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Sample records for clinically important differences

  1. Brief pain inventory--facial minimum clinically important difference.

    Science.gov (United States)

    Sandhu, Sukhmeet K; Halpern, Casey H; Vakhshori, Venus; Mirsaeedi-Farahani, Keyvan; Farrar, John T; Lee, John Y K

    2015-01-01

    Neurosurgeons are frequently the primary physicians measuring pain relief in patients with trigeminal neuralgia (TN). Unfortunately, the measurement of pain can be complex. The Brief Pain Inventory-Facial (BPI-Facial) is a reliable and validated multidimensional tool that consists of 18 questions. It measures 3 domains of pain: 1) pain intensity (worst and average pain intensity), 2) interference with general activities of daily living (ADL), and 3) face-specific pain interference. The objective of this paper is to determine the patient-reported minimum clinically important difference (MCID) using the BPI-Facial. The authors conducted a retrospective study of 234 patients with TN seen in a single neurosurgeon's office. Patients completed baseline and 1-month follow-up BPI-Facial questionnaires. The MCID was calculated using an anchor-based approach in which the defined anchor was the 7-point patient global impression of change (PGIC). Two statistical methods were employed: mean change score and optimal cutoff point. Using the mean change score method, the investigators calculated the MCID for the 3 domains of the BPIFacial: 44% and 30% improvement in pain intensity at its worst and average, respectively, 54% improvement in interference with general ADL, and 63% improvement in interference with facial ADL. Using the optimal cutoff point method, they also calculated the MCID for the 3 domains of the BPI-Facial: 57% and 28% improvement in pain intensity at its worst and average, respectively, 75% improvement in interference with general ADL, and 62% improvement in interference with facial ADL. The BPI-Facial is a multidimensional pain scale that measures 3 domains of pain. Although 2 statistical methods were used to calculate the MCID, the optimal cutoff point method was the superior one because it used data from the majority of subjects included in this study. A 57% improvement in pain intensity at its worst and a 28% improvement in pain intensity at its average were

  2. Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations.

    Science.gov (United States)

    Dworkin, Robert H; Turk, Dennis C; McDermott, Michael P; Peirce-Sandner, Sarah; Burke, Laurie B; Cowan, Penney; Farrar, John T; Hertz, Sharon; Raja, Srinivasa N; Rappaport, Bob A; Rauschkolb, Christine; Sampaio, Cristina

    2009-12-01

    An essential component of the interpretation of results of randomized clinical trials of treatments for chronic pain involves the determination of their clinical importance or meaningfulness. This involves two distinct processes--interpreting the clinical importance of individual patient improvements and the clinical importance of group differences--which are frequently misunderstood. In this article, we first describe the essential differences between the interpretation of the clinical importance of patient improvements and of group differences. We then discuss the factors to consider when evaluating the clinical importance of group differences, which include the results of responder analyses of the primary outcome measure, the treatment effect size compared to available therapies, analyses of secondary efficacy endpoints, the safety and tolerability of treatment, the rapidity of onset and durability of the treatment benefit, convenience, cost, limitations of existing treatments, and other factors. The clinical importance of individual patient improvements can be determined by assessing what patients themselves consider meaningful improvement using well-described methods. In contrast, the clinical meaningfulness of group differences must be determined by a multi-factorial evaluation of the benefits and risks of the treatment and of other available treatments for the condition in light of the primary goals of therapy. Such determinations must be conducted on a case-by-case basis, and are ideally informed by patients and their significant others, clinicians, researchers, statisticians, and representatives of society at large.

  3. Are gender differences important for the clinical effects of antidepressants?

    DEFF Research Database (Denmark)

    Hildebrandt, Malene Grubbe; Steyerberg, Ewout Willem; Stage, Kurt Bjerregaard;

    2003-01-01

    OBJECTIVE: Gender differences in antidepressant treatment response, side effects, dropout rates, and plasma concentrations were examined in patients with major and predominantly melancholic depression. METHOD: The study included a subgroup of 292 inpatients (96 men, 196 women) from three Danish d...

  4. Minimal clinically important difference in radiological progression of joint damage. A definition based on patient perspective.

    NARCIS (Netherlands)

    Welsing, P.M.J.; Borm, G.F.; Riel, P.L.C.M. van

    2006-01-01

    OBJECTIVE: To estimate a threshold for minimal clinically important radiological progression of joint damage using its longitudinal relation with functional disability in patients with rheumatoid arthritis (RA). To validate existing estimates of minimal clinically important difference (MCID) using

  5. Health status instruments for patients with COPD in pulmonary rehabilitation: defining a minimal clinically important difference

    OpenAIRE

    Alma, Harma; Jong, Corina de; Jelusic, Danijel; Wittmann, Michael; Schuler, Michael; Blok, Bertine Flokstra-de; Kocks, Janwillem; Schultz, Konrad; van der Molen, Thys

    2016-01-01

    The minimal clinically important difference (MCID) defines to what extent change on a health status instrument is clinically relevant, which aids scientists and physicians in measuring therapy effects. This is the first study that aimed to establish the MCID of the Clinical chronic obstructive pulmonary disease (COPD) Questionnaire (CCQ), the COPD Assessment Test (CAT) and the St George’s Respiratory Questionnaire (SGRQ) in the same pulmonary rehabilitation population using multiple approache...

  6. Inflammation: an important mechanism for different clinical entities of coronary artery diseases

    Institute of Scientific and Technical Information of China (English)

    LI Jian-jun

    2005-01-01

    @@ Although atherosclerosis has been considered to be multi-factorial disease in which genetic, environmental, metabolic factors have been implicated, the gaps remain in our knowledge of the etiopathogenesis of atherosclerosis. There is mounting evidence that inflammation plays an important role in the initiation, development as well as evolution of atherosclerosis, suggesting that atherosclerosis is an inflammation disease.1,2 Although triggers and pathways of inflammation are probably multiple and different in different clinical settings, the data from animals as well as humans including our groups indicated that an inflammatory process was involved in all stages of atherosclerosis appeared in different clinical entities.

  7. Outcome tools used for ambulatory children with cerebral palsy: responsiveness and minimum clinically important differences

    OpenAIRE

    Oeffinger, D; Bagley, A; Rogers, S.; Gorton, G; Kryscio, R; Abel, M.; Damiano, D; Barnes, D.; Tylkowski, C

    2008-01-01

    This prospective longitudinal multicenter study of ambulatory children with cerebral palsy (CP) examined changes in outcome tool score over time, tool responsiveness, and used a systematic method for defining minimum clinically important differences (MCIDs). Three hundred and eighty-one participants with CP (Gross Motor Function Classification System [GMFCS] Levels I–III; age range 4–18y, mean age 11y [SD 4y 4mo]; 265 diplegia, 116 hemiplegia; 230 males, 151 females). At baseline and follow-u...

  8. Minimal Clinically Important Difference of Patient Reported Outcome Measures of Lower Extremity Injuries in Orthopedics

    Science.gov (United States)

    Çelik, Derya; Çoban, Özge; Kılıçoğlu, Önder

    2017-01-01

    Purpose: MCID scores for outcome measures are frequently used evidence-based guides to gage meaningful changes. To conduct a systematic review of the quality and content of the the minimal clinically important difference (MCID) relating to 16 patient-rated outcome measures (PROM) used in lower extremity. Methods: We conducted a systematic literature review on articles reporting MCID in lower extremity outcome measures and orthopedics from January 1, 1980, to May 10, 2016. We evaluated MCID of the 16 patient reported outcome measures (PROM) which were Harris Hip Score (HHS), Oxford Hip Score (OHS), Hip Outcome Score (HOS), Hip Disability and Osteoarthritis Outcome Score (HOOS), The International Knee Documentation Committee Subjective Knee Form (IKDC), The Lysholm Scale, The Western Ontario Meniscal Evaluation Tool (WOMET), The Anterior Cruciate Ligament Quality of Life Questionnaire (ACL-QOL), The Lower Extremity Functional Scale (LEFS), The Western Ontario and Mcmaster Universities Index (WOMAC), Knee İnjury And Osteoarthritis Outcome Score (KOOS), Oxford Knee Score (OKS), Kujala Anterior Knee Pain Scale, The Victorian Institute of Sports Assessment Patellar Tendinosis (Jumper’s Knee) (VİSA-P), Tegner Activity Rating Scale, Marx Activity Rating Scale, Foot And Ankle Outcome Score (FAOS), The Foot Function Index (FFI), Foot And Ankle Ability Measure (FAAM), The Foot And Ankle Disability Index Score and Sports Module, Achill Tendon Total Rupture Score(ATRS), The Victorian İnstitute Of Sports Assesment Achilles Questionnaire(VİSA-A), American Orthopaedic Foot and Ankle Society (AOFAS). A search of the PubMed/MEDLINE, PEDro and Cochrane Cen¬tral Register of Controlled Trials and Web of Science databases from the date of inception to May 1, 2016 was conducted. The terms “minimal clinically important difference,” “minimal clinically important change”, “minimal clinically important improvement” “were combined with one of the PROM as mentioned above

  9. Adaptive behavior in autism: Minimal clinically important differences on the Vineland-II.

    Science.gov (United States)

    Chatham, C H; Taylor, K I; Charman, T; Liogier D'ardhuy, X; Eule, E; Fedele, A; Hardan, A Y; Loth, E; Murtagh, L; Del Valle Rubido, M; San Jose Caceres, A; Sevigny, J; Sikich, L; Snyder, L; Tillmann, J E; Ventola, P E; Walton-Bowen, K L; Wang, P P; Willgoss, T; Bolognani, F

    2017-09-21

    Autism Spectrum Disorder (ASD) is associated with persistent impairments in adaptive abilities across multiple domains. These social, personal, and communicative impairments become increasingly pronounced with development, and are present regardless of IQ. The Vineland Adaptive Behavior Scales, Second Edition (Vineland-II) is the most commonly used instrument for quantifying these impairments, but minimal clinically important differences (MCIDs) on Vineland-II scores have not been rigorously established in ASD. We pooled data from several consortia/registries (EU-AIMS LEAP study, ABIDE-I, ABIDE-II, INFOR, Simons Simplex Collection and Autism Treatment Network [ATN]) and clinical investigations and trials (Stanford, Yale, Roche) resulting in a data set of over 9,000 individuals with ASD. Two approaches were used to estimate MCIDs: distribution-based methods and anchor-based methods. Distribution-based MCID [d-MCID] estimates included the standard error of the measurement, as well as one-fifth and one-half of the covariate-adjusted standard deviation (both cross-sectionally and longitudinally). Anchor-based MCID [a-MCID] estimates include the slope of linear regression of clinician ratings of severity on the Vineland-II score, the slope of linear regression of clinician ratings of longitudinal improvement category on Vineland-II change, the Vineland-II change score maximally differentiating clinical impressions of minimal versus no improvement, and equipercentile equating. Across strata, the Vineland-II Adaptive Behavior Composite standardized score MCID estimates range from 2.01 to 3.2 for distribution-based methods, and from 2.42 to 3.75 for sample-size-weighted anchor-based methods. Lower Vineland-II standardized score MCID estimates were observed for younger and more cognitively impaired populations. These MCID estimates enable users of Vineland-II to assess both the statistical and clinical significance of any observed change. Autism Res 2017. © 2017

  10. Minimal clinically important difference in Parkinson's disease as assessed in pivotal trials of pramipexole extended release.

    Science.gov (United States)

    Hauser, Robert A; Gordon, Mark Forrest; Mizuno, Yoshikuni; Poewe, Werner; Barone, Paolo; Schapira, Anthony H; Rascol, Olivier; Debieuvre, Catherine; Fräßdorf, Mandy

    2014-01-01

    Background. The minimal clinically important difference (MCID) is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson's Disease Rating Scale (UPDRS) scores in early Parkinson's disease (EPD) and for UPDRS scores and "OFF" time in advanced Parkinson's disease (APD). Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR) as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves "a little better" on patient global impression of improvement (PGI-I) minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR) for UPDRS II were -1.8 and -2.0, for UPDRS III -6.2 and -6.1, and for UPDRS II + III -8.0 and -8.1. MCIDs in APD for UPDRS II were -1.8 and -2.3, for UPDRS III -5.2 and -6.5, and for UPDRS II + III -7.1 and -8.8. MCID for "OFF" time (pramipexole ER, pramipexole IR) was -1.0 and -1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.

  11. In vitro interactions between primycin and different statins in their effects against some clinically important fungi.

    Science.gov (United States)

    Nyilasi, Ildikó; Kocsubé, Sándor; Pesti, Miklós; Lukács, Gyöngyi; Papp, Tamás; Vágvölgyi, Csaba

    2010-02-01

    The in vitro antifungal activities of primycin (PN) and various statins against some opportunistic pathogenic fungi were investigated. PN completely inhibited the growth of Candida albicans (MIC 64 microg ml(-1)) and Candida glabrata (MIC 32 microg ml(-1)), and was very effective against Paecilomyces variotii (MIC 2 microg ml(-1)), but had little effect on Aspergillus fumigatus, Aspergillus flavus or Rhizopus oryzae (MICs >64 microg ml(-1)). The fungi exhibited different degrees of sensitivity to the statins; fluvastatin (FLV) and simvastatin (SIM) exerted potent antifungal activities against a wide variety of clinically important fungal pathogens. Atorvastatin, rosuvastatin and lovastatin (LOV) had a slight effect against all fungal isolates tested, whereas pravastatin was completely ineffective. The in vitro interactions between PN and the different statins were investigated using a standard chequerboard titration method. When PN was combined with FLV, LOV or SIM, both synergistic and additive effects were observed. The extent of inhibition was higher when these compounds were applied together, and the concentrations of PN and the given statin needed to block fungal growth completely could be decreased by several dilution steps. Similar interactions were observed when the variability of the within-species sensitivities was investigated.

  12. The Minimal Clinically Important Difference after Simple Decompression for Ulnar Neuropathy at the Elbow

    Science.gov (United States)

    Malay, Sunitha; Chung, Kevin C.; Gaston, Glenn; Haase, R. Steven C.; Hammert, Warren C.; Lawton, Jeff; Merrell, Greg A.; Nassab, Paul F.; Song, Jae W.; Yang, Lynda J.S.

    2013-01-01

    Purpose Establishing minimally clinically important difference (MCID) for patient-reported outcomes questionnaires is an important component of outcomes research to understand treatment effectiveness from the patient’s perspective. For patients with ulnar neuropathy at the elbow (UNE), these assessments are vital to examine how much change in the questionnaire scores equate to patient satisfaction. Methods We calculated the change in scores of Michigan Hand Outcomes Questionnaire (MHQ), Disabilities of the Arm, Shoulder and Hand questionnaire (DASH), and Carpal Tunnel Questionnaire (CTQ) from preoperative to 3,6 and 12 months postoperatively after ulnar nerve simple decompression procedure. We used the anchor based approach of receiver operating characteristic curves to determine the MCID. Results On average, MCID of 10, 12, and 7 points were identified for pain, function, and ADL domains of MHQ. Similarly, DASH, CTQ-symptom severity scale, and CTQ-function severity scale had an average MCID of 7, 0.7, and 0.3 points respectively. At the 3, 6, and 12 months’ time-points, an MCID of 9, 8, and 13 points for pain, 12, 12, and 12 points for function, and 6, 8, and 6 points for ADL domains of the MHQ were identified; similarly an MCID of 8, 7, and 7 points for DASH; 0.4, 0.7, and 0.7 points for CTQ- symptom severity scale; and 0.3, 0.3, and 0.4 points for CTQ-function severity scale were established. Conclusion The smaller MCIDs of MHQ, DASH, and even smaller MCIDs of CTQ found in our study indicate that a small change in the scores identified satisfied patients. Simple decompression surgery for UNE produced patient satisfaction with only a small change in their questionnaire scores. The implications of this finding are that simple decompression surgery for UNE is a highly effective procedure and the outcomes questionnaires used are highly responsive, which minimizes sample size requirements for future research studies relating to UNE. PMID:23474160

  13. Susceptibility of clinically important dermatophytes against statins and different statin-antifungal combinations.

    Science.gov (United States)

    Nyilasi, Ildikó; Kocsubé, Sándor; Krizsán, Krisztina; Galgóczy, László; Papp, Tamás; Pesti, Miklós; Nagy, Katalin; Vágvölgyi, Csaba

    2014-02-01

    The investigation of the antifungal activities of drugs whose primary activities are not related to their antimicrobial potential is in the current forefront of research. Statin compounds, which are routinely used as cholesterol-lowering drugs, may also exert direct antimicrobial effects. In this study, the in vitro antifungal activities of various statins (lovastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin and pravastatin) were examined against one isolate each of four dermatophyte species (Trichophyton mentagrophytes, Trichophyton rubrum, Microsporum canis and Microsporum gypseum). Basically, statins were effective in inhibiting all dermatophyte studied, but were particularly active against M. canis and T. mentagrophytes. Fluvastatin and simvastatin were active against all of the tested fungi causing a complete inhibition of their growth at very low concentrations (6.25-12.5 μg/ml). Lovastatin and rosuvastatin had inhibitory effects at higher concentrations (25-128 μg/ml), while atorvastatin and pravastatin proved the less effective. The in vitro interactions between statins and different antifungals (ketoconazole, itraconazole, fluconazole, amphotericin B, nystatin, griseofulvin, terbinafine and primycin) were also investigated using a standard chequerboard broth microdilution method. Synergetic interactions were observed in several cases, most of them were noticed when statins were combined with terbinafine and the different azoles. Some combinations were particularly active (ketoconazole-simvastatin or terbinafine-simvastatin), as they were found to exert synergistic effect against all of the investigated isolates. The other antifungals showed synergistic interactions with statins in only certain cases. These results suggest that statins exert substantial antifungal effects against dermatophyte fungi and they should be promising components in a combination therapy as they can act synergistically with a number of clinically used antifungal

  14. The accuracy of different biopsy strategies for the detection of clinically important prostate cancer: a computer simulation.

    Science.gov (United States)

    Lecornet, Emilie; Ahmed, Hashim Uddin; Hu, Yipeng; Moore, Caroline M; Nevoux, Pierre; Barratt, Dean; Hawkes, David; Villers, Arnaud; Emberton, Mark

    2012-09-01

    The true accuracy of different biopsy strategies for detecting clinically significant prostate cancer is unknown, given the positive evaluation bias required for verification by radical prostatectomy. To evaluate how well different biopsy strategies perform at detecting clinically significant prostate cancer we used computer simulation in cystoprostatectomy cases with cancer. A computer simulation study was performed on prostates acquired at radical cystoprostatectomy. A total of 346 prostates were processed and examined for prostate cancer using 3 mm whole mount slices. The 96 prostates that contained cancer were digitally reconstructed. Biopsy simulations incorporating various degrees of random localization error were performed using the reconstructed 3-dimensional prostate computer model. Each biopsy strategy was simulated 500 times. Two definitions of clinically significant prostate cancer were used to define the reference standard, including definition 1--Gleason score 7 or greater, and/or lesion volume 0.5 ml or greater and definition 2--Gleason score 7 or greater, and/or lesion volume 0.2 ml or greater. A total of 215 prostate cancer foci were present. The ROC AUC to detect and rule out definition 1 prostate cancer was 0.69, 0.75, 0.82 and 0.91 for 12-core transrectal ultrasound biopsy with a random localization error of 15 and 10 mm, 14-core transrectal ultrasound biopsy and template prostate mapping using a 5 mm sampling frame, respectively. To our knowledge our biopsy simulation study is the first to evaluate the performance of different sampling strategies to detect clinically important prostate cancer in a population that better reflects the demographics of a screened cohort. Compared to other strategies standard transrectal ultrasound biopsy performs poorly for detecting clinically important cancer. Marginal improvement can be achieved using additional cores placed anterior but the performance attained by template prostate mapping is optimal. Copyright

  15. Minimal Clinically Important Difference in Parkinson’s Disease as Assessed in Pivotal Trials of Pramipexole Extended Release

    Directory of Open Access Journals (Sweden)

    Robert A. Hauser

    2014-01-01

    Full Text Available Background. The minimal clinically important difference (MCID is the smallest change in an outcome measure that is meaningful for patients. Objectives. To calculate the MCID for Unified Parkinson’s Disease Rating Scale (UPDRS scores in early Parkinson’s disease (EPD and for UPDRS scores and “OFF” time in advanced Parkinson’s disease (APD. Methods. We analyzed data from two pivotal, double-blind, parallel-group trials of pramipexole ER that included pramipexole immediate release (IR as an active comparator. We calculated MCID as the mean change in subjects who received active treatment and rated themselves “a little better” on patient global impression of improvement (PGI-I minus the mean change in subjects who received placebo and rated themselves unchanged. Results. MCIDs in EPD (pramipexole ER, pramipexole IR for UPDRS II were −1.8 and −2.0, for UPDRS III −6.2 and −6.1, and for UPDRS II + III −8.0 and −8.1. MCIDs in APD for UPDRS II were −1.8 and −2.3, for UPDRS III −5.2 and −6.5, and for UPDRS II + III −7.1 and −8.8. MCID for “OFF” time (pramipexole ER, pramipexole IR was −1.0 and −1.3 hours. Conclusions. A range of MCIDs is emerging in the PD literature that provides the basis for power calculations and interpretation of clinical trials.

  16. Measuring surgical outcomes in cervical spondylotic myelopathy patients undergoing anterior cervical discectomy and fusion: assessment of minimum clinically important difference.

    Directory of Open Access Journals (Sweden)

    Brenda M Auffinger

    Full Text Available OBJECT: The concept of minimum clinically important difference (MCID has been used to measure the threshold by which the effect of a specific treatment can be considered clinically meaningful. MCID has previously been studied in surgical patients, however few studies have assessed its role in spinal surgery. The goal of this study was to assess the role of MCID in patients undergoing anterior cervical discectomy and fusion (ACDF for cervical spondylotic myelopathy (CSM. METHODS: Data was collected on 30 patients who underwent ACDF for CSM between 2007 and 2012. Preoperative and 1-year postoperative Neck Disability Index (NDI, Visual-Analog Scale (VAS, and Short Form-36 (SF-36 Physical (PCS and Mental (MCS Component Summary PRO scores were collected. Five distribution- and anchor-based approaches were used to calculate MCID threshold values average change, change difference, receiver operating characteristic curve (ROC, minimum detectable change (MDC and standard error of measurement (SEM. The Health Transition Item of the SF-36 (HTI was used as an external anchor. RESULTS: Patients had a significant improvement in all mean physical PRO scores postoperatively (p<0.01 NDI (29.24 to 14.82, VAS (5.06 to 1.72, and PCS (36.98 to 44.22. The five MCID approaches yielded a range of values for each PRO: 2.00-8.78 for PCS, 2.06-5.73 for MCS, 4.83-13.39 for NDI, and 0.36-3.11 for VAS. PCS was the most representative PRO measure, presenting the greatest area under the ROC curve (0.94. MDC values were not affected by the choice of anchor and their threshold of improvement was statistically greater than the chance of error from unimproved patients. CONCLUSION: SF-36 PCS was the most representative PRO measure. MDC appears to be the most appropriate MCID method. When MDC was applied together with HTI anchor, the MCID thresholds were: 13.39 for NDI, 3.11 for VAS, 5.56 for PCS and 5.73 for MCS.

  17. The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients.

    Science.gov (United States)

    Fakurnejad, Shayan; Scheer, Justin K; Lafage, Virginie; Smith, Justin S; Deviren, Vedat; Hostin, Richard; Mundis, Gregory M; Burton, Douglas C; Klineberg, Eric; Gupta, Munish; Kebaish, Khaled; Shaffrey, Christopher I; Bess, Shay; Schwab, Frank; Ames, Christopher P

    2015-09-01

    Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined. The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups. Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL

  18. Two Japanese siblings affected with Chikungunya fever with different clinical courses: Imported infections from the Cook Islands.

    Science.gov (United States)

    Kondo, Makoto; Akachi, Shigehiro; Ando, Katsuhiko; Nomura, Tatsuma; Yamanaka, Keiichi; Mizutani, Hitoshi

    2016-06-01

    Two Japanese siblings visited the Cook Islands on business and stayed for 2 months. The sister developed a high fever, arthralgia, erythema and leg edema on the day after returning to Japan. The brother also developed neck and joint pain on the day following the sister's onset. Subsequently, his erythematous lesions spread over his whole body. Chikungunya virus was detected from the sister's blood and urine by specific reverse transcription polymerase chain reaction, but not in the brother's samples. Retrospectively, his history of Chikungunya fever was confirmed by the presence of the anti-Chikungunya virus immunoglobulin (Ig)M and IgG antibodies using the specific enzyme-linked immunoassay. In Japan, no autochthonous case of Chikungunya fever was reported previously. We should give attention to the imported infectious diseases for epidemic prevention. This report warns about the danger of the imported infectious diseases, and also suggests that covering the topic of infectious disease in the world is critical to doctors as well as travelers. © 2016 Japanese Dermatological Association.

  19. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Children & Clinical Studies NHLBI Trials Clinical Trial Websites Children and Clinical Studies Learn more about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to ...

  20. Assessment of the minimum clinically important difference in quality of life in schizophrenia measured by the Quality of Well-Being Scale and disease-specific measures.

    Science.gov (United States)

    Thwin, Soe Soe; Hermes, Eric; Lew, Robert; Barnett, Paul; Liang, Matthew; Valley, Danielle; Rosenheck, Robert

    2013-10-30

    This study examines the psychometric properties of the Quality of Well Being Scale (QWB), the Positive and Negative Syndrome Scale (PANSS), the Heinrich-Carpenter Quality of Life Scale (QOLS), and the Lenert PANSS-based utility measure in a cohort of patients with schizophrenia and identifies threshold values of clinically meaningful change using the Clinical Global Impressions scale (CGI), as the anchor. The correlation of these measures at baseline and change at 6 and 12 months post enrollment in a comparative effectiveness trial was evaluated in 350 veterans with schizophrenia or schizoaffective disorder. An equipercentile method was used to estimate the minimum clinically important difference (MCID) for each measure. Effect size of 0.30-0.50 for baseline quality of life associated with inpatient status supported concurrent validity. The QWB was moderately correlated with disease-specific measures. The MCID as detected by the CGI at 6 months was 0.17 for QWB, 0.15 for the Lenert utility score, 1.13 for the QOLS, and 20.2 for the PANSS. These differences were stable at 12 months. The QWB is significantly correlated with disease specific measures of health related quality of life in schizophrenia. Published by Elsevier Ireland Ltd.

  1. Evaluation of the measurement model and clinically important differences for menopause-specific quality of life associated with bazedoxifene/conjugated estrogens.

