Brain integrity and cerebral atrophy in Vietnam combat veterans with and without posttraumatic stress disorder

Posttraumatic stress disorder (PTSD) is associated with decreased hippocampal volume, but the relationship between trauma and brain morphology in the absence of PTSD is less clear. In this study, measures of brain integrity were determined by estimating gray and white matter regional brain volumes using structural magnetic resonance imaging in six patients with PTSD and in five controls with comparable trauma exposure but without clinical evidence of PTSD. The only statistically significant volume difference between groups was observed multivariately in the white matter of the right temporal lobe (superior temporal gyrus, fusiform gyrus, parahippocampal gyrus, white-matter stem, middle temporal gyrus, and inferior temporal gyrus), although small sample sizes limit the power to detect between-group differences. Both groups showed heterogeneity in cerebral atrophy.     

Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects

OBJECTIVE: To compare delinquent behavior and early substance use between the children in the Multimodal Treatment Study of Children With ADHD (MTA; N = 487) and those in a local normative comparison group (n = 272) at 24 and 36 months postrandomization and to test whether these outcomes were predicted by the randomly assigned treatments and subsequent self-selected prescribed medications. METHOD: Most MTA children were 11 to 13 years old by 36 months. Delinquency seriousness was coded ordinally from multiple measures/reporters; child-reported substance use was binary. RESULTS: Relative to local normative comparison group, MTA children had significantly higher rates of delinquency (e.g., 27.1% vs. 7.4% at 36 months; p = .000) and substance use (e.g., 17.4% vs. 7.8% at 36 months; p = .001). Children randomized to intensive behavior therapy reported less 24-month substance use than other MTA children (p = .02). Random effects ordinal growth models revealed no other effects of initial treatment assignment on delinquency seriousness or substance use. By 24 and 36 months, more days of prescribed medication were associated with more serious delinquency but not substance use. CONCLUSIONS: Cause-and-effect relationships between medication treatment and delinquency are unclear; the absence of associations between medication treatment and substance use needs to be re-evaluated at older ages. Findings underscore the need for continuous monitoring of these outcomes as children with attention-deficit/hyperactivity disorder enter adolescence.     

Mismatch repair deficiency is an uncommon mechanism of alkylator resistance in pediatric malignant gliomas: A report from the children's oncology group

Background

Alkylating agents are commonly used in the treatment of childhood malignant gliomas. Overexpression of O⁶‐methylguanine‐DNA methyltransferase (MGMT) constitutes an important mechanism for resistance to such agents, and MGMT status has been associated with outcome in several recent trials. Deficiency in mismatch repair (MMR) function has been implicated in preclinical studies as an additional potential mechanism of resistance to methylating agents, such as temozolomide, independent of tumor MGMT status. However, the frequency of this abnormality as a clinical resistance mechanism in childhood malignant gliomas has not been well characterized.

Methods

To address this issue, we examined the frequency of microsatellite instability (MSI), a marker of defective MMR, in a series of 68 tumors, derived from newly diagnosed patients treated on the Children's Cancer Group 945 study, and the Children's Oncology Group ACNS0126 and 0423 studies. MSI was assessed using a panel of six microsatellite markers, including BAT‐25, BAT‐26, CAT‐25, D2S123, D5S346, and D17S250. MGMT immunoreactivity was assessed in parallel to allow comparison of the relative incidence of MGMT overexpression and MSI.

Results

Only three tumors had high‐level MSI involving three or more markers; the remainder had no MSI at any of the loci examined. These children did not have unusual features in terms of their outcome. In contrast to the infrequency of MSI, 25 tumors (37%) exhibited MGMT overexpression as assessed by immunohistochemistry. None of the tumors with MSI exhibited overexpression of MGMT.

Conclusion

MMR deficiency is an infrequent contributor to initial alkylator resistance in children with malignant gliomas. Pediatr Blood Cancer. 2010;55:1066–1071. © 2010 Wiley‐Liss, Inc.     

