Low triiodothyronine: a new facet of inflammation in end-stage renal disease

Because inflammation influences thyroid function, it was hypothesized that low plasma free triiodothyronine (fT3) in ESRD may be an unsuspected expression of the inflammatory state of these patients. This study investigated (1) the steady-state relationship between fT3 and inflammation markers (IL-6 and C-reactive protein) and markers of endothelial activation (intercellular adhesion molecule-1 [ICAM-1] and vascular cellular adhesion molecule-1 [VCAM-1]) in 200 hemodialysis (HD) patients and (2) the effect of intercurrent acute inflammatory/infectious processes on plasma fT3 in a group of 17 patients with chronic kidney disease (CKD). HD patients displayed lower (P < 0.001) plasma fT3 than healthy subjects (n = 31) and clinically euthyroid patients with chronic diseases and normal renal function (n = 262). When HD patients were subdivided into IL-6 tertiles, fT3 was progressively lower across tertile increments (P < 0.001). Accordingly, regression analysis showed strong and inverse associations (P < or = 0.002) between fT3 and IL-6, C-reactive protein, ICAM-1, and VCAM-1, and, with the exception of the ICAM-fT3 relationship, these associations remained highly significant (P < or = 0.004) in multiple regression analyses adjusting for demographic variables, risk factors, and other potential confounders. In patients who had CKD and were studied during intercurrent inflammatory/infectious processes, fT3 was significantly lower (P = 0.008) at the zenith of inflammation than after its resolution. Low circulating fT3 is frequently observed in inflammatory illnesses, and the same association exists in patients with CKD and in ESRD. This association may entail a causal link because fT3 is acutely and reversibly suppressed in patients with CKD during inflammatory processes triggered by intercurrent infections.     

Routine chest X-ray after percutaneous tracheostomy is unnecessary

Percutaneous tracheostomy (PT) is an increasingly common procedure in the management of critically ill patients. Current practice for both open and percutaneous tracheostomies is a post-procedure chest X-ray to rule out potentially life-threatening complications such as a pneumothorax or tube malposition. Our study evaluated the utility of chest X-ray after PT. A retrospective chart review was conducted for patients undergoing PT at Kern Medical Center between January 1999 and December 2003. Charts were reviewed for age, sex, and clinical outcome as well as the radiologist's interpretation of the postprocedure chest X-ray. A total of 73 procedures were completed in 47 men and 26 women. The majority of the tracheostomies were in trauma patients who needed prolonged ventilatory support. There were no complications identified on postprocedure chest X-ray. A single patient was converted to an open procedure secondary to bleeding. We conclude that routine chest X-ray after PT is unnecessary.     

Links Between Parenting and Core Beliefs: Preliminary Psychometric Validation of the Young Parenting Inventory

This study describes the psychometric validation of the young parenting inventory (YPI), and tested specific hypotheses regarding the link between one’s experience of their parent’s behaviors and the development of schema-level core beliefs. The YPI is a measure of perceived parenting experiences, hypothesized to represent the origins of negative core beliefs. This preliminary validation consisted of analyses of factor structure, internal consistency, test–retest reliability, and construct validity. A large non-clinical student sample (N = 422) completed the YPI, and a subset also completed the Young Schema Questionnaire-Short form (YSQ-S). Factor analyses demonstrated that a shorter version of the questionnaire (YPI-R) could be developed to represent coherent and meaningful perceptions of each parent. The YPI-R consists of nine scales. Each scale had good test–retest reliability and adequate internal consistency. Significant associations between the YPI-R scales and negative core beliefs (as measured by the YSQ-S) indicated partial construct validity. At this preliminary stage, it can be concluded that the YPI-R has an acceptable level of psychometric utility. However, the hypothesized parenting-negative core belief links were not all substantiated.     

Transient facial nerve paralysis after mandibular sagittal osteotomy

Facial nerve injuries are rare complications after orthognathic surgery. A literature review shows that such damages can develop with various mechanisms and are usually transient. Two cases of delayed facial paralysis after mandibular osteotomy with spontaneous recovery are reported.     

Myoepithelioma of the tongue

Soft tissue myoepitheliomas, in contrast to salivary gland myoepitheliomas, are benign neoplasms that typically occur in the soft tissues of the extremities. Both are characterized by a multilobular proliferation of polygonal to fusiform cells embedded in a variably myxoid to chondromyxoid matrix. A histologically similar lesion that has a marked predilection for the anterior dorsum of the tongue has been referred to as ectomesenchymal chondromyxoid tumor. The morphological and immunohistochemical resemblance of soft tissue myoepitheliomas to ectomesenchymal chondromyxoid tumors has led to the use of these designations interchangeably. We present a case of myoepithelioma of the tongue and review the literature, with emphasis on the differential diagnosis and histogenesis of this lesion and pertinent nosologic considerations.     

