Some Observations on Studying Therapists Instead of Treatment Packages

Some practical problems are highlighted with regard to studying the outcomes of individual therapists, including the long and inconsistent success in finding therapist variables that explain differential client treatment response. Research on the individual therapist makes it clear that considerable variability in outcome exists at the extreme ends of the normal distribution of therapist effects. Much less is known about the variability of client outcomes within specific therapists' clients. We encourage further research on therapist effects, but concede that such research is not likely to provide actionable information for routine clinical care. In the meantime, client treatment response needs to be monitored if positive outcomes are to be maximized.     

Cardiac magnetic resonance feature tracking of the right ventricle in convalescent Kawasaki disease in a large single center

BackgroundThe changes in right ventricular (RV) contractility of Kawasaki disease (KD) still remain unclear.HypothesisWe aimed to determine whether RV systolic dysfunction can be detected by cardiac magnetic resonance (CMR) feature tracking and to find its association with coronary artery lesions (aneurysm, thrombosis and stenosis).MethodsPeak systolic myocardial longitudinal, radial and circumferential strain and the strain rate (RVSL, RVSR, RVSC, RVSRL, RVSRR and RVSRC) in the global RV and three levels (basal, middle and apical) were measured in 66 patients with convalescent KD. A total of 20 controls were included. Comparisons were made with controls and among KD subgroups divided with coronary artery lesions.ResultsRVSC (−10.575% vs. −10.760%), RVSL (−18.150% vs. −18.712%) and RVSRC (−0.815/s vs. −0.924/s) were slightly lower in KD group without significant difference. All the strain and strain rate presented lowest in the basal level. In subgroup comparison, lower RVSL and RVSRL were observed in the giant coronary artery aneurysm (CAA) group; RVSR (15.844% vs. 16.897%), RVSRR (1.245/s vs. 1.322/s) and RVSRC (−0.715/s vs. −0.895/s) were lower in thrombosed group; RVSRL (−1.27/s vs. −1.503/s) were lower in stenosis group. All the comparison in subgroups did not reach significant difference. From the analysis of receiver operating characteristic curve, RVSRL had a better ability to identify KD with giant CAA and stenosis. For the identification of thrombosis, RVSRC had a better ability.ConclusionsLower strain and strain rates of RV were detected in convalescent KD. More pronounced in those with persisting coronary artery lesions.     

New approaches to understanding the immune response to vaccination and infection

The immune system is a network of specialized cell types and tissues that communicates via cytokines and direct contact, to orchestrate specific types of defensive responses. Until recently, we could only study immune responses in a piecemeal, highly focused fashion, on major components like antibodies to the pathogen. But recent advances in technology and in our understanding of the many components of the system, innate and adaptive, have made possible a broader approach, where both the multiple responding cells and cytokines in the blood are measured. This systems immunology approach to a vaccine response or an infection gives us a more holistic picture of the different parts of the immune system that are mobilized and should allow us a much better understanding of the pathways and mechanisms of such responses, as well as to predict vaccine efficacy in different populations well in advance of efficacy studies. Here we summarize the different technologies and methods and discuss how they can inform us about the differences between diseases and vaccines, and how they can greatly accelerate vaccine development.     

手足口病伴神经系统症状85例分析

目的：探讨手足口病伴早期神经系统症状患者的临床特征及结局。方法对85例手足口病住院病例的临床表现、实验室检查、治疗转归及病原学等资料进行分析,其中热性惊厥（FC）62例,占72.94%,HFMD重症早期（易惊、肢体抖动、嗜睡）23例,占27.06%。结果（1）FC组主要表现为在发热第一天出现1-3次抽搐,持续1-10分钟不等,发作停止后神志恢复正常,无阳性病理神经征,部分有既往史和家族惊厥史;重症早期组主要表现为病后3-4天出现易惊、肢体抖动、嗜睡,于治疗后1-3天正常,无阳性病理神经征。（2）两组发热及皮疹持续时间的差异均无明显统计学意义,P均＞0.05。（3）多数患者存在血白细胞、C反应蛋白、糖升高及低钠血症,部分有心肌酶谱升高、心电图异常,以FC组为主。（4）病原检测：EV71-RNA（+）45例（52.94%）,CoxA 16-RNA（+）19例（22.35%）,肠道病毒通用核酸（+）12例（14.12%）,余9例（10.59%）检测均阴性,无交叉阳性结果。（5）平均住院5.86±1.89天,随访均未见后遗症。结论早期识别HFMD伴神经系统症状患者的病情及病因,有助于指导治疗及判断预后。     

二维斑点追踪技术评估舒张性心力衰竭患者左室心肌收缩运动的价值

目的探讨二维斑点追踪技术(2D-STI)评价舒张性心力衰竭(DHF)患者左心室(左室)心肌收缩运动的价值。方法 30例DHF患者(A组)、30例DHF可疑患者(B组)及30例正常人(C组)行常规超声测量相关指标。应用2D-STI测量三组左室径向及纵向各18节段收缩期峰值应变。结果与C组比较,A、B组E/A降低,E/E′升高(P<0.05);与B组比较,A组E/A降低,E/E′升高(P<0.05)。A组所有节段径向及纵向收缩期峰值应变均低于C组(P<0.05)。A组部分节段径向及纵向收缩期峰值低于B组(P<0.05)。结论 2D-STI可作为一种无创性定量检测方法准确评价DHF患者左室心肌收缩运动。     

