Cover Image,Volume 80, Issue 3

Primary dysmenorrhea affects the quality of life in young women, particularly school and work performance. This study investigated the mechanisms of penehyclidine hydrochloride (PHC) efficacy on a rat model of primary dysmenorrhea. The model was induced by injecting both estradiol benzoate and oxytocin. Different doses of PHC were administrated intraperitoneally following estradiol benzoate administration. Writhing scores were assessed, and pathological changes of the uterus were observed via hematoxylin and eosin staining. Western blot and real-time PCR were used to evaluate the expression level of the M₃ receptor, both TLR₃ and TLR₄ in uterine tissue, and the level of Ca²⁺ was measured in uterine tissues. Writhing scores significantly decreased in the PHC treatment group compared to model, and PHC alleviated the occurrence of edema or necrosis in the uteri compared to model group. PHC can decrease the M₃ receptor, TLR₃, TLR₄ expression, and the Ca²⁺ level compared to the model group. PHC is a potential candidate for the future treatment of primary dysmenorrhea due to its ability to attenuate muscarinic receptors and TLRs.

National Early Warning Score Is Modestly Predictive of Care Escalation after Emergency Department-to-Floor Admission

BackgroundDecompensation on the medical floor is associated with increased in-hospital mortality.ObjectiveOur aim was to determine the accuracy of the National Early Warning Score (NEWS) in predicting early, unplanned escalation of care in patients admitted to the hospital from the emergency department (ED) compared to the Shock Index (SI) and the quick Sepsis-Related Organ Failure Assessment (qSOFA) score.MethodsWe conducted a retrospective cohort study of patients admitted directly from the ED to monitored or unmonitored beds (November 9, 2015 to April 30, 2018) in 3 hospitals. Interhospital transfers were excluded. Patient data, vital status, and bed assignment were extracted from the electronic medical record. Scores were calculated using the last set of vital signs prior to leaving the ED. Primary endpoint was in-hospital death or placement in an intermediate or intensive care unit within 24 h of admission from the ED. Scores were compared using the area under the receiver operating curve (AUROC).ResultsOf 46,018 ED admissions during the study window, 39,491 (85.8%) had complete data, of which 3.7% underwent escalation in level of care within 24 h of admission. NEWS outperformed (AUROC 0.69; 95% confidence interval [CI] 0.68–0.69) qSOFA (AUROC 0.63; 95% CI 0.62–0.63; p < 0.001) and SI (AUROC 0.60; 95% CI 0.60–0.61; p < 0.001) at predicting unplanned escalations or death at 24 h.ConclusionsThis multicenter study found NEWS was superior to the qSOFA score and SI in predicting early, unplanned escalation of care for ED patients admitted to a general medical-surgical floor.     

WAIS-III VIQ–PIQ and VCI–POI Discrepancies in Lateralized Cerebral Damage

We evaluated Verbal IQ (VIQ)–Performance IQ (PIQ) and Verbal Comprehension Index (VCI)–Perceptual Organization Index (POI) discrepancies among 16 patients with right-sided and 20 with left-sided cerebral lesions. Means for age and education among left hemisphere-damaged patients were 46.25 years (SD = 17.42) and 12.17 years (SD = 2.87). Means and standard deviations for age and education were 47.86 years (SD = 16.83) and 12.27 years (SD = 2.46) for those with right-sided damage. Left hemisphere lesions produced nonsignificant VIQ < PIQ and VCI < POI means, whereas right hemisphere damage resulted in significant VIQ > PIQ and VCI > POI mean discrepancies. Additional analyses indicated that neither discrepancy score was effective in identifying lateralized brain damage.     