    Science.gov (United States)

    Bushmakin, Andrew G; Abraham, Lucy; Pinkerton, JoAnn V; Cappelleri, Joseph C; Mirkin, Sebastian

    2014-08-01

    This study aims to confirm the factor structure of the Menopause-Specific Quality of Life (MENQOL) questionnaire by using confirmatory factor analysis (CFA) and to determine whether improvements in menopause-specific health-related quality of life (HRQOL) observed with bazedoxifene (BZA)/conjugated estrogens (CE) relative to placebo are clinically meaningful. Postmenopausal women with seven or more moderate to severe hot flushes per day (or ≥50 per wk) received BZA 20 mg/CE 0.45 mg, BZA 20 mg/CE 0.625 mg, or placebo for 12 weeks. HRQOL and treatment satisfaction were evaluated using the MENQOL questionnaire and the Menopause Symptoms Treatment Satisfaction Questionnaire, respectively. The structure of the MENQOL questionnaire was evaluated using CFA. To estimate clinically important differences (CIDs) in HRQOL, we used a repeated-measures model to estimate changes in MENQOL domain and total scores using Menopause Symptoms Treatment Satisfaction Questionnaire items as anchors. The CFA model fits the MENQOL data (Bentler's comparative fit index >0.9). CID estimates ranged from 0.5 to 1.2 for the MENQOL domains and total score. Change from baseline in MENQOL vasomotor domain score for BZA 20 mg/CE 0.45 mg and BZA 20 mg/CE 0.625 mg compared with placebo was greater than the estimated CID, as were changes in MENQOL physical domain and total scores for BZA 20 mg/CE 0.625 mg compared with placebo. CFA confirms the factor structure of the MENQOL questionnaire. Treatment with BZA/CE provides clinically meaningful improvements in HRQOL in a population of postmenopausal women with bothersome vasomotor symptoms.

  2. Implications of the minimal clinically important difference for health-related quality-of-life outcomes: a comparison of sample size requirements for an incontinence treatment trial.

    Science.gov (United States)

    Halme, Alex S; Fritel, Xavier; Benedetti, Andrea; Eng, Ken; Tannenbaum, Cara

    2015-03-01

    Sample size calculations for treatment trials that aim to assess health-related quality-of-life (HRQOL) outcomes are often difficult to perform. Researchers must select a target minimal clinically important difference (MCID) in HRQOL for the trial, estimate the effect size of the intervention, and then consider the responsiveness of different HRQOL measures for detecting improvements. Generic preference-based HRQOL measures are usually less sensitive to gains in HRQOL than are disease-specific measures, but are nonetheless recommended to quantify an impact on HRQOL that can be translated into quality-adjusted life-years during cost-effectiveness analyses. Mapping disease-specific measures onto generic measures is a proposed method for yielding more efficient sample size requirements while retaining the ability to generate utility weights for cost-effectiveness analyses. This study sought to test this mapping strategy to calculate and compare the effect on sample size of three different methods. Three different methods were used for determining an MCID in HRQOL in patients with incontinence: 1) a global rating of improvement, 2) an incontinence-specific HRQOL instrument, and 3) a generic preference-based HRQOL instrument using mapping coefficients. The sample size required to detect a 20% difference in the MCID for the global rating of improvement was 52 per trial arm, 172 per arm for the incontinence-specific HRQOL outcome, and 500 per arm for the generic preference-based HRQOL outcome. We caution that treatment trials of conditions for which improvements are not easy to measure on generic HRQOL instruments will still require significantly greater sample size even when mapping functions are used to try to gain efficiency. Copyright © 2015 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Assessing the Stroke-Specific Quality of Life for Outcome Measurement in Stroke Rehabilitation: Minimal Detectable Change and Clinically Important Difference

    Directory of Open Access Journals (Sweden)

    Wu Ching-yi

    2011-01-01

    Full Text Available Abstract Background This study was conducted to establish the minimal detectable change (MDC and clinically important differences (CIDs of the physical category of the Stroke-Specific Quality of Life Scale in patients with stroke. Methods MDC and CIDs scores were calculated from the data of 74 participants enrolled in randomized controlled trials investigating the effects of two rehabilitation programs in patients with stroke. These participants received treatments for 3 weeks and underwent clinical assessment before and after treatment. To obtain test-retest reliability for calculating MDC, another 25 patients with chronic stroke were recruited. The MDC was calculated from the standard error of measurement (SEM to indicate a real change with 95% confidence for individual patients (MDC95. Distribution-based and anchor-based methods were adopted to triangulate the ranges of minimal CIDs. The percentage of scale width was calculated by dividing the MDC and CIDs by the total score range of each physical category. The percentage of patients exceeding MDC95 and minimal CIDs was also reported. Results The MDC95 of the mobility, self-care, and upper extremity (UE function subscales were 5.9, 4.0, and 5.3 respectively. The minimal CID ranges for these 3 subscales were 1.5 to 2.4, 1.2 to 1.9, and 1.2 to 1.8. The percentage of patients exceeding MDC95 and minimal CIDs of the mobility, self-care, and UE function subscales were 9.5% to 28.4%, 6.8% to 28.4%, and 12.2% to 33.8%, respectively. Conclusions The change score of an individual patient has to reach 5.9, 4.0, and 5.3 on the 3 subscales to indicate a true change. The mean change scores of a group of patients with stroke on these subscales should reach the lower bound of CID ranges of 1.5 (6.3% scale width, 1.2 (6.0% scale width, and 1.2 (6.0% scale width to be regarded as clinically important change. This information may facilitate interpretations of patient-reported outcomes after stroke

  4. Children and Clinical Studies: Why Clinical Studies Are Important

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    Full Text Available ... about Children and Clinical Studies Importance of Children in Clinical Studies Children have often had to accept ... treatments based on what is known to work in adults. To improve clinical care of children, more ...

  5. Assessment of the Minimum Clinically Important Difference in the Timed Up and Go Test After Surgery for Lumbar Degenerative Disc Disease.

    Science.gov (United States)

    Gautschi, Oliver P; Stienen, Martin N; Corniola, Marco V; Joswig, Holger; Schaller, Karl; Hildebrandt, Gerhard; Smoll, Nicolas R

    2017-03-01

    The Timed Up and Go Test (TUG Test) has previously been described as a reliable tool to evaluate objective functional impairment in patients with degenerative disc disease. The aim of this study was to assess the minimum clinically important difference (MCID) of the TUG Test. The TUG Test (measured in seconds) was correlated with validated patient-reported outcome measures (PROs) of pain intensity (Visual Analog Scale for back and leg pain), functional impairment (Oswestry Disability Index, Roland Morris Disability Index), and health-related quality of life measures (Short Form-12 and EuroQol 5D). Three established methods were used to establish anchor-based MCID values using responders of the following PROs (Visual Analog Scale back and leg pain, Oswestry Disability Index, Roland Morris Disability Index, EuroQol 5D index, and Short Form-12 Physical Component Summary) as anchors: (1) average change, (2) minimum detectable change, and (3) change difference approach. One hundred patients with a mean ± SD age of 56.2 ± 16.1 years, 57 (57%) male, 45 patients undergoing microdiscectomy, 35 undergoing lumbar decompression, and 20 undergoing fusion surgery were studied. The 3 MCID computation methods revealed a range of MCID values according to the PRO used from 0.9 s (Oswestry Disability Index based on the change difference approach) to 6.0 s (EuroQol 5D index based on the minimum detectable change approach), with a mean MCID of 3.4 s for all measured PROs. The MCID for the TUG Test time is highly variable depending on the computation technique used. The average TUG Test MCID was 3.4 s using all 3 methods and all anchors.

  6. Minimal clinically important differences in the EORTC QLQ-BM22 and EORTC QLQ-C15-PAL modules in patients with bone metastases undergoing palliative radiotherapy.

    Science.gov (United States)

    Raman, Srinivas; Ding, Keyue; Chow, Edward; Meyer, Ralph M; Nabid, Abdenour; Chabot, Pierre; Coulombe, Genevieve; Ahmed, Shahida; Kuk, Joda; Dar, A Rashid; Mahmud, Aamer; Fairchild, Alysa; Wilson, Carolyn F; Wu, Jackson S Y; Dennis, Kristopher; DeAngelis, Carlo; Wong, Rebecca K S; Zhu, Liting; Brundage, Michael

    2016-10-01

    Validated tools for evaluating quality of life (QOL) in patients with bone metastases include the EORTC QLQ-BM22 and QLQ-C15-PAL modules. A statistically significant difference in metric scores may not be clinically significant. To aid in their interpretation, we performed analyses to determine the minimal clinically important differences (MCID) for these QOL instruments. Both anchor-based and distribution-based methods were used to determine the MCID among patients with bone metastases enrolled in a randomized phase III trial. For the anchor-based approach, overall QOL as measured by the QLQ-C15-PAL module was used as the anchor and only the subscales with moderate or better correlation were used for subsequent MCID analysis. In the anchor-based approach, patients were classified as improved, stable or deteriorated by the change in the overall QOL score from baseline to follow-up after 42 days. The MCID and confidence interval was then calculated for all subscales. In the distribution-based approach, the MCID was expressed as a proportion of the standard deviation and standard error measurement from the subscale score distribution. A total of 204 patients completed the questionnaires at baseline and follow-up. Only the dyspnea and insomnia subscales did not have at least moderate correlation with the overall QOL anchor. Using the anchor-based approach, 10/11 subscales had an MCID score significantly different than 0 for improvement and 3/11 subscales had a significant MCID score for deterioration. The magnitude of MCID scores was higher for improvement in comparison with deterioration. For improvement, the anchor-based approach showed good agreement with the distribution-based approach when using 0.5 SD as the MCID. However, there was greater lack of agreement between these approaches for deterioration. We present the MCID scores for the EORTC QLQ-BM22 and QLQ-C15-PAL QOL instruments. The results of this study can guide clinicians in the interpretation of these

  7. Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication

    NARCIS (Netherlands)

    A.P. Conijn (Anne P.); W. Jonkers (Wilma); E.V. Rouwet (Ellen); A. Vahl (Anco); J.A. Reekers (Jim); M.J. Koelemay

    2015-01-01

    textabstractPurpose: The minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment

  8. [Listeriosis in Mexico: Clinical and epidemiological importance].

    Science.gov (United States)

    Castañeda-Ruelas, Gloria; Eslava-Campos, Carlos; Castro-Del Campo, Nohelia; León-Félix, Josefina; Chaidez-Quiroz, Cristóbal

    2014-01-01

    Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there's a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

  9. Listeriosis in Mexico: Clinical and epidemiological importance

    Directory of Open Access Journals (Sweden)

    Gloria Castañeda-Ruelas

    2014-11-01

    Full Text Available Listeriosis is caused by Listeria monocytogenes, an important food-borne disease due to its clinical forms, high mortality rate, and the economic impact in both clinical and food production industries. In Mexico, the lack of epidemiological surveillance systems leads to the need of accurate data on the incidence of listeriosis and its association with food-borne disease. In this paper, we present data about the presence of this bacterium in food, reports related to clinical cases of listeriosis, and information of diseases in which L. monocytogenes may be involved. However, in most of these cases the etiology was not established. Given this, there´s a need to inform and warn the appropriate entities, to define strategies for the mandatory search of L. monocytogenes through the whole food production chain and clinical suspects, for the epidemiological importance and control of listeriosis in Mexico.

  10. Responsiveness and minimal clinically important change

    DEFF Research Database (Denmark)

    Christiansen, David Høyrup; Frost, Poul; Falla, Deborah

    2015-01-01

    Study Design A prospective cohort study nested in a randomized controlled trial. Objectives To determine and compare responsiveness and minimal clinically important change of the modified Constant score (CS) and the Oxford Shoulder Score (OSS). Background The OSS and the CS are commonly used...... to assess shoulder outcomes. However, few studies have evaluated the measurement properties of the OSS and CS in terms of responsiveness and minimal clinically important change. Methods The study included 126 patients who reported having difficulty returning to usual activities 8 to 12 weeks after...... were observed for the CS and the OSS. Minimal clinically important change ROC values were 6 points for the OSS and 11 points for the CS, with upper 95% cutoff limits of 12 and 22 points, respectively. Conclusion The CS and the OSS were both suitable for assessing improvement after decompression surgery....

  11. Importance of clinical examination in dentoalveolar trauma.

    Science.gov (United States)

    Marão, Heloisa Fonseca; Panzarini, Sônia Regina; Manrrique, Gustavo Rodrigues; Luvizuto, Eloá Rodrigues; Evangelista Melo, Moriel

    2012-09-01

    Dental injuries are often the result of direct trauma. The most affected teeth are the upper incisors, and the most frequent lesions are coronal fractures, contusions, and lip and alveolar mucosa lacerations. The objective of this study was to draw attention to the importance of the correct management of cases of crow fractures associated with soft tissue lacerations when the fragment is not located. This is a clinical case of crown fracture, the fragment of which remained lodged inside the lip. After fragment removal, the clinical case showed a satisfactory repair emphasizing the importance of a meticulous clinical examination to achieve a correct diagnosis and an appropriate treatment plan, which is essential for a favorable prognosis.

  12. Is Cervical Inlet Patch Important Clinical Problem?

    Science.gov (United States)

    SAHIN, Gurol; ADAS, Gokhan; KOC, Bora; AKCAKAYA, Adem; DOGAN, Yasar; Goksel, Suha; Yalcin, Ozben

    2014-01-01

    AIM: In this study we aim to determine the frequency of Inlet Patch (IP) and its association to clinical symptoms and draw attention to be aware of this heterotopic gastric mucosa. METHODS: This study was a prospective case series that IP was detected in the upper gastrointestinal endoscopy. Patients with laringopharyngeal reflux symptoms underwent endoscopy between March 2009 and July 2012 in two different institutions. All the biopsies were obtained from if there is the IP lesion and antral or/and gastric mucosa. The data was prospectively evaluated. The prevalence was compared with those of patients that did not determine IP in the study period. RESULTS: 3907 upper gastrointestinal system endoscopy was performed while 123 patients consist of 51 male and 72 female was determined as IP. The prevalence of IP in patiens who underwent upper gastrointestinal endoscopy was 3.14% in our study. The majority of symptoms of those who had IP were laringopharyngeal reflux symptoms. Heterotopic gastric mucosa was fixed in 114 cases while 28 chronic inflammation, 9 esophagitis, 5 intestinal metaplasia, 4 glicogenic acanthosis were obtained as additional findings in pathological examinations. CONCLUSION: Heterotopic gastric mucosa in the proximal esophagus is a frequent finding if the endoscopist is aware of this entity. The importance of IP is the increasing number of cases of neoplastic transformation. Symptomatic patients should be treated and should be considered of the complications of heterotopic gastric mucosa. PMID:25018682

  13. Clinical importance of the middle meningeal artery.

    Science.gov (United States)

    Chmielewski, Przemyslaw; Skrzat, Janusz; Walocha, Jerzy

    2013-01-01

    Middle meningeal artery (MMA)is an important branch which supplies among others cranial dura mater. It directly attaches to the cranial bones (is incorporated into periosteal layer of dura mater), favors common injuries in course of head trauma. This review describes available data on the MMA considering its varability, or treats specific diseases or injuries where the course of MMA may have clinical impact.

  14. Students' Assessment and Self-assessment of Nursing Clinical Faculty Competencies: Important Feedback in Clinical Education?

    Science.gov (United States)

    Lovrić, Robert; Prlić, Nada; Zec, Davor; Pušeljić, Silvija; Žvanut, Boštjan

    2015-01-01

    The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.

  15. Definition of Nonresponse to Analgesic Treatment of Arthritic Pain: An Analytical Literature Review of the Smallest Detectable Difference, the Minimal Detectable Change, and the Minimal Clinically Important Difference on the Pain Visual Analog Scale

    Directory of Open Access Journals (Sweden)

    Melissa E. Stauffer

    2011-01-01

    Full Text Available Our objective was to develop a working definition of nonresponse to analgesic treatment of arthritis, focusing on the measurement of pain on the 0–100 mm pain visual analog scale (VAS. We reviewed the literature to assess the smallest detectable difference (SDD, the minimal detectable change (MDC, and the minimal clinically important difference (MCID. The SDD for improvement reported in three studies of rheumatoid arthritis was 18.6, 19.0, and 20.0. The median MDC was 25.4 for 7 studies of osteoarthritis and 5 studies of rheumatoid arthritis (calculated for a reliability coefficient of 0.85. The MCID increased with increasing baseline pain score. For baseline VAS tertiles defined by scores of 30–49, 50–65, and >65, the MCID for improvement was, respectively, 7–11 units, 19–27 units, and 29–37 units. Nonresponse can thus be defined in terms of the MDC for low baseline pain scores and in terms of the MCID for high baseline scores.

  16. Giant U waves: an important clinical clue

    Directory of Open Access Journals (Sweden)

    Verma N

    2011-04-01

    Full Text Available Nitin Verma, Vincent M Figueredo, Allan M Greenspan, Gregg S PressmanAlbert Einstein Medical Center, Philadelphia, PA, USAAbstract: Electrocardiographic U waves are a common clinical finding, and yet are poorly understood by many physicians. They can be seen in many clinical conditions, most importantly hypokalemia and ischemic heart disease. Over the years, many theories have been put forth to explain their origin. While still not completely understood, it now appears that mechanoelectrical interactions are responsible for normal U waves. Pathologic U waves may be seen in ischemic heart disease where they sometimes point to acute ischemic events. The large U waves of hypokalemia are most likely not true U waves but rather the terminal deflection in a bifid T wave.Keywords: U waves, hypokalemia, myocardial ischemia, electrocardiogram

  17. [Clinical importance of thyroid gland cytology].

    Science.gov (United States)

    Ting, S; Synoracki, S; Bockisch, A; Führer, D; Schmid, K W

    2015-11-01

    The cytological evaluation of fine needle biopsies (FNB) of the thyroid gland crucially depends on a close cooperation between clinicians and cytopathologists. Scintigraphy, sonography as well as clinical data and patient history are necessary for a correct interpretation of the indications for FNB; moreover, these data are of outstanding importance for cytopathologists for the correct interpretation of the cytomorphological findings. This overview describes the present standards in the acquisition, technical workup and cytopathological interpretation of thyroid gland tissue obtained by FNB, particularly focusing on the rapidly growing relevance of additional molecular pathological investigations to increase the diagnostic accuracy of thyroid FNB.

  18. Introducing the Concept of the Minimally Important Difference to Determine a Clinically Relevant Change on Patient-Reported Outcome Measures in Patients with Intermittent Claudication

    Energy Technology Data Exchange (ETDEWEB)

    Conijn, Anne P., E-mail: a.p.conijn@amc.nl [Academic Medical Center, Departments of Vascular Surgery and Interventional Radiology (Netherlands); Jonkers, Wilma, E-mail: wilma.jonkers@achmea.nl [Achmea Insurances, Division of Health Care (Netherlands); Rouwet, Ellen V., E-mail: e.rouwet@erasmusmc.nl [Erasmus Medical Center, Department of Vascular Surgery (Netherlands); Vahl, Anco C., E-mail: a.c.vahl@olvg.nl [Onze Lieve Vrouwe Gasthuis, Department of Vascular Surgery (Netherlands); Reekers, Jim A., E-mail: j.a.reekers@amc.nl [Academic Medical Center, Department of Radiology (Netherlands); Koelemay, Mark J. W., E-mail: m.j.koelemaij@amc.nl [Academic Medical Center, Department of vascular surgery (Netherlands)

    2015-10-15

    PurposeThe minimally important difference (MID) represents the smallest change in score on patient-reported outcome measures that is relevant to patients. The aim of this study was to introduce the MID for the Vascular Quality of Life Questionnaire (VascuQol) and the walking impairment questionnaire (WIQ) for patients with intermittent claudication (IC).MethodsIn this multicenter study, we recruited 294 patients with IC between July and October 2012. Patients completed the VascuQol, with scores ranging from 1 to 7 (worst to best), and the WIQ, with scores ranging from 0 to 1 (worst to best) at first visit and after 4 months follow-up. In addition, patients answered an anchor-question rating their health status compared to baseline, as being improved, unchanged, or deteriorated. The MID for improvement and deterioration was calculated by an anchor-based approach, and determined with the upper and lower limits of the 95 % confidence interval of the mean change of the group who had not changed according to the anchor-question.ResultsFor the MID analyses of the VascuQol and WIQ, 163 and 134 patients were included, respectively. The MID values for the VascuQol (mean baseline score 4.25) were 0.87 for improvement and 0.23 for deterioration. For the WIQ (mean baseline score 0.39), we found MID values of 0.11 and −0.03 for improvement and deterioration, respectively.ConclusionIn this study, we calculated the MID for the VascuQol and the WIQ. Applying these MID facilitates better interpretation of treatment outcomes and can help to set treatment goals for individual care.

  19. Cerebral hemodynamics: concepts of clinical importance

    Directory of Open Access Journals (Sweden)

    Edson Bor-Seng-Shu

    2012-05-01

    Full Text Available Cerebral hemodynamics and metabolism are frequently impaired in a wide range of neurological diseases, including traumatic brain injury and stroke, with several pathophysiological mechanisms of injury. The resultant uncoupling of cerebral blood flow and metabolism can trigger secondary brain lesions, particularly in early phases, consequently worsening the patient's outcome. Cerebral blood flow regulation is influenced by blood gas content, blood viscosity, body temperature, cardiac output, altitude, cerebrovascular autoregulation, and neurovascular coupling, mediated by chemical agents such as nitric oxide (NO, carbon monoxide (CO, eicosanoid products, oxygen-derived free radicals, endothelins, K+, H+, and adenosine. A better understanding of these factors is valuable for the management of neurocritical care patients. The assessment of both cerebral hemodynamics and metabolism in the acute phase of neurocritical care conditions may contribute to a more effective planning of therapeutic strategies for reducing secondary brain lesions. In this review, the authors have discussed concepts of cerebral hemodynamics, considering aspects of clinical importance.

  20. [Clinical microbiology laboratory and imported parasitic diseases].

    Science.gov (United States)

    Martín-Rabadán, Pablo; Martínez-Ruiz, Rocío; Cuadros, Juan; Cañavate, Carmen

    2010-12-01

    Imported parasitosis represents an increasingly frequent diagnostic challenge for microbiology laboratories. A surge in immigration and international travel has led to a rise in the number of imported cases of parasitosis, and this trend is expected to continue in the future. The present article addresses this challenge by reviewing recommended diagnostic approaches and tests. Currently, microscopy is always recommended when analysing blood samples for parasites. If malaria is suspected, rapid antigen testing (including at least HRP2 antigen) should also be performed. The work-up for suspected leishmaniasis should include serology, culture, and in selected cases detection of antigen in urine. In suspected Chagas disease, two different serological tests should be performed. PCR for blood protozoa is highly sensitive, although it cannot be used to rule out Chagas disease, since this condition may be present without parasitemia. Accurate diagnosis of intestinal amebiasis usually requires PCR or antigen detection tests. In helminthiasis, traditional microscopy may need to be complemented with other tests, such as agar plate culture for strongyloidiasis, Og4C3 antigen detection for bancroftian filariasis, and antibody detection test for filariasis and schistosomiasis.

  1. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & Clinical Studies NHLBI Trials Clinical Trial Websites News & ...

  2. Clinically important factors influencing endothelial function.

    Science.gov (United States)

    Vapaatalo, H; Mervaala, E

    2001-01-01

    The endothelium, a continuous cellular monolayer lining the blood vessels, has an enormous range of important homeostatic roles. It serves and participates in highly active metabolic and regulatory functions including control of primary hemostasis, blood coagulation and fibrinolysis, platelet and leukocyte interactions with the vessel wall, interaction with lipoprotein metabolism, presentation of histocompatibility antigens, regulation of vascular tone and growth and further of blood pressure. Many crucial vasoactive endogenous compounds like prostacyclin, thromboxane, nitric oxide, endothelin, angiotensin, endothelium derived hyperpolarizing factor, free radicals and bradykinin are formed in the endothelial cells to control the functions of vascular smooth muscle cells and of circulating blood cells. These versatile and complex systems and cellular interactions are extremely vulnerable. The balances may be disturbed by numerous endogenous and exogenous factors including psychological and physical stress, disease states characterized by vasospasm, inflammation, leukocyte and platelet adhesion and aggregation, thrombosis, abnormal vascular proliferation, atherosclerosis and hypertension. The endothelial cells are also the site of action of many drugs and exogenous toxic substances (e.g. smoking, alcohol). As markers and assays for endothelial dysfunction, direct measurement of nitric oxide, its metabolites from plasma and urine, functional measurement of vascular nitric oxide dependent responses and assay of different circulating markers have been used. In numerous pathological conditions (e.g. atherosclerosis, hypertension, congestive heart failure, hyperhomocysteinemia, diabetes, renal failure, transplantation, liver cirrhosis) endothelial dysfunction has been described to exist. Some of them, as well as hormonal and nutritional factors and drug treatment will be discussed in this short review.

  3. Statistics in clinical research: Important considerations.

    Science.gov (United States)

    Barkan, Howard

    2015-01-01

    Statistical analysis is one of the foundations of evidence-based clinical practice, a key in conducting new clinical research and in evaluating and applying prior research. In this paper, we review the choice of statistical procedures, analyses of the associations among variables and techniques used when the clinical processes being examined are still in process. We discuss methods for building predictive models in clinical situations, and ways to assess the stability of these models and other quantitative conclusions. Techniques for comparing independent events are distinguished from those used with events in a causal chain or otherwise linked. Attention then turns to study design, to the determination of the sample size needed to make a given comparison, and to statistically negative studies.

  4. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ... Clinical Studies Children have often had to accept medicines and treatments based on what is known to ...

  5. The importance of clinical and management scripts.

    Science.gov (United States)

    Levin, Roger P

    2004-07-01

    Simply having excellent clinical skills is not enough to enable you to achieve practice goals. In the end, people will validate the quality of the practice based on the way you and your team communicate. It is amazing to realize how much impact we have on other individuals, based purely on what we say. A well-groomed dentist and staff possessing very attractive features and beautiful teeth almost invariably will work in the practice's favor. However, these traits, powerful as they may be, are incomplete without the ability to say the right thing at the right time. In the practice, the easiest way to ensure consistently excellent communication is to use clinical and management scripts. Nothing you do in your practice will equal the impact of what you say because it affects patient perceptions of quality and overall customer service experiences. Your goal is to have all routine communications in the practice turned into written scripts within 6 months.

  6. Electrical storm: definitions, clinical importance, and treatment.

    Science.gov (United States)

    Gao, Dongsheng; Sapp, John L

    2013-01-01

    With increasing use of implantable cardioverter defibrillators, physicians are increasingly called upon to manage recurrent ventricular tachycardia, sometimes in the form of frequent recurrences known as electrical storm (or ventricular tachycardia storm). Standard antiarrhythmic drug therapy may suppress storms, but, when refractory, interventions such as catheter ablation or in some cases surgical cardiac denervation may be helpful. Earlier interventional management may confer better outcomes than persisting with antiarrhythmic pharmacologic therapy. The clinical syndrome of electrical storm has been defined empirically. An outcome-derived definition may better guide clinicians on when and how to treat this emergent problem. When available, an early interventional approach is preferred.

