Impedance signature of pharyngeal gaseous reflux

BACKGROUND: Pharyngeal impedance changes induced by various pharyngeal reflux events have not been characterized. OBJECTIVES: To characterize pharyngeal impedance changes induced by participant-perceived belching events. METHODS: We systematically evaluated pharyngeal impedance and pH changes related to 453 belch events in 11 gastroesophageal reflux disease, 10 reflux attributed-laryngitis patients and 16 controls. RESULTS: Of 453 belch events, 362 were analyzable. Of these, 72% occurred within 10 s, 93% within 20 s, 99% within 30 s and 100% within 40 s of the time that participants marked a belch event. In 15% impedance changes in the pharynx preceded, in 12% they were simultaneous and in 73% they occurred after the start of the impedance change in the proximal esophagus. Time interval between the two events ranged between 0.4+/-0.03 and 0.7+/-0.1 s. In all, there were three types of belch-induced impedance changes: (a) impedance increase, (b) impedance decrease and (c) multiphasic. Twenty percent of impedance events associated with belching had less than 50% change from baseline, whereas in 51% changes exceeded or were equal to 50%. Among events with a drop in pharyngeal impedance, only two satisfied the criteria for the liquid reflux event. CONCLUSIONS: Pharyngeal ventilation of gastric gaseous content seems to have a unique impedance signature. During pharyngeal gas reflux events, impedance changes may start before or after proximal esophageal changes. Belching may induce negative pharyngeal changes that do not meet the criteria for liquid reflux. These findings need to be taken into consideration in the analysis of pharyngeal reflux events.     

Sociodemographic Risk Factors for Autism in a US Metropolitan Area

The present study examined the association between autism and sociodemographic factors, overall and in subgroups of children with autism with and without mental retardation (Autism/MR and Autism/No MR, respectively); the association was further examined in subanalyses by child's source of ascertainment to assess the presence of ascertainment bias. In the main analyses, one marker of higher social class (higher median family income) was significantly associated with autism overall. Both markers of higher social class (higher maternal education and higher median family income) were significantly associated with autism/no MR, but not associated with autism/MR. In the subanalyses, associations with social class varied by ascertainment source. Future studies should consider phenotypic subgroups of children with autism and must consider potential ascertainment bias.     

Predictors of subjective well-being among individuals with multiple sclerosis

Neuropsychological and psychosocial predictors of subjective well-being (SWB) were examined among 74 persons with multiple sclerosis (MS). The multidimensional construct of SWB was assessed by self-report measures of acute psychological distress, global life satisfaction, and health-related quality of life (HRQoL). Objective disease-related indices were obtained from medical records and neuropsychological testing. Unawareness of deficit, a frequent aspect of executive function impairments in MS, was measured as the discrepancy between patient self-report of functional abilities and a caregiver's report of the patient's abilities. Results indicate that a substantial proportion of patients experienced diminished SWB and that disease characteristics such as duration and severity have differential relationships to SWB outcomes. Multiple regression analyses indicated that, in the context of a combined predictive model, social support and unawareness of deficit provided unique information in predicting all three aspects of SWB, beyond that accounted for by disease characteristics. Both social support and unawareness of deficit were associated with positive well-being outcomes. Neuropsychological impairment was adversely related to life satisfaction and HRQoL, but it did not add unique information to the prediction of these outcomes. The findings present a unique view of SWB among individuals with MS in the absence of acute exacerbation of the illness.     

Calcaneal fractures: what the surgeon needs to know

The calcaneus is an uncommonly fractured bone that plays a critical role in foot biomechanics, weight-bearing, and the ability to wear a shoe. The radiologist acts as a consultant during screening, operative planning, and follow-up imaging of these often complex injuries. Effective communication between radiologist and surgeon requires an understanding of calcaneal anatomy, goals of surgical reduction, and factors that affect patient management and outcomes. In the following pictorial review we will discuss radiologic screening/classification/characterization and their correlation with surgical management and patient morbidity.     

Efficacy of denileukin diftitox in subcutaneous panniculitis-like T-cell lymphoma

Subcutaneous panniculitis-like lymphomas (SPTCLs) are a heterogeneous group of diseases characterized by pleomorphic lymphocytes infiltrating the subcutis in a lobular panniculitis-like pattern. Characterization of SPTCL based on T-cell phenotype has prognostic significance in that most patients with the alpha/beta T-cell phenotype of SPTCL demonstrate clinically indolent behavior, whereas those with gamma/delta variant typically manifest more aggressive disease. In the past, traditional therapies have included single-agent or systemic multi-agent chemotherapy with or without radiation therapy, immunosuppressive therapies, or, in refractory patients, bone marrow transplantation. We describe complete clinical regression of disease and a median response duration of > 6 months in 2 patients with SPTCL treated with corticosteroids and denileukin diftitox. Furthermore, the addition of bexarotene to denileukin diftitox restored a clinical response in 1 of the patients after disease progression, suggesting the activity of this combination in patients with SPTCL.     