Tiempo de isquemia caliente y complicaciones postoperatorias después de la nefrectomía parcial por carcinoma de células renales

ObjectiveTo evaluate the correlations between PADUA and RENAL scores, WIT and postoperative complications in a cohort of patients who underwent elective open or minimally invasive nephron sparing surgery for renal cell carcinoma.Material and methodsWe analyzed 96 consecutive patients who underwent partial nephrectomy for renal cell carcinoma between 2004 and 2013 at our Institution. The Spearman test was used to compare categorical variables. For all statistical analyses, a two-sided P < .05 was considered statistically significant.ResultsThe median (IQR) PADUA score was 7 (7-8) and the median (IQR) RENAL score was 7 (6-8). The median (IQR) warm ischemia time was 14 min (8-20). Low grade and high grade postoperative complications were found in 27 (28.1%) and 6 (6.3%) patients, respectively. PADUA risk group categories significantly correlated with WIT > 20 minutes and high grade postoperative complications, respectively (P = .04), regardless of the surgical approach. RENAL risk group categories significantly predicted longer hilar clamping time in our cohort (P = .04), but no statistically significant correlations with high grade postoperative complications were found.ConclusionsIn our retrospective series nephrometric scores demonstrated to significantly predict longer warm ischemia time and higher postoperative complications, especially in those patients with more challenging and complex renal tumors. Therefore, when planning to perform partial nephrectomy, urologists should widely use these comprehensive tools.     

The utility of the Mattis Dementia Rating Scale in Parkinson's disease mild cognitive impairment

BackgroundThe Movement Disorders Society (MDS) recently proposed guidelines for diagnosis of mild cognitive impairment in Parkinson's disease (PD-MCI) that includes two assessment levels: abbreviated (Level I) and comprehensive (Level II). The aim of this study was to determine the utility of the Mattis Dementia Rating Scale (MDRS), a recommended Level I test, for detecting Level II PD-MCI diagnosis.MethodsThe study sample included 30 patients diagnosed with PD-MCI based on Level II MDS criteria and 68 PD patients with normal cognition (PD-NC). Receiver operator curve (ROC) analyses were generated to measure the sensitivity and specificity of various MDRS cutoff scores. To examine the utility of the MDRS as a screening tool, the optimal cutoff point was defined as the lowest value providing ≥80% sensitivity. For use of the MDRS as a diagnostic tool, the optimal cutoff point was defined as the highest value providing ≥80% specificity.ResultsROC analyses showed that the optimal MDRS cutoff score for screening purposes and diagnostic purposes were ≤140 and ≤137, respectively. However, an examination of sensitivity/specificity values for the screening cutoff scores suggested that a total score of ≤139 for screening purposes yielded a better balance between sensitivity (77%) and specificity (65%).ConclusionsIn a clinical setting, in which detection of PD-MCI may be important, a total MDRS score of ≤139 can be used to detect PD-MCI. In research and other settings in which diagnostic certainty is more important, a score of ≤137 may be more useful.     

Physiological effects of brominated flame retardants on NC/Nga mice

Purpose: Brominated flame retardants (BFRs) are used as an additive or reactive components in various materials. Regarding their health concerns, their immunotoxicity have not been clarified yet.

Materials and methods: In the current study, we examined the effects of systemic exposure to two types of BFRs, DE71 and DE79, on pathophysiologic traits of murine atopic dermatitis (AD). Male NC/Nga mice were repeatedly injected intraperitoneally with DE71 and DE79 and/or mite allergen (Dermatophagoides pteronyssinus: Dp) into their right ears. Thereafter, clinical scores, macroscopic findings of inflammatory foci, and Ig values in serum were examined.

Results: Both DEs significantly aggravated clinical scores induced by mite allergen including skin dryness and edema. Total IgE titer was significantly greater in the Dp?+?DE79 group than in the Dp group.

Conclusions: Taken together, exposure to BFRs can exacerbate AD-like skin lesions related to mite allergen in mice. The accentuating effects may be mediated, at least in part, through hyperproduction of IgE.     

Effects of testing style on language scores of four‐year‐old low‐income ‘control’ children in intervention projects 1

Language scores on the Illinois Test of Psycholinguistic Achievement (ITPA) attained by untreated disadvantaged four year olds were examined as a function of project testing style. In the Family Development Research Program (FDRP) an optimal testing style maximized child comfort, and permitted multiple visits to complete assessment. Despite the level of poverty and disadvantage of the preschoolers, FDRP children were significantly more likely than preschoolers from other intervention projects to achieve normal and near normal scores on subtests of ITPA.

Implicationsas of differences in testing style for understanding program effectiveness are drawn and suggestions are given for maximizing children's test performance.