  7. Fluorescence characterization of clinically-important bacteria.

    Directory of Open Access Journals (Sweden)

    Lewis R Dartnell

    Full Text Available Healthcare-associated infections (HCAI/HAI represent a substantial threat to patient health during hospitalization and incur billions of dollars additional cost for subsequent treatment. One promising method for the detection of bacterial contamination in a clinical setting before an HAI outbreak occurs is to exploit native fluorescence of cellular molecules for a hand-held, rapid-sweep surveillance instrument. Previous studies have shown fluorescence-based detection to be sensitive and effective for food-borne and environmental microorganisms, and even to be able to distinguish between cell types, but this powerful technique has not yet been deployed on the macroscale for the primary surveillance of contamination in healthcare facilities to prevent HAI. Here we report experimental data for the specification and design of such a fluorescence-based detection instrument. We have characterized the complete fluorescence response of eleven clinically-relevant bacteria by generating excitation-emission matrices (EEMs over broad wavelength ranges. Furthermore, a number of surfaces and items of equipment commonly present on a ward, and potentially responsible for pathogen transfer, have been analyzed for potential issues of background fluorescence masking the signal from contaminant bacteria. These include bedside handrails, nurse call button, blood pressure cuff and ward computer keyboard, as well as disinfectant cleaning products and microfiber cloth. All examined bacterial strains exhibited a distinctive double-peak fluorescence feature associated with tryptophan with no other cellular fluorophore detected. Thus, this fluorescence survey found that an emission peak of 340nm, from an excitation source at 280nm, was the cellular fluorescence signal to target for detection of bacterial contamination. The majority of materials analysed offer a spectral window through which bacterial contamination could indeed be detected. A few instances were found of

  8. [Ectoparasitosis of clinical importance in Chile].

    Science.gov (United States)

    Moreno M, Claudia

    2011-10-01

    Several parasitic diseases affect the skin and appendages in humans, the most common are head lice and scabies. Both diseases have worldwide distribution with geographical variations. In Chile, the reported prevalence of head lice is 20-25% and of scabies 1-5%. Other ectoparasites include fleas and mite, causing transient parasitosis related to human and animal contact. These parasites are associated with various factors such as poor personal hygiene, promiscuity, long hair, crowding, and sharing of combs, among others. Various effective pharmacological therapies are available, which base on several active compounds. Important therapeutic options include topical treatments with pyrethroids, lindane, crotamiton, and malathion as well as oral medications such as ivermectin, which is used in case of drug intolerance, poor treatment response, infections with multiple parasites or concomitant bacterial infections. For some drugs, resistance has been reported in patients received multiple dosis.

  9. Children and Clinical Studies: Why Clinical Studies Are Important

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    Full Text Available ... Health Information Center Health Professionals Systematic Evidence Reviews & Clinical Practice Guidelines Resources Continuing Education Researchers Funding Training & Career Development ...

  10. The Clinical Importance of the Heterogeneity of HER2 neu

    Directory of Open Access Journals (Sweden)

    Enrique Davila

    2010-07-01

    Full Text Available We report on a patient with breast cancer in whom there were areas of the tumor that were 3+ positive and negative for HER2 neu by immunohistochemistry, adjacent to each other. Depending on the area tested the results were completely different. The clinical implications are important. We recommend retesting a large portion of the tumor in all cases of initially negative test results.

  11. Children and Clinical Studies: Why Clinical Studies Are Important

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    Full Text Available ... of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical Trials What Are Clinical Trials? Children & ... the general public. Last Updated: August 3, 2015 Resources Educational Website - English / Spanish ... FEAR ACT OIG CONTACT US National Institutes of Health Department of Health and Human Services USA.gov

  12. [Clinical importance and diagnosis of halitosis].

    Science.gov (United States)

    Akos, Nagy; Zsolt, Brugoviczky; Péter, Novák; Gábor, Nagy

    2012-09-01

    The origin of halitosis comes from the Latin word "halitus" meaning 'breath, exhaled air', and in the Hungarian terminology it means bad and smelly breath. The human body emits a number of volatile molecules, which have a peculiar odour. Their presence is influenced by several factors, such as genetic, nutritional and psychological factors. Since bad breath belongs to taboo subjects, halitosis can often lead to social isolation. To determine the incidence of halitosis, an exact diagnosis is needed which sometimes predestinates the possible treatment as well. Investigators estimate the incidence about 50% in the whole population. The male/female ratio is the same and the incidence is growing with age. The diagnosis can be genuine halitosis, pseudo halitosis and halitophobia. We can divide the genuine type into physiological and pathophysiological subtypes. The cause of the halitosis usually can be found in the oral cavity. The volatile sulfur compounds (VSC) produced by some of the oral bacteria are responsible for its development. Only 10% of the causes are extraoral, mostly inflammation of airways or gastrointestinal disorders. The judgment of halitosis is based on three objective methods: the organoleptic, the sulphide monitoring and the gas cromatography methods. Since the origin of the halitosis is mainly the oral cavity, dentists should treat them. Beyond the dental treatments the enhancement of the oral hygiene, the continuous motivation and monitoring are also very important, such as the use of tongue cleansing and special anti-malodour rinses.

  13. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... NHLBI Entire Site Health Topics News & Resources Intramural Research Public Health Topics Education & Awareness Resources Contact The ... Researchers Funding Training & Career Development Division of Intramural Research Research Resources Research Meeting Summaries Technology Transfer Clinical ...

  14. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Topics News & Resources Intramural Research Public Health Topics Education & Awareness Resources Contact The Health Information Center Health ... Systematic Evidence Reviews & Clinical Practice Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural ...

  15. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... Topics News & Resources Intramural Research Public Health Topics Education & Awareness Resources Contact The Health Information Center Health ... Systematic Evidence Reviews & Clinical Practice Guidelines Resources Continuing Education Researchers Funding Training & Career Development Division of Intramural ...

  16. Children and Clinical Studies: Why Clinical Studies Are Important

    Medline Plus

    Full Text Available ... to fill an important gap in information and education for parents, clinicians, researchers, children, and the general public. Last Updated: August 3, 2015 ... US National Institutes of Health Department of Health and Human Services USA.gov

  17. The importance of fluid balance in clinical practice.

    Science.gov (United States)

    Scales, Katie; Pilsworth, Julie

    This article reviews the physiology that underpins normal fluid balance and discusses how fluid balance can be affected by illness. Clinical assessment of hydration and the importance of fluid balance record keeping are explained. Recommendations are made to improve fluid balance management in clinical practice and the professional importance of record keeping is highlighted.

  18. The importance of practice guidelines in clinical care.

    Science.gov (United States)

    Sciarra, Erica

    2012-01-01

    This position paper is a brief review of the importance of practice guidelines in clinical use. Emphasis is placed on evidence-based practice guidelines and research. This position paper attests to the importance of the use of guidelines that direct clinical nursing practice.

  19. MARTIN–GRUBER ANASTOMOSIS AND ITS CLINICAL IMPORTANCE

    Directory of Open Access Journals (Sweden)

    I. G. Mikhaylyuk

    2015-01-01

    Full Text Available The communication between the median and ulnar nerves on the forearm, known as the Martin–Gruber anastomosis, is widespread in the general population. Despite the fact that this connection is described by anatomists in XVIII century, its importance has only recently been appreciated because of the widespread of the electrophysiological techniques in clinical practies. However, in the Russian literature aspects of its practical value described so far is not enough. This article deals with the prevalence of the anastomosis, its anatomical and electrophysiological classification, options innervation of muscles of the hand, is carried out through him, described electrophysiological methods and criteria for its diagnosis, including the collision technique, in healthy subjects and patients with lesions of the median and ulnar nerves, given its practical value. Such a course of nerve fibers through this anastomosis can have a significant impact on the clinical manifestations in patients with lesions of the median and ulnar nerves, as well as the results of an electrophysiological study. Martin–Gruber anastomosis provides variability innervation muscles of the hand, which can make it difficult topic diagnostic damage to the median and ulnar nerves, in addition, because of the connection between the nerves of the clinical presentation may not reflect the extent of their defeat: the hand muscles function can be preserved with full nerve damage or, conversely, significantly disrupted with minimal nerve lesions. Moreover, different electrophysiological findings on patients with pathology of the median or ulnar nerves in the conditions of functioning anastomosis may also complicate the interpretation of the clinical data. Thus, knowledge of the anatomy and physiology of the Martin–Gruber communication as necessary for the electrophysiologist for correct interpretation of the finding and the clinician to accurately diagnose the pathology of the median

  20. Taxonomy and antifungal susceptibility of clinically important Rasamsonia species

    DEFF Research Database (Denmark)

    Houbraken, J.; Giraud, S.; Meijer, M.

    2013-01-01

    In recent years, Geosmithia argillacea has been increasingly reported in humans and animals and can be considered an emerging pathogen. The taxonomy of Geosmithia was recently studied, and Geosmithia argillacea and related species were transferred to the new genus Rasamsonia. The diversity among...... a set of Rasamsonia argillacea strains, including 28 clinical strains, was studied, and antifungal susceptibility profiles were generated. Data obtained from morphological studies and from phylogenetic analyses of internal transcribed spacer (ITS) and partial _-tubulin and calmodulin sequences revealed...... was the least active of the antifungals tested. The phenotypically similar species R. brevistipitata and R. cylindrospora had different antifungal susceptibility profiles, and this indicates that correct species identification is important to help guide appropriate antifungal therapy....

  1. The clinical importance of changes in outcome scores after treatment for chronic low back pain

    National Research Council Canada - National Science Library

    Hägg, O; Fritzell, P; Nordwall, A

    2003-01-01

    ... importance of the outcome scores. The aims of the present study were three-fold. Firstly, it aimed to estimate the minimal clinically important difference of three multi-item outcome instruments...

  2. Interprofessional clinical education: clinicians' views on the importance of leadership.

    Science.gov (United States)

    Missen, Karen; Jacob, Elisabeth R; Barnett, Tony; Walker, Lorraine; Cross, Merylin

    2012-01-01

    The current shortage of health professionals necessitates new approaches to clinical education that can expand the number of undergraduate students undertaking clinical placements without increasing the burden on clinical staff or placing patients at risk. Interprofessional education has the potential to help increase clinical capacity whilst enriching students' clinical experience. This paper reports on a project which investigated the potential for interprofessional education to increase undergraduate clinical placement capacity in clinical settings. The project utilised an exploratory descriptive methodology to obtain the views of health care professionals about the use of interprofessional education in clinical education at three rural health facilities in Victoria, Australia. Participants (n = 57) had a key role with each health care facility in coordinating and facilitating undergraduate clinical placements. This paper examines the clinicians' views about the central role that leadership plays in actioning interprofessional education in the clinical setting. Whilst interprofessional education was regarded favourably by the majority of participants, data indicated that leadership from education providers, health services, and regulatory authorities was crucial to enable interprofessional education to be implemented and sustained within the clinical learning environment. Without leadership from each of these three spheres of influence, interprofessional education will continue to be difficult to implement for undergraduate students and compromise their exposure to an important aspect of the working life of health care professionals. Such a failure will limit graduates' readiness for collaborative and cross-disciplinary practice.

  3. Graduate admissions in clinical neuropsychology: the importance of undergraduate training.

    Science.gov (United States)

    Karazsia, Bryan T; Stavnezer, Amy Jo; Reeves, Jonathan W

    2013-11-01

    Discussions of and recommendations for the training of clinical neuropsychologists exist at the doctoral, internship, and post-doctoral level. With few exceptions, the literature on undergraduate preparations in clinical neuropsychology is sparse and lacks empirical evidence. In the present study, graduate-level faculty and current trainees completed surveys about graduate school preparations. Faculty expectations of minimum and ideal undergraduate training were highest for research methods, statistics, and assessment. Preferences for "goodness of fit" also emerged as important admissions factors. These results offer evidence for desirable undergraduate preparations for advanced study in clinical neuropsychology. Although undergraduate training in psychology is intentionally broad, results from this study suggest that students who desire advanced study in clinical neuropsychology need to tailor their experiences to be competitive in the application process. The findings have implications for prospective graduate students, faculty who train and mentor undergraduates, and faculty who serve on admissions committees.

  4. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations

    DEFF Research Database (Denmark)

    Dworkin, R.H.; Turk, D.C.; Wyrwich, K.W.;

    2008-01-01

    . Provisional benchmarks for identifying clinically important changes in specific outcome measures that can be used for outcome studies of treatments for chronic pain are proposed. PERSPECTIVE: Systematically collecting and reporting the recommended information needed to evaluate the clinical importance......A consensus meeting was convened by the Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) to provide recommendations for interpreting clinical importance of treatment outcomes in clinical trials of the efficacy and effectiveness of chronic pain treatments. A group...... of 40 participants from universities, governmental agencies, a patient self-help organization, and the pharmaceutical industry considered methodologic issues and research results relevant to determining the clinical importance of changes in the specific outcome measures previously recommended by IMMPACT...

  5. [The importance of clinical observations for medical research].

    Science.gov (United States)

    Koller, F

    1976-10-30

    Medical progress owes a great deal to the fundamental medical sciences and to the application of chemistry, physics and mathematics to medical problems. However, clinical observations and investigations are still of decisive importance in any field of medicine. By a feed-back mechanism they may even stimulate and fertilize fundamental medical sciences. Thus, our knowledge of the blood coagulation mechanism has been considerably enlarged by clinical analysis of hereditary bleeding disorders. - Chemotherapy of neoplastic diseases started from clinical observations during World War I (production of leucopenia by sulfur mustard gas). - Surgical procedures and their consequences have contributed greatly to our knowledge of thyroid function, of the segmental anatomy of the lung, and of the conduction system of the heart. - Observations of side effects of drugs have often enlarged or completely changed their primary clinical indications: from antibacterial sulfonamides, anti-diabetic, antihypertensive and powerful diuretic drugs have been developed, and from histaminics the modern neuroleptics and antidepressants. - Fundamental immunology has been enormously activated by clinical transplantation of kidney and bone marrow. Selective immunological defects in men, real experiments of nature, contributed much to our knowledge of the various types of allergic response. The quality of clinical investigations, particularly of controlled clinical trials, has been considerably improved during the last two decades. Although it is an applied science the reliability of its results is to-day comparable with that of "pure" natural sciences. However, medicine is more than a natural science: examples of outstanding scientists who at the same time were great and human physicians are presented.

  6. Anomalous posterior clinoid process and its clinical importance

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2007-09-01

    Full Text Available The anterior, middle and the posterior clinoid processes are located in the middle cranial fossa of the skull. The posterior boundary of the pituitary fossa is formed by the dorsum sellae, the supero-lateral angles of which are raised to form the posterior clinoid process. Unlike the anterior clinoid process, the posterior clinoid process has received less attention in past research studies. The anatomy textbooks do not mention about the anomalies pertaining to the posterior clinoid process and the main source of information are the research reports. The present osteological study describes anomalous posterior clinoid process, detected in two human skulls, during routine undergraduate medical teaching and also discusses its clinical importance. The posterior clinoid process anomalies may be responsible for the altered arrangement of the tentorium cerebelli which is attached to it. The internal carotid artery is often explored by the neuro-surgeon and any bony abnormalities in its vicinity, would result in a difficult situation, while performing clinoidectomy operations. Anomalous posterior clinoid process, may compress the internal carotid artery. The close position of the superior petrosal sinus and the internal carotid artery to the posterior clinoid process, makes it vulnerable to injuries and thus it is important for the neuro-surgeons performing clinoidectomy operations. The anatomy of the posterior clinoid process may be important for neuro surgeons and radiologists in day to day clinical practice.

  7. Anomalous posterior clinoid process and its clinical importance.

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2009-11-01

    Full Text Available The anterior, middle and the posterior clinoid processes are located in the middle cranial fossa of the skull. The posterior boundary of the pituitary fossa is formed by the dorsum sellae, the supero-lateral angles of which are raised to form the posterior clinoid process. Unlike the anterior clinoid process, the posterior clinoid process has received less attention in past research studies. The anatomy textbooks do not mention about the anomalies pertaining to the posterior clinoid process and the main source of information are the research reports. The present osteological study describes anomalous posterior clinoid process, detected in two human skulls, during routine undergraduate medical teaching and also discusses its clinical importance. The posterior clinoid process anomalies may be responsible for the altered arrangement of the tentorium cerebelli which is attached to it. The internal carotid artery is often explored by the neuro-surgeon and any bony abnormalities in its vicinity, would result in a difficult situation, while performing clinoidectomy operations. Anomalous posterior clinoid process, may compress the internal carotid artery. The close position of the superior petrosal sinus and the internal carotid artery to the posterior clinoid process, makes it vulnerable to injuries and thus it is important for the neuro-surgeons performing clinoidectomy operations. The anatomy of the posterior clinoid process may be important for neuro surgeons and radiologists in day to day clinical practice.

  8. [Clinical importance and diagnostic methods of minimal hepatic encephalopathy].

    Science.gov (United States)

    Stawicka, Agnieszka; Zbrzeźniak, Justyna; Świderska, Aleksandra; Kilisińska, Natalia; Świderska, Magdalena; Jaroszewicz, Jerzy; Flisiak, Robert

    2016-02-01

    Minimal hepatic encephalopathy (MHE) encompasses a number of neuropsychological and neurophysiological disorders in patients suffering from liver cirrhosis, who do not display abnormalities during a medical interview or physical examination. A negative influence of MHE on the quality of life of patients suffering from liver cirrhosis was confirmed, which include retardation of ability of operating motor vehicles and disruption of multiple health-related areas, as well as functioning in the society. The data on frequency of traffic offences and accidents amongst patients diagnosed with MHE in comparison to patients diagnosed with liver cirrhosis without MHE, as well as healthy persons is alarming. Those patients are unaware of their disorder and retardation of their ability to operate vehicles, therefore it is of utmost importance to define this group. The term minimal hepatic encephalopathy (formerly "subclinical" encephalopathy) erroneously suggested the unnecessity of diagnostic and therapeutic procedures in patients with liver cirrhosis. Diagnosing MHE is an important predictive factor for occurrence of overt encephalopathy - more than 50% of patients with this diagnosis develop overt encephalopathy during a period of 30 months after. Early diagnosing MHE gives a chance to implement proper treatment which can be a prevention of overt encephalopathy. Due to continuing lack of clinical research there exist no commonly agreed-upon standards for definition, diagnostics, classification and treatment of hepatic encephalopathy. This article introduces the newest findings regarding the importance of MHE, scientific recommendations and provides detailed descriptions of the most valuable diagnostic methods.

  9. Importance of the different posterolateral knee static stabilizers: biomechanical study

    Directory of Open Access Journals (Sweden)

    Rodrigo Campos Pace Lasmar

    2010-01-01

    Full Text Available PURPOSE: The purpose of this study was to evaluate the relative importance of the different static stabilizers of the posterolateral corner of the knee in cadavers. METHODS: Tests were performed with the application of a varus and external rotation force to the knee in extension at 30 and 60 degrees of flexion using 10 cadaver knees. The forces were applied initially to an intact knee and then repeated after a selective sectioning of the ligaments into the following: section of the lateral collateral ligament; section of the lateral collateral ligament and the popliteofibular complex; and section of the lateral collateral ligament, the popliteofibular complex and the posterolateral capsule. The parameters studied were the angular deformity and stiffness when the knees were submitted to a 15 Newton-meter varus torque and a 6 Newton-meter external tibial torque. Statistical analysis was performed using the ANOVA (Analysis of Variance and Tukey's tests. RESULTS AND CONCLUSION: Our findings showed that the lateral collateral ligament was important in varus stability at 0, 30 and 60 degrees. The popliteofibular complex was the most important structure for external rotation stability at all angles of flexion and was also important for varus stability at 30 and 60 degrees. The posterolateral capsule was important for varus stability at 0 and 30 degrees and for external rotation stability in extension. Level of evidence: Level IV (cadaver study.

  10. Variations in Transverse Foramina of Cervical Vertebrae: Morphology & Clinical Importance

    Directory of Open Access Journals (Sweden)

    Vaishakhi Gonsai

    2015-12-01

    Full Text Available Background: The purpose of this study is to investigate variations in transverse foramina in the cervical vertebrae and its morphological and clinical importance. Materials and Method : The variations in the number and size of transverse foramina was studied in total 200 human dried cervical vertebrae, which were taken from the Department of Anatomy, B.J.Medical College, Ahmedabad. All the vertebrae were observed for variation in number and size of transverse foramina. Results: Out of 200 cervical vertebrae, complete double transverse foramina were observed in 40 vertebrae (20%, among them unilateral double foramina were found in 31 vertebrae (15.5% and the bilateral double foramina were found in 9 vertebrae (4.5%. Incomplete double transverse foramina were observed in 22 vertebrae (11%, among them unilateral double foramina were found in 16 vertebrae (8% and bilateral double foramina were observed in 6 vertebrae (3%. Conclusion: Complete unilateral double transverse foramina of cervical vertebrae were more common than bilateral. Also unilateral small size transverse foramina of cervical vertebrae were also common. This variation is important for the neurosurgeon during cervical surgery. Under such condition the course of the vertebral artery may be distorted. It is also useful for Radiologist during CT and MRI scan.

  11. Hierarchical satisfying optimal algorithm with different importance and priorities

    Institute of Scientific and Technical Information of China (English)

    Li Shaoyuan; Teng Changjun

    2005-01-01

    A hierarchical satisfying optimal algorithm incorporating different importance and preemptive priorities is formulated. With the priority structure given by the decision-maker in the constrained multi-objective multi-degree-of-freedom optimization (CMMO) problem, the commonly used quadratic programming model is converted into a two-level optimization problem solved by the tolerant lexicographic method and the varying-domain optimization method. In contrast to previous works, the proposed approach allows the decision-maker to determine a desirable achievement degree for each goal to reflect explicitly the relative importance of these goals. The resulting solutions satisfy both the preemptive priority structure and have the maximum achievement degrees in sum. The power of the proposed approach is demonstrated with an example.

  12. An important difference between "exposed" and "photodistributed" underscores the importance of identifying common reactions.

    Science.gov (United States)

    Jacob, Sharon E; Breithaupt, Andrew D

    2009-09-01

    This article presents the case of a patient with rheumatoid arthritis who was referred to dermatology for what was suspected to be a photosensitivity reaction to hydroxychloroquine, a common culprit in photodrug reactions. Despite the patient's insistence to the contrary, the cause of her eruption was an airborne allergic contact dermatitis to chemicals she was exposed to during her longtime hobby of soap-making. This case serves as an important illustration of the anatomical differences between eruptions occurring in exposed and photodistributed areas. This article also discusses the causes of dermatitis that may mimic photodrug reactions.

  13. Discriminative ability of two different external anchors: improvement appears better than importance

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    2009-01-01

    Title:    Discriminative ability of two different external anchors: improvement appears better than importance. Authors and affiliation: Henrik H. Lauridsen, DC, MSc, PhD*, Claus Manniche, MD, DMSc‡, Werner Vach, PhD §, Niels Grunnet-Nilsson DC, MD, PhD*, Jan Hartvigsen, DC, PhD*† * Clinical...... better discriminative abilities compared to the importance criterion. Consequently, we recommend using improvement and not importance as an anchor to determine the MIC....

  14. Discriminative ability of two different external anchors: improvement appears better than importance

    DEFF Research Database (Denmark)

    Lauridsen, Henrik Hein

    Title:    Discriminative ability of two different external anchors: improvement appears better than importance. Authors and affiliation: Henrik H. Lauridsen, DC, MSc, PhD*, Claus Manniche, MD, DMSc‡, Werner Vach, PhD §, Niels Grunnet-Nilsson DC, MD, PhD*, Jan Hartvigsen, DC, PhD*†   * Clinical...... better discriminative abilities compared to the importance criterion. Consequently, we recommend using improvement and not importance as an anchor to determine the MIC....

  15. The Clinical Importance of Changes in Diabetic Retinopathy Severity Score.

    Science.gov (United States)

    Ip, Michael S; Zhang, Jiameng; Ehrlich, Jason S

    2017-05-01

    To investigate the clinical importance of changes in diabetic retinopathy severity score (DRSS) in patients with diabetic macular edema (DME) treated with intravitreal ranibizumab. Post hoc analysis of the phase III RIDE and RISE studies of ranibizumab for treatment of DME. Four hundred sixty-eight eyes treated with ranibizumab from randomization with gradable DRSS on baseline fundus photographs. Visual and anatomic outcomes were examined in eyes grouped according to DRSS change from baseline to month 24. Mean best-corrected visual acuity (BCVA) letter score change, proportion of patients with 15 or more Early Treatment Diabetic Retinopathy Study (ETDRS) letter score change, mean contrast sensitivity change, proportion of patients with resolved macular edema, and leakage on fluorescein angiography. Most (56.8%) patients treated with ranibizumab experienced 1-step or more improvement in DRSS from baseline to month 24; 40.0% had no change, and 3.2% experienced DRSS worsening. Patients with DRSS stability or improvement had greater mean BCVA letter score changes (+15.1, +14.2, +11.3, and +11.2 letters for ≥3-step improvement, ≥2-step improvement, 1-step improvement, and no DRSS change, respectively) compared with +5.0 letters in patients who had any DRSS worsening. Best-corrected visual acuity letter score gain of 15 letters or more was more common in patients with 2-step or 3-step or more DRSS improvement (51.9% and 44.6%, respectively) compared with those with a 1-step DRSS improvement, no change, or worsening (37.9%, 39.6%, and 26.7%, respectively). A loss of 15 letters or more in BCVA was more common in patients with any DRSS worsening (13.3%) compared with patients who had stable or improved DRSS (0%-2.8%). Resolution of macular edema was more common in patients with DRSS improvement: 84.2%, 87.7%, and 92.3% of patients with 1-step, 2-step or more, and 3-step or more improvement in DRSS achieved central foveal thickness of 250 μm or less, compared with

  16. The importance of Good Clinical Practice guidelines and its role in clinical trials.

    Science.gov (United States)

    Vijayananthan, A; Nawawi, O

    2008-01-01

    Good Clinical Practice (GCP) is an international ethical and scientific quality standard for the design, conduct, performance, monitoring, auditing, recording, analyses and reporting of clinical trials. It also serves to protect the rights, integrity and confidentiality of trial subjects. It is very important to understand the background of the formation of the ICH-GCP guidelines as this, in itself, explains the reasons and the need for doing so. In this paper, we address the historical background and the events that led up to the formation of these guidelines. Today, the ICH-GCP guidelines are used in clinical trials throughout the globe with the main aim of protecting and preserving human rights.

