Prospective study of outcome of infants with infantile spasms treated during controlled studies of ACTH and prednisone

We report the long-term outcome of 64 infants with infantile spasms, followed prospectively, using controlled treatment schedules and objective techniques (24-hour EEG and video monitoring) to determine response. Average age at follow-up was 50 months. Of the 64 infants, three (5%) died; of the others, 41 (67%) had developmental retardation of 50% or more or an IQ of 50 or less. Eight patients (13%) composed our cryptogenic study group and were so classified on the basis of normal CT scan, normal development prior to onset of infantile spasms, and undetermined cause. These patients had the better outcome; 38% had normal development or were only mildly retarded. Both the responders and nonresponders in our symptomatic group had a poor outcome; only 5% had normal development or mild impairment. Outcome was not significantly influenced by short versus long treatment lag or by response to therapy. Other types of seizures occurred in 34 patients (53%). In summary, the overall prognosis for long-term outcome in these 64 patients with infantile spasms was poor.     

Detection threshold differences to crossed and uncrossed disparities

Using a sample of 85 subjects measurements were made of minimum stimulus durations necessary for detection of crossed and uncrossed disparity stimuli which were presented in five positions in the visual field: centre, lower, upper, right, and left field. The results indicated large detection duration differences between the two disparity conditions, with a marked superiority for crossed disparity detection at all positions. A left-right visual field anisotropy was demonstrated for crossed disparity stimuli.     

National survey to assess current practices in the diagnosis and management of young people with dementia

BACKGROUND: The Royal College of Psychiatrists has recommended that old age psychiatrists may be best placed to take responsibility for service provision for younger people with dementia. There are concerns however, that if referral between specialists, particularly neurologists and old age psychiatrists, is incomplete, patients may be under investigated or inappropriately followed up. OBJECTIVES: We have assessed the current level of referral between these specialists, how each investigates their patients and details of follow up care. METHOD: We conducted a postal survey of all consultant neurologists and consultant old age psychiatrists in the UK with an overall response rate of 64%. RESULTS and CONCLUSIONS: The ideal of full collaboration between old age psychiatrists and neurologists is not achieved. Young patients may be under investigated if managed solely by an old age psychiatrist and may not receive adequate follow up services if managed solely by a neurologist.     

Poor elemental food quality reduces the toxicity of fluoxetine on Daphnia magna

Most chemical contaminants released into the aquatic environment have been tested for their toxicity to aquatic organisms using standardized test protocols. The extent that results from such toxicity tests vary with the quality of food provided to the test organism remains largely unknown. Here, we determined whether the elemental food quality consumed by a common test organism, Daphnia magna, affects the toxicity of a pharmaceutical, fluoxetine. We found strong interactive effects of food quality and fluoxetine on daphnid survival, growth, and reproduction. Specifically, we found that D. magna fed phosphorus (P)- and nitrogen (N)-rich algal food experienced greater toxicity due to fluoxetine. For example, the 6-day LC(50) values for fluoxetine decreased from 0.33 to 0.15 mg L(-1) when food C:P ratios were increased from 100 to 800. One explanation for this result is that fluoxetine, as a selective serotonin reuptake inhibitor, increases the activity of serotonin, whose production is linked to growth metabolism in D. magna. A regulatory role of serotonin for D. magna's growth and reproduction would be consistent with its mitogenic roles in other organisms, although this possibility would require further study. Nevertheless, these results demonstrate the need to consider elemental food quality in ecotoxicological testing protocols that are aimed at evaluating the risks of exposure to chemicals in the aquatic environment.     

超长段尿道狭窄术后勃起功能的评估

目的 探讨自体组织替代治疗超长段尿道狭窄对勃起功能的影响.方法 回顾性分析2007年1月至2009年1月采用不同自体组织补片(阴囊纵隔、包皮内板、口腔黏膜)Onlay术式替代治疗超长段男性尿道狭窄患者的临床资料,并随访患者ⅡEF-5评分、QOL评分及最大尿流率,并与术前相应情况进行分析.结果 根据研究标准收集23份有效数据.患者术前及术后3、6、12个月QOL评分分别为5.22±0.75、1.22±1.40、1.82±1.17、2.07±0.46,最大尿流率分别为(3.93±3.62)、(22.46±4.65)、(23.81±6.22)、(21.52±7.44)ml/s,术后不同时期均较术前明显改善(P＜0.01).术前及术后3、6、12个月ⅡEF-5评分分别为14.47±9.55、14.70±5.32、14.26±3.29和14.58±3.62,组间比较差异无统计学意义(P＞0.05).9例狭窄部位累及至后尿道者术后3、6、12个月ⅡEF-5评分分别为11.67±2.59、12.35±1.83、13.19±1.67,14例单纯前尿道狭窄者分别为17.79±6.42、16.57±4.78、16.01±3.85,2组间比较差异均有统计学意义(P＜0.05).狭窄累及后尿道患者多元线性回归分析中,年龄、受伤时间及尿道狭窄段长度与替代术后ⅡEF-5评分呈多元线性相关.结论 自体组织替代治疗男性超长段尿道狭窄对勃起功能影响不明显;狭窄段累及后尿道时可能对患者勃起功能产生一定影响.患者年龄和受伤时间对勃起功能有协同影响作用.

