Attitude and Knowledge of Physicians and Nurses About Ionizing Radiation

The purpose of this study was to describe physicians' and nurses' knowledge and attitude about the potential dangers of imaging tests. The study comprised 144 participants; 68 physicians, and 76 nurses. Over 70% of the physicians reported that to complete their diagnosis, they always sent patients for ionized testing. Most of the physicians and nurses indicated that they knew that these tests could cause cancer and genetic changes. Over 80% of the medical staff did not know the amount of environmental radiation that was equal to an x-ray test or computed tomography scan. Thirty percent of the respondents noted that they did not protect the patient's sensitive organs during radiation procedures. As for the physicians and nurses in the invasive unit, they did not follow precise instructions for self-protection from exposure to radiation while working. There is a necessity to follow up on quantity of exposure to x-ray and computed tomography scan radiation for all patients and to promote physicians' and nurses' knowledge about protection from exposure to radiation.     

Modified High-Dose Melphalan and Autologous Stem Cell Transplantation for Immunoglobulin Light Chain Amyloidosis

High-dose melphalan and autologous stem cell transplantation (HDM/SCT) have been used in patients with immunoglobulin light chain (AL) amyloidosis for over 2 decades now with durable responses, prolonged survival, and decreasing treatment-related mortality. Historically, patients with poorer baseline functional status, advanced age, renal compromise, and cardiac involvement have been treated with a risk-adapted modified conditioning dose of melphalan (mHDM) of 100 to 140 mg/m² before SCT. In part because of these baseline characteristics, patients receiving mHDM/SCT have had poorer outcomes compared with patients receiving full-dose melphalan at 200 mg/m². With the advent of novel therapeutic agents such as proteasome inhibitors, immunomodulatory agents, and monoclonal antibodies for the treatment of AL amyloidosis, it is imperative to understand the long-term effects of mHDM/SCT. Here we report the long-term outcomes of 334 patients with AL amyloidosis treated with mHDM/SCT. Median overall survival was 6.1 years and median event-free survival 4.3 years, with median overall survival reaching 13.4 years for patients who had achieved a hematologic complete response (CR). Overall hematologic response rate was 69%, and treatment-related mortality was 3% after 2010. Thus, mHDM/SCT leads to prolonged survival and favorable outcomes, especially if a hematologic CR is achieved.     

Quantitative evaluation of prostatectomy for benign prostatic hypertrophy under a national health insurance law: a multi-centre study

Assessing regional variation between various medical centres in diagnostic and surgical processes is an approach aimed at evaluating the quality of care. This study analyses the differences between eight medical centres in Israel, where all citizens are covered by medical insurance, through the National Health Insurance Law (NHIL). The analysis refers to the diagnostic process, type of surgery and immediate post-surgical complications associated with prostatectomy for benign prostatic hypertrophy (BPH), which is the most frequent surgical procedure performed on men aged 50+. The study sample was comprised of 261 consecutive prostatectomy patients operated on in eight Israeli medical centres (MC), located in various parts of the country, between November 1996 and April 1997. Co-operation with participating directors of surgical wards was obtained after confidentiality of information had been assured. Surgeons in selected departments abstracted data routinely recorded in the patient's file and filled-out a standard one-page questionnaire. The following items were included: age, the presence of accompanying chronic diseases, preoperative tests, type of operation, and post-surgical complications. In the various MCs 32.6% of the patients underwent more than five preoperative tests ranging from 8.9% to 88.9% (<0.01). Assessment of kidney and bladder normality ranged from 75% to 100% (P < 0.01). The rate of patients whose prostatic symptoms (I-PSS) were assessed ranged from 0% to 79% (P < 0.01). There were also differences in severity of prostatism between the MCs, with severe symptoms ranging from 54.0% to 89.3% (P < 0.05), for type of operation performed (for 'open' prostatectomies, 35.4% to 68.0%, P < 0.01) and post-operative complications (19.0% to 41.6%, P = 0.07). After controlling for case-mix, type of operation was the most important predictor for post-surgical complications. MCs with low volume of surgeries had a higher rate of postoperative complications. We conclude that diagnostic and type of operation and post-surgical complications differed between various MCs. Participating surgeons were willing to fill out a one-page standard questionnaire from data routinely recorded in patients' files.     