  17. PET: the importance of physicists for the clinical arena

    CERN Multimedia

    2005-01-01

    David Townsend giving a seminar at CERN on 9 February. The past few years have seen significant advances in the development of instrumentation for Positron Emission Tomography (PET). The recent appearance of combined PET and Computed Tomography (CT) scanners that can simultaneously image both anatomy and function is of particular importance. This was the main subject of "Advances in PET imaging: from physics to physician", a seminar presented at CERN by David Townsend on Wednesday 9 February  and organized by the TT and PH groups. David Townsend, who started his career at CERN in the 1970s, is now Professor at the Department of Medicine, University of Tennessee Medical Center (Knoxville, TN). Recipient of the 2004 Clinical Scientist of the Year Award, he is an internationally renowned researcher and PET physicist, with over 25 years of experience in the field. His 1999 image of the year, an award from the Society of Nuclear Medicine in the US, was produced using a combined state-of-the art PET and a true d...

  18. Host response to nontuberculous mycobacterial infections of current clinical importance.

    Science.gov (United States)

    Orme, Ian M; Ordway, Diane J

    2014-09-01

    The nontuberculous mycobacteria are a large group of acid-fast bacteria that are very widely distributed in the environment. While Mycobacterium avium was once regarded as innocuous, its high frequency as a cause of disseminated disease in HIV-positive individuals illustrated its potential as a pathogen. Much more recently, there is growing evidence that the incidence of M. avium and related nontuberculous species is increasing in immunocompetent individuals. The same has been observed for M. abscessus infections, which are very difficult to treat; accordingly, this review focuses primarily on these two important pathogens. Like the host response to M. tuberculosis infections, the host response to these infections is of the TH1 type but there are some subtle and as-yet-unexplained differences.

  19. Clinically important drug-drug interactions in primary care.

    Science.gov (United States)

    Dhabali, A A H; Awang, R; Zyoud, S H

    2012-08-01

    Drug-drug interactions (DDIs) cause considerable morbidity and mortality worldwide and may lead to hospital admission. Sophisticated computerized drug information and monitoring systems, more recently established in many of the emerging economies, including Malaysia, are capturing useful information on prescribing. Our aim is to report on an investigation of potentially serious DDIs, using a university primary care-based system capturing prescription records from its primary care services. We retrospectively collected data from two academic years over 20 months from computerized databases at the Universiti Sains Malaysia (USM) from users of the USM primary care services. Three hundred and eighty-six DDI events were observed in a cohort of 208 exposed patients from a total of 23,733 patients, representing a 2-year period prevalence of 876·4 per 100,000 patients. Of the 208 exposed patients, 138 (66·3%) were exposed to one DDI event, 29 (13·9%) to two DDI events, 15 (7·2%) to three DDI events, 6 (2·9%) to four DDI events and 20 (9·6%) to more than five DDI events. Overall, an increasing mean number of episodes of DDIs was noted among exposed patients within the age category ≥70 years (P=0·01), an increasing trend in the number of medications prescribed (P<0·001) and an increasing trend in the number of long-term therapeutic groups (P<0·001). We describe the prevalence of clinically important DDIs in an emerging economy setting and identify the more common potentially serious DDIs. In line with the observations in developed economies, a higher number of episodes of DDIs were seen in patients aged ≥70 years and with more medications prescribed. The easiest method to reduce the frequency of DDIs is to reduce the number of medications prescribed. Therapeutic alternatives should be selected cautiously. © 2011 Blackwell Publishing Ltd.

  20. Copy number variation plays an important role in clinical epilepsy

    Science.gov (United States)

    Olson, Heather; Shen, Yiping; Avallone, Jennifer; Sheidley, Beth R.; Pinsky, Rebecca; Bergin, Ann M.; Berry, Gerard T.; Duffy, Frank H.; Eksioglu, Yaman; Harris, David J.; Hisama, Fuki M.; Ho, Eugenia; Irons, Mira; Jacobsen, Christina M.; James, Philip; Kothare, Sanjeev; Khwaja, Omar; Lipton, Jonathan; Loddenkemper, Tobias; Markowitz, Jennifer; Maski, Kiran; Megerian, J. Thomas; Neilan, Edward; Raffalli, Peter C.; Robbins, Michael; Roberts, Amy; Roe, Eugene; Rollins, Caitlin; Sahin, Mustafa; Sarco, Dean; Schonwald, Alison; Smith, Sharon E.; Soul, Janet; Stoler, Joan M.; Takeoka, Masanori; Tan, Wen-Han; Torres, Alcy R.; Tsai, Peter; Urion, David K.; Weissman, Laura; Wolff, Robert; Wu, Bai-Lin; Miller, David T.; Poduri, Annapurna

    2015-01-01

    Objective To evaluate the role of copy number abnormalities detectable by chromosomal microarray (CMA) testing in patients with epilepsy at a tertiary care center. Methods We identified patients with ICD-9 codes for epilepsy or seizures and clinical CMA testing performed between October 2006 and February 2011 at Boston Children’s Hospital. We reviewed medical records and included patients meeting criteria for epilepsy. We phenotypically characterized patients with epilepsy-associated abnormalities on CMA. Results Of 973 patients who had CMA and ICD-9 codes for epilepsy or seizures, 805 patients satisfied criteria for epilepsy. We observed 437 copy number variants (CNVs) in 323 patients (1–4 per patient), including 185 (42%) deletions and 252 (58%) duplications. Forty (9%) were confirmed de novo, 186 (43%) were inherited, and parental data were unavailable for 211 (48%). Excluding full chromosome trisomies, CNV size ranged from 18 kb to 142 Mb, and 34% were over 500 kb. In at least 40 cases (5%), the epilepsy phenotype was explained by a CNV, including 29 patients with epilepsy-associated syndromes and 11 with likely disease-associated CNVs involving epilepsy genes or “hotspots.” We observed numerous recurrent CNVs including 10 involving loss or gain of Xp22.31, a region described in patients with and without epilepsy. Interpretation Copy number abnormalities play an important role in patients with epilepsy. Given that the diagnostic yield of CMA for epilepsy patients is similar to the yield in autism spectrum disorders and in prenatal diagnosis, for which published guidelines recommend testing with CMA, we recommend the implementation of CMA in the evaluation of unexplained epilepsy. PMID:24811917

  1. Similar or Different? The Importance of Similarities and Differences for Support Between Siblings

    NARCIS (Netherlands)

    Voorpostel, Marieke; Lippe, Tanja van der; Dykstra, Pearl A.; Flap, Henk

    2007-01-01

    Using a large-scale Dutch national sample (N = 7,126), the authors examine the importance of similarities and differences in the sibling dyad for the provision of support. Similarities are assumed to enhance attraction and empathy; differences are assumed to be related to different possibilities for

  2. Importance of clinical microbiologists for U.S. healthcare infrastructure.

    Science.gov (United States)

    Carvalho, John

    2011-01-01

    Clinical microbiologists are highly skilled scientists within national hospitals and reference laboratories who diagnose patients with infections by emerging pathogens. Most advanced training for clinical microbiologists occurs at universities, where an individual can receive certification as a "Medical Laboratory Scientist" (MLS). Unfortunately, many MLS programs have closed in the United States and this has caused a shortage of clinical microbiologists at U.S. hospitals and reference laboratories. This paper explores the present crisis in MLS training and its ramifications for the emergence of antibiotic-resistant bacteria, the economics of hospitals, and the overall health of the nation, and provides resolutions for better public health policy with respect to MLS education.

  3. Clinical and Business Intelligence: Why It's Important to Your Pharmacy.

    Science.gov (United States)

    Pinto, Brian; Fox, Brent I

    2016-07-01

    According to the Healthcare Information Management and Systems Society, "Clinical & Business Intelligence (C&BI) is the use and analysis of data captured in the healthcare setting to directly inform decision-making" (http://www.himss.org/library/clinical-business-intelligence). Some say that it is the right information given to the right person at the right time in the right way. No matter how you define it, the fact remains that timely access, synthesis, and visualization of clinical data have become key to how health professionals make patient care decisions and improve care delivery.

  4. Sex and gender differences in clinical medicine.

    Science.gov (United States)

    Regitz-Zagrosek, Vera; Seeland, Ute

    2012-01-01

    Sex and gender differences in frequent diseases are more widespread than one may assume. In addition, they have significant yet frequently underestimated consequences on the daily practice of medicine, on outcomes and effects of therapies. Gender medicine is a novel medical discipline that takes into account the effects of sex and gender on the health of women and men. The major goal is to improve health and health care for both, for women as well as for men. We give in this chapter an overview on sex and gender differences in a number of clinical areas, in cardiovascular diseases, pulmonary diseases, gastroenterology and hepatology, in nephrology, autoimmune diseases, endocrinology, hematology, neurology. We discuss the preferential use of male animals in drug development, the underrepresentation of women in early and cardiovascular clinical trials, sex and gender differences in pharmacology, in pharmacokinetics and pharmacodynamics, in management and drug use. Most guidelines do not include even well-known sex and gender differences. European guidelines for the management of cardiovascular diseases in pregnancy have only recently been published. Personalized medicine cannot replace gender-based medicine. Large databases reveal that gender remains an independent risk factor after ethnicity, age, comorbidities, and scored risk factors have been taken into account. Some genetic variants carry a different risk in women and men. The sociocultural dimension of gender integrating lifestyle, environment, stress, and other variables cannot be replaced by a sum of biological parameters. Because of this prominent role of gender, clinical care algorithms must include gender-based assessment.

  5. Niacin revisited: clinical observations on an important but underutilized drug.

    Science.gov (United States)

    Henkin, Y; Oberman, A; Hurst, D C; Segrest, J P

    1991-09-01

    To evaluate the efficacy and side effects of niacin therapy in dyslipidemic individuals. A retrospective analysis of patients' charts. An outpatient referral-based clinic specializing in the treatment of lipid disorders. All patients with dyslipidemia treated by niacin (n = 82) at the Atherosclerosis Detection and Prevention Clinic during 1987 to 1990, including a subgroup of 17 dyslipidemic heart transplant recipients. Niacin was well tolerated in 83% of the nontransplant group (n = 65) at an average dose of 2.5 +/- 0.9 g/day. Similar beneficial lipoprotein effects were found in the transplant and nontransplant patients. The high-density lipoprotein cholesterol (HDL-C) response to niacin therapy was independent of the baseline (HDL-C level. In the transplant group, 11 patients (65%) discontinued treatment, primarily because of hyperglycemia; this was especially prominent in those patients with pretreatment diabetes mellitus. Of the 15 patients using sustained-release niacin, eight cases of hepatitis were recorded, some during therapy with relatively low niacin doses. Several different sustained-release preparations were responsible for this phenomenon, suggesting that the cause was not a contaminant in the preparation. No cases of hepatitis were documented in the 67 patients using regular niacin. One case of hepatitis was recently observed in a patient who switched from one type to regular niacin to another; however, we have data to suggest that the substituted preparation was not an immediate-release niacin. A familial predisposition to hepatitis is suggested by the occurrence of this side effect in identical twin brothers and two sisters. A pharmacy survey disclosed that most pharmacists are unaware of the relationship of sustained-release niacin to hepatitis, have a negative impression of regular niacin, and do not stock this formulation. Finally, we found that in this small sample of patients, niacin used with lovastatin is a particularly effective drug

  6. public health importance of lassa fever epidemiolggy, clinical features

    African Journals Online (AJOL)

    important precautive measures to take when handling a patient with Lassa fever. ... protective devices are important preventive measures when managing a patient with Lassa fever infection. As Lassa fever ... ness, as well as sexual contact with a partner during ... countries in Africa have reported Lassa outbreaks and.

  7. [Congenital retinal folds in different clinical cases].

    Science.gov (United States)

    Munteanu, M

    2005-01-01

    We present 12 clinical cases of congenital retinal folds with different etiologies: posterior primitive vitreous persistency and hyperplasia (7 cases),retinocytoma (1 case). retinopathy of prematurity (1 case), astrocytoma of the retina (1 case), retinal vasculitis (1 case), Goldmann-Favre syndrome (1 case). Etiopathogenic and nosological aspects are discussed; the congenital retinal folds are interpreted as a symptom in a context of a congenital or acquired vitreo-retinal pathology.

  8. Racial Differences in Intelligence: The Importance of the Executive System.

    Science.gov (United States)

    Borkowski, John G.; Krause, Audrey

    1983-01-01

    The hypothesis that racial differences in IQ stem from differences in components of executive systems including knowledge base, control processes, and metacognition was investigated. Group differences in metamemory, strategy use, and general knowledge, but not perceptual efficiency, were observed. Metamemory predicted crystallized but not fluid…

  9. [Clinical research I. The importance of the research design].

    Science.gov (United States)

    Talavera, Juan O

    2011-01-01

    The endeavor of clinical research to study a group of patients is to make a diagnosis, estimate the prognosis and prove a treatment. For this purpose is used the scientific method: 1) the architectural arrangement, which can be divided into cause-effect and the process of research; 2) the methodological approach, which includes controlled clinical trials, cohorts, case control, and cross-sectional designs; 3) the goal-oriented approach, in which studies on diagnostic tests, prognosis, treatment and risk or causal factors are grouped. The designs mentioned above are considered primary studies; it means that the information was obtained directly from the subjects studied. There is a second category of studies, which uses information obtained from the primary studies. This is the reason why they are considered as secondary or integrative studies.

  10. [Recurrent clinical mastitis in dairy cattle - importance and causes].

    Science.gov (United States)

    Grieger, A-S; Zoche-Golob, V; Paduch, J-H; Hoedemaker, M; Krömker, V

    2014-01-01

    Clinical mastitis as a frequently recurrent event can cause substantive economic loss on dairy farms. The reason for recurrent mastitis can be either a persistent infection of the bovine mammary gland by a mastitis pathogen or a reinfection of a quarter or udder after bacteriological cure. The virulence properties of a mastitis pathogen and the cure odds of an individual cow determine the development of persistent infections. Clinical episodes may alternate with periods without symptoms in the course of persistent infections. Strategies to reduce cases of recurrent mastitis have to include improved treatment concepts and measures to decrease new infection rates. The present literature review summarises the knowledge of definitions, frequencies, causes and effects of recurrent mastitis.

  11. Important compositional characteristics in the clinical use of adhesive systems.

    Science.gov (United States)

    Miyazaki, Masashi; Tsujimoto, Akimasa; Tsubota, Keishi; Takamizawa, Toshiki; Kurokawa, Hiroyasu; Platt, Jeffrey A

    2014-03-01

    Improvements in dentin bonding systems have influenced modern restorative dentistry. The desire for minimal invasiveness has resulted in more-conservative cavity design, which basically relies on the effectiveness of current dentin bonding systems. Interaction of adhesives with enamel and dentin is based on two systems, commonly described as etch-and-rinse and self-etch. Priming and bonding agents can be separate or combined, resulting in two- or three-step systems for etch-and-rinse adhesives and one- or two-step systems for self-etch adhesives. Self-etch systems use acidic functional monomers that simultaneously demineralize and impregnate tooth structures. Etch-and-rinse and self-etch systems have advantages and disadvantages, which are primarily related to the simplified bonding procedures required under clinical conditions. Knowledge of the composition, characteristics, and mechanisms of adhesion for each adhesive system is critical in selecting the ideal adhesive materials for clinical use.

  12. The most important culture differences and elements of intercultural communication

    Institute of Scientific and Technical Information of China (English)

    张乐

    2012-01-01

    This paper wrote about the cultural differences. There are four dimensions: power distance, uncertainty avoidance, individualism and masculinity. After that, paper talked about the intercultural communication, which contains language, non-verbal communication, time and space concept. Then talked different cultures do cause problems in business. To avoid misunderstanding and clashes, the international managers should realize and understand the different cultures, adapt themselves to fit into the business environment in order to get the best achievement in business.

  13. CLINICAL IMPORTANCE OF INTERLEUKIN-4 IN SYSTEMIC SCLERODERMA

    Directory of Open Access Journals (Sweden)

    T A Nevskaya

    2002-01-01

    Full Text Available The aim of the study was to investigate whether serum levels of interleukin-4 ( IL-4 reflects the clinical disease status and laboratory features of systemic sclerosis (SSc. IL-4 was measured by ELISA in forty patients wilh SSc. We revealed IL-4 (Ю-lOOOpg/ml in sera from 12 of 40 pts (30%. These pts had significantly less duration of disease, the progression of skin and visceral involvement by the time of investigation and a trend lo the greater frequency of lung fibrosis. There was no correlation of IL-4 level with type of SSc. The pts with increased scrum levels of IL-4 had higher levels of circulated immune complexes, y-globulins, but the levels of acute phase reactants (CRP, fibrinogen were lower compared with the of others. We suggest that serum IL-4 may serve a biologic marker for the progression of skin and lung fibrosis, but the results require confirmation in longitudinal study.

  14. A STUDY ON THORACIC VERTEBRAL SYNOSTOSIS & ITS CLINICAL IMPORTANCE

    Directory of Open Access Journals (Sweden)

    Md. Khaleel

    2015-01-01

    Full Text Available Vertebral anomalies are of interest not only to anatomist, but also to orthopedician, neurologist & neurosurgeons. Various vertebral anomalies of anatomic interest have been reported namely; occipitalisation, sacralisation, lumbarisation, absence of posterior elements of vertebral arch & vertebral s ynostosis. The fusion of vertebral column is rare anomalies usually congenital in origin. The fusion of thoracic vertebrae can present many clinical sign including congenital scoliosis. A study on 594 dry adult human vertebrae of unknown age & sex collected from the department of anatomy and phase I students of KBNIMS, Kalaburagi, Karnataka. The study was done over a period of 6 months (July to December 2014 during routine osteology classes for 1 year MBBS, we found the fusion of typical thoracic vertebrae between T 3 & T 4 . The cause could be failure of re - segmentation of somitomeres or acquired.

  15. Is clinical breast examination important for breast cancer detection?

    Science.gov (United States)

    Provencher, L.; Hogue, J.C.; Desbiens, C.; Poirier, B.; Poirier, E.; Boudreau, D.; Joyal, M.; Diorio, C.; Duchesne, N.; Chiquette, J.

    2016-01-01

    Background Screening clinical breast examination (cbe) is controversial; the use of cbe is declining not only as a screening tool, but also as a diagnostic tool. In the present study, we aimed to assess the value of cbe in breast cancer detection in a tertiary care centre for breast diseases. Methods This retrospective study of all breast cancers diagnosed between July 1999 and December 2010 at our centre categorized cases according to the mean of detection (cbe, mammography, or both). A cbe was considered “abnormal” in the presence of a mass, nipple discharge, skin or nipple retraction, edema, erythema, peau d’orange, or ulcers. Results During the study period, a complete dataset was available for 6333 treated primary breast cancers. Cancer types were ductal carcinoma in situ (15.3%), invasive ductal carcinoma (75.7%), invasive lobular carcinoma (9.0%), or others (2.2%). Of the 6333 cancers, 36.5% (n = 2312) were detected by mammography alone, 54.8% (n = 3470) by mammography and cbe, and 8.7% (n = 551) by physician-performed cbe alone (or 5.3% if considering ultrasonography). Invasive tumours diagnosed by cbe alone were more often triple-negative, her2-positive, node-positive, and larger than those diagnosed by mammography alone (p < 0.05). Conclusions A significant number of cancers would have been missed if cbe had not been performed. Compared with cancers detected by mammography alone, those detected by cbe had more aggressive features. Clinical breast examination is a very low-cost test that could improve the detection of breast cancer and could prompt breast ultrasonography in the case of a negative mammogram. PMID:27536182

  16. Importance of life domains in different cultural groups.

    Science.gov (United States)

    Elizur, Dov; Kantor, Jeffrey; Yaniv, Eyal; Sagie, Abraham

    2008-01-01

    This study assessed the role of individualism and collectivism in the shaping of personal values of Canadians, Israelis, and Palestinians. Based on Sagie and Elizur's (1996) multifaceted approach, we distinguished personal values that are individual centered (i.e., associated with one's home, family, or work) from collective-centered values (i.e., associated with the religion, sports, or politics). The magnitude of the difference between both value types differs according to cultural orientation. As compared with Palestinians, we predicted that Canadians and Israelis would rank individual-centered values higher and collective-centered values lower. Data obtained from samples of Palestinians, Israelis, and Canadians supported this hypothesis.

  17. An Important Part of Me: A Dialogue about Difference

    Science.gov (United States)

    Lico, Sofia; Luttrell, Wendy

    2011-01-01

    This article is an experiment in writing about and across differences; it seeks to open up dialogue between adults and young people in childhood and youth studies research. The coauthors, Sofia and Wendy, met through Wendy's longitudinal research project, which explores the roles that gender, race, and immigrant status play in how young people…

  18. Incidental extracerebral findings on brain nonenhanced magnetic resonance imaging: frequency, nondetection rate, and clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Ming-Liang; Wei, Xiao-Er [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Lu, Li-Yan [Nanjing Medical University, Department of Radiology, Nanjing First Hospital, Nanjing (China); Li, Wen-Bin [School of Medicine, Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People' s Hospital, Shanghai (China); Kashgar Prefecture Second People' s Hospital, Imaging Center, Kashgar (China)

    2017-03-15

    This study aims to elucidate the frequency, nondetection rate, and clinical importance of incidental extracerebral findings (IECFs) on brain nonenhanced magnetic resonance imaging (MRI). A total of 8284 brain MRIs performed between January 1, 2015 and December 31, 2015 were evaluated for the presence of IECFs and the distribution of IECFs was analyzed. IECFs were categorized as E1 (clinically unimportant, e.g., sinus mucosal thickening); E2 (likely unimportant, e.g., pharyngeal mucosal symmetrical thickening); and E3 (potentially important, e.g., pharyngeal mucosal asymmetrical thickening). The nondetection rate was determined by comparing the results of the structured approach with the initial MRI reports. The medical records were examined for patients with E3 IECFs to assess clinical importance and outcome of these lesions. A total of 5992 IECFs were found in 4469 of the 8284 patients (54.0%). E1 findings constituted 82.2% (4924/5992) of all IECFs; E2 constituted 16.6% (995/5992) and E3 constituted 1.2% (73/5992). Overall IECFs and E1 findings were significantly more common in male patients (P < 0.05). Statistically significant difference was also seen between the different age groups (P < 0.001). The nondetection rate was 56.9% (3409/5992) for overall IECFs and 32.9% (24/73) for E3 IECFs. Of the 73 patients with E3 IECFs, 34 (46.6%) received final diagnosis and appropriate treatment during the study period. IECFs are prevalent in clinical patients on brain MR images with a nondetection rate of 32.9% for potentially important (E3) findings. The reporting of IECFs according to clinical importance is helpful for patients' management. (orig.)

  19. Clinical practice: the diagnosis of imported malaria in children.

    Science.gov (United States)

    Maltha, Jessica; Jacobs, Jan

    2011-07-01

    The present paper reviews the diagnosis of imported malaria in children. Malaria is caused by a parasite called Plasmodium and occurs in over 100 countries worldwide. Children account for 10-15% of all patients with imported malaria and are at risk to develop severe and life-threatening complications especially when infected with Plasmodium falciparum. Case-fatality ratios vary between 0.2% and 0.4%. Children visiting friends and relatives in malaria endemic areas and immigrants and refugees account for the vast majority of cases. Symptoms are non-specific and delayed infections (more than 3 months after return from an endemic country) may occur. Microscopic analysis of the thick blood film is the cornerstone of laboratory diagnosis. For pragmatic reasons, EDTA-anticoagulated blood is accepted, provided that slides are prepared within 1 h after collection. Information about the Plasmodium species (in particular P. falciparum versus the non-falciparum species) and the parasite density is essential for patient management. Molecular methods in reference settings are an adjunct for species differentiation. Signals generated by automated hematology analyzers may trigger the diagnosis of malaria in non-suspected cases. Malaria rapid diagnostic tests are reliable in the diagnosis of P. falciparum but not for the detection of the non-falciparum species. They do not provide information about parasite density and should be used as an adjunct (and not a substitute) to microscopy. In case of persistent suspicion and negative microscopy results, repeat testing every 8-12 h for at least three consecutive samplings is recommended. A high index of suspicion and a close interaction with the laboratory may assure timely diagnosis of imported malaria.

  20. Local anesthetics: dentistry's most important drugs, clinical update 2006.

    Science.gov (United States)

    Malamed, Stanley F

    2006-12-01

    Local anesthetics are the safest most effective drugs in medicine for the control and management of pain. They also represent the most important drugs in dentistry. Today, dentistry has a spectrum of local anesthetics that permit pain control to be tailored to the specific needs of the patient: short-, intermediate-, and long-acting drugs. Bupivacaine has become a standard part of the armamentarium for postsurgical pain control while articaine has become the second-most used local anesthetic in the United States since its introduction in 2000. Despite an increase in anecdotal reports of paresthesia since articaine's introduction there is yet, no supporting scientific evidence.

  1. The clinical importance of dynamic lung hyperinflation in COPD.

    Science.gov (United States)

    O'Donnell, Denis E; Laveneziana, Pierantonio

    2006-12-01

    Lung hyperinflation commonly accompanies expiratory flow-limitation in patients with Chronic Obstructive Pulmonary Disease (COPD) and contributes importantly to dyspnea and activity limitation. It is not surprising, therefore, that lung hyperinflation has become an important therapeutic target in symptomatic COPD patients. There is increasing evidence that acute dynamic increases in lung hyperinflation, under conditions of worsening expiratory flow-limitation and increased ventilatory demand (or both) can seriously stress cardiopulmonary reserves, particularly in patients with more advanced disease. Our understanding of the physiological mechanisms of dynamic lung hyperinflation during both physical activity and exacerbations in COPD continues to grow, together with an appreciation of its serious negative mechanical and sensory consequences. In this review, we will discuss the basic pathophysiology of COPD during rest, exercise and exacerbation so as to better understand how this can be pharmacologically manipulated for the patient's benefit. Finally, we will review current concepts of the mechanisms of symptom relief and improved exercise endurance following pharmacological lung volume reduction.

