Three-dimensional gadolinium-enhanced MR angiography of vascular complications after liver transplantation

OBJECTIVE: The goal of this study was to evaluate three-dimensional gadolinium-enhanced MR angiography as a tool for examination of liver transplant patients with potential vascular complications. MATERIALS AND METHODS: Thirty-eight consecutive three-dimensional gadolinium-enhanced MR angiograms were obtained in 34 patients. Results were retrospectively reviewed and correlated with conventional angiography in 20 of the 38 cases and sonography in 37 of the 38 cases. MR angiograms were evaluated for technical adequacy, vascular patency, and parenchymal abnormalities, and results were compared with angiography and sonography. Conventional angiography and surgery were used as gold standards when available. RESULTS: Thirty-four (90%) of 38 MR angiograms were technically adequate. Vascular abnormalities were identified in 20 patients, and 19 of these patients subsequently underwent angiography, surgery, or both. There were seven cases of hepatic artery thrombosis; all were detected with MR angiography with no false-positive or false-negative interpretations. Seven patients had moderate to severe hepatic artery stenosis (>50% narrowing as determined by conventional angiography). MR angiography revealed this stenosis in six of the seven patients, with one false-negative and three false-positive interpretations. Portal vein thrombosis was detected in three patients, and portal vein stenosis was detected in two patients. CONCLUSION: Three-dimensional gadolinium-enhanced MR angiography is useful in the examination of liver transplant patients and offers a noninvasive adjunct in patients with difficult or indeterminate sonographic examinations.     

Methodology in meta–analysis: a study from Critical Care meta–analytic practice

Methodological aspects of meta-analytic practice, heterogeneity, publication bias, metaregression and effect metric, were investigated in 14 meta-analyses reflecting major therapeutic concern in Critical Care practice. Compared with the standard Q test, the exact Zelen test was more sensitive in identifying heterogeneity. Assessment of heterogeneity impact by the I ² statistic was consistent with inferences afforded by both the Q and Zelen test. Publication bias was subject to test and metric determination: funnel plots exhibited variable asymmetry across studies and between metrics; the regression asymmetry test appeared more sensitive than the rank correlation test; the “trim and fill” method was the most sensitive, but suggested, on the basis of quantification of the effects of potentially missing studies, that meta-analyses may be resistant to such missingness. Metaregression of treatment effect against control risk using Bayesian hierarchical regression in all metrics (log odds ratio, log risk ratio and RD) suggested that naïve linear regression approaches over-diagnosed significant relationships and exhibited regression dilution. Heterogeneity, publication bias and risk related treatment effects all demonstrate estimator and metric dependence; the RD metric would appear the most capricious in this regard.     

Releasing information to families of persons with severe mental illness: a survey of NAMI members

OBJECTIVE: Guidelines for the treatment of severe mental illness recommend that providers share information with families and involve them in treatment. However, research indicates that consumer-provider-family collaboration is not part of routine clinical practice. This study examined the process of releasing information to families and the types of information they receive. METHODS: Self-administered surveys were completed by 219 family and consumer members of the National Alliance for the Mentally Ill. The surveys gathered information about their experiences with providers' releasing information. Consumers' attitudes toward collaboration and family members' satisfaction with providers were also measured. Regression analyses examined the relationship between consumers' attitudes toward family involvement and whether providers discussed family involvement or the release of information with consumers. Further analyses examined the relationship between family satisfaction and release of information. RESULTS: The majority of family respondents (72 percent) reported that they received some specific information about their relative's mental illness. Most families received information about diagnosis and medications, but few received information about the treatment plan. Few consumers reported that their permission was requested to release information to their families. Consumers' attitudes toward their family and toward family involvement were significantly associated with whether they were encouraged by their provider to involve a family member in their treatment. No significant relationship was found between consumers' attitudes and whether their provider discussed the release of information. Family members' satisfaction was positively related to whether they received information from providers. CONCLUSIONS: The findings suggest that although some information is shared with families, collaboration is not currently part of routine clinical practice.     

Identification of serious drug-drug interactions: results of the partnership to prevent drug-drug interactions.

