Agreement between proxy- and self-report scores on PROMIS health-related quality of life domains in pediatric burn survivors: a National Institute on Disability,Independent Living,and Rehabilitation Research Burn Model System Study

Quality of Life Research - To examine agreement between pediatric burn survivor self- and caregiver proxy-report on multiple PROMIS domains and examine factors associated with differences between...     

Should a history section be included on the National Youth Sports Program preparticipation physical examination?

The National Youth Sports Program (NYSP) is an annual event sponsored by the National Collegiate Athletic Association that provides structured sports and enrichment programs to youth of low socioeconomic status. As part of the program, youths undergo a free medical examination that uses a physical examination checklist but does not include a section on medical history. To determine what additional information a medical history would provide, a history form was used in conjunction with the regular preparticipation examination for participants in the 1996 NYSP at the North Carolina Agricultural and Technical State University. The history form provided information such as family history of sudden death, personal history of asthma or bone injury, and whether participants took medications or used corrective lenses. Seventy-nine percent of the completed history forms documented a positive response to at least one question. Of these, only 5% had physical findings on examination. Conversely, 15% of participants had physical findings that were not reported on the history form. Because much of what is discovered by a medical history often is not found on physical examination and because history information can be used to prevent the occurrence of an accident or illness, this study suggests that the use of such a form is beneficial in providing a more comprehensive screening.     

Antigenic heterogeneity of the hepatitis C virus NS4 protein as modeled with synthetic peptides

The effect of sequence heterogeneity on the immunologic properties of two strong antigenic regions of the hepatitis C virus (HCV) NS4 protein was studied by using a set of 443 overlapping 20-mer synthetic peptides. One antigenic region comprising the cleavage site between NS4a and NS4b (region 5-1-1) was modeled with peptides derived from 73 different known sequences, representing HCV genotypes 1-6. The other antigenic region, designated region 59 and located at the C-terminus of the NS4b protein, was modeled with peptides from 7 known sequences representing genotypes 1-3. All peptides were tested for antigenic reactivity by enzyme immunoassay with a panel of anti-HCV-positive serum specimens representing genotypes 1-5. The data demonstrated that immunoreactive peptides fell into two groups. One group, represented by N-terminal peptides, demonstrated genotype-independent immunoreactivity; the other group, from the central part of region 5-1-1, showed strict genotype specificity. Nineteen peptides from the genotype-independent group strongly immunoreacted with a wide range of serum samples containing antibodies to all 5 HCV genotypes. Twenty-five peptides from the genotype-specific group were found to strongly react with serum containing antibodies only to the genotype from which the peptides were derived. Similar to the N-terminal part of region 5-1-1, peptides derived from region 59 did not show genotype-specific immunoreactivity. Some peptides derived from the central part of region 59 showed very strong and broad antigenic reactivity. Thus, after examining two antigenic regions of the NS4 protein, we identified short sequences that can be used for the efficient detection of either genotype-independent or genotype-specific HCV antibodies.     

A combined method for estimating ventilatory threshold

BACKGROUND: The aims of this study were to compare two new methods (Dmax and CUSUM) for determination of the ventilatory threshold and to examine the consequences of estimation by application of these methods in combination. METHODS: Experimental design: a comparative design was used. Setting: the study was performed in the Exercise Physiology Laboratory in the Faculty of Medicine, Sel?uk University. Participants: thirty-two untrained males (20.6 +/- 1.2 yrs) performed an incremental exercise test on a cycle ergometer. Interventions: there is no intervention. Measures: ventilatory and gas exchange variables were measured breath-by-breath. The ventilatory thresholds were detected by conventional linear regression, CUSUM, Dmax and combined CUSUM-Dmax methods. RESULTS: The ventilatory thresholds determined by Dmax method gave the highest r-values compared to the criterion method. There was no statistical difference between thresholds determined by all methods or by the same method using different variables. Ventilatory thresholds could not be determined by the conventional linear regression method in three subjects but were determined in all subjects by the other three methods. CONCLUSIONS: Although all methods presented in this study can be used in the determination of ventilatory threshold, the Dmax method was found to be the most valid one. When using the CUSUM method, combining it with the Dmax method increases the validity of the measurement.     

Cryptorchidism as a result of burn injury

Thermal injury of the genitalia usually occurs as part of larger body surface burns. The most common sequelae of burns of the penoscrotal region are contractures of penile shaft, but we did not encounter any reported cases in English Literature with cryptorchidism as a sequel of burn injury. A 7 year old boy with cryptorchidism as a component of extensive perineal and inguinal burn deformity is reported to indicate the role of burn injury in cryptorchidism. Cryptorchidism as a component of perineal burn injury may be caused by the attachment of the cremaster muscle or fascia to the abdominal wall during the process of wound healing. As healing process of wounds on inguinal region by contraction may cause testis entrapment and cryptorchidism, a careful genital examination bears a great importance in inguinal burn deformities in order not to miss any trapped testis and replace it as early as possible before degenerative changes begin.     

A phase I and pharmacokinetic trial of terephthalamidine (NSC 57155) as a 120-hour continuous infusion

In this phase I study, terephthalamidine was administered as a 120-hour continuous infusion repeated every 21 days. Thirteen patients received 27 courses of terephthalamidine at four dose levels (14, 28, 46, and 70 mg/m²/day). Dose-limiting toxicity consisted of profound and intractable anorexia, weight loss and prostration in all patients. Toxicity was delayed and accompanied by hyponatremia and hypokalemia. No hematologic or other toxicity was documented. One patient with adenocarcinoma of the lung had a 40% decrease in mediastinal lymph nodes and resolution of a pleural effusion lasting 2 months. Pharmacokinetic analysis by HPLC was performed in all patients during their first course. The harmonic mean terminal half-life for terephthalamidine was 23 hours with a plasma clearance of 1.7 l/hr/m². Both plasma concentrations achieved during infusion (r² = 0.9) and area under the curve (AUC) (r² = 0.8) were proportional to increase in dose (p < 0.002). Renal excretion accounted for 64% of the total cumulative dose, with an average renal clearance of 1.16 l/hr/m². Due to the unacceptable toxicity seen at all doses with this schedule, no further studies are recommended unless the mechanism of toxicity is better understood and can be prevented.