Abstract：

Objective To investigate the effect of substitutive reconstruction of long urethral stricture on male erectile function. Methods From January 2007 to January 2009, 23 patients with anterior or posterior long urethral stricture were accepted for a variety of onlay substitutive procedures, including lingual mucosa, perputial skin, and mid-scrotal skin. During the follow-up, data from the International Index of Erectile Function-5 (ⅡEF-5) questionnaire and the Quality of Life (QOL) questionnaire as well as maximal flow rate were recorded. All data were compared with those obtained before surgery. Results Significant improvement in QOL (1.22 ± 1.40, 1.82 ± 1. 17,2.07± 0.46) and maximal flow rate (22.46± 4.65, 23.81 ± 6.22, 21.52 ±7.44 ) could be observed 3, 6 and 12 months after surgery compared with those before surgery (5. 22 ± 0. 75, 3. 93 ± 3. 62)(P＜0.01). No significant differences in the responses to the ⅡEF-5 questionnaire were observed among all patients during the follow-up (P＞0. 05). At the 3, 6 and 12 months after procedure,scores of ⅡEF-5 in patients with anterior urethral stricture ( 17.79 ± 6.42, 16. 57 ± 4. 78, 16.01 ±3.85) were significantly higher than those with posterior urethral stricture (11.67 ± 2.59, 12.35 ±1.83,13. 19±1.67, P＜0.05). In patients with posterior urethral stricture, the multiple linear regression showed that age, time interval of injury and length of stricture were related to the ⅡEF-5score (P＜0.05). Conclusions Substitutive reconstruction for treating the long urethral stricture has little effect on male erectile function. But the location of stricture, especially extended to posterior urethra, may have impact on the erectile function.     

Cervical spine abnormalities in Down Syndrome.

Down Syndrome (DS) is the most common of the chromosomal disorders and manifests abnormalities in several organ systems. While mental retardation, skull and brain anomalies, and the development of Alzheimer-type neuropathological changes in patients greater than age 40 years are well recognized by neurologists and neuropathologists, less appreciated are the various cervical spine abnormalities that can occur. Widening of the anterior atlanto-odontoid distance (AAOD) and atlantooccipital instability occur in up to 21% and 63% of DS patients, respectively, but neurologic complaints are uncommon and rarely are severe enough to contribute to the patient's demise. We present a case of 49-year-old DS patient whose triplegia, subacute progressive respiratory failure, and death could be attributed to severe degenerative joint disease of the cervical spine with osteophyte formation and severe spinal canal stenosis. We provide the first detailed correlation study between pre-mortem magnetic resonance imaging (MRI) and extensive autoptic dissection in an adult DS patient with cervical spine abnormalities, as well as a review of the literature.     

Assessing the Legacy of a Legislative Workgroup for Bidirectional Integration of Services

Across the USA, health care systems are recognizing the value of integrating behavioral health services and primary care. The Texas Legislature took a unique approach to integration, passing legislation creating a Workgroup to explore key issues, identify best practices, and recommend policy and practice changes. This article situates the Workgroup in a rapidly evolving policy environment, describing the passage of integrated health care legislation in Texas, the Integration of Health and Behavioral Health Services Workgroup that was created by the legislation, and the policy recommendations that emerged from the Workgroup. The article analyzes how the Workgroup process intersected with a changing policy environment in Texas and nationally, opening the door for essential collaboration and partnership. The Workgroup ultimately laid the groundwork for integration's key role in a comprehensive Medicaid transformation waiver designed to expand access, improve population health and satisfaction with treatment, while better managing costs.     

Potent, orally active heterocycle-based combretastatin A-4 analogues: synthesis, structure-activity relationship, pharmacokinetics, and in vivo antitumor activity evaluation

The synthesis and structure-activity relationship study of a series of compounds with heterocycles in place of the cis double bond in combretastatin A-4 (CA-4) are described. Substituted tosylmethyl isocyanides were found to be the key intermediates in construction of the heterocycles. Cytotoxicities of the heterocycle-based CA-4 analogues were evaluated against NCI-H460 and HCT-15 cancer cell lines. 3-Amino-4-methoxyphenyl and N-methyl-indol-5-yl were the best replacements for the 3-hydroxy-4-methoxyphenyl in CA-4. 4,5-Disubstituted imidazole was found to be the best for the replacement of the cis double bond in CA-4. Medicinal chemistry efforts led to the discovery of compounds 24h and 25f that were found to be 32 and 82% bioavailable, respectively, in rat. Evaluation of 24h and 25f against murine M5076 reticulum sarcoma in mice revealed that both compounds were orally efficacious with an increase in life span of 38.5 and 40.5%, respectively.