Comparison of existing disease activity indices in the follow-up of patients with Beh?et’s disease

The objective of this study was to determine the concordance between the Iranian Behçet’s disease dynamic activity measure (IBDDAM) or the Behçet’s disease current activity form (BDCAF) and expert physician global assessment (PGA) in the evaluation of disease activity changes in Behçet’s disease (BD). In a prospective study, 117 consecutive patients with BD were evaluated in their two consecutive follow-up visits by IBDDAM and BDCAF. The change in disease activity was determined (increased, unchanged or decreased) according to the PGA. We used receiver operating characteristic (ROC) curve to determine an appropriate cutoff point for disease activity change. Comparison was made by Stata and kappa analysis. Comparing the area under the ROC curve showed a significant difference between IBDDAM and BDCAF (p < 0.03). The difference was more significant between nonocular IBDDAM and BDCAF (p < 0.002). Better concordance was also observed for IBDDAM (nonocular and total) with PGA than BDCAF. The difference was not significant for ocular IBDDAM. The best cutoff point for nonocular IBDDAM was 0.45, for ocular IBDDAM was 3.5, and for BDCAF was 1 point. IBDDAM was the preferred method for the evaluation of disease activity change in patients with BD (without ocular involvement) considering a change of at least 0.45.     

Diffusion tensor tractography of the human brain cortico-ponto-cerebellar pathways: a quantitative preliminary study

Purpose

To investigate the utility of diffusion tensor tractography at 1mm slice thickness to map and quantify the whole trajectory of different cortico‐ponto‐cerebellar pathways of the healthy adult human brain.

Materials and Methods

This work was approved by the local Institutional Review Board, and was Health Insurance Portability and Accountability Act (HIPAA) compliant. Five healthy right‐handed men (age range, 24–37 years) were studied and written informed consent was obtained. Diffusion tensor imaging data acquired with 1‐mm slice thickness at a 3.0 Tesla (T) clinical MRI scanner were prepared and analyzed using tractography methods to reconstruct the cortico‐ponto‐cerebellar pathways which included the fronto‐ponto‐cerebellar, parieto‐ponto‐cerebellar, occipito‐ponto‐cerebellar, and temporo‐ponto‐cerebellar tracts.

Results

We demonstrate the feasibility of tractographic mapping and quantification of the four cortico‐ponto‐cerebellar system components based on their cortical connections in the healthy human brain using DTI data with thin 1‐mm sections.

Conclusion

In vivo quantification of different cortico‐ponto‐cerebellar pathways based on cortical connection is feasible, using 1‐mm slices at 3.0T. J. Magn. Reson. Imaging 2010;32:809–817. © 2010 Wiley‐Liss, Inc.     

Relationship of stimulated saliva 17β-estradiol and oral dryness feeling in menopause

Objectives

The aim of this study was to compare stimulated whole saliva 17β-estradiol of menopausal women with/without oral dryness (OD) feeling, and evaluate the relationship between saliva 17β-estradiol and severity of OD feeling.

Methods

A case-control study was carried out in 76 selected menopausal women aged 41–77 years with or without OD feeling (38 as case and 38 as control) conducted at the Clinic of Oral Medicine, Tehran university of medical sciences. Paraffin-stimulated saliva samples were obtained by expectoration. Xerostomia inventory (XI) score was used as an index of OD feeling severity. The saliva 17β-estradiol concentration was measured by ELISA. Statistical analysis of Student's t-test and Spearman correlation was used.

Results

No significant difference was found in stimulated whole saliva flow rate between the two groups, but the mean concentration and output of saliva 17β-estradiol were significantly lower in case than control. There was significant negative correlation between XI score and stimulated whole saliva concentration (r = −0.391, P = 0.004) and output (r = −0.302, P = 0.002) of 17β-estradiol in menopausal women.

Conclusions

It seems that there is a negative correlation between OD feeling severity and stimulated whole saliva 17β-estradiol in menopausal women.     

