Syncope and Structural Heart Disease: Historical Criteria for Vasovagal Syncope and Ventricular Tachycardia

Syncope and Structural Heart Disease. Introduction: To develop evidence‐based criteria that distinguish syncope due to ventricular tachycardia (VT) from vasovagal syncope (VVS) in patients with structural heart disease (SHD). Methods and Results: One hundred and thirty‐four patients with syncope and SHD completed a 118‐item questionnaire and underwent noninvasive and invasive diagnostic assessments in a prospective cohort study. The contributions of symptoms to diagnoses were estimated with logistic regression and a point score was developed and then tested using receiver‐operator characteristic analysis. The effectiveness of the decision rule was evaluated with long‐term outcome. There were 21 patients with tilt‐positive VVS, 78 with clinically declared or inducible VT, and 35 with no identified cause of syncope. Six features were significant predictors. Factors that predicted VT included male sex and age at onset >35 years; factors predicting VVS included prolonged sitting or standing; developing presyncope preceded by stress; recurrent headaches; and experiencing fatigue, which lasts longer than 1 minute after syncope. The point score correctly classified 92% of patients, diagnosing VT with 99% sensitivity and 68% specificity. The negative predictive value is ≥96%. Fully 67% of patients with undiagnosed syncope were classified as having VT based upon their symptoms. The decision rule predicted 9‐year arrhythmia‐free survival (VVS 84%, VT 39%, hazard ratio 4.32) and 9‐year overall survival (VVS 66%, VT 37%, hazard ratio 2.87). Conclusions: The causes of syncope in patients with SHD, and their clinical outcomes, can be estimated accurately based on the clinical history. The history safely screens out the possibility of VT as a cause of syncope. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1358‐1364, December 2010)     

高效液相色谱法测定抗菌消炎片中绿原酸、黄芩苷、黄芩素和大黄酚的含量

目的:采用高效液相色谱法测定抗菌消炎片中绿原酸、黄芩苷、黄芩素和大黄酚的含量.方法:抗菌消炎片去包衣粉末用50%甲醇超声提取30 min;色谱柱为Agilen Eclipse Plus-C18柱(4.6 mm×250 mm,5 μm);流动相:A相为0.1%磷酸水溶液,B相为甲醇,C相为乙腈,梯度洗脱;流速:0.8 ml/min;温度:30℃;进样量:10 μl;检测波长:254 nm.结果:绿原酸、黄芩苷、黄芩素和大黄酚4种成分在45 min内基线分离.峰面积(Y)对浓度(X)的标准曲线分别为:绿原酸 Y=12.89X-12.66,r=0.999 9;黄芩苷 Y=13.96X-1.013,r=1.0;黄芩素 Y=35.82X-4.923,r=0.999 9;大黄酚 Y=44.16X-3.280,r=0.999 9.方法学考察表明,日内及日间精密度、最低检测限均符合相关标准,加样回收率分别为(n=3):绿原酸101.5%(RSD=1.6%);黄芩苷103.4%(RSD=1.4%);黄芩素99.3%(RSD=2.0%);大黄酚98.1%(RSD=1.7%).结论:采用高效液相色谱法同时测定抗菌消炎片中绿原酸、黄芩苷、黄芩素和大黄酚的含量,样品处理简便,测定结果准确,可用于该制剂的质量控制.     