  2. Bone biology in the elderly: clinical importance for fracture treatment

    Directory of Open Access Journals (Sweden)

    Rolvien Tim

    2016-12-01

    Full Text Available Age-related bone impairment often leads to fragility fractures in the elderly. Although excellent surgical care is widely provided, diagnosis and treatment of the underlying bone disorder are often not kept in mind. The interplay of the three major bone cells – osteoblasts, osteoclasts, and osteocytes – is normally well regulated via the secretion of messengers to control bone remodeling. Possible imbalances that might occur in the elderly are partly due to age, genetic risk factors, and adverse lifestyle factors but importantly also due to imbalances in calcium homeostasis (mostly due to vitamin D deficiency or hypochlorhydria, which have to be eliminated. Therefore, the cooperation between the trauma surgeon and the osteologist is of major importance to diagnose and treat the respective patients at risk. We propose that any patient suffering from fragility fractures is rigorously screened for osteoporosis and metabolic bone diseases. This includes bone density measurement by dual-energy X-ray absorptiometry, laboratory tests for calcium, phosphate, vitamin D, and bone turnover markers, as well as additional diagnostic modalities if needed. Thereby, most risk factors, including vitamin D deficiency, can be identified and treated while patients who meet the criteria for a specific therapy (i.e. antiresorptive and osteoanabolic receive such. If local health systems succeed to manage this process of secondary fracture prevention, morbidity and mortality of fragility fractures will decline to a minimum level.

  3. [Importance of using basic statistics adequately in clinical research].

    Science.gov (United States)

    Rodrigues, Célio Fernando de Sousa; Lima, Fernando José Camello de; Barbosa, Fabiano Timbó

    2017-04-10

    The inadequate use of basic statistics is the main responsible for scientific article misinterpretation. The purpose of this review article was to review some basic statistical topics to alert authors and readers about the importance of basic statistics proper reporting. A bibliographical and cross-sectional study was carried out,which analyzed publications in books and articles in the following databases: SciELO (Scientific Electronic Library Online) and PubMed (Available from the National Center for Biotechnology Information). Medical research is not free from the risk of false positive and false negative results due to the choice of statistical tests and presence of small sample sizes. Understanding the correct use of basic statistics leads to fewer errors in reporting the results of studies performed and in the interpretation of their conclusions. Copyright © 2017. Publicado por Elsevier Editora Ltda.

  4. Differences in clinical experiences of ADN and BSN students.

    Science.gov (United States)

    Oermann, M H

    1998-05-01

    Prior research has suggested that clinical experience for nursing students is stressful. Concern about making an error and harming the patient, limited knowledge and skills for practice, and difficulties in interacting with the teacher and others in the clinical setting are some of the stressors reported by students. Few studies have compared these stresses and the clinical experiences in general between students in associate degree (ADN) and baccalaureate (BSN) nursing programs. The purposes of this research were to compare the clinical experiences of ADN and BSN students at different levels in the programs and describe these experiences from the students' perspectives. As such, both quantitative and qualitative data were collected from 415 students in ADN and BSN programs in the Midwest. The ADN students reported significantly higher stress in clinical practice than BSN students (t = 2.16, p ADN and BSN students in clinical practice increased as they progressed through the programs. The semester prior to graduation was the most stressful time in terms of clinical practice for both ADN and BSN students. The instructor was the predominant stressor reported by students in ADN programs across all levels of the curriculum. Among BSN students, the most prevalent stresses were coping with demands associated with patient care and the clinical teacher. The findings highlight the important role of the clinical faculty in both types of nursing programs.

  5. Occurrence and diversity of clinically important Vibrio species in the aquatic environments of Georgia

    Directory of Open Access Journals (Sweden)

    Tamari eKokashvili

    2015-10-01

    Full Text Available Among the more than 70 different Vibrio species inhabiting marine, estuarine, and freshwater ecosystems, 12 are recognized as human pathogens. The warm subtropical climate of the Black Sea coastal area and inland regions of Georgia likely provides a favorable environment for various Vibrio species. From 2006 to 2009, the abundance, ecology, and diversity of clinically important Vibrio species were studied in different locations in Georgia and across seasons. Over a 33-month period, 1,595 presumptive Vibrio isolates were collected from the Black Sea (n=657 and freshwater lakes around Tbilisi (n=938. Screening of a subset of 440 concentrated and enriched water samples by PCR-electrospray ionization/mass spectrometry (PCR-ESI/MS detected the presence of DNA from eight clinically important Vibrio species: V. cholerae, V. parahaemolyticus, V. vulnificus, V. mimicus, V. alginolyticus, V. harveyi, V. metschnikovii, and V. cincinnatiensis. Almost ninety percent of PCR/ESI-MS samples positive for Vibrio species were collected from June through November. Three important human pathogenic Vibrio species (V. cholerae, V. parahaemolyticus, and V. vulnificus were detected in 62.8%, 37.8%, and 21.4% of samples testing positive for vibrios, respectively. The results of these activities suggest that natural reservoirs for human-pathogenic Vibrios exist in Georgian aquatic environments. Water temperature at all sampling sites was positively correlated with the abundance of clinically important Vibrio spp. (except V. metschnikovii and salinity was correlated with species composition at particular Black Sea sites as well as inland reservoirs.

  6. Interstellar Isomers: The Importance of Bonding Energy Differences

    CERN Document Server

    Remijan, A J; Lovas, F J; Plusquellic, D F; Jewell, P R; Remijan, Anthony J.

    2005-01-01

    We present strong detections of methyl cyanide, vinyl cyanide, ethyl cyanide and cyanodiacetylene molecules with the Green Bank Telescope (GBT) toward the Sgr B2(N) molecular cloud. Attempts to detect the corresponding isocyanide isomers were only successful in the case of methyl isocyanide for its J(K)=1(0)-0(0) transition, which is the first interstellar report of this line. To determine the spatial distribution of methyl isocyanide, we used archival Berkeley-Illinois-Maryland Association (BIMA) array data for the J(K)=4(K)-3(K) (K=0-3) transitions but no emission was detected. From ab initio calculations, the bonding energy difference between the cyanide and isocyanide molecules is >8500 cm^-1 (>12,000 K). That we detect methyl isocyanide emission with a single antenna (Gaussian beamsize(Omega_B)=1723 arcsec^2) but not with an interferometer (Omega_B=192 arcsec^2), strongly suggests that methyl isocyanide has a widespread spatial distribution toward the Sgr B2(N) region. Thus, large-scale, non-thermal proc...

  7. Neuroticism and cortisol: The importance of checking for sex differences.

    Science.gov (United States)

    DeSoto, M Catherine; Salinas, Manuel

    2015-12-01

    Existent research documents an unclear and contradictory pattern between cortisol and personality variables, especially neuroticism. Specifically, no effect, positive correlations and negative correlations have all been reported to exist between cortisol and neuroticism. The current study tested whether males and females have a fundamentally different relationship between HPA activation and neuroticism and if this might partially account for some of the discrepancy in findings. Saliva samples (n=183) for cortisol were collected three times across a 90min period. Neuroticism was measured via the NEO-FFI. For men, neuroticism was positively correlated with cortisol level (r=.29). For women it was negatively correlated. The negative correlation between neuroticism and cortisol level remained when oral contraceptive use was statistically controlled, and the statistical significance actually increased (partial r=-.20). This suggests a slight suppressor effect, explainable by prior research on correlates of oral contraceptive use. Overall, these findings may offer some explanation for the discrepant results that have been reported in the existing literature regarding neuroticism and cortisol measures.

  8. [Allergic fungi: importance of the standardization of fungal extracts and their application on clinical practice].

    Science.gov (United States)

    Ruiz Reyes, Héctor; Rodríguez Orozco, Alain R

    2006-01-01

    Among the aeroallergens associated to asthma and allergic rhinitis, the fungi are a common cause of diagnostic and therapeutic problems. The wide variety and distribution of fungal species and the complex characterization of their allergenicity, is a complex item. The fungus extracts used to diagnose and treat sensitizations are frequently non effective, and different varieties of extracts are globally distributed. The standardization of commercial fungi extracts results extremely important as diagnostic procedure as well as to decide an efficacious and safe immunotherapy. This paper reviews important methodological steps to the standardization of fungi extracts, and finally the clinical use of these extracts.

  9. Inhibition properties of propolis extracts to some clinically important enzymes.

    Science.gov (United States)

    Baltas, Nimet; Yildiz, Oktay; Kolayli, Sevgi

    2016-01-01

    The present study was conducted to envisage inhibition effects of propolis on the crucial enzymes, urease, xanthine oxidase (XO) and acetylcholinesterase (AChE). Some of the antioxidant properties of the propolis samples were determined using the total phenolic content (TPE) and total flavonoids in the eight different ethanolic propolis extracts (EPE) samples. Inhibition values of the enzymes were expressed as inhibition concentration (IC50; mg/mL or μg/mL) causing 50% inhibition of the enzymes with donepezil, acetohydroxamic acid and allopurinol as reference inhibitors. All the propolis extracts exhibited variable inhibition effects on these enzymes, but the higher the phenolic contents the lower the inhibitions values (IC50 = 0.074 to 1.560 mg/mL). IC50 values of the P5 propolis sample having the highest TPE, obtained from Zonguldak, for AChE, urease and XO were 0.081 ± 0.009, 0.080 ± 0.006 and 0.074 ± 0.011 μg/mL, respectively. The EPE proved to be a good source of inhibitor agents that can be used as natural inhibitors to serve human health.

  10. [Clinical difference between thiazolidinediones and biguanides].

    Science.gov (United States)

    Hotta, N

    2001-11-01

    Hyperglycemia in patients with type 2 diabetes mellitus is caused by peripheral insulin resistance, which results in decreased insulin-mediated glucose disposal and increased endogenous glucose production, and inadequate insulin secretion. Recently, either biguanides or thiazolidinediones among oral hypoglycemic agents is widely used to patients with type 2 diabetes mellitus for reversal of insulin resistance. As clinical difference between biguanides and thiazolidinediones in reducing blood glucose, the former primarily lowers endogenous glucose production presumably at the level of liver, whereas the latter increases insulin-mediated peripheral glucose disposal, which occurs predominantly in skeletal muscle. Therefore, combination therapy with these two drugs results in further improvement in glucose control. Combination therapy including these two drugs is attractive prospects in future treatment for patients with type 2 diabetes.

  11. Measuring students’ approaches to learning in different clinical rotations

    Directory of Open Access Journals (Sweden)

    Emilia Ova

    2012-11-01

    Full Text Available Abstract Background Many studies have explored approaches to learning in medical school, mostly in the classroom setting. In the clinical setting, students face different conditions that may affect their learning. Understanding students’ approaches to learning is important to improve learning in the clinical setting. The aim of this study was to evaluate the Study Process Questionnaire (SPQ as an instrument for measuring clinical learning in medical education and also to show whether learning approaches vary between rotations. Methods All students involved in this survey were undergraduates in their clinical phase. The SPQ was adapted to the clinical setting and was distributed in the last week of the clerkship rotation. A longitudinal study was also conducted to explore changes in learning approaches. Results Two hundred and nine students participated in this study (response rate 82.0%. The SPQ findings supported a two-factor solution involving deep and surface approaches. These two factors accounted for 45.1% and 22.5%, respectively, of the variance. The relationships between the two scales and their subscales showed the internal consistency and factorial validity of the SPQ to be comparable with previous studies. The clinical students in this study had higher scores for deep learning. The small longitudinal study showed small changes of approaches to learning with different rotation placement but not statistically significant. Conclusions The SPQ was found to be a valid instrument for measuring approaches to learning among clinical students. More students used a deep approach than a surface approach. Changes of approach not clearly occurred with different clinical rotations.

  12. Gender differences in Parkinson's disease: clinical characteristics and cognition.

    Science.gov (United States)

    Miller, Ivy N; Cronin-Golomb, Alice

    2010-12-15

    More men than women are diagnosed with Parkinson's disease (PD), and a number of gender differences have been documented in this disorder. Examples of clinical characteristics that appear in men more often than women include rigidity and rapid eye movement behavior disorder, whereas more women than men exhibit dyskinesias and depression. Differences between men and women in cognition have not been extensively examined, though there are reports of deficits in men in aspects of cognition that contribute to activities of daily living, in verbal fluency, and in the recognition of facial emotion, and deficits in women in visuospatial cognition. Side of disease onset may interact with gender to affect cognitive abilities. One possible source of male-female differences in the clinical and cognitive characteristics of PD is the effect of estrogen on dopaminergic neurons and pathways in the brain. This effect is not yet understood, as insight into how the fluctuation of estrogen over the lifetime affects the brain is currently limited. Further attention to this area of research will be important for accurate assessment and better management of PD. Attention should also be directed to multiple covariates that may affect clinical characteristics and cognition. Knowledge about differences in the presentation of PD symptoms in men and women and about the pathophysiology underlying those differences may enhance the accuracy and effectiveness of clinical assessment and treatment of the disease.

  13. The Importance of Children in Clinical Trials | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... please turn Javascript on. Feature: Medicines for Children The Importance of Children in Clinical Trials Past Issues / ... rare event. Can you point to some of the successes with children from clinical trials research in ...

  14. Occurrence and Diversity of Clinically Important Vibrio Species in the Aquatic Environment of Georgia

    Science.gov (United States)

    Kokashvili, Tamar; Whitehouse, Chris A.; Tskhvediani, Ana; Grim, Christopher J.; Elbakidze, Tinatin; Mitaishvili, Nino; Janelidze, Nino; Jaiani, Ekaterine; Haley, Bradd J.; Lashkhi, Nino; Huq, Anwar; Colwell, Rita R.; Tediashvili, Marina

    2015-01-01

    Among the more than 70 different Vibrio species inhabiting marine, estuarine, and freshwater ecosystems, 12 are recognized as human pathogens. The warm subtropical climate of the Black Sea coastal area and inland regions of Georgia likely provides a favorable environment for various Vibrio species. From 2006 to 2009, the abundance, ecology, and diversity of clinically important Vibrio species were studied in different locations in Georgia and across seasons. Over a 33-month period, 1,595 presumptive Vibrio isolates were collected from the Black Sea (n = 657) and freshwater lakes around Tbilisi (n = 938). Screening of a subset of 440 concentrated and enriched water samples by PCR-electrospray ionization/mass spectrometry (PCR-ESI/MS) detected the presence of DNA from eight clinically important Vibrio species: V. cholerae, V. parahaemolyticus, V. vulnificus, V. mimicus, V. alginolyticus, V. harveyi, V. metschnikovii, and V. cincinnatiensis. Almost 90% of PCR/ESI-MS samples positive for Vibrio species were collected from June through November. Three important human-pathogenic Vibrio species (V. cholerae, V. parahaemolyticus, and V. vulnificus) were detected in 62.8, 37.8, and 21.4% of samples testing positive for Vibrios, respectively. The results of these activities suggest that natural reservoirs for human-pathogenic Vibrios exist in Georgian aquatic environments. Water temperature at all sampling sites was positively correlated with the abundance of clinically important Vibrio spp. (except V. metschnikovii), and salinity was correlated with species composition at particular Black Sea sites as well as inland reservoirs. PMID:26528464

  15. The minimal important difference for residual volume in patients with severe emphysema

    NARCIS (Netherlands)

    Hartman, Jorine E.; ten Hacken, Nick H. T.; Klooster, Karin; Boezen, H. Marike; de Greef, Mathieu H. G.; Slebos, Dirk-Jan

    2012-01-01

    Residual volume (RV) measured by body plethysmography is a routine measurement in clinical pulmonary practice and is often an important outcome variable in clinical trials. However, it is not known what size of improvement can be regarded as being important in severe emphysema patients. Therefore, t

  16. The Minimal Important Difference in Physical Activity in Patients with COPD.

    Directory of Open Access Journals (Sweden)

    Heleen Demeyer

    Full Text Available Changes in physical activity (PA are difficult to interpret because no framework of minimal important difference (MID exists. We aimed to determine the minimal important difference (MID in physical activity (PA in patients with Chronic Obstructive Pulmonary Disease and to clinically validate this MID by evaluating its impact on time to first COPD-related hospitalization.PA was objectively measured for one week in 74 patients before and after three months of rehabilitation (rehabilitation sample. In addition the intraclass correlation coefficient was measured in 30 patients (test-retest sample, by measuring PA for two consecutive weeks. Daily number of steps was chosen as outcome measurement. Different distribution and anchor based methods were chosen to calculate the MID. Time to first hospitalization due to an exacerbation was compared between patients exceeding the MID and those who did not.Calculation of the MID resulted in 599 (Standard Error of Measurement, 1029 (empirical rule effect size, 1072 (Cohen's effect size and 1131 (0.5SD steps.day-1. An anchor based estimation could not be obtained because of the lack of a sufficiently related anchor. The time to the first hospital admission was significantly different between patients exceeding the MID and patients who did not, using the Standard Error of Measurement as cutoff.The MID after pulmonary rehabilitation lies between 600 and 1100 steps.day-1. The clinical importance of this change is supported by a reduced risk for hospital admission in those patients with more than 600 steps improvement.

  17. The importance of inducible clindamycin resistance in enterotoxin positive S. aureus isolated from clinical samples

    Directory of Open Access Journals (Sweden)

    Memariani M

    2009-07-01

    Full Text Available "nBackground: Clindamycin is a suitable antibiotic for treatment of skin and soft tissue infections. Moreover, it can suppress toxin production in many pathogenic bacteria such as S. aureus. There are two mechanisms of resistance in this antibiotic. Constitutive resistance can be detected by standard disk diffusion method but in the case of inducible resistance, D-test should be carried out. The main aim of this study is to determine prevalence of clindamycin inducible resistance among methicillin resistant and susceptible isolates of S. aureus isolated from different clinical samples. "nMethods: A total of 87 clinical isolates from clinical samples were collected. Methicillin resistance was determined using standard disk diffusion method. Subsequently, D-test was carried out according to CLSI guideline. Presence of the sea gene (enterotoxin A was detected by PCR using specific primers. "nResults: Out of 87 isolates, 18(20.7% were clindamycin inducible resistant while constitutive resistance was detected among 21(24.1% isolates. The 95% Confidence intervals for the proportion of inducible clindamycin resistance among clinical isolates of S. aureus was 12.2% to 29.2%. The inducible phenotype in MRSA isolates was more common than that of MSSA isolates (33.3% vs 5.1%.Significant differences were found between prevalence of inducible clindamycin resistance and type of infection (p=0.045. Importantly, there was a significant correlation between sea gene and the constitutive/inducible resistance (p<0.0001. "nConclusions: Due to the high prevalence of clindamycin inducible resistance among clinical isolates of S. aureus, we recommend D-test to avoid treatment failure.

  18. What is clinical leadership and why might it be important in dentistry?

    Science.gov (United States)

    Brocklehurst, P; Ferguson, J; Taylor, N; Tickle, M

    2013-03-01

    The concept of leadership means different things to different people. At present there is no single definition of leadership nor an established theoretical approach. Despite this, leadership in the clinical environment is becoming increasingly cited as an important component in the transition of the National Health Service (NHS) and in the development of clinician led services. In medicine, clinical commissioning groups (CCGs) will soon be operational and the Department of Health (DH) seeks to establish a similar approach in dentistry, where local clinicians drive forward a quality agenda with a focus on patient outcomes. To facilitate this, the NHS Commissioning Board (NHSCB) are in the process of developing Local Professional Networks (LPNs) for dentistry. Given this shift towards localism and clinician led services it would appear that leadership will have a significant role in both medicine and dentistry. This paper explores what leadership is, before determining why it might be important in providing a clinician-led, patient-based and outcomes-focused service.

  19. Orofacial granulomatosis: clinical signs of different pathologies.

    Science.gov (United States)

    Troiano, Giuseppe; Dioguardi, Mario; Giannatempo, Giovanni; Laino, Luigi; Testa, Nunzio Francesco; Cocchi, Roberto; De Lillo, Alfredo; Lo Muzio, Lorenzo

    2015-01-01

    Orofacial granulomatosis (OFG) is an uncommon disease characterized by persistent or recurrent soft tissue enlargement, oral ulceration and a variety of other orofacial features. It could be an oral manifestation of a systemic disease. For a correct differential diagnosis, local and systemic conditions characterized by granulomatous inflammation should be excluded using appropriate clinical and laboratory investigations. In fact, the diagnosis of OFG may be confirmed only by histopathological identification of noncaseating granulomas. The literature from 1943 to 2014 was reviewed with emphasis on the etiology of OFG and on clinical manifestations of systemic pathologies associated with OFG. The precise cause of OFG is still unknown, although several theories have been suggested, such as infection, hereditary factors and allergy. OFG is a disease that has a wide spectrum of presentation, which may include the oral manifestation of a systemic condition such as Crohn's disease, sarcoidosis, granulomatosis with polyangiitis and Melkersson-Rosenthal syndrome.

  20. Determining the minimally important difference for the Oral Health Impact Profile-20.

    LENUS (Irish Health Repository)

    Allen, P Finbarr

    2009-04-01

    In the context of clinical trials, measurement of change is critical. The aim of this study was to determine the minimally important difference (MID) for the Oral Health Impact Profile-20 (OHIP-20) when used with partially dentate patients undergoing treatment that included the provision of removable partial dentures. In a prospective clinical trial, 51 consecutive patients were provided with removable partial dentures. In addition to demographic and dental status data, patients completed an OHIP-20 prior to treatment. One month postoperatively, patients completed a post-treatment OHIP-20 and a global transition scale. Domains assessed in the global transition scale were appearance, ability to chew food, oral comfort, and speech. The MID for the OHIP-20 was calculated using the anchor-based approach. From the initial sample of 51 patients, 44 completed post-treatment questionnaires and were included in the analysis. Change scores in the four transition domains indicated that new dentures had a positive impact in the majority of subjects, especially in perceived impact on chewing and appearance. The study provided a guideline as to what constitutes the MID for the OHIP-20. This benchmark can be used when interpreting the impact of clinical intervention for replacing missing teeth and for power calculation in statistical analyses.

  1. Differences between insurance organizations: do consumers perceive differences in important areas?

    NARCIS (Netherlands)

    Delnoij, D.M.J.; Hendriks, M.; Brouwer, W.; Spreeuwenberg, P.

    2006-01-01

    Background: Competition on the insurance market assumes that insurance organizations differ in what they offer, that the consumers of insurance products perceive differences, and that information about differences is available in a transparent way. With the introduction of the insurance reform in Th

  2. Differences between insurance organizations: do consumers perceive differences in important areas?

    NARCIS (Netherlands)

    Delnoij, D.M.J.; Hendriks, M.; Brouwer, W.; Spreeuwenberg, P.

    2006-01-01

    Background: Competition on the insurance market assumes that insurance organizations differ in what they offer, that the consumers of insurance products perceive differences, and that information about differences is available in a transparent way. With the introduction of the insurance reform in

  3. [The importance of clinical data management in improvement of drug evaluation].

    Science.gov (United States)

    Huang, Qin; Wang, Jun

    2015-11-01

    Although the importance of clinical data is drawing more attention in drug development in China, the clinical data management is not good enough in the clinical trials right now. With the development of internet and progress of information technology, especially with the setup of the state innovation strategy for drug development, it is necessary and urgent to improve the clinical data quality. Good data quality is the primary basis of technical evaluation of drug at the marketing authorization. So Center for Drug Evaluation of CFDA has made some endeavors to enhance data management in the clinical trials in recent years. This article is focused on these aspects of data managment.

  4. Sex differences in health research and clinical guideline development

    NARCIS (Netherlands)

    Keuken, D.G.

    2008-01-01

    In current medical practice, research based evidence is an important foundation for clinical decision making. Clinical practice guidelines are a major instrument for keeping physicians up-to-date about this evidence. In order to provide optimal care to both men and women, it is important that sex di

  5. Differences Between Clinical Trials of Medical Devices and Drugs

    Institute of Scientific and Technical Information of China (English)

    ZHANG Zhi-jun; LIU Wei

    2014-01-01

    How to design clinical trials for medical devices is a problem plaguing the industry today. As there are many differences in clinical trials of medical devices and drugs. This paper describes the differences of the two points from the perspectivs of defi-nition of medical devices and drugs, scope, phasing, subjects and design of clinical trials in details, aiming to help the related personnel make scientific decisions while conduct-ing clinical trial design for medical devices.

  6. Silicone Oil: Different Physical Proprieties and Clinical Applications

    Science.gov (United States)

    Barca, Francesco; Caporossi, Tomaso; Rizzo, Stanislao

    2014-01-01

    Silicone oils are important tools in vitreoretinal surgery because they have the ability to displace aqueous humor from the retinal surface, maintaining the adhesion between retina and retinal pigment epithelium. To understand this capability, it is important to know the silicone oil characteristics. Herein, we report first on the main chemical-physical proprieties and then we review the clinical applications of the current silicone oil which is lighter than water with particular reference to their indications with small gauge vitrectomy. Finally, we describe the surgical techniques to inject and remove this type of silicone oil. In the summary of this paper, we explain why silicone oils are today increasingly used and why their introduction has improved the prognosis of several retinal diseases. In fact, having different types of silicone oils allows us to choose the appropriate endotamponade for every single case. PMID:25013785

  7. Silicone Oil: Different Physical Proprieties and Clinical Applications

    Directory of Open Access Journals (Sweden)

    Francesco Barca

    2014-01-01

    Full Text Available Silicone oils are important tools in vitreoretinal surgery because they have the ability to displace aqueous humor from the retinal surface, maintaining the adhesion between retina and retinal pigment epithelium. To understand this capability, it is important to know the silicone oil characteristics. Herein, we report first on the main chemical-physical proprieties and then we review the clinical applications of the current silicone oil which is lighter than water with particular reference to their indications with small gauge vitrectomy. Finally, we describe the surgical techniques to inject and remove this type of silicone oil. In the summary of this paper, we explain why silicone oils are today increasingly used and why their introduction has improved the prognosis of several retinal diseases. In fact, having different types of silicone oils allows us to choose the appropriate endotamponade for every single case.

  8. From the NIH Director: The Importance of Clinical Trials | NIH MedlinePlus the Magazine

    Science.gov (United States)

    ... of this page please turn Javascript on. From the NIH Director: The Importance of Clinical Trials Past Issues / Summer 2011 ... Francis S. Collins, M.D., Ph.D., Director of the National Institutes of Health, led the successful effort ...

  9. Chronic Chagas cardiopathy in Chile. Importance of Trypanosoma cruzi burden and clinical evaluation.

    Science.gov (United States)

    Apt, Werner; Arribada, Arturo; Zulantay, Inés; Saavedra, Miguel; Muñoz, Catalina; Toro, Bruno; Vega, Bastián; Rodríguez, Jorge

    2016-10-01

    Currently there are no biological markers to indicate which individuals with chronic indeterminate period of Chagas disease develop heart disease and who will remain all his life in this phase. The aim of this survey was to determine if Trypanosoma cruzi burden is related to the presence of heart disease in patients with chronic Chagas disease. 200 patients who had not been treated, 100 with cardiopathy and 100 without, groups A and B respectively, were submitted to clinical study and electrocardiogram, Echo-Doppler was performed for group A in which all important known causes of cardiopathy were discarded. In both groups xenodiagnosis, conventional PCR and quantitative PCR were undertaken. The 100 cardiopaths had 133 electrocardiographic alterations most of them in grade II of the New York Heart Association classification. 98 cardiopaths were classified in grade I by Echo-Doppler and only 2 cases were in grade III due to low ejection fraction. The difference in average parasitemia in patients of group A and B was not significant and no statistically differences were observed between average parasitemia of cardiopaths grade II versus grade I of NYHA. This results allow to characterize same clinical, electrocardiographical and parasitological features in chagasic cardiopaths of Chile.