Procalcitonin is useful whereas C-reactive protein is not, to predict complications following coronary artery bypass surgery

BACKGROUND: The respective value of procalcitonin (PCT) and C-reactive protein (CRP) as markers of postoperative complications after coronary bypass surgery is unclear. Therefore, complications during one week after surgery were studied to evaluate the predictive role of PCT and CRP changes during the immediate postoperative period. METHODS: Thirty-two patients, in whom an uneventful immediate postoperative course was anticipated, were prospectively enrolled and followed-up to the 7th postoperative day. At the end of the follow-up, patients were divided into two groups. Group A were patients with an uncomplicated postoperative course and Group B were patients with a complicated postoperative course. RESULTS: Serum samples were drawn for PCT and CRP determination after induction of anesthesia (baseline), at the end of surgery and daily until postoperative day 2. Baseline serum PCT concentrations were 0.11 +/- 0.09 and 0.20 +/- 0.21 ng/mL in Groups A and B, respectively (NS). Serum PCT concentration increased compared with baseline in both groups during the first two days after surgery. The increase in serum PCT concentration was significantly greater in Group B than A patients (p < 0.0002). Considering a perioperative abnormal cut-off value of >0.5 ng/mL, there were none in Group A versus 57% in Group B (p < 0.0001). Baseline serum CRP concentrations were 1.44 +/- 1.30 and 1.58 +/- 1.35 ng/mL in Groups A and B, respectively (NS). After surgery, CRP increased significantly compared with baseline in both groups. When changes in time-varying variables were included in a logistic model, complications were predicted by changes (between baseline and end of surgery values) of PCT (coefficient = 9.410; t = 2.18) and heart rate (coefficient = 0.075; t = 1.57), whereas changes of CRP, white blood cells, mean blood and central venous pressures did not contribute statistically. The model constant was -4.827 (t = -2.43) and the ROC curve area was 0.8971. Thus, absolute PCT changes of 0.20, 0.40 and 0.60 ng/mL carry an approximate risk of 5, 26 and 69%, respectively, of postoperative complications in the time frame of this study. CONCLUSIONS: A postoperative serum PCT concentration of >0.5 ng/mL is highly suggestive of a postoperative complication. CRP changes do not contribute to predictive information.     

Looking at the heart of low and high heart rate variability fearful flyers: self-reported anxiety when confronting feared stimuli

Previous research has shown that phobic subjects with low heart rate variability (HRV) are less able to inhibit an inappropriate response when confronted with threatening words compared to phobic subjects with high HRV [Johnsen, B.H., Thayer, J.F., Laberg, J.C., Wormnes, B., Raadal, M., Skaret, E., et al., 2003. Attentional and physiological characteristics of patients with dental anxiety. Journal of Anxiety Disorders, 17, 75–87]. The aim of this study was to evaluate changes in self-reported anxiety when low HRV and high HRV fearful flyers (N = 15) and a matched control group (N = 15) were exposed to flight-related pictures, flight-related sounds or both pictures and sounds. We hypothesized that sounds would be crucial to evoke fear. Also, low HRV fearful flyers were expected to report higher anxiety than high HRV fearful flyers assuming anxiety as their inappropriate response. Decreases on HRV measures were also predicted for a subgroup of phobic participants (N = 10) when confronted with the feared stimuli. Our data supported the hypothesis that sounds are crucial in this kind of phobia. Low HRV fearful flyers reported higher anxiety than high HRV fearful flyers in two out of three aversive conditions. The predicted HRV decreases were not found in this study. Results are discussed in the context of avoidance of exposure-based treatments.     

Analytical assessment of MALDI-TOF Imaging Mass Spectrometry on thin histological samples. An insight in proteome investigation

BACKGROUND: The development of MALDI Imaging Mass Spectrometry is a promising technique in the investigation of biological molecular repertoire. We have pursued an analytical assessment of this technique in its application to proteome analysis. METHODS: A specific statistical method of analysis has been developed to enable data processing in the absence of internal standards, by defining similarity scores. RESULTS: The investigated linear mode MALDI-TOF set-up allows to obtain data variations comprised within the 30% of variation when assaying tissues samples from the same animal, while the 60% of variation was highlighted in the inter-mice series assaying syngenic animals. CONCLUSIONS: This analytical assessment represents the first step of a process that should validate the utilisation of this technique in the clinical practice.