Psychometric properties of an International Classification of Functioning, Disability and Health (ICF)-oriented, adaptive questionnaire for the assessment of mobility, self-care and domestic life.

OBJECTIVE: Development of an adaptive, International Classification of Functioning, Disability and Health (ICF)-oriented patient questionnaire on mobility and self-care based on an item response theory model (MOSES questionnaire). METHODS: Using item reconstruction rules, items were developed for the ICF chapters "mobility", "self-care" and "domestic life". The resulting instrument, together with other instruments (SF-36, Short Musculoskeletal Function Assessment Questionnaire (SMFA), MacNew, Functional Independence Measure (FIM), Barthel) was presented to 549 patients with musculoskeletal disease, 212 patients with cardiac disease and 258 neurological rehabilitation patients in rehabilitation clinics in Germany. RESULTS: The MOSES questionnaire includes 58 items on 12 scales and fulfills the requirements of the 1-parameter item response theory model (Rasch model). The results indicate good reliability and high construct validity and sensitivity to change of the instrument. In the construction and selection of items, ICF contents that include complex processes of evaluation, and which presuppose skills that are not acquired prior to the individual learning process, were omitted due to a lack of unidimensionality. CONCLUSION: The successful implementation of the concept of applying rules to ICF categories in formulating the items of a patient questionnaire showed that the goal of a theory-driven measurement of activities using the ICF is feasible. The results of the project also raise questions as to the homogeneity of the contents of some ICF categories.     

Polymorphisms in Inflammation-related Genes and Risk of Gastric Cancer (Finland)

Helicobacter pylori infection is an important risk factor for gastric cancer, but <3% of carriers of this organism will ever develop gastric cancer. Since inflammation plays a significant role in gastric carcinogenesis, it has been suggested that polymorphisms in genes involved in inflammatory response may partly explain why only a subgroup of patients infected with H. pylori develop gastric cancer. We compared relative frequencies of 17 single nucleotide polymorphisms (SNPs) in eight inflammation-related genes between 112 gastric cancer patients and 208 controls. Cases and controls were selected from a large cohort of Finnish male smokers who were recruited into the Alpha-Tocopherol, Beta-Carotene Cancer Prevention (ATBC) Study. The studied SNPs were IL-1A (−889 C/T), IL-1B (−511 C/T and −31 T/C), IL-6 (−174 G/C and −597 G/A), IL-8 (−251 T/A, +396 T/G and +781 C/T), IL-8RA (Ex2 +860 G/C), IL-8RB (Exon 3 +1235 T/C, Exon 3 +811 C/T, and Exon 3 +1010 G/A), IL-10 (−819 C/T, −592 C/A, −1082 A/G), and TNF A (−308 G/A, −238 G/A). We found no statistically significant association between any of these SNPs, or the number of pro-inflammatory polymorphisms, with risk of gastric cancer. Our results do not support the hypothesis that polymorphisms in genes involved in the inflammatory response confer differences in gastric cancer risk among different individuals.     

Rotator cuff calcifications: treatment with ultrasound-guided percutaneous needle aspiration and lavage

 Objective. To analyze the results of ultrasound (US)-guided needle puncture, aspiration and lavage in the treatment of symptomatic calcific tendinitis of the rotator cuff. Design and patients. Atraumatic pain in 61 shoulders of 58 patients was resistant to conservative therapy. The average age of the treated patients was 42 years (range 26–49 years), follow-up was 12 months, and the mean diameter of the calcifications was 1.6 cm (range 1.1–2.9 cm). With US guidance and local anesthesia, two needles were placed within each calcification. The calcification was punctured 10–15 times and saline solution injected and aspirated using the needles until the aspirate was free of calcific particles. Results and conclusions. Based on radiographs at 1 year follow-up, 74% (45 of 61) of the calcifications decreased, including 28% (17 of 61) which disappeared totally, and 26% (16 of 61) were unchanged. Calcifications with a faint or absent shadow on US proved to be nearly liquid (slurry calcification in 93% (14 of 15) of cases and could be aspirated. Clinical results were excellent in 74% (45 of 61), moderate in 16% (10 of 61) and poor in 10% (6 of 61) of cases. US offers technical advantages over fluoroscopy, and the typical US image of a slurry calcification helps to select the most suitable patients for aspiration treatment. The results are comparable with those using fluoroscopic guidance.     

Chronic beryllium disease and glutathione biosynthesis genes

OBJECTIVE: Because glutathione (GSH) has been reported to be increased in chronic beryllium disease (CBD) and is associated with immune modulation, associations between CBD and gene polymorphisms of the rate-limiting enzyme in GSH synthesis, glutamate cysteine ligase (GCL), were investigated. Glutamate cysteine ligase consists of a catalytic subunit (GCLC) and modifier subunit (GCLM). METHODS: Patients with CBD, beryllium-sensitized subjects (BeS), and beryllium-exposed subjects without CBD were genotyped for the GCLC GAG trinucleotide repeat polymorphism (GCLC TNR), the GCLC-129 single nucleotide polymorphism (SNP), and the GCLM-588 SNP. RESULTS: Results indicate that GCLC TNR genotype 7/7 is negatively associated with CBD (odds ratio [OR] = 0.28, 95% confidence interval [CI] = 0.08-0.95) and the GCLM-588 C/C SNP genotype is associated with CBD susceptibility (OR = 3.07, 95% CI = 1.00-9.37). No differences were noted in the BeS group. CONCLUSIONS: This study suggests that GSH modulation may play a role in CBD pathogenesis, but not in sensitization to beryllium.     

Optimal utilization of donor grafts with extended criteria: a single-center experience in over 1000 liver transplants

OBJECTIVE: Severely limited organ resources mandate maximum utilization of donor allografts for orthotopic liver transplantation (OLT). This work aimed to identify factors that impact survival outcomes for extended criteria donors (ECD) and developed an ECD scoring system to facilitate graft-recipient matching and optimize utilization of ECDs. METHODS: Retrospective analysis of over 1000 primary adult OLTs at UCLA. Extended criteria (EC) considered included donor age (>55 years), donor hospital stay (>5 days), cold ischemia time (>10 hours), and warm ischemia time (>40 minutes). One point was assigned for each extended criterion. Cox proportional hazard regression model was used for multivariate analysis. RESULTS: Of 1153 allografts considered in the study, 568 organs exhibited no extended criteria (0 score), while 429, 135 and 21 donor allografts exhibited an EC score of 1, 2 and 3, respectively. Overall 1-year patient survival rates were 88%, 82%, 77% and 48% for recipients with EC scores of 0, 1, 2 and 3 respectively (P < 0.001). Adjusting for recipient age and urgency at the time of transplantation, multivariate analysis identified an ascending mortality risk ratio of 1.4 and 1.8 compared to a score of 0 for an EC score of 1, and 2 (P < 0.01) respectively. In contrast, an EC score of 3 was associated with a mortality risk ratio of 4.5 (P < 0.001). Further, advanced recipient age linearly increased the death hazard ratio, while an urgent recipient status increased the risk ratio of death by 50%. CONCLUSIONS: Extended criteria donors can be scored using readily available parameters. Optimizing perioperative variables and matching ECD allografts to appropriately selected recipients are crucial to maintain acceptable outcomes and represent a preferable alternative to both high waiting list mortality and to a potentially futile transplant that utilizes an ECD for a critically ill recipient.