Neuropsychological predictors of conversion from mild cognitive impairment to Alzheimer’s disease: a feature selection ensemble combining stability and predictability

Background

Predicting progression from Mild Cognitive Impairment (MCI) to Alzheimer’s Disease (AD) is an utmost open issue in AD-related research. Neuropsychological assessment has proven to be useful in identifying MCI patients who are likely to convert to dementia. However, the large battery of neuropsychological tests (NPTs) performed in clinical practice and the limited number of training examples are challenge to machine learning when learning prognostic models. In this context, it is paramount to pursue approaches that effectively seek for reduced sets of relevant features. Subsets of NPTs from which prognostic models can be learnt should not only be good predictors, but also stable, promoting generalizable and explainable models.

Methods

We propose a feature selection (FS) ensemble combining stability and predictability to choose the most relevant NPTs for prognostic prediction in AD. First, we combine the outcome of multiple (filter and embedded) FS methods. Then, we use a wrapper-based approach optimizing both stability and predictability to compute the number of selected features. We use two large prospective studies (ADNI and the Portuguese Cognitive Complaints Cohort, CCC) to evaluate the approach and assess the predictive value of a large number of NPTs.

Results

The best subsets of features include approximately 30 and 20 (from the original 79 and 40) features, for ADNI and CCC data, respectively, yielding stability above 0.89 and 0.95, and AUC above 0.87 and 0.82. Most NPTs learnt using the proposed feature selection ensemble have been identified in the literature as strong predictors of conversion from MCI to AD.

Conclusions

The FS ensemble approach was able to 1) identify subsets of stable and relevant predictors from a consensus of multiple FS methods using baseline NPTs and 2) learn reliable prognostic models of conversion from MCI to AD using these subsets of features. The machine learning models learnt from these features outperformed the models trained without FS and achieved competitive results when compared to commonly used FS algorithms. Furthermore, the selected features are derived from a consensus of methods thus being more robust, while releasing users from choosing the most appropriate FS method to be used in their classification task.

     

How good is the evidence that light at night can affect human health?

Graefe's Archive for Clinical and Experimental Ophthalmology -     

妊娠期肝内胆汁淤积症患者瘙痒情况与围生儿结局

目的探讨妊娠期肝内胆汁淤积症（ICP）患者瘙瘁情况与围生儿结局的关系。方法对84例有完整病史及分娩记录的ICP患者的临床资料进行回顾性分析。结果瘙痒症状发生早、分娩前瘙痒症状持续时间长者中胆汁酸、胆红素同时升高的比例增加，胆汁酸、胆红素值升高；羊水胎粪污染发生率、早产率、新生儿窒息发生率增加，差异有显著性（P〈0．05）。结论ICP患者瘙痒情况与胆汁酸、胆红素的改变及围生儿结局有一定的关系，医、患均需高度重视，早发现、早诊断、早治疗，适时终止妊娠，改善围生儿预后。     

Mothers and Fathers of Children with Cerebral Palsy: Differences in Future Expectations

Parents’ expectations are known to be a central component in children’s development through multiple pathways; however, limited information exists regarding expectations of parents of children with developmental disabilities. The purpose of the current study was to examine future expectations of parents of children with cerebral palsy (CP), as well as the differences in expectations between mothers and fathers. Forty-nine mothers and fathers of children with CP (6–12 years) participated in this study. Parents completed a Parental Future Expectations Questionnaire for Children with Disabilities, and a Perception of Child’s Ability questionnaire, as well as the Pediatric Evaluation Disability Inventory (PEDI). The Gross Motor Function Measure-66 (GMFM-66) was completed by physical therapists. Parental differences in future expectations were analyzed and multiple-stepwise regressions established parental expectations’ predictors. Parents’ expectations correlated with their child’s characteristics. Parents of children with lower levels of functioning reported lower expectations. No differences were found between mothers’ and fathers’ future expectations; however, differences were found between expectations’ predictors. Predictors of mothers’ expectations were their perceptions of their child’s abilities as well as child’s performance. Fathers’ predictors were child’s level of functional impairment and their perceptions of their child’s abilities. The results indicate that parental expectations relate to their child’s functional ability and differ between parents in relation to the child’s level of impairment (fathers) or child’s actual performance (mothers). These differences should be acknowledged by clinicians when they provide specific support for children with chronic physical disabilities and their families.     

