Temperature Rhythm in Aneurysmal Subarachnoid Hemorrhage

Introduction  In the acute phase following brain injury, alterations in temperature regulation occur commonly and are associated with poorer outcome. However, few studies have examined temperature rhythm following brain insult, such as rupture and surgical management of ruptured cerebral aneurysms, and its association with clinical factors and outcome. Methods  This study describes diurnal temperature patterns in patients hospitalized for acute management of cerebral aneurysms (n = 86). Temperature mesor, amplitude, and acrophase were estimated from recorded temperature measurements using cosinor analysis. The association of these patterns with clinical condition, mortality, and 6-month functional outcome was examined. Results  Changes in the temperature cosinor parameters were varied and individual. Most patients experienced elevated mesors (Mean ± SD, 37.8 ± 0.4°C) and blunted amplitudes (0.27 ± 0.14°C). Acrophases were widely dispersed, with only 27% in the normative 12 noon to 6 PM quadrant. Cosinor parameters (particularly the mesor) showed greater alteration in patients with worse initial condition (e.g. Hunt and Hess score ≥ 2: P = 0.001, Glasgow Coma Scale < 15: P = 0.001) and poorer 6-month outcome (e.g. mortality: P = 0.013, Extended Glasgow Outcome Scale < 5: P = 0.018). Conclusion  Abnormal cosinor parameters provided additional predictive information in relation to outcome, beyond the impact of initial neurologic condition. Further research is needed to understand the pathophysiology of temperature regulation following cerebral aneurysm rupture and to determine if temperature management strategies can alter outcome.     

The effect on comorbidity and pain in patients with osteoarthritis

Comorbidities can affect how patients experience pain associated with chronic disease. Despite numerous studies on the association of pain with chronic conditions, few account for the multiple comorbidities associated with the highly prevalent chronic disease osteoarthritis (OA). OA generally is not lethal but it greatly impacts health care utilization and costs mainly primarily due to pain and disability. This paper describes how comorbidities impact OA pain reporting. We identified the common comorbidities associated with OA and examined the comorbidity measures utilized to identify the comorbidities. Using the identified comorbidities, we related how they may contribute to the pain experience for OA patients. We describe how OA treatment and multiple comorbidities may impact on treatment decisions.     

A new surgical technique for keratoglobus-tectonic lamellar keratoplasty followed by secondary penetrating keratoplasty.

PURPOSE: To develop a technique that achieves satisfactory visual rehabilitation in keratoglobus, without the problems of re-epithelialization failure and with minimal risk of graft rejection. METHODS: A patient with bilateral keratoglobus and visual acuities of light perception in the right eye and 6/60 in the left underwent a tectonic lamellar keratoplasty to the right eye. The cornea was first trephined to the depth of the anterior stroma within the limbus. A lamellar dissection technique then was used to tunnel into sclera under the limbus to preserve stem cells. The host corneal epithelium was completely débrided, and a donor corneoscleral button, denuded of its endothelium, was laid on top. A paracentesis was made, and aqueous was aspirated until the anterior chamber had collapsed enough to take up a more physiologic shape. The donor corneoscleral graft was sutured into the prefashioned scleral bed with long, interrupted sutures. Once in situ, the donor graft was débrided of epithelium, and the host limbus was sutured on to it, covering its scleral component. Six months later, a penetrating keratoplasty was performed. The same procedure was performed on the left eye 2 years later. RESULTS: The right eye maintained a best-corrected visual acuity of 6/60 for 16 months after the penetrating graft until the graft decompensated, leaving a final acuity of counting fingers. The left eye maintained a best-corrected visual acuity of 6/18. CONCLUSION: Tectonic lamellar keratoplasty to preserve the host limbus, followed by secondary penetrating keratoplasty, is a realistic alternative to other procedures for the surgical management of keratoglobus.     

Refractive surgery for graft-induced astigmatism after penetrating keratoplasty for keratoconus.

