     

Factors influencing the participation of gastroenterologists and hepatologists in clinical research

Background  

Although clinical research is integral to the advancement of medical knowledge, physicians face a variety of obstacles to their participation as investigators in clinical trials. We examined factors that influence the participation of gastroenterologists and hepatologists in clinical research.     

Role of socioeconomic indicators in the prediction of all causes and coronary heart disease mortality in over 12,000 men – The Italian RIFLE pooling project

The relationship of socioeconomic indicators (education, occupation and residence) to short-term all cause mortality and coronary heart disease (CHD) mortality was evaluated in an Italian population sample. Socioeconomic indicators (education, occupational level and residence) and major CHD risk factors were measured in 12,361 males aged 40–69 years; mortality data by cause were collected for the next 6 years. All cause and CHD mortality risk ratio (RR) in the different educational and occupational levels and residence were computed by Cox proportional hazards models. After 6 years 385 men died, of whom 105 were coronary fatalities. No association with educational level was found for all cause mortality (RR: 1.00 high, 0.71 medium, 0.77 low) and for CHD mortality (RR: 1.00 high, 0.39 intermediate, 0.71 low). Occupational level was significantly associated (p < 0.031) with all cause mortality (RR: 1.00 high-intermediate, 1.27 low). Urban vs. rural residence (RR: 1.00) showed a RR for all cause mortality of 1.33 (p < 0.011). Adjustment for bio-behavioral risk factors did not change the above results; only mortality for CHD of urban vs. rural residents increased (RR: 1.94, p = 0.004). In conclusion the negative association of mortality with occupational level, albeit not with education, indicates that occupation is a better indicator of socioeconomic status in Italy. Status incongruity as well as residence in an urban environment could be risk conditions for total and CHD mortality.     

Frequency of RAS and p53 Mutations in Acute Promyelocytic Leukemias

The frequency of RAS and p53 mutations was investigated in 30 acute promyelocytic leukemias by single strand conformation polymorphism analysis and direct sequencing of ge-nomic DNA. Only two cases bore N-RAS codon 12 mutations and none had p53 mutations responsible for aminoacid substitutions. It would, therefore, seem that neither RAS nor p53 are involved in acute promyelocytic leukemogenesis.     

The growth-restricted fetus: risk of mortality by each additional week of expectant management

Objective: To compare fetal/infant mortality risk associated with each additional week of expectant management with the infant mortality risk of immediate delivery in growth-restricted pregnancies.

Methods: A retrospective cohort study was conducted of singleton, nonanomalous pregnancies from the 2005–2008 California Birth Registry comparing pregnancies affected and unaffected by growth restriction, defined using birth weights as a proxy for fetal growth restriction (FGR). Birth weights were subdivided as greater than the 90th percentile, between the 10th percentile and 90th percentile, and less than the 10th percentile. Cases greater than the 90th percentile were excluded from analysis. Cases less than the 10th percentile were considered to have FGR and were further subcategorized into <10th percentile, <5th percentile, and <3rd percentile. We compared the risk of infant death at each gestational age week against a composite risk representing the mortality risk of one additional week of expectant management.

Results: We identified 1,641,000 births, of which 110,748 (6.7%) were less than 10th percentile. The risk of stillbirth increased with gestational age with the risk of stillbirth at each week of gestation inversely proportional to growth percentile. The risks of fetal and infant mortality with expectant management outweighed the risk of infant death for all FGR categories analyzed beginning at 38 weeks. However, the absolute risks differed by growth percentiles, with the highest risks of infant death and stillbirth in the <3rd percentile cohort. At 39 weeks, absolute risks were low, although the number needed to deliver to prevent 1 death ranged from 413 for <3rd percentile to 2667 in unaffected pregnancies.

Conclusion: At 38 weeks, the mortality risk of expectant management for one additional week exceeds the risk of delivery across all growth-restricted cohorts, despite variation in absolute risk by degree of growth restriction.     

Translation and validation of the Transition Readiness Assessment Questionnaire (TRAQ)

Objective

To translate and validate the Brazilian Portuguese version of the Transition Readiness Assessment Questionnaire in a population of adolescents and young adults with chronic rheumatologic disorders. This questionnaire evaluates the patient's readiness for making the transition from the pediatric health service to adult care.

Apocrine Carcinoma, Adenopathies, and Raised TAG-72 Serum Tumor Marker

Background. The detection of tumor-associated glycoprotein-72 in the serum of patients with carcinomas, basically of the colon, has proved to be of great use in the follow-up of these gastrointestinal adenocarcinomas.
Results. We report the case of a male patient presenting adenopathies in the right axilla. The histologic study of an adjacent skin tumor enabled the diagnosis of a cutaneous apocrine carcinoma. Among the studies made, the increase in the serum antibody CA72.4 can be highlighted. The tumor marker was negative after the extirpation of the skin tumor and the axillary adenopathies.
Conclusion. To our best knowledge, this is the first case in which a tumor serum marker is associated with a cutaneous apocrine carcinoma, a fact that should be confirmed with further patients. Its use in the monitoring of this infrequent skin neoplasia is also noteworthy.     

Synergistic Antinociceptive Effects of Ketamine and Morphine in the Orofacial Capsaicin Test in the Rat

Background: The clinical efficacy of the noncompetitive N-methyl-d-aspartate receptor antagonist ketamine for treating orofacial pain has already been reported. Side effects related to psychotomimetic disturbances, however, limit ketamine use as an analgesic. Theoretically, this limitation could be minimized by using low doses of ketamine in combination with other analgesics. In the present study, the potential synergistic antinociceptive interaction between ketamine and morphine in the orofacial capsaicin test in rats was investigated.

Methods: Male Sprague-Dawley rats were subcutaneously injected with solvent, ketamine, morphine, or combination of both drugs. Thirty minutes later, the orofacial capsaicin test was performed by injecting of 1.5 [mu]g/25 [mu]l of a capsaicin solution into the vibrissa pad. Animal behavior was recorded on videotape and analyzed off-line. The total time spent on rubbing-scratching nociceptive behavior during a period of 42 min was measured.

Results: Subcutaneously administered ketamine (0.4, 1.25, 4, 12.5 mg/kg), morphine (0.5, 1, 2, 4 mg/kg) and ketamine + morphine (0.20 + 0.12, 0.40 + 0.24, 0.80 + 0.49, 1.61 + 0.97, 3.21 + 1.94 mg/kg) reduced the rat facial rubbing-scratching behavior in a dose-dependent manner. Isobolographic analysis showed that the ketamine + morphine association inhibited the studied behavior in a superadditive manner.