  10. The importance of knowledge, skills, and attitude attributes for veterinarians in clinical and non-clinical fields of practice: a survey of licensed veterinarians in Quebec, Canada.

    Science.gov (United States)

    Doucet, Michèle Y; Vrins, André

    2009-01-01

    To improve content validity and the pertinence of outcome assessment tools used for the undergraduate Doctor of Veterinary Medicine program at the University of Montreal's Faculté de médecine vétérinaire, a survey of members of the Quebec veterinary association was conducted. This survey aimed to determine the importance of a list of 71 attributes-categorized as knowledge, general skills, specific skills, and attitudes-for clinical and non-clinical types of professional activities. The results indicated that all basic knowledge components, general skills, and attitudes were equally important for all types of veterinary professional activities, while the importance of specific skills was significantly different for clinical practice and non-clinical fields. It was therefore proposed that outcomes assessment surveys of stakeholders, such as alumni and employers, be analyzed separately for each type of career option.

  11. THE IMPORTANCE OF OBSERVING THE DIFFERENCE IN WEBSITE EVALUATIONS OBTAINED FROM DIFFERENT PERSPECTIVES

    Directory of Open Access Journals (Sweden)

    Biljana Rondović

    2017-06-01

    Full Text Available The purpose of this paper is to show how website evaulations differ if performed by different evaluators despite the same methodological framework being used for the assessment. A quantitative analysis of websites was performed according to the modified evaluation framework based on the 2QCV3Q-model. The AHP method was used for the verification of the weight criteria, while a single-factor ANOVA was used to check the difference in the average scores of the evaluations performed by three groups of evaluators The results obtained by the single-factor ANOVA showed a statistically significant difference in the average scores of internal evaluation when compared to the evaluation done by clients and independent evaluators. The results obtained can be used in the banking industry as guidelines and recommendations for the future design or redesign of websites, as well as a literary base for comparative analyses of this kind in developing countries.

  12. A study of practical parameters and their relative importance as perceived by various stakeholders in clinical trials.

    Science.gov (United States)

    Pant, R; Joshi, Y

    2011-01-01

    A contract research organization (CRO) is a company which conducts a Good Clinical Practice (GCP) in clinical trial. There are literally hundreds of CROs worldwide employing a workforce of nearly 100,000 professionals. The project proposes the study of practical parameters and their relative importance as perceived by the various stakeholders in clinical trials. The survey was conducted in Bangalore and New Delhi. Primary market data was obtained by primary market research which included 80 clinical trial stakeholders by having a preliminary communication with them, followed by administering a questionnaire along with prior permission. There were 15 Sponsors/ CROs, 27 Investigators /Monitors and 38 Ethics committee members involved in the study. It was shown from the study that a clinical investigator involved in a clinical trial is responsible for ensuring that an investigation is conducted according to the signed investigator statement, the investigational plan, and applicable regulations; for protecting the rights, safety, and welfare of the subjects under the investigator's care; and for the control of drugs under investigation. It was also shown from the study that the sponsors of a clinical trial carry the ultimate responsibility for the initiation, management and financing of the clinical trial. The study has identified a specific training need at the level of the individual stakeholder to perform a particular job function and to identify the actual practical parameters in the Indian context important for the conduction of clinical trials (GCP) with respect to the different stakeholders, to determine the relative importance of these parameters as perceived by various stakeholders involved in clinical trials, and to identify the relative contributions of different stakeholders to the success/ satisfactory conduct of a clinical trial.

  13. Different Clinical Features of Acral Abortive Hemangiomas

    Directory of Open Access Journals (Sweden)

    N. Vega Mata

    2017-01-01

    Full Text Available Some infantile hemangiomas called in literature “minimal or arrested growth hemangiomas” or “abortive hemangiomas” are present at birth and have a proliferative component equaling less than 25% of its total surface area. Often, they are mistaken for vascular malformation. We present five patients (three girls and two boys with abortive hemangiomas diagnosed between January 2010 and December 2015 localized in acral part of the extremities. They were congenital lesions resembling precursor of hemangiomas but did not show proliferation phase. Immunohistochemical Glut-1 was performed in all of them as a way to confirm the abortive hemangioma diagnosis. The most common appearance was a reticulated erythematous patch with multiple fine telangiectasias on the surface. We remark that one of them presented a segmental patch with two different morphologies and evolutions. The proximal part showed pebbled patches of bright-red hemangioma and presented proliferation and the distal part with a reticulated network-like telangiectasia morphology remained unchanged. We detected lower half of the body preference and dorsal region involvement preference without ventral involvement. The ulceration occurred in three patients with two different degrees of severity.

  14. A visitor's guide to effect sizes: statistical significance versus practical (clinical) importance of research findings.

    Science.gov (United States)

    Hojat, Mohammadreza; Xu, Gang

    2004-01-01

    Effect Sizes (ES) are an increasingly important index used to quantify the degree of practical significance of study results. This paper gives an introduction to the computation and interpretation of effect sizes from the perspective of the consumer of the research literature. The key points made are: 1. ES is a useful indicator of the practical (clinical) importance of research results that can be operationally defined from being "negligible" to "moderate", to "important". 2. The ES has two advantages over statistical significance testing: (a) it is independent of the size of the sample; (b) it is a scale-free index. Therefore, ES can be uniformly interpreted in different studies regardless of the sample size and the original scales of the variables. 3. Calculations of the ES are illustrated by using examples of comparisons between two means, correlation coefficients, chi-square tests and two proportions, along with appropriate formulas. 4. Operational definitions for the ES s are given, along with numerical examples for the purpose of illustration.

  15. Is Clinical Competence Perceived Differently for Student Daily Performance on the Wards versus Clerkship Grading?

    Science.gov (United States)

    Wimmers, Paul F.; Kanter, Steven L.; Splinter, Ted A. W.; Schmidt, Henk G.

    2008-01-01

    Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers…

  16. Is clinical competence perceived differently for student daily performance on the wards versus clerkship grading?

    Science.gov (United States)

    Wimmers, Paul F; Kanter, Steven L; Splinter, Ted A W; Schmidt, Henk G

    2008-12-01

    Clinical rotations play an important role in the medical curriculum and are considered crucial for student learning. However, competencies that should be learned can differ from those that are assessed. In order to explore which competencies are considered important for daily performance of student on the wards and to what extent clinical teachers consider the same competencies important for clerkship grading, a survey that consisted of 21 different student characteristics was administered to clinical teachers. Two independent factor analyses using structural equation modeling were conducted to abstract underlying latent relationships among the different student characteristics and to define a clinical competence profile for daily performance of students on the wards and clerkship grading. Differences between the degree of importance for student daily ward performance and clerkship grading are considered and discussed. The results of the survey indicate that the degree of importance of competencies are rated different for daily performance of students on the wards and clerkship grades. Competencies related to the diagnostic process are more important for clerkship grading, whereas interpersonal skills, professional qualities, and motivation are more important for daily ward performance. It is concluded that the components of clinical competence considered important for adequate performance are not necessarily in alignment with what is required for grading. Future research should focus on an explanation why clinical educators think differently about the importance of competencies for student examination in contrast to what is required for adequate daily performance on the wards.

  17. Different Techniques of MRU: Pitfalls & Clinical Applications

    Directory of Open Access Journals (Sweden)

    H. Nayyeri

    2005-08-01

    Full Text Available Introduction & Background: Magnetic resonance urography (MRU refers to MR imaging of the urinary col-lecting systems and it provides information roughly analogous to conventional intravenous urography. There are two basic MRU imaging strategies, (1 Static MRU uses T2W scans and rely on the presence of fluid in the pelvicaliceal systems and the ureters; (2 Excretory MRU is performed after administration of IV Gd using a 3D gradient echo sequence. Static MRU is best used for dilated collecting systems and can be employed regardless of renal function. Excretory MRU is usually preferred over static techniques for the demonstration of non-distended ureters; however, it is contraindicated in severely impaired renal function. As MR urograms are often displayed as maximum intensity projections, a low signal intensity ureteral stone surrounded by high signal intensity urine may be obscured on maximum intensity projection images. A prob-lem in static MR urography is the superimposition of fluid-filled structures (i.e. bowel loops, gall bladder and bile ducts, CSF, or any intraabdominal fluid collection on reconstructed images which may create false posi-tive findings or obscure true abnormalities. Non-distended ureters may escape detection on static MR uro-grams, resulting in the incorrect diagnosis of complete ureteral obstruction. Parapelvic cysts may simulate hy-dronephrosis while calyceal diverticulae may simulate simple renal cysts on static MRU. Excretory MR urography is performed in all such cases; however, Gd may create different problems when it becomes too concentrated within the collecting system. Sufficiently concentrated Gd shortens T2 relaxation times to the point that signal loss from T2 relaxation exceeds the T1 shortening effects of the contrast agent. This may result in poor visualization of all or a portion of collecting system on T1W images. Concentrated Gd in the renal collecting system also causes signal loss on T2W images

  18. Important considerations for designing and reporting epidemiologic and clinical studies in dental traumatology

    DEFF Research Database (Denmark)

    Andersson, Lars; Andreasen, Jens O

    2011-01-01

    The purpose of this article is to suggest important considerations for epidemiologic and clinical studies in the field of dental traumatology. The article is based on the authors' experiences from research in this field and editorial board work for the scientific journal Dental Traumatology....... Examples are given of issues where development is important. The importance of planning ahead of the study and consulting with experts in other fields is emphasized....

  19. Gender-related clinical and neurocognitive differences in individuals seeking treatment for pathological gambling

    DEFF Research Database (Denmark)

    Grant, Jon E; Chamberlain, Samuel R; Schreiber, Liana R N

    2012-01-01

    Understanding variations in disease presentation in men and women is clinically important as differences may reflect biological and sociocultural factors and have implications for selecting appropriate prevention and treatment strategies. The aim of this study was to investigate clinical and cogn...... and cognitive differences in treatment-seeking people with pathological gambling as a function of gender....

  20. 基于中医临床试验的匹兹堡睡眠质量指数最小重要差值的研究%Study on Minimal Important Difference of the Pittsburgh Sleep Quality Index Based on Clinical Trial of Traditional Chinese Medicine

    Institute of Scientific and Technical Information of China (English)

    路桃影; 李艳; 潘集阳; 吴大嵘

    2013-01-01

    [目的]评估匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index,PSQI)在失眠人群中的最小重要差值(minimal important difference,MID).[方法]采用中医药随机对照试验的数据进行研究(注册号:ChiCTR-TRC-10001138),将广州中医药大学第二附属医院和暨南大学第一附属医院两个中心的152例失眠患者纳入研究,分为试验组和对照组,排除不合格及脱落病例后共纳入137例,试验组70例给予中药、平衡针及睡眠卫生指导,对照组67例给予安慰剂、轻微针刺及睡眠卫生指导,分别在药物干预前、治疗第29天及第56天的随访阶段由患者填写PSQI,使用锚定法和分布法对PSQI的MID进行评估.[结果]在治疗第29天,PSQI得分差值的变化范围在1.93 ~ 2.90之间.在第56天的随访阶段,pSQI得分差值的变化范围在1.63~3.98之间.分布法中效应值估计的PSQI的MID变化范围在1.14~ 1.75之间,平均为1.54.标准测量误差得出的PSQI的MID变化范围在1.69~1.80之间,平均为1.75.[结论]使用锚定法和分布法评估PSQI的MID,对临床及量表研究具有重要的参考价值.%Objective To assess the minimal important difference (MID) of the Pittsburgh Sleep Quality Index (PSQI) in insomnia patients,a standardized self-rated questionnaire for measuring the patient's sleep quality.Methods Data was obtained from an existed clinical trial (registration number:ChiCTR-TRC-10001138),which was part of a randomized,placebo-controlled trial conducted at outpatient department of the Second Affiliated Hospital of Guangzhou University of Chinese Medicine and First Affiliated Hospital of Jinan University,involving 152 insomnia patients,which were divided into treatment group and control group.After excluding the disqualified and dropped out patients,137 patients were analyzed.Patients in the treatment group (N=70) were given Chinese herbal decoction,balance-needling acupuncture and sleep hygiene education.The control group (N

  1. Adhesive systems: important aspects related to their composition and clinical use

    Directory of Open Access Journals (Sweden)

    Mario Honorato Silva e Souza Junior

    2010-06-01

    Full Text Available This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and infuence of handling characteristics. Scanning electron microscopy (SEM images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classifed according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specifc acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and defciencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplifed ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

  2. Adhesive systems: important aspects related to their composition and clinical use.

    Science.gov (United States)

    Silva e Souza, Mario Honorato; Carneiro, Karina Gama Kato; Lobato, Marcelo Figueiredo; Silva e Souza, Patrícia de Almeida Rodrigues; de Góes, Mário Fernando

    2010-01-01

    This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-etch and glass ionomer. The etch-and-rinse systems require a specific acid-etch procedure and may be performed in two or three steps. Self-etch systems employ acidic monomers that demineralize and impregnate dental substrates almost at the same time. These systems are separated in one or two steps. Some advantages and deficiencies were noted for etch-and-rinse and self-etch approaches, mainly for the simplified ones due to some chemical associations and interactions. The SEM micrographs illustrate different relationships between adhesive systems and dental structures, particularly dentin. The knowledge of composition, characteristics and mechanisms of adhesion of each adhesive system is of fundamental importance to permit the adoption of ideal bonding strategies under clinical conditions.

  3. Clinical importance of personality difficulties: diagnostically sub-threshold personality disorders.

    Science.gov (United States)

    Karukivi, Max; Vahlberg, Tero; Horjamo, Kalle; Nevalainen, Minna; Korkeila, Jyrki

    2017-01-14

    Current categorical classification of personality disorders has been criticized for overlooking the dimensional nature of personality and that it may miss some sub-threshold personality disturbances of clinical significance. We aimed to evaluate the clinical importance of these conditions. For this, we used a simple four-level dimensional categorization based on the severity of personality disturbance. The sample consisted of 352 patients admitted to mental health services. All underwent diagnostic assessments (SCID-I and SCID-II) and filled in questionnaires concerning their social situation and childhood adversities, and other validated tools, including the Beck Depression Inventory (BDI), Alcohol Use Disorders Identification Test (AUDIT), health-related quality of life (15D), and the five-item Mental Health Index (MHI-5). The patients were categorized into four groups according to the level of personality disturbance: 0 = No personality disturbance, 1 = Personality difficulty (one criterion less than threshold for one or more personality disorders), 2 = Simple personality disorder (one personality disorder), and 3 = Complex/Severe personality disorder (two or more personality disorders or any borderline and antisocial personality disorder). The proportions of the groups were as follows: no personality disturbance 38.4% (n = 135), personality difficulty 14.5% (n = 51), simple personality disorder 19.9% (n = 70), and complex/severe personality disorder 24.4% (n = 86). Patients with no personality disturbance were significantly differentiated (p personality disorders stood out as being worst off. Social dysfunction was related to the severity of the personality disturbance. Patients with a personality difficulty or a simple personality disorder had prominent symptoms and difficulties, but the differences between these groups were mostly non-significant. An elevated severity level of personality disturbance is associated with an

  4. Zika virus and the risk of imported infection in returned travelers: Implications for clinical care.

    Science.gov (United States)

    Goorhuis, Abraham; von Eije, Karin J; Douma, Renée A; Rijnberg, Noor; van Vugt, Michele; Stijnis, Cornelis; Grobusch, Martin P

    2016-01-01

    Since late 2015, an unprecedented outbreak of Zika virus is spreading quickly across Southern America. The large size of the current outbreak in The Americas will also result in an increase in Zika virus infections among travelers returning from endemic areas. We report five cases of imported Zika virus infection to The Netherlands. Although the clinical course is usually mild, establishing the diagnosis is important, mainly because of the association with congenital microcephaly and the possibility of sexual transmission.

  5. The attitudes of medical students in Europe toward the clinical importance of embryology.

    Science.gov (United States)

    Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Standley, Henrietta; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Chirculescu, Andy

    2016-03-01

    Although there have been many studies reporting the attitudes of medical students to the clinical importance of gross anatomy, little is known about their opinions concerning the clinical importance of embryology. Using Thurstone and Chave methods to assess attitudes, nearly 1,600 medical students across Europe in the early stages of their training provided responses to a survey that tested the hypothesis that they do not regard embryology as highly clinically relevant. Indeed, we further proposed that student attitudes to gross anatomy are much more positive than those toward embryology. Our findings show that our hypotheses hold, regardless of the university and country surveyed and regardless of the teaching methods employed for embryology. Clearly, embryology has a significant part to play in medical education in terms of understanding prenatal life, of appreciating how the organization of the mature human body has developed, and of providing essential information for general medical practice, obstetrics and pediatrics, and teratology. However, while newly recruited medical students understand the importance of gross anatomy in the development of professional competence, understanding the importance of embryology requires teachers, medical educationalists, and devisors of medical curricula to pay special attention to informing students of the significant role played by embryology in attaining clinical competence and achieving the knowledge and understanding of the biomedical sciences that underpins becoming a learned member of a health care profession. © 2015 Wiley Periodicals, Inc.

  6. [The importance of test control for the post-graduate education in clinical rhinology].

    Science.gov (United States)

    Nosulia, E V; Kim, I A; Kosiakov, S Ia; Piskunov, G Z; Vinnikov, A K

    2014-01-01

    This publication deals with the problems pertaining to the improvement of the system of the post-graduate education in otorhinolaryngology with special reference to one of its topical fields, clinical rhinology. The authors emphasize the importance of one of the principal components of the post-graduate education under the present-day conditions, namely organization of control and self-control of learning the new material, self-monitoring and individual correction of the level of knowledge. Special attention is given to the training tests that can be used to adequately simulate the decision-making process with respect to a concrete clinical situation. It is concluded that the systematic application of test control is one of the most important prerequisites for the enhancement of the effectiveness of the post-graduate education in clinical otorhinolaryngology.

  7. Minimal important difference after hand surgery: a prospective assessment for DASH, MHQ, and SF-12

    Science.gov (United States)

    Maia, Maurício Vieira de Pádua; de Moraes, Vinícius Ynoe; dos Santos, João Baptista Gomes; Faloppa, Flávio; Belloti, João Carlos

    2016-01-01

    Introduction: Minimal important difference (MID) score is an important measure for surgical clinical research and impacts on treatment decisions. Our approach considered patient satisfaction as the relevant anchor criteria. The aims of this study were: determine after surgery MID for three relevant questionnaires: Disabilities of the Arm, Shoulder and Hand (DASH), Michigan Hand Questionnaire (MHQ), and Short Form 12 (SF-12); and assess the correlation between these scores and patient reported satisfaction. Methods: Adult patients where surgery was indicated for any hand/wrist conditions. Study was conducted in a teaching hospital, São Paulo, Brazil. Participants responded to DASH, SF-12, MHQ, and a Likert satisfaction scale before and three months after a procedure. Satisfaction was considered as the anchor for determining MID after a procedure. The correlation between satisfaction and the instruments were measured. Two statistical approaches were utilized for determining MIDs and were used for consistency and generalizability purposes. For MID determination, receiver operating curves were utilized and MID cut-offs were followed by sensitivity and specificity measures. Results: Fifty patients were included with no follow-up losses. MID for DASH was 18.8 and 15.4. MID for MHQ was 14.7 for both approaches. Data from SF-12 was not reliable after statistical analyses and demonstrated poor correlation with patient satisfaction. MID for DASH and MHQ were found and demonstrated larger standards than literature-reported patients when surgery was not the main intervention. DASH and MHQ had moderate correlation with patient reported satisfaction. SF-12 MID was not reliable and had poor correlation to patient satisfaction. These data suggests that ambulatory hand surgery patients may have greater expectations regarding improvement than other patients. PMID:27716460

  8. Inhibitory effect of Allium sativum and Zingiber officinale extracts on clinically important drug resistant pathogenic bacteria

    Directory of Open Access Journals (Sweden)

    Gull Iram

    2012-04-01

    Full Text Available Abstract Background Herbs and spices are very important and useful as therapeutic agent against many pathological infections. Increasing multidrug resistance of pathogens forces to find alternative compounds for treatment of infectious diseases. Methods In the present study the antimicrobial potency of garlic and ginger has been investigated against eight local clinical bacterial isolates. Three types of extracts of each garlic and ginger including aqueous extract, methanol extract and ethanol extract had been assayed separately against drug resistant Escherichia coli, Pseudomonas aeruginosa, Bacillus subtilis, Staphylococcus aureus, Klebsiella pneumoniae, Shigella sonnei, Staphylococcusepidermidis and Salmonella typhi. The antibacterial activity was determined by disc diffusion method. Results All tested bacterial strains were most susceptible to the garlic aqueous extract and showed poor susceptibility to the ginger aqueous extract. The (minimum inhibitory concentration MIC of different bacterial species varied from 0.05 mg/ml to 1.0 mg/ml. Conclusion In the light of several socioeconomic factors of Pakistan mainly poverty and poor hygienic condition, present study encourages the use of spices as alternative or supplementary medicine to reduce the burden of high cost, side effects and progressively increasing drug resistance of pathogens.

  9. Dental Erosion and Its Growing Importance in Clinical Practice: From Past to Present

    Directory of Open Access Journals (Sweden)

    Ann-Katrin Johansson

    2012-01-01

    Full Text Available Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject.

  10. Dental Erosion and Its Growing Importance in Clinical Practice: From Past to Present

    Science.gov (United States)

    Johansson, Ann-Katrin; Omar, Ridwaan; Carlsson, Gunnar E.; Johansson, Anders

    2012-01-01

    Since the mid-1990s, the focus of studies on tooth wear has steadily shifted from the general condition towards the more specific area of dental erosion; equally, a shift has occurred from studies in adults to those in children and adolescents. During this time, understanding of the condition has increased greatly. This paper attempts to provide a critical overview of the development of this body of knowledge, from earlier perceptions to the present. It is accepted that dental erosion has a multifactorial background, in which individual and lifestyle factors have great significance. Notwithstanding methodological differences across studies, data from many countries confirm that dental erosion is common in children and young people, and that, when present, it progresses rapidly. That the condition, and its ramifications, warrants serious consideration in clinical dentistry, is clear. It is important for the oral healthcare team to be able to recognize its early signs and symptoms and to understand its pathogenesis. Preventive strategies are essential ingredients in the management of patients with dental erosion. When necessary, treatment aimed at correcting or improving its effects might best be of a minimally invasive nature. Still, there remains a need for further research to forge better understanding of the subject. PMID:22505907

  11. Implementation of new clinical programs in the VHA healthcare system: the importance of early collaboration between clinical leadership and research.

    Science.gov (United States)

    Wu, R Ryanne; Kinsinger, Linda S; Provenzale, Dawn; King, Heather A; Akerly, Patricia; Barnes, Lottie K; Datta, Santanu K; Grubber, Janet M; Katich, Nicholas; McNeil, Rebecca B; Monte, Robert; Sperber, Nina R; Atkins, David; Jackson, George L

    2014-12-01

    Collaboration between policy, research, and clinical partners is crucial to achieving proven quality care. The Veterans Health Administration has expended great efforts towards fostering such collaborations. Through this, we have learned that an ideal collaboration involves partnership from the very beginning of a new clinical program, so that the program is designed in a way that ensures quality, validity, and puts into place the infrastructure necessary for a reliable evaluation. This paper will give an example of one such project, the Lung Cancer Screening Demonstration Project (LCSDP). We will outline the ways that clinical, policy, and research partners collaborated in design, planning, and implementation in order to create a sustainable model that could be rigorously evaluated for efficacy and fidelity. We will describe the use of the Donabedian quality matrix to determine the necessary characteristics of a quality program and the importance of the linkage with engineering, information technology, and clinical paradigms to connect the development of an on-the-ground clinical program with the evaluation goal of a learning healthcare organization. While the LCSDP is the example given here, these partnerships and suggestions are salient to any healthcare organization seeking to implement new scientifically proven care in a useful and reliable way.

  12. Evaluation of different systems for clinical quantification of varicose veins.

    Science.gov (United States)

    Cornu-Thénard, A; De Vincenzi, I; Maraval, M

    1991-04-01

    One hundred twenty-five lower limbs with varicose veins were studied clinically, essentially by palpation. Two specialists in venous pathology scored the severity of the varicose veins from 0 to 20. Comparison between the different clinical parameters and the scores of the specialists showed that two systems of clinical quantification gave good results and were easy to use. One system is the maximum diameter of the largest varicose vein; the other system is the sum of maximum diameters over 7 sections (3 for thigh, 3 for leg, 1 for foot). This latter system gives a more precise evaluation of the clinical severity of the varicose veins.

  13. Elevation Differences between MMPI-2 Clinical and Restructured Clinical (RC) Scales: Frequency, Origins, and Interpretative Implications

    Science.gov (United States)

    Sellbom, Martin; Ben-Porath, Yossef S.; McNulty, John L.; Arbisi, Paul A.; Graham, John R.

    2006-01-01

    The frequency, origin, and interpretative implications of elevation differences on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) clinical and restructured clinical (RC) scales were examined. Two large clinical samples consisting of 1,770 outpatients and 2,438 inpatients were used for this study. Three potential factors…

  14. The attitudes of medical students in Europe toward the clinical importance of histology.

    Science.gov (United States)

    Moxham, Bernard John; Emmanouil-Nikoloussi, Elpida; Brenner, Erich; Plaisant, Odile; Brichova, Hana; Kucera, Tomas; Pais, Diogo; Stabile, Isobel; Borg, Jordy; Scholz, Michael; Paulsen, Friedrich; Luis Bueno-López, José; Alfonso Arraez Aybar, Luis; De Caro, Raffaele; Arsic, Stojanka; Lignier, Baptiste; Chirculescu, Andy

    2017-07-01

    Many studies have been undertaken to assess the attitudes of medical students to the clinical importance of gross anatomy. However, much less is known about their attitudes toward the clinical importance of histology. Using Thurstone and Chave methods to assess attitudes, over 2,000 early stage medical students across Europe provided responses to a survey that tested the hypothesis that the students have a high regard for histology's clinical relevance. Regardless of the university and country surveyed, and of the teaching methods employed for histology, our findings were not consistent with our hypotheses, students providing a more moderate assessment of histology's importance compared to gross anatomy but more positive than their attitudes toward embryology. Histology should play a significant role in medical education in terms of appreciating not just normal structure and function but also pathology. We conclude that teachers of histology should pay special attention to informing newly-recruited medical students of the significant role played by histology in attaining clinical competence and in underpinning their status as being learned members of a healthcare profession. This work was conducted under the auspices of the Trans-European Pedagogic Research Group (TEPARG). Clin. Anat. 30:635-643, 2017. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  15. A lack of genetic basis for biovar differentiation in clinically important Corynebacterium diphtheriae from whole genome sequencing.

