A case of thyroid hormone resistance: Prospective follow-up during pregnancy and obstetric outcome

We describe the case of a patient with resistance to thyroid hormone (R243W substitution) and her obstetric outcome. The patient gave birth to a healthy girl, unaffected by the R243W mutation. Two years later, following an uneventful pregnancy, a baby boy was born at term; he presented the same thyroid hormone receptor mutation as his mother. Follow-up of gestational thyroid hormone levels is reported during both pregnancies and related to obstetric outcome.     

Trunk and upper extremity kinematics during sitting pivot transfers performed by individuals with spinal cord injury

BACKGROUND: Although reaching an optimal level of independence during sitting pivot transfer is crucial for individuals with spinal cord injury, little is known regarding the kinematic requirements of this functional task. METHODS: Ten males with spinal cord injury performed independent sitting pivot transfers between an initial seat and a target one placed at same (50 cm), lower (40 cm), and higher heights (60 cm) than the initial one, using their usual movement strategies. Three-dimensional trunk, shoulder, elbow and wrist kinematics were collected bilaterally during sitting pivot transfers. Each sitting pivot transfer was divided into three phases for analysis: pre-lift, lift-pivot and post-lift. Temporal parameters were also documented. FINDINGS: Peak shoulder extension displacement and velocities were always higher at the leading shoulder compared to the trailing one (P<0.004), and almost coincided with peak trunk velocities early during the lift phase. With increasing target seat height, shoulder flexion (P<0.011) and elbow extension (P<0.013) displacements and velocities of the trailing upper extremity augmented and reached higher values at this upper extremity compared to the leading upper extremity, with one exception at the shoulder. Elbows generally remained flexed (min=28-56 degrees ) during the lift phase of all transfers whereas extreme wrist extension positions (max=84-88 degrees ) were documented across all transfers. Total durations of transfers (2.6-2.8s) and lift-pivot phases (1.0-1.3s) were not affected by target seat heights. INTERPRETATION: Sitting pivot transfers are characterized by substantial angular displacements and velocities at the trunk and upper extremities. Some kinematic parameters documented during sitting pivot transfers may increase the risk of developing secondary musculoskeletal impairments in this population.     

Noninvasive prediction of organ graft rejection and outcome using gene expression patterns

Development of predictive, diagnostic, and prognostic biomarkers of allograft status and outcome is important and challenging, and may be rewarded with individualized therapy for the organ graft recipient. Herein, we summarize noninvasive messenger RNA profiling studies for ascertaining allograft status and outcome. Nucleic acid-based biomarkers of allograft status have been developed by several laboratories, but the studies have primarily been single center investigations. Ongoing multicenter trials including the Clinical Trials in Organ Transplantation (https://www.ctotstudies.org) should help further to define the clinical utility of noninvasively developed messenger RNA profiles as biomarkers of allograft status and outcome.     

Pericardial effusion coincident with sirolimus therapy: a review of Wyeth's safety database

Sirolimus is an immunosuppressive agent approved for prophylaxis of acute rejection in renal transplant patients aged 13 years or older. A retrospective review of pericardial effusion coincident with sirolimus therapy was conducted from key clinical trials and spontaneous reporting sources. A significantly higher rate of pericardial effusion occurred with sirolimus versus azathioprine treatment in a cardiac transplantation trial (28.6% versus 9.3%, respectively). Cases of pericardial effusion were also observed in the sirolimus treatment arms of three de novo renal transplant studies (rates 0.5 to 1.9%). Although most of the pericardial effusions occurred in cardiac transplantation, sirolimus is not approved for this use. As of January 31, 2007, the Wyeth safety database (which includes clinical trial data and spontaneous reports) contained reports of pericardial effusion in 56 sirolimus-treated patients, 31 of whom required pericardial drainage. These data suggest that pericardial effusion should be considered in the differential diagnosis of a clinical deterioration in posttransplant patients treated with sirolimus. The adverse reaction of pericardial effusion has been added to product labeling.     

Étalonnage de l’inventaire de croyances et perceptions associées à la douleur (ICPD)

This work aimed to realize standardization of the French version of the Pain Beliefs and Perception Inventory (PBPI): l’inventaire de croyances et de perceptions associées à la douleur (ICPD). In all, 448 chronic pain patients consulting in the Center of the Pain of the University Hospital of ‘La Timone’ (Marseille) completed the ICPD. Five classes including each 20% of the subjects were operated. Information is well summarized and the subjects all are also distinguished. The frequencies cumulated by class move away little from the theoretical cumulative frequencies. After calculation of the rough scores for each dimension, it is thus possible to locate a patient compared to the reference sample by using the classes. The ICPD has a real diagnostic value to evaluate in a multidimensional way the psychosocial experience of chronic pain. Complementary research is needed to evaluate its utility in the context of chronic pain patient care.