Flow cytometry evaluation of in vitro cellular necrosis and apoptosis induced by silver nanoparticles

Particles possess unique properties in the nanoscale, e.g., enhanced catalytic activity, high surface area, and light emission/absorption properties, that might result in interference with colorimetric in vitro cytotoxicity assays such as MTT, XTT or MTS. Alternatively, assays that do not use spectrophotometric detection, such as trypan blue exclusion or flow cytometry (FC) based assays, are less likely to be influenced by nanoparticle interference. The aim of this study was to evaluate FC assays to assess the cytotoxicity of three different sizes (10, 100, or 200 nm) of silver nanoparticles (AgNPs) at different mass concentrations (1, 25, or 50 ug/ml) in L-929 fibroblast cells. After 4 h and 24 h exposure, cell necrosis and apoptosis were assessed using 7-AAD and Annexin V dyes, respectively, with FC. The data indicate that cell necrosis and apoptosis in AgNP-exposed fibroblasts depends on dose, exposure time, and AgNP size. The data indicate that AgNPs produced a dose- and time-dependent decrease in cell viability; however, 10 nm AgNPs were significantly more toxic than larger-sized particles. Thus, standard FC assays can be utilized to assess apoptosis and necrosis in response to nanomaterial exposure.     

Additional Prognostic Value of 2D Right Ventricular Speckle-Tracking Strain for Prediction of Survival in Heart Failure and Reduced Ejection Fraction: A Comparative Study With Cardiac Magnetic Resonance

ObjectivesThis study sought to compare the prognostic value of 2-dimensional (2D) right ventricular (RV) speckle tracking (STE) against cardiac magnetic resonance (CMR) RV ejection fraction (EF) and feature tracking (FT) and conventional echocardiographic parameters on overall and cardiovascular (CV) survival in patients with heart failure with reduced EF (HFrEF).BackgroundPrior works showed that RV systolic function predicts prognosis in HFrEF. 2D RVSTE had recently been proposed as new echocardiographic method to evaluate RV dysfunction.MethodsA total of 266 patients with HFrEF (mean LVEF 23 ± 7%, 60 ± 14 years of age; 29% women) underwent RV function assessment using CMR and 2D echocardiography and were followed for a primary endpoint of overall death and secondary endpoint of CV death.ResultsAverage CMR-RVEF was 42 ± 15%, average STE RV global longitudinal strain (STE-RVGLS) was −18.0 ± 4.9%, and average CMR-FT-RVGLS was −11.8 ± 4.3%. After a median follow-up of 4.7 years, 102 patients died, 84 of a CV cause. RVEF, FT-RVGLS, tricuspid annulus plane systolic excursion (TAPSE), fractional area change (FAC), and STE-RVGLS were significant univariate predictors of overall and cardiac death. In multivariate Cox regression, age, ischemic etiology, diabetes, New York Heart Association functional class III to IV, and beta-blocker treatment were independent clinical predictors of overall mortality. CMR-RVEF (chi-square to enter = 3.9; p < 0.05), FT-RVGLS (chi-square to enter 3.7; p = 0.05), FAC (chi-square to enter 6.2; p = 0.02), and TAPSE (chi-square to enter = 4.1; p = 0.04) provided additional prognostic value over these baseline parameters, but the additional predictive value of STE-RVGLS (chi-square to enter = 10.8; p < 0.001) was significantly (p < 0.05) higher than the other tests. Additional hazard ratio to predict overall mortality was 2.5 (95% confidence interval [CI]: 1.6 to 3.9) for STE-RVGLS <−19%, 2.15 (95% CI: 1.34 to 3.43) for TAPSE >15 mm, 1.6 (95% CI: 1.02 to 2.49) for FAC >39%, 1.93 (95% CI: 1.25 to 2.99) for RVEF >41%, and 1.87 (95% CI: 1.10 to 3.19) for CMR-FT-RVGLS <−15%.Conclusions2D RVGLS provides strong additional prognostic value to predict overall and CV mortality in HFrEF, with higher predictive value than CMR-RVEF, CMR-FT-RVGLS, TAPSE, or FAC. This supports use of STE-RVGLS to identify higher-risk HFrEF patients.     

Modeling hybrid rough set-based classification procedures to identify hemodialysis adequacy for end-stage renal disease patients

Healthcare problems observed in the majority of end-stage renal disease (ESRD) patients regarding hemodialysis (HD) treatment are serious issues for the Taiwanese healthcare services, and an interesting topic is thus the adequacy of HD therapy. This study successfully models a hybrid procedure to measure HD adequacy to assess therapeutic effects and to explore the relationship between accuracy and coverage for interested parties. The proposed model has better accuracy, a lower standard deviation, and fewer attributes than the listed methods under various evaluation criteria. The study results are useful to subsequent researchers to develop suitable applications, and to ESRD patients and their doctors to ensure satisfactory medical quality.