Predicting normal lung function in patients with childhood spinal cord injury

STUDY DESIGN: A prospective observational study. OBJECTIVES: To compare the height and arm span measurements in childhood spinal cord injured (SCI) people and examine the subsequent effect on calculating the predicted lung function using standard formulae and to discuss which of the two measurements is the most appropriate to use in these formulae. SETTING: National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK. METHOD: A total of 12 children had lung function tests performed and at the same time had height and armspan measured. The predicted lung function was calculated twice; once using height and then using arm span and compared. The actual lung function test results were expressed as percentage of the two predicted values, respectively, and compared. RESULTS: The difference between the mean height (1499 mm) and arm span (1649 mm) measurements was significant (P<0.001). In all cases, the arm span measurement was greater than the height. The two predicted lung function values (one calculated using height and the other armspan) were significantly different (P<0.001). When lung function test results were expressed as percentage of the two predicted values they gave a very different interpretation of the results. The actual performance was much lower than the predicted values if arm span, rather than height, was used in prediction equations. CONCLUSION: In childhood SCI, the difference in height and arm span is significant. This affects the predicted lung function values significantly and thus changes the interpretation of the lung function test results. The most appropriate measurement to use in prediction equations (height or arm span) in these subjects is yet to be decided.     

In vivo measurements of glutamine + glutamate (Glx) and N-acetyl aspartate (NAA) levels in human partial epilepsy

OBJECTIVE: To investigate whether cerebral levels of N-acetyl aspartate (NAA), and glutamine + glutamate (Glx), are interictally altered in the epileptogenic regions of patients with partial seizures. MATERIAL AND METHODS: NAA, Glx, creatine (Cr), choline (Cho) and myo-inositol (mI) was measured in 28 patients with partial epilepsy and 10 healthy controls using localized 1H magnetic resonance spectroscopy. According to the multimethodological consensus, the epileptogenic region was mesial temporal in 18 and neocortical in 10 patients. RESULTS: The Glx/NAA and Glx/Cr ratios in epileptogenic regions were higher, and the NAA/Cr ratios lower than in the homologous regions (P=0.013, P=0.002 and P<0.0001). Applying the 95% confidence interval of controls, 17 of the 20 mesial temporal epileptogenic regions were correctly identified by an increased Glx/NAA and 15 of 20 by a decreased NAA/Cr ratio. Among patients with neocortical epilepsy the Glx/NAA ratio was increased in 8 of the 10 epileptogenic regions, whereas the NAA/Cr ratio was decreased in three. CONCLUSION: Both Glx and NAA are useful to identify the epileptogenic zone. The Glx/NAA ratios may be particularly useful to indentify neocortical epileptogenic regions.     

Recognizing, Scoring, and Predicting Blast Injuries RID="" ID="" This International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC) article was presented at the 37th World Congress of Surgery International Surgical Week (ISW97), Acapulco, Mexico, August 24–30, 1997.

n = 665, 51%) had an ISS ranging from 0 to 34 (mean 13) had wounds ranging from G1ST (soft tissue wounds caused by low energy transfer) to G3VF (massive wounds with fractures and injury of vital structures) according to the RCWC, with PSS/IS scores from 2 to 105 (mean 60). Statistically significant correlation was found between ISS and PSS/IS as well as RCWC and PSS/IS. Cytokines (IL-1, TNF _alpha ) and amino acids responded to a blast injury in similar manner as to gunshot wounds with a greater ISS or more severe RCWC injury type. The subjective sensations in blasted patients (deafness, thoracic pain, vertigo) and mediators, confirmed in previous experimental investigations as important factors in the pathogenesis of blast injuries (TxA ₂ , sulfidopeptide leukotrienes) were relationed only to the PSS/IS.RID=" ID=" <E5>Correspondence to:</E5> I. Cernak, M.D., Ph.D.     