An Embryonic Staging Table for In Ovo Development of Eublepharis macularius,the Leopard Gecko

Squamates constitute a major vertebrate radiation, representing almost one‐third of all known amniotes. Although speciose and morphologically diverse, they remain poorly represented in developmental studies. Here, we present an embryonic staging table of in ovo development for the basal gekkotan Eublepharis macularius (the leopard gecko) and advocate this species as a laboratory‐appropriate developmental model. E. macularius, is a hardy and tractable species of relatively large body size (with concomitantly relatively large eggs and embryos), that is widely available and easy to maintain and propagate. Additionally, E. macularius displays a body plan appropriate to the study of the plesiomorphic quadrupedal condition of early pentadactylous terrestrial amniotes. Although not unexpected, it is worth noting that the morphological events characterizing limb development in E. macularius are comparable with those described for the avian Gallus gallus. Therefore, E. macularius holds great promise as a model for developmental studies focusing on pentadactyly and the formation of digits. Furthermore, it is also attractive as a developmental model because it demonstrates temperature‐dependent sex determination. The staging table presented herein is based on an all‐female series and represents the entire 52 day in ovo period. Overall, embryogenesis of E. macularius is similar to that of other squamates in terms of developmental stage attained at the time of oviposition, patterns of limb and pharyngeal arch development, and features of the appearance of scalation and pigmentation, indicative of a conserved developmental program. Anat Rec, 292:1198–1212, 2009. © 2009 Wiley‐Liss, Inc.     

Contingency management for treatment of substance use disorders: a meta-analysis

AIMS: To examine the effectiveness of contingency management (CM) techniques in treating substance use disorders (i.e. illicit drugs, alcohol, tobacco). DESIGN: Meta-analysis was used to determine the average effect size and potential moderators in 47 comparisons of the effectiveness of CM from studies based on a treatment-control group design and published between 1970 and 2002. FINDINGS: The mean effect size (ES) of CM was positive, with a magnitude of d = 0.42 using a fixed effects model. The magnitude of the ES declined over time, following treatment. CM was more effective in treating opiate use (d = 0.65) and cocaine use (d = 0.66), compared with tobacco (d = 0.31) or multiple drugs (d = 0.42). Larger effect sizes were associated with higher researcher involvement, earlier studies and shorter treatment duration. CONCLUSIONS: Study findings suggest that CM is among the more effective approaches to promoting abstinence during the treatment of substance use disorders. CM improves the ability of clients to remain abstinent, thereby allowing them to take fuller advantage of other clinical treatment components.     

A meta-analysis of voucher-based reinforcement therapy for substance use disorders

AIMS: To systematically investigate the effectiveness of voucher-based reinforcement therapy for the treatment of substance use disorders. METHODS: Effect sizes and 95% confidence intervals were calculated for studies published between January 1991 and March 2004 that utilized voucher-based reinforcement therapy (VBRT) or related monetary-based incentives to treat substance use disorders (SUDs). FINDINGS: Thirty studies involved interventions targeting abstinence from drug use using experimental designs where effects on treatment outcome could be attributed to the VBRT intervention. The estimated average effect size (r) for those studies was 0.32 (95% CI 0.26-0.38). Analyses of variables thought to moderate VBRT effect sizes revealed that more immediate voucher delivery and greater monetary value of the voucher were associated with larger effect sizes. Additional studies were identified wherein VBRT was used to target clinic attendance (n = 6) or medication compliance (n = 4). VBRT studies targeting attendance produced average effect sizes of 0.15 (95% CI 0.02-0.28), while those that targeted medication compliance produced an average effect of 0.32 (95% CI 0.15-0.47). No significant moderators were identified for these 10 studies. CONCLUSIONS: Overall, VBRT generated significantly better outcomes than did control treatments. These results further support the efficacy of VBRT, quantify the magnitude of its effects, identify significant moderators and suggest potential directions for future research.     