Of a series of 201 corneal transplants for keratoconus over a 20-year period, 42 grafts (39 eyes of 38 patients) required further surgery because of intolerable astigmatism (range, -3 diopters [D] to -18 D; mean, 8.9 D). Relaxing incisions, compressive resuturing, and augmented relaxing incisions were the techniques used. All procedures resulted in a similar mean reduction in cylinder -3.6 to 5 D, but the outcome with augmented relaxing incisions was less predictable. Six grafts required two or more procedures for a satisfactory outcome. All patients had corrected visual acuity of 20/30 or better after surgery, and 75% had visual acuity of 20/20 or better. The cumulative time until 90% of the grafts had useful vision was 32 months after refractive surgery. Relaxing incisions offer the prospect of more rapid visual rehabilitation than compressive resuturing.     

Breed relationships facilitate fine-mapping studies: a 7.8-kb deletion cosegregates with Collie eye anomaly across multiple dog breeds

The features of modern dog breeds that increase the ease of mapping common diseases, such as reduced heterogeneity and extensive linkage disequilibrium, may also increase the difficulty associated with fine mapping and identifying causative mutations. One way to address this problem is by combining data from multiple breeds segregating the same trait after initial linkage has been determined. The multibreed approach increases the number of potentially informative recombination events and reduces the size of the critical haplotype by taking advantage of shortened linkage disequilibrium distances found across breeds. In order to identify breeds that likely share a trait inherited from the same ancestral source, we have used cluster analysis to divide 132 breeds of dog into five primary breed groups. We then use the multibreed approach to fine-map Collie eye anomaly (cea), a complex disorder of ocular development that was initially mapped to a 3.9-cM region on canine chromosome 37. Combined genotypes from affected individuals from four breeds of a single breed group significantly narrowed the candidate gene region to a 103-kb interval spanning only four genes. Sequence analysis revealed that all affected dogs share a homozygous deletion of 7.8 kb in the NHEJ1 gene. This intronic deletion spans a highly conserved binding domain to which several developmentally important proteins bind. This work both establishes that the primary cea mutation arose as a single disease allele in a common ancestor of herding breeds as well as highlights the value of comparative population analysis for refining regions of linkage.     

Profile of atrial fibrillation inpatients: Cardiovascular risk factors and cardiac rehabilitation programme delivery and referral patterns

Atrial fibrillation (AF) is increasingly common; however, the cardiovascular risk factor profile and the patterns of delivery and referral to cardiac rehabilitation (CR) in this population are poorly described. We conducted an audit of medical records (n = 145) of patients admitted with AF in one local health district in Sydney, Australia. Patients were aged a mean 72 years, and 51% were male. Lack of risk factor documentation was common. Despite this, 65% had two or more modifiable cardiovascular risk factors, including hypertension (63%) and hypercholesterolaemia (52%). Referral to Phase II CR occurred for 25% and was decreased with permanent AF diagnosis and increased with more risk factors. AF patients admitted to hospital have multiple cardiovascular risk factors but limited risk factor screening and/or referral to outpatient CR programmes.     

Comparative expressed-sequence-tag analysis of differential gene expression profiles in PC-12 cells before and after nerve growth factor treatment.

Nerve growth factor-induced differentiation of adrenal chromaffin PC-12 cells to a neuronal phenotype involves alterations in gene expression and represents a model system to study neuronal differentiation. We have used the expressed-sequence-tag approach to identify approximately 600 differentially expressed mRNAs in untreated and nerve growth factor-treated PC-12 cells that encode proteins with diverse structural and biochemical functions. Many of these mRNAs encode proteins belonging to cellular pathways not previously known to be regulated by nerve growth factor. Comparative expressed-sequence-tag analysis provides a basis for surveying global changes in gene-expression patterns in response to biological signals at an unprecedented scale, is a powerful tool for identifying potential interactions between different cellular pathways, and allows the gene-expression profiles of individual genes belonging to a particular pathway to be followed.