Identification of different bacterial species in biofilms using confocal Raman microscopy

Confocal Raman microspectroscopy is used to discriminate between different species of bacteria grown in biofilms. Tests are performed using two bacterial species, Streptococcus sanguinis and Streptococcus mutans, which are major components of oral plaque and of particular interest due to their association with healthy and cariogenic plaque, respectively. Dehydrated biofilms of these species are studied as a simplified model of dental plaque. A prediction model based on principal component analysis and logistic regression is calibrated using pure biofilms of each species and validated on pure biofilms grown months later, achieving 96% accuracy in prospective classification. When biofilms of the two species are partially mixed together, Raman-based identifications are achieved within ～2 μm of the boundaries between species with 97% accuracy. This combination of spatial resolution and predication accuracy should be suitable for forming images of species distributions within intact two-species biofilms.     

An audit of advice on fitness to drive during accident and emergency department attendance

Introduction

Large numbers of patients attending accident and emergency (A&E) departments drive to and from the consultation. This audit set out to examine if patients attending A&E were advised about their fitness to drive.

Method

The authors carried out a retrospective audit over a one month period. The Driver and Vehicle Licensing Authority (DVLA) booklet “At a glance guide to the current medical standards of fitness to drive” was used to derive a list of conditions that require driving restrictions. Any condition within these guidelines was audited. If the patient was discharged and diagnosed as having a condition requiring the patient to cease driving, the notes were scrutinised for any evidence that the doctor had given advice about driving.

Results

A total of 337 patients were discharged with conditions which may have required some restrictions to driving; 332 sets of notes were available. Twenty two patients needed restrictions to be placed on their driving. Only one patient had any documented evidence of the examining doctor informing them of restrictions to be placed on driving.

Conclusions

The study provides clear evidence that patients were not being informed about their fitness to drive following consultation in the authors'' A&E department. Previous studies have shown that doctors'' knowledge on driving restrictions is poor. Further education is needed for A&E doctors and patient information leaflets should be provided to explain the restrictions placed on a driver''s licence if they have certain illnesses.     

A review of methods to measure dietary sodium intake

With the rising prevalence of heart failure, it is imperative to investigate reasons for dietary sodium nonadherence and to develop evidence-based interventions to promote adherence. However, one of the biggest obstacles in studying adherence to a low sodium diet is the imprecision in measurement of dietary sodium intake. The purpose of this article is to critically review current methods used to measure dietary sodium intake. Specifically, 24-hour urine, single- and multiple-day food records, and 24-hour dietary recalls are compared and contrasted. The reliability and validity of these methods are discussed. When choosing a method to measure dietary sodium, it is important also to consider other strengths and weaknesses of each method. The "best" method to be used in research may depend not only on the above information, but also on the research question as well as characteristics of the population under study.     

Influence of Caregiving on Lifestyle and Psychosocial Risk Factors Among Family Members of Patients Hospitalized with Cardiovascular Disease

Background  Few data have evaluated the relationship between caregiving and cardiovascular disease (CVD) risk. Objective  The purpose of this study was to determine the prevalence and predictors of caregiver strain and to evaluate the association between caregiving and CVD lifestyle and psychosocial risk factors among family members of recently hospitalized CVD patients. Design and Participants  Participants in the NHLBI Family Intervention Trial for Heart Health (FIT Heart) who completed a 6-month follow-up were included in this analysis (n = 263; mean age 50 ± 14 years, 67% female, 29% non-white). Measurements  At 6 months, standardized information was collected regarding depression, social support, and caregiver strain (high caregiver strain = ≥7). Information on lifestyle risk factors, including obesity, physical activity, and diet, were also collected using standardized questionnaires. Logistic regression models on the association between caregiving and CVD risk factors were adjusted for significant confounders. Results  The prevalence of serving as a CVD patient’s primary caregiver or caring for the patient most of the time was 50% at 6 months. Caregivers (primary/most) were more likely to be women (81% vs 19%, p < .01), married/living with someone (p < .01), >50 years old (p < .01), have ≤ high school education (p < .01), be unemployed (p < .01), get less physical activity (p < .01), and have a higher waist circumference (p < .01) than non-caregivers (some/occasional/none). Mean caregiver strain scores were significantly higher among those with depressive symptoms (p < .01) and low social support (p < .01) in a multivariable adjusted model. Conclusions  Caregivers of cardiac patients may be at increased risk themselves for CVD morbidity and mortality compared to non-caregivers due to suboptimal lifestyle and psychosocial risk factors.