Transmission of a dsRNA in bell pepper and evidence that it consists of the genome of an endornavirus

A double-stranded (ds) RNA from bell pepper (BP-dsRNA) cv Yolo Wonder was inherited maternally and paternally after crossing Yolo Wonder with Jalapeño M or Hungarian Wax pepper. Partial sequence information was obtained from two cDNA clones derived from the BP-dsRNA and based on sequence similarity was related to members of the genus Endornavirus. Clones of the BP-dsRNA hybridized with similar dsRNAs from four other pepper cultivars, suggesting that all five dsRNAs tested are related. One of the cDNA clones contained a region that had significant similarity with UDP-glucose:glycosyltransferases from fungi, bacteria, plants, and three endornaviruses. Data presented indicate that the BP-dsRNA is the genome of a distinct species of the genus Endornavirus.     

TCF7L2 is reproducibly associated with type 2 diabetes in various ethnic groups: a global meta-analysis

TCF7L2 variants have been consistently associated with type 2 diabetes (T2D) in populations of different ethnic descent. Among them, the rs7903146 T allele is probably the best proxy to evaluate the effect of this gene on T2D risk in additional ethnic groups. In the present study, we investigated the association between the TCF7L2 rs7903146 polymorphism and T2D in Moroccans (406 normoglycemic individuals and 504 T2D subjects) and in white Austrians (1,075 normoglycemic individuals and 486 T2D subjects). Then, we systematically reviewed the association of this single nucleotide polymorphism (SNP) with T2D risk in a meta-analysis, combining our data with data from previous studies. The allelic odds ratios (ORs) for T2D were 1.56 [1.29-1.89] (p = 2.9 x 10(-6)) and 1.52 [1.29-1.78] (p = 3.0 x 10(-7)) in Moroccans and Austrians, respectively. No heterogeneity was found between these two different populations by Woolf test (chi (2) = 0.04, df = 1, p = 0.84). We found 28 original published association studies dealing with the TCF7L2 rs7903146 polymorphism in T2D. A meta-analysis was then performed on 29,195 control subjects and 17,202 cases. No heterogeneity in genotypic distribution was found (Woolf test: chi (2) = 31.5, df = 26, p = 0.21; Higgins statistic: I2 = 14.1%). A Mantel-Haenszel procedure was then performed to provide a pooled odds ratio (OR) of 1.46 [1.42-1.51] (p = 5.4 x 10(-140)). No publication bias was detected, using the conservative Egger's regression asymmetry test (t = -1.6, df = 25, p = 0.11). Compared to any other gene variants previously confirmed by meta-analysis, TCF7L2 can be distinguished by its tremendous reproducibility of association with T2D and its OR twice as high. In the near future, large-scale genome-wide association studies will fully extend the genome coverage, potentially delivering other common diabetes-susceptibility genes like TCF7L2.     

Improved enzyme-linked immunosorbent assay to reveal Mycoplasma agassizii exposure: a valuable tool in the management of environmentally sensitive tortoise populations

The precarious status of desert (Gopherus agassizii) and gopher (Gopherus polyphemus) tortoises has resulted in research and conservation efforts that include health assessments as a substantial component of management decision-making. Therefore, it is critical that available diagnostic tests for diseases impacting these species undergo rigorous standardization and validation. Since 1992, analysis of exposure of tortoises to Mycoplasma agassizii, an etiological agent of upper respiratory tract disease, has relied on the detection of specific M. agassizii antibody by enzyme-linked immunosorbent assay (ELISA). We report here substantive refinements in the diagnostic assay and discuss the implications of its use in wildlife conservation and management. The ELISA has been refined to include more stringent quality control measures and has been converted to a clinically more meaningful titer reporting system, consistent with other diagnostic serologic tests. The ELISA results for 5,954 desert and gopher tortoises were plotted, and a subset of these serum samples (n = 90) was used to determine end-point titers, to establish an optimum serum dilution for analyzing samples, and to construct a standard curve. The relationship between titer and A405 was validated using 77 serum samples from known positive (n = 48) and negative (n = 29) control tortoises from prior transmission studies. The Youden index, J, and the optimal cut point, c, were estimated using ELISA results from the 77 control sera. Based on this evaluation, the refinement has substantially improved the performance of the assay (sensitivity of 0.98, specificity of 0.99, and J of 0.98), thus providing a clinically more reliable diagnostic test for this important infection of tortoises.