Vitamin D pathway gene polymorphisms,diet, and risk of postmenopausal breast cancer: a nested case-control study

Introduction  

Vitamin D receptor (VDR) polymorphisms have been inconsistently associated with breast cancer risk. Whether risk is influenced by polymorphisms in other vitamin D metabolism genes and whether calcium or vitamin D intake modifies risk by genotype have not been evaluated.     

Comparison of the microsatellite instability analysis system and the Bethesda panel for the determination of microsatellite instability in colorectal cancers

Microsatellite instability (MSI) analysis of colorectal cancers is clinically useful to identify patients with hereditary nonpolyposis colorectal cancer (HNPCC) caused by germline mutations of mismatch repair genes. MSI status may also predict cancer response/resistance to certain chemotherapies. We evaluated the MSI Analysis System (Promega Corp.; five mononucleotide and two pentanucleotide repeats) and compared the results to the Bethesda panel, which interrogates five microsatellite loci recommended by the 1997 National Cancer Institute-sponsored MSI workshop (three dinucleotide and two mononucleotide repeats). Thirty-four colorectal cancers were analyzed by both assays. The overall concordance between the two assays was 85% (29 of 34). There was complete concordance between the two assays for all of the MSI-high (11 of 11) and microsatellite stable (MSS; 18 of 18) cases. In the 11 MSI-high cases, all 5 of the mononucleotide loci in the MSI Analysis System demonstrated shifted alleles (100% sensitivity), and each shift resulted in products that were smaller in size than the germline alleles. All (5 of 5) of the cases interpreted as MSI-low by the Bethesda assay were interpreted as MSS by the MSI Analysis System. Our results suggest that the MSI Analysis System is generally superior and may help resolve cases of MSI-low into either MSI-high or MSS.     

Proteomics: applications relevant to transfusion medicine

With the completion of the human genome sequence, it is now possible to analyze the many individual components that comprise complex biologic systems. Despite this sequence data, understanding the biologic relationships of all proteins of a given cell or biologic sample (the proteome) is still an exceedingly difficult task. However, new technology developments mean that proteomics research can be used to investigate a variety of biologic systems. Already, these studies have given valuable insight for the development of improved diagnostic and therapeutic products. The present review aims to provide a basic understanding of proteomics research by discussing the methods used to study large numbers of proteins and by reviewing the application of proteomics methods to transfusion medicine.     

A multiplexed real-time PCR assay for rapid detection of Chlamydia trachomatis and identification of serovar L-2, the major cause of Lymphogranuloma venereum in New York

Lymphogranuloma venereum (LGV) is caused by a rare form of Chlamydia trachomatis that is difficult to diagnose, since culture is not readily available, and since other methods are not reliable or lack sensitivity. We report here a rapid, sensitive, and specific real-time multiplex polymerase chain reaction (PCR) assay capable of detecting C. trachomatis and identifying serovar L-2 in the same reaction, directly from rectal swabs. The analytical sensitivity of the assay was 25 genome copies for C. trachomatis, and 50 genome copies for L-2. The analytical specificity was 100%, as demonstrated with a diverse range of C. trachomatis serovars and other site-specific bacterial pathogens. With the use of a rapid DNA extraction method, a blinded validation of spiked rectal swabs correctly identified 30 samples containing C. trachomatis cells, L-2 DNA, or negative samples. The multiplexed PCR assay also identified serovar L-2 in 13 of 70 rectal swab samples taken from symptomatic patients. Twelve additional samples were positive for C. trachomatis only, and omp1 sequencing determined these samples as either serovar D, E, G, J, or K. This assay represents the first real-time PCR method capable of detecting C. trachomatis DNA, and of simultaneously identifying C. trachomatis infection as serovar L-2.     

Diverse faces of domestic violence.

Domestic violence is one of the most common causes of serious injury among women. Domestic violence victims endure physical and psychological sequelae that often go undetected by the health care professionals they encounter. There are many barriers women who are victims of domestic violence face. Women of color encounter additional barriers such as stereotypes that construct domestic violence as a "minority" issue. This article surveys the relevant literature to provide the reader with a review of the current state of knowledge for this special sub-population of domestic violence victims. Health care professionals need to be aware of the issues of this sub-population and be appropriately educated and trained to actively screen them. In addition, health care professionals need to be culturally sensitive to the needs of women of color who may experience domestic violence in order to appropriately screen and refer women for services that meet their needs.