Drug users’ adherence to a 6-month vaccination protocol: Effects of motivational incentives

Vaccines represent a new and promising avenue of treatment for drug abuse but pose new medication adherence challenges due to prolonged and widely spaced administration schedules. This study examined effects of prize-based incentives on retention and medication adherence among 26 cocaine users involved in a 6-month hepatitis B vaccination series. Participants could meet with research staff weekly for 24 weeks and receive 7 injections containing either the Hepatitis B vaccine or a placebo. All participants received $10 at each weekly visit (maximum of $240). Those randomly assigned to the incentive program received additional monetary payments on an escalating schedule for attendance at weekly monitoring and vaccination visits with maximum possible earnings of $751. Group attendance diverged after study week 8 with attendance better sustained in the incentive than control group (group by time interaction, p = .035). Overall percent of weekly sessions attended was 82% for incentive versus 64% for control (p = .139). Receiving all scheduled injections were 77% of incentive versus 46% of control participants (p = .107). A significantly larger percentage (74% versus 51%; p = .016) of injections were received by incentive versus control participants on the originally scheduled day. Results suggest that monetary incentives can successfully motivate drug users to attend sessions regularly and to receive injected medications in a more reliable and timely manner than may be seen under usual care procedures. Thus, incentives may be useful for addressing adherence and allowing participants to reap the full benefits of newly developed medications.     

Resets do not appear to increase the rate of adverse events or prolong relapse in voucher-based reinforcement therapy

Voucher-based reinforcement therapy (VBRT) is an efficacious contingency management intervention for substance use disorders that provides escalating voucher values to reinforce continuous abstinence and typically resets escalated values to the initial low level upon detection of drug use. The objective of this study involving 130 methadone-maintained outpatients receiving VBRT was to investigate whether resets (a) increase risk for adverse events (AEs) and (b) delay return to abstinence in relation to magnitude of voucher reset. Weeks following resets were examined for increased likelihood of AEs using a Poisson regression. A Cox proportional hazards model was used to determine if higher resets increased the number of days until a negative urine specimen. Results showed that resets did not increase the likelihood of AEs nor were higher resets related to an increased delay to abstinence. Research involving larger samples is needed to produce sufficient data directly addressing safety concerns of various treatment stakeholders.     

配对四格表的一致性检验

给出了一种对配对四格表进行一致性检验的检验方法。     

The mindedness of maternal touch: An investigation of maternal mind-mindedness and mother-infant touch interactions

Increasing evidence shows that maternal touch may promote emotion regulation in infants, however less is known about how parental higher-order social cognition abilities are translated into tactile, affect-regulatory behaviours towards their infants. During 10 min book-reading, mother-infant sessions when infants were 12 months old (N = 45), we investigated maternal mind-mindedness (MM), the social cognitive ability to understand an infant’s mental state, by coding the contingency of maternal verbal statements towards the infants’ needs and desires. We also rated spontaneous tactile interactions in terms of their emotional contingency. We found that frequent non-attuned mind-related comments were associated with touch behaviours that were not contingent with the infant’s emotions; ultimately discouraging affective tactile responses from the infant. However, comments that were more appropriate to infant’s mental states did not necessarily predict more emotionally-contingent tactile behaviours. These findings suggest that when parental high-order social cognitive abilities are compromised, they are also likely to translate into inappropriate, tactile attempts to regulate infant’s emotions.     

Staining Correction in Digital Pathology by Utilizing a Dye Amount Table

The stained colors of the tissue components are popularly used as features for image analysis. However, variations in the staining condition of the histology slides prompt variations to the color distribution of the stained tissue samples which could impact the accuracy of the analysis. In this paper, we present a method to correct the staining condition of a histology image. In the method, a look-up table (LUT) based on the dye amounts absorbed by the sample is built. The LUT can be built when either (i) the source and reference staining conditions are specified or (ii) when the user simply wants to recreate his/her preferred staining condition without specifying any reference slide. The effectiveness of the present method was evaluated in two aspects: (i) CIELAB color difference of nuclei, cytoplasm, and red blood cells, between the ten different slides of liver tissue, and (ii) classification of the different tissue components. Application of the present staining correction method reduced the color difference between the slides by an average factor of 9.8 and the classification performance of a linear discriminant classifier improved by 16.5 % on the average. Results of the paired t test statistical analysis further showed that the reduction in the CIELAB color difference between the slides and the improvement in the classifier’s performance when staining correction was implemented is significant at p < 0.001.