Surgical anatomy of the hypotympanum

Anatomical characteristics of the hypotympanum were tested on 50 temporal bones. The hypotympanum has the shape of an irregular bony groove which is surrounded by five walls. The outer wall is formed by the tympanic part of the temporal bone. In 65 per cent of the cases the inner wall is formed by part of the petrous bone which extends under the promontory; in 25 per cent it is formed only by the lower part of the promontory; and in 10 per cent it corresponds to the juncture of the promontory and the petrous bone. The lower wall is clearly defined in 48.2 per cent of cases and corresponds to the juncture of its inner and outer walls. In 65 per cent of cases a recess of the inferior hypotympanic sinus is found on the floor of the hypotympanum. In 25.3 per cent of cases the jugular bulb protrudes into the tympanic cavity. In 73.4 per cent of cases the front wall is formed by part of the petrous bone which extends from its floor towards the tympanic opening of the protympanum, and in 26 per cent of the cases it is formed by the wall of the internal carotid artery. On the front wall, in 22.4 per cent of cases, a recess of the anterior hypotympanic sinus is found. The back wall is formed by elements of the styloid complex and in five per cent of the cases a recess or posterior hypotympanic sinus is found on it.     

Quantitative sensory tests (perceptual thresholds) in patients with spinal cord injury

This article was presented at the Premeeting Workshop on Outcome Measures at the American Spinal Injury Association (ASIA) Annual Scientific Meeting in Dallas, Texas, in May 2005. The article summarizes preliminary findings of three quantitative sensory tests that were evaluated as part of the International Spinal Research Trust Clinical Initiative study: perceptual thresholds to electrical, vibration, and thermal stimulation. The results gathered so far suggest that the three tests are simple, reproducible, and applicable in a clinical setting. The tests seem to add resolution and sensitivity to the standard clinical testing and could be useful adjuncts in longitudinal monitoring of spinal cord injury for research purposes.     

A High-Throughput Amplicon Screen for Somatic UBA1 Variants in Cytopenic and Giant Cell Arteritis Cohorts

Journal of Clinical Immunology -     

Mechanistic immunological based classification of rheumatoid arthritis

The classical autoimmunity paradigm in rheumatoid arthritis (RA) is strongly supported by immunogenetics suggesting follicular helper T-cell responses driving high titre specific autoantibodies that pre-dates disease onset. Using the immunological disease continuum model of inflammation against self with “pure” adaptive and innate immune disease at opposite boundaries, we propose a novel immune mechanistic classification describing the heterogeneity within RA. Mutations or SNPs in autoinflammatory genes including MEFV and NOD2 are linked to seronegative RA phenotypes including some so called palindromic RA cases. However, just as innate and adaptive immunity are closely functionally integrated, some ACPA+ RA cases have superimposed “autoinflammatory” features including abrupt onset attacks, severe attacks, self-limiting attacks, relevant autoinflammatory mutations or SNPs and therapeutic responses to autoinflammatory pathway therapies including colchicine and IL-1 pathway blockade. An emergent feature from this classification that non-destructive RA phenotypes, both innate and adaptive, have disease epicentres situated in the extracapsular tissues. This mixed innate and adaptive immunopathogenesis may be the key to understanding severe disease flares, resistant disease subsets that are unresponsive to standard therapy and for therapies that target the autoinflammatory component of disease that are not currently considered by expert therapeutic recommendations.     

Compounding of a topical drug with prospective natural surfactant-stabilized pharmaceutical bases: Physicochemical and in vitro/in vivo characterization - A ketoprofen case study

Recently, healthcare professionals again began realizing the benefits of preparing customized medications to meet specific patient needs. The objective of this work was to develop and evaluate simple pharmaceutical bases stabilized with natural-origin surfactant of alkyl polyglucoside (APG) type as prospective ready-to-use bases and compare them to widely used pharmacopoeial ones. Additionally, the ability of the formulated bases to sustain isopropyl alcohol was assessed as well as its influence on ketoprofen skin absorption (as a co-solvent and potential penetration enhancer). In order to evaluate the manifold characteristics a topical drug product should possess, a comprehensive characterization was performed using different techniques.Physicochemical characterization demonstrated satisfactory physical stability of APG-stabilized bases upon the addition of alcohol. In vitro release/permeation studies failed to show significant difference in ketoprofen liberation/permeation profiles from different bases. However, the extent of ketoprofen delivery in vivo was clearly increased from APG bases, relative to that obtained from pharmacopoeia quality one, implying a distinct influence of the emulsion systems’ colloidal structures. Taking also into account the rheological behavior of APG bases, revealing their ameliorated sensory characteristics, it could be concluded that the investigated APG bases could be considered as preferential option in drug compounding related to the conventional ones.