Oncosurgical and reconstructive concepts in the treatment of soft tissue sarcomas: a retrospective analysis

Background  Patients with soft tissue sarcomas are initially treated in community hospitals and in the private practice setting in the majority of cases. Thus, this disease entity is initially treated by surgeons with limited experience and expertise regarding the complex and demanding therapeutic regimen necessary to address this distinct group of malignancies. Methods  A retrospective analysis was conducted with a particular focus on factors affecting patient outcome, oncosurgical intervention, and plastic surgical reconstruction. Results  A total of 75 patients were included in the study. Only 66% of all patients presented with a primary tumor. The remaining 34% presented with either local recurrence or distant metastasis. The oncosurgical procedure most commonly performed was wide excision (69%). However, amputation was unavoidable in 7% of cases. Single-step reconstruction included primary closure (19%), skin grafting (19%), local fascio- or myocutaneous flap transfer (31%), as well as free flap transfer (31%). 17 patients (20%) have deceased due to their underlying disease. Yet another 10% are alive with evidence of residual tumor. Kaplan–Meier analysis displayed significant differences in overall survival rate depending on disease stage upon initial presentation. Conclusion  Based on our data favorable oncological outcomes with satisfactory functional results and limb preservation are achievable if oncological principles for resection are respected and reconstruction is performed according to plastic surgical principles.     

Haemodynamic effects of −75 mmHg negative pressure therapy in a porcine sternotomy wound model

Previous research has shown ?125 mmHg to be the optimal negative pressure for creating an environment that promotes wound healing, and this has therefore been adopted as a standard pressure for patients with deep sternal wound infection. However, it has not yet been clearly shown that ?125 mmHg is the optimal pressure from a haemodynamic point of view. Furthermore, there have been reports of cardiac rupture during ?125 mmHg negative pressure therapy. We therefore studied the effects of a lower pressure: ?75 mmHg. Twelve pigs were used. After median sternotomy, sealed negative pressure therapy of ?75 mmHg was applied. Baseline measurements were made and continuous recording of the cardiac output, end‐tidal CO₂ production, mean arterial pressure, mean pulmonary pressure (pulmonary artery pressure), systemic vascular resistance, pulmonary vascular resistance, left atrial pressure and central venous pressure was started. Six pigs served as controls. No statistically significant difference was observed in any of the haemodynamic parameters studied, compared with the controls. The present study shows that, with a suitable foam application technique, ?75 mmHg can be applied without compromising the central haemodynamics.     

Consciousness of the first order in blindsight

At suprathreshold levels, detection and awareness of visual stimuli are typically synonymous in nonclinical populations. But following postgeniculate lesions, some patients may perform above chance in forced-choice detection paradigms, while reporting not to see the visual events presented within their blind field. This phenomenon, termed "blindsight," is intriguing because it demonstrates a dissociation between detection and perception. It is possible, however, for a blindsight patient to have some "feeling" of the occurrence of an event without seeing per se. This is termed blindsight type II to distinguish it from the type I, defined as discrimination capability in the total absence of any acknowledged awareness. Here we report on a well-studied patient, D.B., whose blindsight capabilities have been previously documented. We have found that D.B. is capable of detecting visual patterns defined by changes in luminance (first-order gratings) and those defined by contrast modulation of textured patterns (textured gratings; second-order stimuli) while being aware of the former but reporting no awareness of the latter. We have systematically investigated the parameters that could lead to visual awareness of the patterns and show that mechanisms underlying the subjective reports of visual awareness rely primarily on low spatial frequency, first-order spatial components of the image.     

Disturbances of parathyroid hormone–vitamin D axis in non-cholestatic chronic liver disease: a cross-sectional study

Purpose  

Liver has an important role in metabolism of vitamin D. This study aimed to evaluate the patterns of vitamin D–parathyroid hormone (PTH) disturbance and correlate it in patients with non-cholestatic chronic liver disease (CLD).