Extent of agreement between patient and physician ratings of emotional distress

The extent of agreement between subjects’ self-ratings on the Hopkins Symptom Checklist (HSCL) and physicians’ ratings on three other scales for emotional distress was examined in two nonpsychiatric groups–women attending a family-planning service and persons participating in a community health survey. Agreement between patient and physician assessments of depression and anxiety was high, and the HSCL proved to be accurate in identifying symptomatic patients. The findings support the value of the HSCL as a screening instrument for the detection of anxiety and depression in nonpsychiatric medical patients.     

Abnormal visual-evoked responses and opsoclonus

A 73-year-old woman presented with classic opsoclonus two weeks following an acute febrile illness. Four weeks later a complete clinical recovery was evident. Six weeks after onset of the problem, or 2 weeks after resolution of the abnormal eye movements, a pattern reversal visual evoked response showed a delayed response in both eyes and had an unusually high amplitude. For the next 2 months the patient complained of occasional blurring of vision. A repeat visual evoked response test after 4 months revealed normal latency and amplitude in both eyes. The possible mechanisms for the visual evoked response abnormality are discussed.     

Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer: initial report

PURPOSE: To compare quality of life (QOL) and xerostomia between head-and-neck cancer patients who received standard radiotherapy (RT) and patients matched by factors known to affect QOL who received intensity-modulated RT (IMRT). METHODS AND MATERIALS: This was a prospective, longitudinal study of patients with head-and-neck cancer requiring bilateral neck irradiation who received IMRT at the University of Michigan and patients who received standard RT at affiliated clinics. Each patient received a validated head-and-neck cancer-related QOL questionnaire (HNQOL) consisting of four multi-item domains--Eating, Communication, Pain, and Emotion--and a validated patient-reported xerostomia questionnaire (XQ). In both questionnaires, the answers were scored 0-100, with higher scores denoting worse QOL or xerostomia. The questionnaires were given before therapy and at 1, 3, 6, 12, 18, and 24 months after the completion of therapy. Each standard RT patient was matched with several IMRT patients according to tumor site, stage, RT status (postoperative or definitive), and age. A linear mixed-effects model was fit to compare outcomes between the two treatment groups and to model trends over time. To account for matching, the differences in scores between the matched sets of patients were fit as a random intercept. Also, matching was taken into account in the model by using the standard error of the within-paired-groups differences. RESULTS: Between 1997 and 2002, 10 patients who had received standard RT and answered the XQ and HNQOL through at least 1 year were included in the study. Each of these patients was matched with a subgroup of 2-5 patients (median, 3) who had received IMRT, had similar patient and tumor characteristics, and answered the same questionnaires. A total of 30 patients were included in the IMRT group. During the initial months after therapy, the XQ and HNQOL summary scores worsened significantly in both groups compared with the pretherapy scores. Starting at 6 months, improvements of both XQ and HNQOL scores were found over time in the IMRT patients (p = 0.01 and 0.04, respectively), compared with no trend of improvement in the standard RT patients (p = 0.5 and 0.9, respectively). The trend of improvement over time in QOL in the IMRT patients was noted in most of the HNQOL domains (Eating: p = 0.07, Pain: p = 0.05, Emotion: p = 0.04, and Communication: p = 0.13), compared with no trend of improvement in most of the domains in the standard RT patients. As the scores of the IMRT (but not the standard RT) patients improved over time, the differences between the groups in the mean XQ and HNQOL summary scores widened. At 12 months, median XQ and HNQOL scores were lower (better) in the IMRT compared with the standard RT patients by 19 and 20 points, respectively, adjusted for the pretherapy values (p = 0.2). In both groups, the pretherapy XQ and HNQOL summary scores were significantly related to the respective posttherapy scores (p = 0.02 and p < 0.01, respectively). CONCLUSIONS: After initial posttherapy declines in both groups, xerostomia and QOL improved over time after IMRT but not after standard RT. The potential benefits gained from IMRT in xerostomia or in QOL, compared with standard RT, are best reflected late (> or = 6 months) after therapy.     

An/micr-Ophthalmia, Cleft Lip/Palate, and Short Limbs: A New Syndrome Simulating a Short Rib Syndrome

We report on a male infant born at 38 weeks of gestation with hydrocephalus, right anophthalmia, left microphthalmia, cleft palate, midline cleft of lip, and microphallus. Autopsy showed pulmonary bronchial lymphangiectasia, hepatic periportal fibrosis, adrenal agenesis, ventricular septal defect, aortic stenosis, and undescended testes. The radiographic findings include short limbs and mild shortness of ribs. Karyotype with high-resolution banding was normal (46,XY). The combination of anomalies in this case could suggest a ciliopathy and may represent a new entity similar to that described by Cideciyan et al. [ 1 ].     

