Recalibration of the SCORE risk chart for the Russian population

Persisting high levels of cardiovascular mortality in Russia present a specific case among developed countries. Application of cardiovascular risk prediction models holds great potential for primary prevention in this country. Using a unique set of cohort follow-up data from Moscow and Saint Petersburg, this study aims to test and recalibrate the Systematic Coronary Risk Evaluation (SCORE) methods for predicting CVD mortality risks in the general population. The study is based on pooled epidemiological cohort data covering the period 1975–2001. The algorithms from the SCORE project were used for the calibration of the SCORE equation for the Moscow and St. Petersburg populations (SCORE-MoSP). Age-specific 10-year cumulative cardiovascular mortality rates were estimated according to the original SCORE-High and SCORE-Low equations and compared to the estimates based on the recalibrated SCORE-MoSP model and observed CVD mortality rates. Ten-year risk prediction charts for CVD mortality were derived and compared using conventional SCORE-High and recalibrated SCORE-MoSP methods. The original SCORE-High model tends to substantially under-estimate 10-year cardiovascular mortality risk for females. The SCORE-MoSP model provided better results which were closer to the observed rates. For males, both the SCORE-High and SCORE-MoSP provided similar estimates which tend to under-estimate CVD mortality risk at younger ages. These differences are also reflected in the risk prediction charts. Using non-calibrated scoring models for Russia may lead to substantial under-estimation of cardiovascular mortality risk in some groups of individuals. Although the SCORE-MoSP provide better results for females, more complex scoring methods involving a wider range of risk factors are needed.     

Parental phonological memory contributes to prediction of outcome of late talkers from 20 months to 4 years: a longitudinal study of precursors of specific language impairment

Background

Many children who are late talkers go on to develop normal language, but others go on to have longer-term language difficulties. In this study, we considered which factors were predictive of persistent problems in late talkers.

Methods

Parental report of expressive vocabulary at 18 months of age was used to select 26 late talkers and 70 average talkers, who were assessed for language and cognitive ability at 20 months of age. Follow-up at 4 years of age was carried out for 24 late and 58 average talkers. A psychometric test battery was used to categorize children in terms of language status (unimpaired or impaired) and nonverbal ability (normal range or more than 1 SD below average). The vocabulary and non-word repetition skills of the accompanying parent were also assessed.

Results

Among the late talkers, seven (29%) met our criteria for specific language impairment (SLI) at 4 years of age, and a further two (8%) had low nonverbal ability. In the group of average talkers, eight (14%) met the criteria for SLI at 4 years, and five other children (8%) had low nonverbal ability. Family history of language problems was slightly better than late-talker status as a predictor of SLI.. The best predictors of SLI at 20 months of age were score on the receptive language scale of the Mullen Scales of Early Learning and the parent''s performance on a non-word repetition task. Maternal education was not a significant predictor of outcome.

Conclusions

In this study, around three-quarters of late talkers did not have any language difficulties at 4 years of age, provided there was no family history of language impairment. A family history of language-literacy problems was found to be a significant predictor for persisting problems. Nevertheless, there are children with SLI for whom prediction is difficult because they did not have early language delay.     

Novel mutations in the SH3BP2 gene associated with sporadic central giant cell lesions and cherubism

Central giant cell lesion (CGCL) is a reactive bone lesion that occurs mainly in the mandible, characterized by the multinucleated osteoclast-like giant cells in a background of oval to spindle-shaped mononuclear cells. The etiology is unknown and occurs more commonly in young adults. Cherubism, a rare disease found predominantly in females has histologic characteristics indistinguishable from those of CGCL and is caused by mutations mostly present in exon 9 of the SH3BP2 gene. In this study, we investigated four cases of CGCL and one case of cherubism. DNA was extracted from peripheral blood and tumor tissue and all coding and flanking regions of the SH3BP2 amplified by PCR and directly sequenced to identify underlying mutations. Two novel mutations were found; a heterozygous missense mutation c.1442A>T (Q481L) in exon 11 in one sporadic case of CGCL and a heterozygous germline and tumor tissue missense mutation c.320C>T (T107M) in exon 4 in one patient with cherubism. These findings open a new window to investigate the possible relationship between the pathogenesis of the cherubism and CGCL.     

Trigeminal nerve: anatomic correlation with MR imaging

Through correlation with cryomicrotic sections, the appearance of the trigeminal nerve and its branches on magnetic resonance images is described in healthy individuals and in patients with tumors involving this nerve. Coronal images are best for defining the different parts of the nerve and for making a side-to-side comparison. Sagittal images are useful to demonstrate tumors involving the gasserian ganglion.     

Where there are no data: what has happened to life expectancy in Georgia since 1990?

In recent years there has been a considerable increase in understanding of changes in mortality in Russia and some other former Soviet republics. However, the situation in the republics of the Caucasus remains poorly understood. Information on Georgia is especially fragmentary as a fifth of the country remains outside government control, there has been large scale migration since 1991, and the introduction of fees for vital registration has compromised the quality of official statistics. The aim of the study is to produce plausible estimates for life expectancy in Georgia for the period 1990-1998 and thus to assess whether Georgia has undergone changes similar to other former Soviet republics in the post-independence period. Four models were used to construct life tables. Model 1 used officially published statistics on deaths and population. Model 2 applied new estimates of population derived from household surveys to the observed deaths. Model 3 adjusted model 2 for under-registration at extremes of life, with parameter estimates derived from a survey of infant mortality and comparison of observed rates with Coale-Demeny standard life tables. Model 4 arose following inspection of death rates by cause that revealed implausible discontinuities in cancer mortality rates and involved applying the estimates of under-registration that this finding implied to model 3.The four models produce quite different estimates of life expectancy, differing by 7.8 y for men and 6.8 y for women by 1998. In any of the models, however, Georgia does not appear to have experienced the marked deterioration in life expectancy seen in Russia following the transition to independence. Importantly, Georgia had also not experienced a marked improvement in life expectancy during the 1985 Soviet anti-alcohol campaign, again unlike other Soviet republics.Official statistics substantially over-estimate life expectancy at birth in Georgia. Despite undergoing a civil war, life expectancy in Georgia has been less affected by the transition than has Russia and the overall trends in mortality since the mid 1980s suggest that this may be because alcohol has played a smaller role in these changes than it did in Russia.