Drug use in women with anorexia and bulimia nervosa

Forty-two inpatient women with bulimia nervosa and 29 women with anorexia nervosa were surveyed regarding eating behavior, patterns of licit and illicit substance use, and relation between drug use and appetite. Substantial use of licit substances such as laxatives, diuretics, and emetics were reported in women with bulimia nervosa. In addition, alcohol and cigarette use were significantly more common in women with bulimia nervosa than anorexia nervosa. The majority of bulimic subjects reported that smoking decreased appetite, alcohol increased appetite, and laxatives had no effect on appetite. Analysis of temporal patterns of drug intake suggested that binging and purging as well as alcohol, cigarette, and laxative use were considerably more prevalent in the evening hours. We suggest that the high rates of drug use in women with bulimia nervosa may be related to effects of food deprivation associated with the disorder.     

Unfinished Business in Classifying HPV-Positive Oropharyngeal Carcinoma: Identifying the Bad Apples in a Good Staging Barrel

This commentary highlights three important findings in the study by Vijayvargiya et al, published in this journal, involving 9554 oropharyngeal cancer patients from the SEER database. Firstly, there is improved performance in outcome prediction with TNM-8 in HPV+ OPC. However, heterogeneity exists, especially in TNM-8 stage I disease, and there is need for ongoing improvement in risk stratification. Several anatomical and non-anatomical prognostic factors have been proposed. Among them, radiologic extranodal extension has emerged as one of the promising parameters to be considered for future staging. These baseline prognostic factors should address sensitivity, specificity, and diagnostic accuracy to serve different clinical needs. Secondly, cure is possible for some patients presenting with M1 disease. Optimal management of such patients remains to be explored, and clinical trials targeting de novo M1 disease should be encouraged to optimize outcomes for this subset. Finally, methodologies to address missing tumor HPV status in historical cohorts have been discussed, including using baseline demographics and clinical characteristics, as well as statistical procedures such as multiple imputation.     

The continuous measurement of arterial pulse wave velocity

It has long been known that arterial pulse wave velocity (PWV) depends on arterial extensibility. Since extensibility is a function of arterial pressure, as well as of various pathological states, the measurement of PWV provides a promising approach to the indirect monitoring of the cardiovascular system. The present paper describes a Pulse Wave Velocity Computer designed to measure and record PWV in humans. Utilizing the EKG complex and a downstream pulse signal to define pulse-transit-time over a known arterial length, the computer calculates an individual velocity value for each emitted pulse, and generates a continuous, stepwise-analog record of the PWV. Some initial experimental work with human subjects is presented. Observations are reported for the PWV during rest, during deep breathing, and during execution of Valsalva maneuvers. In all cases the continuous PWV record appears to follow closely variations in arterial pressure, apparently adhering, in the Valsalva results, more to systolic than diastolic changes. Observed subject differences attest to the PWV's diagnostic value, and it is suggested that the continuous PWV may be a significant and useful circulatory indicant.     

Modification of chronic schizophrenics' abstractions through enriched stimuli and social censure

Examined the abstracting abilities of good and poor premorbid chronic schizophrenics on single and multiple proverbs, as well as the effects of censure on each group. Two groups of 16 Ss each, comparable in terms of education, IQ and age, were presented with single and multiple sets of proverbs in two sessions and were asked to give the meanings of the proverbs. Half of each group received immediate negative verbal feedback when their performance fell below criteria. Both groups showed significant improvement in the multiple proverb condition. There was also a significant Group × Censure interaction. It is suggested that good premorbids may suffer more from interference in processing stimuli, while poor premorbids suffer more from interference in response selection or from a motivational deficit.     

PBL in the undergraduate MD program at McMaster University: three iterations in three decades.

When the undergraduate MD program of McMaster University admitted its first cohort of 20 students in 1969, it heralded a major change in medical school pedagogy that has influenced the education of medical students around the world. The three-year PBL curriculum, which emphasized small-group tutorials, self-directed learning, a minimal number of didactic presentations, and student evaluation that was based almost entirely on performance in the tutorial, represented a radical departure from traditional curricula. Since the inception of the original curriculum in 1969, there have been two major curriculum revisions, the most recent of which was in 2005. The original curriculum attempted to integrate both basic science and clinical science into the biomedical problems. The second iteration of the curriculum focused on priority health problems and centered on a list of common medical problems as the foundation for curriculum organization, on the basis that an understanding of the management of common conditions included areas of knowledge that would be essential for clinical competence. Under the third, current curriculum, the COMPASS (concept-oriented, multidisciplinary, problem-based, practice for transfer, simulations in clerkship, streaming) model was adopted. Under this concept-based system, emphasis is placed on underscoring the underlying concepts in the curriculum with a logical sequencing of both the concepts and the body systems. This article briefly reviews the history of the development of the undergraduate MD program at McMaster and the three curricula that have been developed during the past three decades.     

Differential Effects of Dietary versus Exercise Intervention on Intrahepatic MAIT Cells and Histological Features of NAFLD

Background: Mucosal-associated invariant T (MAIT) cells promote inflammation in obesity and are implicated in the progression of non-alcoholic fatty liver disease (NAFLD). However, as the intrahepatic MAIT cell response to lifestyle intervention in NAFLD has not been investigated, this work aimed to examine circulating and intrahepatic MAIT cell populations in patients with NAFLD, after either 12 weeks of dietary intervention (DI) or aerobic exercise intervention (EI). Methods: Multicolour flow cytometry was used to immunophenotype circulating and intrahepatic MAIT cells and measure MAIT cell expression (median fluorescence intensity, MFI) of the activation marker CD69 and apoptotic marker CD95. Liver histology, clinical parameters, and MAIT cell populations were assessed at baseline (T0) and following completion (T1) of DI or EI. Results: Forty-five patients completed the study. DI participants showed decreased median (interquartile range) expression of the activation marker CD69 on circulating MAIT cells (T0: 104 (134) versus T1 27 (114) MFI; p = 0.0353) and improvements in histological steatosis grade post-intervention. EI participants showed increased expression of the apoptotic marker CD95, both in circulating (T0: 1549 (888) versus T1: 2563 (1371) MFI; p = 0.0043) and intrahepatic MAIT cells (T0: 2724 (862) versus T1: 3117 (1622) MFI; p = 0.0269). Moreover, the percentage of intrahepatic MAIT cells significantly decreased after EI (T0: 11.1 (14.4) versus T1: 5.3 (9.3)%; p = 0.0029), in conjunction with significant improvements in fibrosis stage and hepatocyte ballooning. Conclusions: These data demonstrate independent benefits from dietary and exercise intervention and suggest a role for intrahepatic MAIT cells in the observed histological improvements in NAFLD.