Adaptation of an indirect enzyme-linked immunosorbent assay for seroepidemiological studies of enzootic bovine leukosis

The aim of this study was to compare a domestic indirect enzyme-linked immunosorbent assay (DI-ELISA) and an in-house agar gel immunodiffusion (AGID) test with a commercial indirect ELISA (CI-ELISA) test for the detection of antibodies to bovine leukaemia virus (BLV). BLV proteins were harvested as described by OIE and used in both the DI-ELISA and AGID tests. Analysis of negative sera showed that consideration of a cutoff equivalent to three times the standard deviation value above the mean value of the negative control sera provided an acceptable specificity and reduced the risk of false positive results for the DI-ELISA test. From 460 serum samples, 425 (92%), 416 (90%) and 435 (94%) sera were found to be negative when using either the CI-ELISA, DI-ELISA or AGID test. Of the six serum samples which yielded suspicious results with the CI-ELISA, four were found to be positive by the DI-ELISA, but all of them were negative by the AGID test. DI-ELISA and AGID tests’ relative (to CI-ELISA) sensitivities were 97% and 86%, respectively. DI-ELISA and AGID tests’ relative (to CI-ELISA) specificities were 84% and 100%, respectively. Comparison of the results from a native breed, Sarabi, with Holstein showed that there is no significant (p?<?0.05) difference in the frequency of enzootic bovine leukosis between the two.     

Tubeless percutaneous nephrolithotomy: 5 years of experience in 201 patients

BACKGROUND AND PURPOSE: Our aim was to evaluate the safety, effectiveness, and feasibility of tubeless percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS: From June 2000 to September 2005, 201 patients with renal stones >2 cm underwent tubeless PCNL by a single surgeon. We report details of the outcomes. RESULTS: The complete stone clearance rate was 91.04% (183 patients). After surgery, 18 patients (8.96%) had stones (mean size = 7 mm) detected on a plain abdominal radiograph or ultrasonographic examination and were referred for shockwave lithotripsy. The mean stone size was 30 mm (range 20-40 mm). The mean operative time was 35 minutes (range 30-60 min), and the mean hospital stay was 3.5 days (range 2-5 days). Postoperative ultrasonography did not reveal considerable fluid collection. There were no visceral injuries. Twenty-two (10.9%) patients received a transfusion, and 16 (7.9%) patients had urinary tract infection. CONCLUSION: In our experience, tubeless PCNL is safe, effective, and feasible without any discomfort for patients.     

Infantile Blount's disease treated by hemiplateau elevation and epiphyseal distraction using a specific external fixator: preliminary report

The treatment of infantile Blount's disease remains controversial. The progressive development of epiphysiodesis of the medial tibial physis induced a complex deformity of the lower limb such as severe genu varum, joint incongruity, torsion instability and leg length discrepancy with major functional consequences. Nine knees on eight children (average age was 7 years and 2 months) were treated by a one-time procedure using a specific external fixator that combined elevation of the medial tibial plateau, axial correction in the valgus, complete sterilization of the upper tibial growth cartilage, leg lengthening anticipation and de-rotation if necessary. Magnetic resonance imaging was useful to describe the deformity and to prepare for surgery. Corrections were progressively obtained through the physis plan by means of short incisions and the use of a specific external fixator. The primary results at an average of 24 months were good with a low rate of complications but final evaluation will be conducted at the end of the children's growth period.     

Computational studies on effects of MDMA as an anticancer drug on DNA

This research is designed to further understand the effects of the novel drug MDMA on biologic receptor of DNA. The ultimate goal is to design drugs that have higher affinity with DNA. Understanding the physicochemical properties of the drug as well as the mechanism by which it interacts with DNA should ultimately enable the rational design of novel anticancer or antiviral drugs. Molecular modeling on the complex formed between MDMA and DNA presented this complex to be fully capable of participating in the formation of a stable intercalation site. Furthermore, the molecular geometries of MDMA and DNA bases (Adenine, Guanine, Cytosine, and Thymine) were optimized with the aid of the B3LYP/6-31G* method. The properties of the isolated intercalator and its stacking interactions with adenine···thymine (AT) and guanine···cytosine (GC) nucleic acid base pairs were studied with the DFTB method. DFTB method is an approximate version of the DFT method that was extended to cover the London dispersion energy. The B3LYP/6-31G* stabilization energies of the intercalator···base pair complexes were found to be −9.40 and −12.57 kcal/mol for AT···MDMA and GC···MDMA, respectively. Results from comparison of the DFTB method and HF method conclude close results and support each other.     

Secondary memory CD8+ T cells are more protective but slower to acquire a central-memory phenotype

The formation of memory CD8 T cells is an important goal of vaccination. However, although widespread use of booster immunizations in humans generates secondary and tertiary CD8 T cell memory, experimental data are limited to primary CD8 T cell memory. Here, we show that, compared with primary memory CD8 T cells, secondary memory CD8 T cells exhibit substantially delayed conversion to a central-memory phenotype, as determined by CD62L expression and interleukin (IL)-2 production. This delayed conversion to a central-memory phenotype correlates with reduced basal proliferation and responsiveness to IL-15, although in vitro coculture with a high concentration of IL-15 is capable of inducing proliferation and CD62L upregulation. Functionally, secondary memory CD8 T cells are more protective in vivo on a per cell basis, and this may be explained by sustained lytic ability. Additionally, secondary memory CD8 T cells are more permissive than primary memory CD8 T cells for new T cell priming in lymph nodes, possibly suggesting a mechanism of replacement for memory T cells. Thus, primary and secondary memory CD8 T cells are functionally distinct, and the number of encounters with antigen influences memory CD8 T cell function.