OBJECTIVE: To develop a list of clinically important drug-drug interactions (DDIs) likely to be encountered in community and ambulatory pharmacy settings and detected by a computerized pharmacy system. DESIGN: Cross-sectional, one-time evaluation. SETTING: United States in fall 2001. PARTICIPANTS: An expert panel comprising two physicians, two clinical pharmacists, and an expert on DDIs. INTERVENTIONS: Systematic review of drug interaction compendia and published literature, ratings (on a 1 to 10 scale) of various clinical aspects of DDIs (e.g., clinical importance, quality and quantity of evidence, causal relationship, risk of morbidity and mortality), and a modified Delphi consensus-building process. MAIN OUTCOME MEASURE: Panelists' opinions about clinical importance of DDIs. RESULTS: The expert panel considered 56 DDIs. Of these, 28 had a mean clinical importance score of 8.0 or more. The ratings for clinical importance ranged from 3.2 to 9.6, with a mean +/- SD of 7.5 +/- 1.5 across the combinations examined. The mean score for the quality of literature suggesting the interaction exists ranged from 1.0 to 9.6, with a mean +/- SD of 5.8 +/- 2.5. In terms of substantiation of the interactions evaluated, the mean +/- SD rating was 6.3 +/- 2.2, with a range from 1.4 to 9.2. Through the modified Delphi process, the panel determined that 25 interactions were clinically important. CONCLUSION: Using an expert panel and a standard evaluation tool, 25 clinically important drug interactions that are likely to occur in the community and ambulatory pharmacy settings were identified. Pharmacists should take steps to prevent patients from receiving these interacting medications, and computer software vendors should focus interaction alerts on these and similarly important DDIs.     

Probable mechanisms involved in the antipsychotic-like activity of methyl jasmonate in mice

Naunyn-Schmiedeberg's Archives of Pharmacology - Psychosis is a chronic neuropsychiatric disorder that affects millions of individuals worldwide and impairs the quality of life and productivity...     

Validation of a clinical decision rule: chest X-ray in patients with chest pain and possible acute coronary syndrome

Current literature suggests that a large proportion of chest X-rays (CXRs) performed in emergency department (ED) patients with chest pain and suspected acute coronary syndrome (ACS) are unnecessary. The Canadian ACS Guidelines aim to guide clinicians in the appropriate use of CXR within this patient population. This study determined the prevalence of clinically significant CXR abnormalities and assessed the utility of the guidelines in a population of ED patients with chest pain and suspected ACS. Included in the study were participants over the age of 18 who presented to an Australian metropolitan ED, over a 1-year period, with a primary complaint of chest pain and who had a CXR and troponin level ordered in the ED (N?=?760). We retrospectively compared their radiographic findings with their recommendations for CXR according to the ACS Guidelines. We found that 12 % of the participants had a clinically significant chest X-ray. The guidelines had a sensitivity of 80 % (95 % CI 0.70–0.87) and specificity of 50 % (95 % CI 0.47–0.54). The positive predictive value was 18 % (95 % CI 0.15–0.22) with a 95 % negative predictive value (95 % CI 0.92–0.97). Had the ACS guidelines been applied to our patient population, the number of CXR performed would have been reduced by 47 %. This study suggests that the ACS Guidelines has the potential to reduce the numbers of unnecessary CXR performed in ED patients. However, this would come at the expense of missing a minority of significant CXR abnormalities.     

Assessment of Mycoplasma gallisepticum vaccine efficacy in a co-infection challenge model with QX-like infectious bronchitis virus

Mycoplasma gallisepticum (MG) is the primary cause of chronic respiratory disease in poultry. We investigated the protective efficacy of the live-attenuated ts-11 and 6/85 MG vaccines against a local MG strain and, in order to enhance signs and mimic a typical field situation, we co-infected birds with a virulent strain of QX-like infectious bronchitis virus (IBV). Both vaccines showed similar ability to protect infected chickens from clinical signs, although ts-11 performed slightly better. Despite the lower protection against clinical disease, 6/85-vaccinated birds had significantly (P?≤?0.05) lower tracheal lesion scores and mucosal thickness at day 28 post-vaccination (7 days post-challenge [dpc] with MG, 2 dpc IBV) and day 31 post-vaccination (10 dpc MG challenge, 5 dpc IBV) compared to ts-11 vaccinated birds, but these difference was not significant at day 33 (12 dpc MG, 7 dpc IBV). Pathogen infection and replication was assessed by qPCR, and the 6/85 vaccine produced a more significant (P?≤?0.05) reduction in MG replication in the lungs, kidneys and livers but enhanced late replication in bursae and caecal tonsils. In contrast, the ts-11 vaccine had a more pronounced reductive effect on replication in tracheas, air sacs, bursae and heart at days 28 and 31, yet increased replication in lungs. Interestingly, both vaccines provided non-specific protection against IBV challenge. The co-challenge model provided useful data on vaccine efficacy, especially on days 31 and 33, and tracheas, lungs, air sacs, kidneys, liver and caecal tonsils were the best organs to assess.