    Science.gov (United States)

    Sangal, Vartul; Burkovski, Andreas; Hunt, Alison C; Edwards, Becky; Blom, Jochen; Hoskisson, Paul A

    2014-01-01

    The differentiation of clinically important Corynebacterium diphtheriae into specific biovars is complex and phylogenetically unclear. Comparative genomic analyses of 17 strains indicate that the division of C. diphtheriae into different biovars does not correlate with the variation in the gene content in the relevant metabolic categories that are potentially involved in the biovar discrimination. The biochemical separation is also not supported by phylogenetic analyses, suggesting molecular methods of typing C. diphtheriae strains should be adopted much more widely.

  16. Sex and Age Differences in Adolescents' Value Judgments of Historically Important Events: Theory, Stereotypes and Data.

    Science.gov (United States)

    Kunen, Seth; And Others

    1991-01-01

    Examined how younger and older adolescents differed in their value judgments of historically important events. Subjects (n=154) between the ages of 11 and 27 listed 10 most important events to United States since 1900. Three most frequently cited events were World Wars I and II and Vietnam. Age was much better predictor of value judgments than…

  17. Fatores associados à diferença clinicamente significativa da qualidade de vida relacionada à saúde após condicionamento físico em pacientes com DPOC Factors associated with the minimal clinically important difference for health-related quality of life after physical conditioning in patients with COPD

    Directory of Open Access Journals (Sweden)

    Victor Zuniga Dourado

    2009-09-01

    Full Text Available OBJETIVO: Investigar os fatores associados à diferença clinicamente significativa da qualidade de vida (DCSQV após condicionamento físico em pacientes com DPOC. MÉTODOS: Trinta e cinco pacientes foram submetidos a 12 semanas de condicionamento físico, envolvendo treinamento de força e exercício aeróbio leve. Composição corporal, teste incremental e de endurance em esteira, teste de caminhada de seis minutos, força muscular periférica, PImáx, baseline dyspnea index (BDI e Saint George's Respiratory Questionnaire (SGRQ foram avaliados antes e após o treinamento, e suas alterações (Δ foram calculadas. A DCSQV foi definida como a redução > 4% no escore total do SGRQ. Os pacientes que responderam ao treinamento, apresentando DCSQV, foram alocados no grupo respondedores (R; n = 24, e os demais pacientes foram alocados no grupo não-respondedores (NR; n = 11. RESULTADOS: Os seguintes resultados foram significativamente maiores no grupo R que no grupo NR (p OBJECTIVE: To identify factors associated with the minimal clinically important difference (MCID for health-related quality of life (HRQoL after physical conditioning in patients with COPD. METHODS: Thirty-five patients were submitted to a 12-week program of physical conditioning (strength training plus low-intensity aerobic exercise. Body composition, incremental treadmill test results, endurance treadmill test results, six-minute walk test results, peripheral muscle strength, MIP, baseline dyspnea index (BDI and Saint George's Respiratory Questionnaire (SGRQ scores were assessed at baseline and after the program, thus allowing the variations (Δ to be calculated. The MCID for HRQoL was defined as a reduction of > 4% in the SGRQ total score. Subjects who responded to the program, achieving the MCID for HRQoL, were allocated to the responders (R group (n = 24, and the remainder were allocated to the non-responders (NR group (n = 11. RESULTS: The values obtained for the following

  18. Gender Differences in Perceived Importance and Performance of Penang Island Attributes

    Directory of Open Access Journals (Sweden)

    Omar Shida Irwana

    2014-01-01

    Full Text Available This paper examines the gender differences in perceived importance and performance of Penang Island attributes. The data was drawn from questionnaire survey of 801 international tourists who visited the island between August and November 2012. Previous studies related to gender differences in Malaysian destinations are found scarce and neglected, thus this paper aims to bridge this knowledge gap. The needs to study gender differences are related to the suggestions that men and women engage in different leisure activities, possess different travel motivations and perceive differently when embarking for holiday. The study found a number of gender similarities and differences between the men and women tourists, in terms of their travel style and perceptions of importance and performance of destination attributes. These results indicate that gender may not be the only influence on behaviour and perceptions, and those men and women should not be regarded as homogenous groups.

  19. [The importance of social psychological and clinical factors for prescribing group psychotherapy for neurosis patients].

    Science.gov (United States)

    Grineva, I M; Khokholeva, A A; Obora, V V; Karagodina, E G; Lazarenko, A N

    1989-11-01

    Socio-psychological and clinical factors and their significance for group psychotherapy were investigated in 62 patients with neuroses. The obtained statistically valid differences of some characteristic aspects between groups of patients with positive and negative directives. This indicates the necessity of differential approach to group psychotherapy and active individual and group work on the creation of positive motivation to this type of treatment.

  20. Autonomic Dysfunction in Early Breast Cancer: Incidence, Clinical Importance, and Underlying Mechanisms

    OpenAIRE

    2015-01-01

    Autonomic dysfunction represents a loss of normal autonomic control of the cardiovascular system associated with both sympathetic nervous system overdrive and reduced efficacy of the parasympathetic nervous system. Autonomic dysfunction is a strong predictor of future coronary heart disease, vascular disease and sudden cardiac death. In the current review, we will discuss the clinical importance of autonomic dysfunction as a cardiovascular risk marker among breast cancer patients. We will rev...

  1. Radiation-induced bystander effect: The important part of ionizing radiation response. Potential clinical implications

    Directory of Open Access Journals (Sweden)

    Maria Wideł

    2009-08-01

    Full Text Available It has long been a central radiobiological dogma that the damaging effects of ionizing radiation, such as cell death, cytogenetic changes, apoptosis, mutagenesis, and carcinogenesis, are the results of the direct ionization of cell structures, particularly DNA, or indirect damage via water radiolysis products. However, several years ago attention turned to a third mechanism of radiation, termed the “bystander effect” or “radiation-induced bystander effect” (RIBE. This is induced by agents and signals emitted by directly irradiated cells and manifests as a lowering of survival, cytogenetic damage, apoptosis enhancement, and biochemical changes in neighboring non-irradiated cells. The bystander effect is mainly observed in in vitro experiments using very low doses of alpha particles (range; mGy, cGy, but also after conventional irradiation (X-rays, gamma rays at low as well as conventional doses. The mechanisms responsible for the bystander effect are complex and still poorly understood. It is believed that molecular signals released from irradiated cells induce different signaling ways in non-irradiated neighboring cells, leading to the observed events. The molecular signals may be transmitted through gap junction intercellular communication and through a medium transfer mechanism. The nature of these transmitted factors are diverse, and still not defi nitely established. It seems that RIBE may have important clinical implications for health risk associated with radiation exposure. Potentially, this effectmay have important implications in the creation of whole-body or localized side effects in tissues beyond the irradiation fi eld and also in low-dose radiological and radioisotope diagnostics. Factors emitted by irradiated cells may result in the risk of genetic instability, mutations, and second primary cancer induction. They might also have their own part in inducing and extending post-radiation side effects in normal tissue. The

  2. Prevalence of clinically important posterior fossa emissary veins on CT angiography

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    Yeliz Pekcevik

    2014-01-01

    Full Text Available Purpose: We assessed the prevalence of the clinically important posterior fossa emissary veins detected on computed tomography (CT angiography. Materials and Methods: A total of 182 consecutive patients who underwent 64-slice CT angiography were retrospectively reviewed to determine the clinically important posterior fossa emissary veins. Results: Of 166 patients, the mastoid emissary vein (MEV was not identified in 37 (22.3% patients. It was found bilaterally in 82 (49.4% and unilaterally in 47 (28.3% patients. Only six patients had more than one MEV that were very small (5 mm veins. The posterior condylar vein (PCV was not identified in 39 (23.5% patients. It was found bilaterally in 97 (58.4% and unilaterally in 30 (18.1% patients. Only 15 patients had a very large (>5 mm PCV. The petrosquamosal sinus (PSS was identified only in one patient (0.6% on the left side. The occipital sinus was found in two patients (1.2%. Conclusions: The presence of the clinically important posterior fossa emissary veins is not rare. Posterior fossa emissary veins should be identified and systematically reported, especially prior to surgeries involving the posterior fossa and mastoid region.

  3. Meta-analysis on continuous outcomes in minimal important difference units

    DEFF Research Database (Denmark)

    Shrier, Ian; Christensen, Robin; Juhl, Carsten

    2016-01-01

    OBJECTIVE: To compare results from meta-analyses for mean differences in minimal important difference (MID) units (MDMID), when MID is treated as a random variable vs. a constant. STUDY DESIGN AND SETTING: Meta-analyses of published data. We calculated the variance of MDMID as a random variable u...

  4. Clinical import of Horner syndrome in internal carotid and vertebral artery dissection.

    Science.gov (United States)

    Lyrer, Philippe A; Brandt, Tobias; Metso, Tiina M; Metso, Antti J; Kloss, Manja; Debette, Stephanie; Leys, Didier; Caso, Valeria; Pezzini, Alessandro; Bonati, Leo H; Thijs, Vincent; Bersano, Anna; Touzé, Emmanuel; Gensicke, Henrik; Martin, Juan J; Lichy, Christoph; Tatlisumak, Turgut; Engelter, Stefan T; Grond-Ginsbach, Caspar

    2014-05-06

    To study the prognostic importance of Horner syndrome (HS) in patients with internal carotid artery dissection (ICAD) or vertebral artery dissection (VAD). In this observational study, characteristics and outcome of patients with ICAD or VAD from the CADISP (Cervical Artery Dissection and Ischemic Stroke Patients) database were analyzed. The presence of HS was systematically assessed using a standardized questionnaire. Patients with HS (HS+) were compared with HS- patients. Crude odds ratios (ORs) with 95% confidence intervals and ORs adjusted for age, sex, center, arterial occlusion, bilateral dissection, stroke severity, and type of antithrombotic treatment were calculated. We analyzed 765 patients (n = 496 with ICAD, n = 269 with VAD, n = 303 prospective, n = 462 retrospective). HS was present in 191 (38.5%) of the patients with ICAD and 36 (13.4%) of the patients with VAD (p < 0.001). HS+ ICAD patients presented less often with stroke or TIA (p < 0.001), less often had bilateral (p = 0.019) or occlusive (p = 0.001) dissections, and had fewer severe strokes (p = 0.041) than HS- ICAD patients. HS+ ICAD patients had a better functional 3-month outcome than those without HS (ORcrude = 4.0 [2.4-6.7]), and also after adjustment for outcome-relevant covariates (ORadjusted = 2.0 [1.1-4.0]). HS+ ICAD patients were less likely to have new strokes than HS- ICAD patients (p = 0.039). HS+ VAD patients more often had vessel occlusion (p = 0.014) than HS- patients but did not differ in any of the other aforementioned variables. In patients with ICAD, HS is an easily assessable marker that might indicate a more benign clinical course. HS had no prognostic meaning in patients with VAD.

  5. Retroaortic Left Renal Vein: Multidetector Computed Tomography Angiography Findings and Its Clinical Importance

    Energy Technology Data Exchange (ETDEWEB)

    Karaman, B.; Koplay, M.; Oezturk, E.; Basekim, C.C.; Ogul, H.; Mutlu, H.; Kizilkaya, E.; Kantarci, M. [Dept. of Radiology, Sivas Military Hospital, Sivas (Turkey)

    2007-04-15

    Purpose: To evaluate the appearance, type, frequency, and clinical importance of retroaortic left renal vein (RLRV) in patients examined with multidetector computed tomography (MDCT) angiography. Material and Methods: A total of 1856 patients who underwent CT with urological symptoms (hematuria, flank and abdominal pain, left gonadal vein varicocele) (n = 889) or with symptoms other than urological ones (n = 967) were prospectively evaluated for the presence of RLRV. CT was performed with 110 ml of iodinated contrast material through the antecubital vein at a rate of 3.5 ml/s. Late arterial and early venous phase volumetric data sets were acquired at 30 and 65 s, respectively, from the start of the intravenous injection of contrast medium. In addition to axial images, multiplanar reconstructions (MPR), maximum-intensity projection (MIP), and three-dimensional volume-rendering (3D VR) images were used to assess left renal vein anomalies. Left renal vein anomalies were classified into four types according to their appearance: I) RLRV joining the inferior vena cava (IVC) in the orthotopic position; II) RLRV joining the IVC at level L4-L5; III) circumaortic or collar left renal vein; IV) RLRV joining the left common iliac vein. Results: RLRV was detected in 68 (3.6%) of the 1856 patients, with 26, 22, 17, and three of types I, II, III, and IV, respectively. Forty-four of the 68 patients with RLRV (65%) were in the group with urological symptoms, while 24 patients (35%) were in the group without urological symptoms. Compression of the RLRV was found in 16 patients in the urological symptoms group, while compression was detected in only three patients in the other group. This difference was statistically significant (P<0.05). The most common urological symptom was hematuria. The frequency of urological symptoms was higher in groups II and IV compared to the other groups. Conclusion: MDCT angiography with axial, MPR, MIP, and 3D VR images is effective in the detection of

  6. Sex Differences in Clinical Features of Early, Treated Parkinson's Disease.

    Directory of Open Access Journals (Sweden)

    Erika F Augustine

    Full Text Available To improve our understanding of sex differences in the clinical characteristics of Parkinson's Disease, we sought to examine differences in the clinical features and disease severity of men and women with early treated Parkinson's Disease (PD enrolled in a large-scale clinical trial.Analysis was performed of baseline data from the National Institutes of Health Exploratory Trials in Parkinson's Disease (NET-PD Long-term Study-1, a randomized, multi-center, double-blind, placebo-controlled study of 10 grams of oral creatine/day in individuals with early, treated PD. We compared mean age at symptom onset, age at PD diagnosis, and age at randomization between men and women using t-test statistics. Sex differences in clinical features were evaluated, including: symptoms at diagnosis (motor and symptoms at randomization (motor, non-motor, and daily functioning.1,741 participants were enrolled (62.5% male. No differences were detected in mean age at PD onset, age at PD diagnosis, age at randomization, motor symptoms, or daily functioning between men and women. Differences in non-motor symptoms were observed, with women demonstrating better performance compared to men on SCOPA-COG (Z = 5.064, p<0.0001 and Symbol Digit Modality measures (Z = 5.221, p<0.0001.Overall, men and women did not demonstrate differences in clinical motor features early in the course of PD. However, the differences observed in non-motor cognitive symptoms suggests further assessment of the influence of sex on non-motor symptoms in later stages of PD is warranted.

  7. Examining the Minimal Important Difference of Patient-reported Outcome Measures for Individuals with Knee Osteoarthritis

    DEFF Research Database (Denmark)

    Mills, Kathryn A G; Naylor, Justine M; Eyles, Jillian P

    2016-01-01

    OBJECTIVE: To examine the influence of different analytical methods, baseline covariates, followup periods, and anchor questions when establishing a minimal important difference (MID) for individuals with knee osteoarthritis (OA). Second, to propose MID for improving and worsening on the Knee...... injury and Osteoarthritis Outcome Score (KOOS). METHODS: Retrospective analysis of prospectively collected data from 272 patients with knee OA undergoing a multidisciplinary nonsurgical management strategy. The magnitude and rate of change as well as the influence of baseline covariates were examined...

  8. Republished: Importance of carcinoma-associated fibroblast-derived proteins in clinical oncology.

    Science.gov (United States)

    Valcz, Gabor; Sipos, Ferenc; Tulassay, Zsolt; Molnar, Bela; Yagi, Yukako

    2015-05-01

    Carcinoma-associated fibroblast (CAF) as prominent cell type of the tumour microenvironment has complex interaction with both the cancer cells and other non-neoplastic surrounding cells. The CAF-derived regulators and extracellular matrix proteins can support cancer progression by providing a protective microenvironment for the cancer cells via reduction of chemotherapy sensitivity. On the other hand, these proteins may act as powerful prognostic markers as well as potential targets of anticancer therapy. In this review, we summarise the clinical importance of the major CAF-derived signals influencing tumour behaviour and determining the outcome of chemotherapy.

  9. Importance of carcinoma-associated fibroblast-derived proteins in clinical oncology.

    Science.gov (United States)

    Valcz, Gabor; Sipos, Ferenc; Tulassay, Zsolt; Molnar, Bela; Yagi, Yukako

    2014-12-01

    Carcinoma-associated fibroblast (CAF) as prominent cell type of the tumour microenvironment has complex interaction with both the cancer cells and other non-neoplastic surrounding cells. The CAF-derived regulators and extracellular matrix proteins can support cancer progression by providing a protective microenvironment for the cancer cells via reduction of chemotherapy sensitivity. On the other hand, these proteins may act as powerful prognostic markers as well as potential targets of anticancer therapy. In this review, we summarise the clinical importance of the major CAF-derived signals influencing tumour behaviour and determining the outcome of chemotherapy.

  10. Radiographic superimposition and mandibular peripheral osteoma: the importance of clinical and CT findings.

    Science.gov (United States)

    Boffano, Paolo; Gallesio, Cesare; Roccia, Fabio; Berrone, Sid

    2013-03-01

    Peripheral osteomas are benign, slow-growing osteogenic tumors that are caused by centrifugal growth of the periosteum and develop as masses attached to the cortical plates.The pathogenesis of osteomas is unclear, and embryologic, traumatic, inflammatory, metaplastic, and genetic causes have been proposed. A solitary peripheral osteoma of the jaws is uncommon.The purpose of this paper is to present a peculiar case of mandibular peripheral osteoma with a particular radiographic superimposition that stress the importance of clinical and CT findings.

  11. GENDER DIFFERENCES IN PARKINSON'S DISEASE: CLINICAL CHARACTERISTICS AND COGNITION

    OpenAIRE

    Miller, Ivy N.; Cronin-Golomb, Alice

    2010-01-01

    More men than women are diagnosed with Parkinson's disease (PD), and a number of gender differences have been documented in this disorder. Examples of clinical characteristics that appear in men more often than women include rigidity and rapid eye movement behavior disorder, whereas more women than men exhibit dyskinesias and depression. Differences between men and women in cognition have not been extensively examined, though there are reports of deficits in men in aspects of cognition that c...

  12. Clinic expert information extraction based on domain model and block importance model.

    Science.gov (United States)

    Zhang, Yuanpeng; Wang, Li; Qian, Danmin; Geng, Xingyun; Yao, Dengfu; Dong, Jiancheng

    2015-11-01

    To extract expert clinic information from the Deep Web, there are two challenges to face. The first one is to make a judgment on forms. A novel method based on a domain model, which is a tree structure constructed by the attributes of query interfaces is proposed. With this model, query interfaces can be classified to a domain and filled in with domain keywords. Another challenge is to extract information from response Web pages indexed by query interfaces. To filter the noisy information on a Web page, a block importance model is proposed, both content and spatial features are taken into account in this model. The experimental results indicate that the domain model yields a precision 4.89% higher than that of the rule-based method, whereas the block importance model yields an F1 measure 10.5% higher than that of the XPath method.

  13. Clinical and diagnostic importance of changes of colon at chronic prostatitis

    Directory of Open Access Journals (Sweden)

    V.M. Popkov

    2010-06-01

    Full Text Available The aim of researches was studying clinical, microbiological and morphological characteristic of colon at patients at chronic prostatitis, definition of method of pathogenetic therapy on the basis of the received results. Material and methods of investigation. 50 patients at chronic bacterial prostatitis, 50 patients at asymptomatic inflammatory prostatitis and 30 practically healthy males were inspected. Microflora of prostata's secret and colon, morphology and structure of components of diffuse neuroendocrine system of colon were studied. Clinical, microbiological, иммуногистохимические methods and morphometrical analysis were applied. Results. It is defined, that at 74% patients with asymptomatic inflammatory prostatitis irritable bowel syndrome and at 26% - chronic nonulcerative colitis were diagnosed. At all patients at chronic bacterial prostatitis chronic nonulcerative colitis were detected. These variants were correlleted with different types of intestinal dysbiosis and degree of microbe producing of prostate. Use probiotic Bactistatin® at patients with a chronic prostatitis raises clinical efficiency of antibacterial therapy, promotes reduction of inflammatory changes, restoration of its microbic landscape and neuroendocrine homeostasis of colon. inclusion. At chronic prostatitis structural and functional pathology of colon are often registered, they are connected with clinical variant of prostatitis and can mask of prostata's pathology. Using Bactistatin® at patients with a chronic prostatitis is proved and effective

  14. Late radiation-induced heart disease after radiotherapy. Clinical importance, radiobiological mechanisms and strategies of prevention.

    Science.gov (United States)

    Andratschke, Nicolaus; Maurer, Jean; Molls, Michael; Trott, Klaus-Rüdiger

    2011-08-01

    The clinical importance of radiation-induced heart disease, in particular in post-operative radiotherapy of breast cancer patients, has been recognised only recently. There is general agreement, that a co-ordinated research effort would be needed to explore all the potential strategies of how to reduce the late risk of radiation-induced heart disease in radiotherapy. This approach would be based, on one hand, on a comprehensive understanding of the radiobiological mechanisms of radiation-induced heart disease after radiotherapy which would require large-scale long-term animal experiments with high precision local heart irradiation. On the other hand - in close co-operation with mechanistic in vivo research studies - clinical studies in patients need to determine the influence of dose distribution in the heart on the risk of radiation-induced heart disease. The aim of these clinical studies would be to identify the critical structures within the organ which need to be spared and their radiation sensitivity as well as a potential volume and dose effect. The results of the mechanistic studies might also provide concepts of how to modify the gradual progression of radiation damage in the heart by drugs or biological molecules. The results of the studies in patients would need to also incorporate detailed dosimetric and imaging studies in order to develop early indicators of impending radiation-induced heart disease which would be a pre-condition to develop sound criteria for treatment plan optimisation. Copyright © 2010. Published by Elsevier Ireland Ltd.

  15. Pulsed light for the inactivation of fungal biofilms of clinically important pathogenic Candida species.

    Science.gov (United States)

    Garvey, Mary; Andrade Fernandes, Joao Paulo; Rowan, Neil

    2015-07-01

    Microorganisms are naturally found as biofilm communities more than planktonic free-floating cells; however, planktonic culture remains the current model for microbiological studies, such as disinfection techniques. The presence of fungal biofilms in the clinical setting has a negative impact on patient mortality, as Candida biofilms have proved to be resistant to biocides in numerous in vitro studies; however, there is limited information on the effect of pulsed light on sessile communities. Here we report on the use of pulsed UV light for the effective inactivation of clinically relevant Candida species. Fungal biofilms were grown by use of a CDC reactor on clinically relevant surfaces. Following a maximal 72 h formation period, the densely populated biofilms were exposed to pulsed light at varying fluences to determine biofilm sensitivity to pulsed-light inactivation. The results were then compared to planktonic cell inactivation. High levels of inactivation of C. albicans and C. parapsilosis biofilms were achieved with pulsed light for both 48 and 72 h biofilm structures. The findings suggest that pulsed light has the potential to provide a means of surface decontamination, subsequently reducing the risk of infection to patients. The research described herein deals with an important aspect of disease prevention and public health.

  16. Ovarian cancer cell line panel (OCCP: clinical importance of in vitro morphological subtypes.

    Directory of Open Access Journals (Sweden)

    Corine M Beaufort

    Full Text Available Epithelial ovarian cancer is a highly heterogeneous disease and remains the most lethal gynaecological malignancy in the Western world. Therapeutic approaches need to account for inter-patient and intra-tumoural heterogeneity and detailed characterization of in vitro models representing the different histological and molecular ovarian cancer subtypes is critical to enable reliable preclinical testing. There are approximately 100 publicly available ovarian cancer cell lines but their cellular and molecular characteristics are largely undescribed. We have characterized 39 ovarian cancer cell lines under uniform conditions for growth characteristics, mRNA/microRNA expression, exon sequencing, drug response for clinically-relevant therapeutics and collated all available information on the original clinical features and site of origin. We tested for statistical associations between the cellular and molecular features of the lines and clinical features. Of the 39 ovarian cancer cell lines, 14 were assigned as high-grade serous, four serous-type, one low-grade serous and 20 non-serous type. Three morphological subtypes: Epithelial (n = 21, Round (n = 7 and Spindle (n = 12 were identified that showed distinct biological and molecular characteristics, including overexpression of cell movement and migration-associated genes in the Spindle subtype. Comparison with the original clinical data showed association of the spindle-like tumours with metastasis, advanced stage, suboptimal debulking and poor prognosis. In addition, the expression profiles of Spindle, Round and Epithelial morphologies clustered with the previously described C1-stromal, C5-mesenchymal and C4 ovarian subtype expression profiles respectively. Comprehensive profiling of 39 ovarian cancer cell lines under controlled, uniform conditions demonstrates clinically relevant cellular and genomic characteristics. This data provides a rational basis for selecting models to develop

  17. Drug screening in clinical or forensic toxicology: are there differences?

    Science.gov (United States)

    Gerostamoulos, Dimitri; Beyer, Jochen

    2010-09-01

    Legal and medical practitioners need to remember that, with respect to drug analysis, there are two distinct disciplines in analytical toxicology concerned with human biological matrices, namely clinical and forensic toxicology. Both fields use similar analytical techniques designed to detect and quantify drugs, chemicals and poisons in fluids or tissues. In clinical toxicology, analytical results help to specify the appropriate treatment of a poisoned or intoxicated patient. In forensic toxicology, the results often play a vital role in determining the possible impairment or behavioural changes in an individual, or the contribution of drugs or poisons to death in a medico-legal investigation. This column provides an overview of the similarities and differences inherent in clinical and forensic toxicology.

  18. Use of a respiratory clinical score among different providers.

    Science.gov (United States)

    Liu, Lenna L; Gallaher, Margaret M; Davis, Robert L; Rutter, Carolyn M; Lewis, Toby C; Marcuse, Edgar K

    2004-03-01

    Respiratory assessment of children with asthma or bronchiolitis is problematic because both the components of the assessment and their relative importance vary among care providers. Use of a systematic standard assessment process and clinical score may reduce interobserver variation. Our objective was to determine observer agreement among physicians (MD), nurses (RN), and respiratory therapists (RT), using a standard respiratory clinical score. A clinical score was developed incorporating four physiologic parameters: respiratory rate, retractions, dyspnea, and auscultation. One hundred and sixty-five provider pairs (e.g., MD-MD, RN-RT) independently assessed a total of 55 patients admitted for asthma, bronchiolitis, or wheezing at an urban tertiary-care hospital. A weighted kappa statistic measured agreement beyond chance. Rater pairs had high observed agreement on total score of 82-88% and weighted kappas ranging from 0.52 (MD-RN; 95% CI, 0.19, 0.79) to 0.65 (RN-RN; 95% CI, 0.46, 0.87). Observed agreement on individual components of the score ranged from 58% (auscultation) to 74% (dyspnea), with unweighted kappas of 0.36 (respiratory rate; 95% CI, 0.26, 0.46) to 0.53 (dyspnea; 95% CI, 0.41, 0.65). In conclusion, this respiratory clinical score demonstrates good interobserver agreement between MDs, RNs, and RTs. Future research is needed to examine validity and responsiveness in clinical settings. By standardizing respiratory assessments, use of a clinical score may facilitate care coordination by physicians, nurses, and respiratory therapists and thereby improve care of children hospitalized with asthma and bronchiolitis.

  19. Arylsulfatase A: An Important Metabolic Factor in Pathophysiology of Different Diseases

    Directory of Open Access Journals (Sweden)

    Zsolt Kovacs

    2015-09-01

    Full Text Available Arylsulfatase A (ARSA is a lysosomal enzyme that plays an important role in catalysis of degradation of cerebrosidesulphate. The deficiency of this lysosomal enzyme causes an autosomal recessive disorder, called metachromatic leucodystrophy. However, a low ARSA activity can be observed in clinically healthy people, called ARSA pseudodeficiency. In our study we investigated the possible linkage between ARSA activity and sulfatide deficiency causing characteristic aspects of degenerative diseases, such as end stage kidney disease, type 2 Diabetes mellitus, Parkinson syndrome, prostate cancer and HIV (Human Immunodeficiency Virus infection. We used a spectrophotometric method to determine the activity of ARSA. This method of enzyme dosage is based on a 4 hour long hydrolysis of the ARSA enzyme on 4-nitrocatechol sulfate (p-NCS substrate. The unit of this measurement is nmol/ml/4h. Our findings show significant values in type 2 diabetes, Parkinson syndrome and chronic kidney disease. The importance of sulfatide in these diseases is well-known, thus presumably the variation of the ARSA’s activity might play an important role in the pathophysiology of these diseases, involving a vicious cycle between sulfatide degradation andthese diseases.

  20. Clinical cases of parasitoses and fungal infections important from medical point of view

    Science.gov (United States)

    Błaszkowska, Joanna; Góralska, Katarzyna

    Most important infectious diseases which pose a risk to human health and life are associated with parasites transmitted by a variety of arthropod vectors, or from animal to man. Some of these (malaria, toxoplasmosis, leishmaniosis, dirofilariosis, alveococcosis, cystic echinococcosis) still represent a serious public health problem in many regions in the world. This review describes the epidemiological and clinical aspects of important parasitoses and fungal infections from a medical point of view. It should be emphasized that the development of invasive disease depends on both host (susceptibility/resistance) and parasite factors (pathogenicity/virulence); an immunocompromised state can favour opportunistic parasitic infections: toxoplasmosis, cryptosporidiosis, giardiosis, cyclosporidiosis, blastocystosis and strongyloidosis. This article highlights the role of free-living amoebae in the pathogenesis and transmission of human diseases, the high pathogenicity of Echinococcus multilocularis, and the growing importance of ticks as a reservoir and vector for numerous dangerous pathogens (e.g., Borrelia burgdorferi, Anaplasma phagocytophilum, Babesia microti). It also discusses the diagnostic problems of toxoplasmosis including cross-reactions in serological tests and reviews the search for new drugs and vaccines against toxoplasmosis. Attention is increasingly paid to the role played by the human microbiome in maintaining homeostasis and in the development of fungal infections. This review also presents the most common human superficial fungal infections and the role of Candida albicans infection in the pathogenesis of irritable bowel syndrome.

  1. Who Sees Human? The Stability and Importance of Individual Differences in Anthropomorphism

    Science.gov (United States)

    Waytz, Adam; Cacioppo, John; Epley, Nicholas

    2014-01-01

    Anthropomorphism is a far-reaching phenomenon that incorporates ideas from social psychology, cognitive psychology, developmental psychology, and the neurosciences. Although commonly considered to be a relatively universal phenomenon with only limited importance in modern industrialized societies—more cute than critical—our research suggests precisely the opposite. In particular, we provide a measure of stable individual differences in anthropomorphism that predicts three important consequences for everyday life. This research demonstrates that individual differences in anthropomorphism predict the degree of moral care and concern afforded to an agent, the amount of responsibility and trust placed on an agent, and the extent to which an agent serves as a source of social influence on the self. These consequences have implications for disciplines outside of psychology including human–computer interaction, business (marketing and finance), and law. Concluding discussion addresses how understanding anthropomorphism not only informs the burgeoning study of nonpersons, but how it informs classic issues underlying person perception as well. PMID:24839457

  2. Clinical evaluation of two different materials for retrograde root filling

    OpenAIRE

    Dimova, Cena; Papakoca, Kiro; Kovacevska, Ivona; Evrosimovska, Biljana; Georgiev, Zlatko

    2014-01-01

    BACKGROUND:Retrograde root filling is indicated when periapical inflammation cannot be resolved by conventional endodontic therapy. A retrograde filling should prevent flow of microorganisms and bacterial endotoxins from the root canal into periapical tissues. The aim was to evaluate the clinical and radiographic treatment outcome of two different materials for retrograde root filling (dentin-bonded resin nano composite and glass ionomer cement) using special preparation performance of re...

  3. Different intrafamilial clinical presentation of FMF mutation carriers.

    Science.gov (United States)

    Chalevelakis, Georgios; Apostolakis, Ioannis; Koliou, Xeni; Apessos, Angela; Kyriakopoulou, Vanessa; Vrakidou, Evfimia; Vasilopoulou, Adamantia; Lamnisou, Kleoniki; Nasioulas, Georgios

    2008-03-01

    Familial Mediterranean fever (FMF) is a heterogeneous disorder; at present, it is diagnosed using only genetic methods. In the current study, we performed molecular analysis in two families presenting with FMF. In the first family, we report two brothers with a common genotype (M694V/V726A) but with different clinical presentation. In the second family, we identified the M694V and K695R mutations in a presymptomatic carrier.

  4. Report: Sensitivity pattern of ceftriaxone against different clinical isolates.

    Science.gov (United States)

    Bushra, Rabia; Sial, Ali Akbar; Rizvi, Mehwish; Shafiq, Yousra; Aslam, Nousheen; Bano, Nusrat

    2016-01-01

    Emerging resistance against broad-spectrum antibiotics for standard empiric therapy is a global concern. Ceftriaxone (broad spectrum, third generation cephalosporin) is widely used in tertiary care settings to treat severe bacterial infections usually non-responsive to other antibiotics. The aim of the study is to evaluate the current sensitivity pattern of ceftriaxone (30μg/disk) among different clinical isolates. For this purpose, three hundred clinical isolates including Escherichia coli (25%), Staphylococcus aureus (30%), Salmonella typhi (17%) and Klebsiella pneumoniae(20%) were collected from different pathological laboratories of Karachi, Pakistan. The in-vitro sensitivity of different Gram positive and Gram-negative bacteria was determined by disk-diffusion technique using 0.5 McFarland standard. Results showed that ceftriaxone was highly sensitive against Escherichia coli (90%) and least sensitive against Klebsiella pneumoniae (65%). It is concluded that the sensitivity of ceftriaxone is progressively decreasing in comparison with past studies creating an alarming situation. Therefore, continuous surveillance is required to determine the current resistance status of clinical pathogens and for effective anti-microbial therapy.

  5. Come fly with me: review of clinically important arboviruses for global travelers.

    Science.gov (United States)

    Cleton, Natalie; Koopmans, Marion; Reimerink, Johan; Godeke, Gert-Jan; Reusken, Chantal

    2012-11-01

    Western tourists are increasingly traveling to exotic locations often located in tropical or subtropical regions of the world. The magnitude of international travel and the constantly changing dynamics of arbovirus diseases across the globe demand up-to-date information about arbovirus threats to travelers and the countries they visit. In this review, the current knowledge on arbovirus threats to global travelers is summarized and prioritized per region. Based on most common clinical syndromes, currently known arboviruses can be grouped to develop diagnostic algorithms to support decision-making in diagnostics. This review systematically combines and structures the current knowledge on medically important travel-related arboviruses and illustrates the necessity of a detailed patient history (travel history, symptoms experienced, vaccination history, engaged activities, tick or mosquito bite and use of repellent and onset of symptoms), to guide the diagnosis.

  6. Importance/performance analysis: a tool for service quality control by clinical laboratories.

    Science.gov (United States)

    Scammon, D L; Weiss, R

    1991-01-01

    A study of customer satisfaction with clinical laboratory service is used as the basis for identifying potential improvements in service and more effectively targeting marketing activities to enhance customer satisfaction. Data on customer satisfaction are used to determine the aspects of service most critical to customers, how well the organization is doing in delivery of service, and how consistent service delivery is. Importance-performance analysis is used to highlight areas for future resource reallocation and strategic emphasis. Suggestions include the establishment of performance guidelines for customer contact personnel, the enhancement of timely delivery of reports via electronic transmission (computer and fax), and the development of standardized graphics for request and report forms to facilitate identification of appropriate request forms and guide clients to key items of information on reports.

  7. Autonomic dysfunction in early breast cancer: Incidence, clinical importance, and underlying mechanisms.

    Science.gov (United States)

    Lakoski, Susan G; Jones, Lee W; Krone, Ronald J; Stein, Phyllis K; Scott, Jessica M

    2015-08-01

    Autonomic dysfunction represents a loss of normal autonomic control of the cardiovascular system associated with both sympathetic nervous system overdrive and reduced efficacy of the parasympathetic nervous system. Autonomic dysfunction is a strong predictor of future coronary heart disease, vascular disease, and sudden cardiac death. In the current review, we will discuss the clinical importance of autonomic dysfunction as a cardiovascular risk marker among breast cancer patients. We will review the effects of antineoplastic therapy on autonomic function, as well as discuss secondary exposures, such as psychological stress, sleep disturbances, weight gain/metabolic derangements, and loss of cardiorespiratory fitness, which may negatively impact autonomic function in breast cancer patients. Lastly, we review potential strategies to improve autonomic function in this population. The perspective can help guide new therapeutic interventions to promote longevity and cardiovascular health among breast cancer survivors.

  8. Anomalous extensor tendons of hand: a case report with clinical importance

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2007-06-01

    Full Text Available The extensor digitorum muscle of the hand originates from the common extensor origin i.e., from the lateral epicondyle of the humerus and ends in four tendons, one for each digit except for the thumb. This paper reports a case, in which the tendon of the extensor digitorum ended as four tendons to the index, middle, ring and little fingers, but displayed variations in the number of tendons to each finger. Two tendons of extensor digitorum were observed in the ring and the little finger. Such an arrangement of the tendons of the extensor digitorum may have clinical importance. The presence of multiple tendons may also alter the kinematics around the site of attachment to the phalanx. Knowledge of abnormal and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.

  9. Anomalous extensor tendons of hand: a case report with clinical importance.

    Directory of Open Access Journals (Sweden)

    Shipra Paul

    2009-11-01

    Full Text Available The extensor digitorum muscle of the hand originates from the common extensor origin i.e., from the lateral epicondyle of the humerus and ends in four tendons, one for each digit except for the thumb. This paper reports a case, in which the tendon of the extensor digitorum ended as four tendons to the index, middle, ring and little fingers, but displayed variations in the number of tendons to each finger. Two tendons of extensor digitorum were observed in the ring and the little finger. Such an arrangement of the tendons of the extensor digitorum may have clinical importance. The presence of multiple tendons may also alter the kinematics around the site of attachment to the phalanx. Knowledge of abnormal and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.

  10. Is daily routine important for sleep? An investigation of social rhythms in a clinical insomnia population.

    Science.gov (United States)

    Moss, Taryn G; Carney, Colleen E; Haynes, Patricia; Harris, Andrea L

    2015-02-01

    Social rhythms, also known as daily routines (e.g. exercise, of school or work, recreation, social activities), have been identified as potential time cues to help to regulate the biological clock. Past research has shown links between regularity and healthy sleep. This study examined the regularity and frequency of daytime activities in a clinical insomnia population and a good sleeper comparison group. Participants (N = 69) prospectively monitored their sleep and daily activities for a 2-week period. Although participants with insomnia and good sleepers had similar levels of activity, relative to good sleepers, those with insomnia were less regular in their activities. Findings from this study add to the growing number of studies that highlight the relative importance of the regularity of daytime activities on sleep. Accordingly, future research should test treatment components that focus on regulating daytime activities, which would likely improve treatment outcomes.

  11. Comparison of medication reconciliation and medication review: errors and clinical importance

    DEFF Research Database (Denmark)

    Bjeldbak-Olesen, Mette; Danielsen, Anja Gadsbølle; Tomsen, Dorthe Vilstrup

    2013-01-01

    Introduction: The objective of this study was to compare medication reconciliation and medication review based on number, type and severity of discrepancies and drug-re­lated problems (DRPs), denoted errors. Material and methods: This was a retrospective study conducted at the Department...... of Cardiology, Hillerød Hos­pital. Medication reconciliation compared the prescriptions in patient records, an electronic medication system (EMS) and in discharge summaries (DS). The medication review was based on the EMS. The two methods were performed on the same data material. To assess the clinical...... importance of the errors, a four-point scale was applied. Results: A total of 75 patient records were included. In all, 198 discrepancies were identified by medication reconcili­ation, 2.6 per patient. The most frequent discrepancies were omission of a drug in the DS and discrepancy between the drugs noted...

  12. Amino Acid Compositions of 27 Food Fishes and Their Importance in Clinical Nutrition

    Directory of Open Access Journals (Sweden)

    Bimal Mohanty

    2014-01-01

    Full Text Available Proteins and amino acids are important biomolecules which regulate key metabolic pathways and serve as precursors for synthesis of biologically important substances; moreover, amino acids are building blocks of proteins. Fish is an important dietary source of quality animal proteins and amino acids and play important role in human nutrition. In the present investigation, crude protein content and amino acid compositions of important food fishes from different habitats have been studied. Crude protein content was determined by Kjeldahl method and amino acid composition was analyzed by high performance liquid chromatography and information on 27 food fishes was generated. The analysis showed that the cold water species are rich in lysine and aspartic acid, marine fishes in leucine, small indigenous fishes in histidine, and the carps and catfishes in glutamic acid and glycine. The enriched nutrition knowledge base would enhance the utility of fish as a source of quality animal proteins and amino acids and aid in their inclusion in dietary counseling and patient guidance for specific nutritional needs.

  13. Amino Acid compositions of 27 food fishes and their importance in clinical nutrition.

    Science.gov (United States)

    Mohanty, Bimal; Mahanty, Arabinda; Ganguly, Satabdi; Sankar, T V; Chakraborty, Kajal; Rangasamy, Anandan; Paul, Baidyanath; Sarma, Debajit; Mathew, Suseela; Asha, Kurukkan Kunnath; Behera, Bijay; Aftabuddin, Md; Debnath, Dipesh; Vijayagopal, P; Sridhar, N; Akhtar, M S; Sahi, Neetu; Mitra, Tandrima; Banerjee, Sudeshna; Paria, Prasenjit; Das, Debajeet; Das, Pushpita; Vijayan, K K; Laxmanan, P T; Sharma, A P

    2014-01-01

    Proteins and amino acids are important biomolecules which regulate key metabolic pathways and serve as precursors for synthesis of biologically important substances; moreover, amino acids are building blocks of proteins. Fish is an important dietary source of quality animal proteins and amino acids and play important role in human nutrition. In the present investigation, crude protein content and amino acid compositions of important food fishes from different habitats have been studied. Crude protein content was determined by Kjeldahl method and amino acid composition was analyzed by high performance liquid chromatography and information on 27 food fishes was generated. The analysis showed that the cold water species are rich in lysine and aspartic acid, marine fishes in leucine, small indigenous fishes in histidine, and the carps and catfishes in glutamic acid and glycine. The enriched nutrition knowledge base would enhance the utility of fish as a source of quality animal proteins and amino acids and aid in their inclusion in dietary counseling and patient guidance for specific nutritional needs.

  14. The importance of bacterial and viral infections associated with adult asthma exacerbations in clinical practice.

    Directory of Open Access Journals (Sweden)

    Motoyasu Iikura

    Full Text Available Viral infection is one of the risk factors for asthma exacerbation. However, which pathogens are related to asthma exacerbation in adults remains unclear.The relation between various infections and adult asthma exacerbations was investigated in clinical practice.The study subjects included 50 adult inpatients due to asthma exacerbations and 20 stable outpatients for comparison. The pathogens from a nasopharyngeal swab were measured by multiplex PCR analysis.Asthma exacerbations occurred after a common cold in 48 inpatients. The numbers of patients with viral, bacterial, or both infections were 16, 9, and 9, respectively. The dominant viruses were rhinoviruses, respiratory syncytial virus, influenza virus, and metapneumovirus. The major bacteria were S. pneumoniae and H. influenzae. Compared to pathogen-free patients, the patients with pathogens were older and non-atopic and had later onset of disease, lower FeNO levels, lower IgE titers, and a higher incidence of comorbid sinusitis, COPD, or pneumonia. Compared to stable outpatients, asthma exacerbation inpatients had a higher incidence of smoking and comorbid sinusitis, COPD, or pneumonia. Viruses were detected in 50% of stable outpatients, but a higher incidence of rhinovirus, respiratory syncytial virus, and metapneumovirus infections was observed in asthma exacerbation inpatients. H. influenzae was observed in stable asthmatic patients. Other bacteria, especially S. pneumoniae, were important in asthma exacerbation inpatients.Viral or bacterial infections were observed in 70% of inpatients with an asthma exacerbation in clinical practice. Infection with S. pneumoniae was related to adult asthma exacerbation.

  15. Importance of patient-centred signage and navigation guide in an orthopaedic and plastics clinic.

    Science.gov (United States)

    Maqbool, Talha; Raju, Sneha; In, Eunji

    2016-01-01

    Gulshan & Nanji Orthopaedic and Plastics Center at the North York General Hospital is the second busiest site after the emergency department serving more than 26,000 patients annually. Increase in patient flow, overworked staff, and recent renovations to the hospital have resulted in patients experiencing long wait times, and thusly patient dissatisfaction and stress. Several factors contribute to patient dissatisfaction and stress: i) poor and unfriendly signage; ii) inconsistent utilization of the numbering system; and iii) difficulty navigating to and from the imaging center. A multidisciplinary QI team was assembled to improve the patient experience. We developed a questionnaire to assess patient stress levels at the baseline. Overall, more than half of the patients (54.8%) strongly agreed or agreed to having a stressful waiting experience. Subsequently, based on patient feedback and staff perspectives, we implemented two PDSA cycles. For PDSA 1, we placed a floor graphic (i.e. black tape) to assist patients in navigating from the clinic to the imaging centre and back. For PDSA 2, we involved creating a single 21"×32" patient-friendly sign at the entrance to welcome patients, with clear instructions outlining registration procedures. Surveys were re-administered to assess patient stress levels. A combination of both interventions caused a statistically significant reduction in patient stress levels based on the Kruskal-Wallis and Mann-Whitney U Tests. The present project highlighted the importance of involving stakeholders as well as frontline staff when undertaking quality improvement projects as a way to identify bottlenecks as well as establish sustainable solutions. Additionally, the team recognized the importance of incorporating empirical based solutions and involving experts in the field to optimize results. The present project successfully implemented strategies to improve patient satisfaction and reduce stress in a high flow community clinic. These

  16. Clinical differences of influenza subspecies among hospitalized children.

    Science.gov (United States)

    Acar, Manolya; Sütçü, Murat; Aktürk, Hacer; Törün, Selda Hançerli; Uysalol, Metin; Meşe, Sevim; Salman, Nuran; Somer, Ayper

    2017-03-01

    Clinical findings, mortality, and morbidity rates differ among influenza subspecies. Awareness of these differences will lead physicians to choose the proper diagnostic and therapeutic strategies and to foresee possible complications. The aim of this study was to evaluate the clinical differences of influenza subspecies among hospitalized children. Hospitalized children with proven influenza infection by polymerase chain reaction on nasopharyngeal swab specimens in our clinic, between December 2013 and March 2016, were enrolled. These children were divided into 3 groups as Influenza A/H1N1 (n=42), Influenza A/H3N2 (n=23), and Influenza B (n=35). The median age of the children was 51.5 months (range, 3-204 months). The most common presenting symptoms were fever (n=83), cough (n=58), and difficulty in breathing (n=25). The most common non-respiratory findings were lymphadenopathy (n=18) and gastrointestinal system involvement (n=17). Sixty-two percent of the patients (n=62) had chronic diseases. H1N1 and H3N2 were significantly more common among patients with chronic neurologic disorders and renal failure, respectively. Leukopenia (n=32) and thrombocytopenia (n=22) were the most common pathologic laboratory findings. Neutropenia, elevated CRP levels, and antibiotic use were significantly more common among patients with H1N1 infection. Seven patients were transferred to the intensive care unit with diagnoses of acute respiratory distress syndrome (n=4), encephalitis (n=2), and bronchiolitis (n=1). Two patients with chronic diseases and H1N1 infection died secondary to acute respiratory distress syndrome. Influenza A/H1N1 infection represented more severe clinical disease.

  17. Monitoring of disease biomarkers activity and immunophenotyping as important factors in SLE clinical management.

    Science.gov (United States)

    Subasic, Djemo; Karamehic, Jasenko; Delic-Sarac, Marina; Kasumovic, Mersija; Mekic, Mevludin; Eminovic, Izet; Hasanagic, Nermina

    2012-01-01

    The highly specific biomarkers for monitoring of SLE disease activity are not yet defined up to date, due to existing of different clinical SLE phenotypes caused by individual genetic variation. Basically, numerous clinical complications follow SLE patients such as nephritis, atherosclerosis and cardial, CNS, gastrointestinal and ophthalmological complications, as well. Their monitoring in clinical SLE management can be evaluated by analysing of specific biochemical parameters and require permanent clinical observation. The presence of ANAs and anti-ds-DNAs are usual diagnostic SLE autoimmunity parameters, while SLE disease activity biomarkers are C3 and C4 level, anticardiolipin antibodies, anti-Sm/RNPs and, recently level of CD4 and CD8 lymphocytes. However, the number of TCR molecules on the T-cells surface at SLE patients is lower then in normal condition, and otherwise for these receptors CD molecules make specific connection. On the other hand, the T lymphocytes can be also, therapeutical targets at SLE patients, because of their clear direct involving in SLE pathogenesis. The SLE phenotypes are characterized by double CD negativity ( CD3 +/-, CD4-) caused by abnormal level of IL-2 and IL-17. T-lymphocytes have usually alpha-beta and gamma-delta TCR receptors, but for SLE patients is characteristic lower number gama-delta TCR molecules, detected in the peripheral blood specimens. Taking into account all of the facts, we investigated the level of specific usual SLE activity biomarkers (anti-ds-DNAs, C3, C4, anticardiolipin antibodies (beta-2-IgG, beta-2-IgM, ACA-G, ACA-M, CD4 and CD8 level) in serum specimens of SLE patients who underwent to the corresponding chemotherapy in combination with other biochemical and clinical parameters. Once again proved to be, that SLE biomarker monitoring, could be useful aproach for SLE activity disease and prediction organ damage, as well. In our investigation we used the following methods: immunofluorescence microscopy (IFA

  18. Repeating tests: different roles in research studies and clinical medicine.

    Science.gov (United States)

    Monach, Paul A

    2012-10-01

    Researchers often decide whether to average multiple results in order to produce more precise data, and clinicians often decide whether to repeat a laboratory test in order to confirm its validity or to follow a trend. Some of the major sources of variation in laboratory tests (analytical imprecision, within-subject biological variation and between-subject variation) and the effects of averaging multiple results from the same sample or from the same person over time are discussed quantitatively in this article. This analysis leads to the surprising conclusion that the strategy of averaging multiple results is only necessary and effective in a limited range of research studies. In clinical practice, it may be important to repeat a test in order to eliminate the possibility of a rare type of error that has nothing to do analytical imprecision or within-subject variation, and for this reason, paradoxically, it may be most important to repeat tests with the highest sensitivity and/or specificity (i.e., ones that are critical for clinical decision-making).

  19. Differences in quantitative methods for measuring subjective cognitive decline - results from a prospective memory clinic study

    DEFF Research Database (Denmark)

    Vogel, Asmus; Salem, Lise Cronberg; Andersen, Birgitte Bo

    2016-01-01

    influence reports of cognitive decline. METHODS: The Subjective Memory Complaints Scale (SMC) and The Memory Complaint Questionnaire (MAC-Q) were applied in 121 mixed memory clinic patients with mild cognitive symptoms (mean MMSE = 26.8, SD 2.7). The scales were applied independently and raters were blinded...... decline are not interchangeable when used in memory clinics and the application of different scales in previous studies is an important factor as to why studies show variability in the association between subjective cognitive decline and background data and/or clinical results. Careful consideration...

  20. Importance Level of Construction Managers’ Technical Competency Across Different Contractors’ Demographics in Malaysia

    Directory of Open Access Journals (Sweden)

    Mohammad Hairuddin

    2017-01-01

    Full Text Available It is undeniable that construction managers play a significant role within construction phase, especially when they are representing construction contractor, one of the key stakeholders within construction project’s realm. Reliance towards their technical competency is very much needed for a successfulness of a construction project. Unfortunately, a lot of recurring issues pertaining to their technical incompetency are shrouding the industry. Non-existence of term of reference for construction manager’s technical competency profile is dictated as a major setback. Thus, a dedicated and comprehensive research exploration is conducted in order to bridge the gap through establishment of particular competency. Hence, in this instalment, the authors postulated a question of ‘how?’ which pillars on items’ importance level and correlation among different contractors’ demographics. Initially, data screening processes over outliers test, reliability test, and normality test were conducted. After that, the importance of technical competency for construction manager was analysed based on their central tendency (i.e. means. Finally, Spearman correlation analysis is directed towards observed ranks from diverse contractors’ demographics. In a nutshell, data was free from any extreme outlier and reported high reliability value. However, data was measured as non-normal in nature. Meanwhile, through means, majority of macro items (16 items were in a range of important (4.00 to very important (5.00. Towards the end, findings for Spearman correlation analysis were mostly leaning towards moderate and strong association’s strength across different clusters of diverse contractors’ demographics. Nevertheless, there were evidences that major variability of findings for both tests is exhibited through contractors’ grades. Therefore, succeeding in-depth quantitative analysis is paramount in order to pin-point significant values onto each individual

  1. [Urticaria pigmentosa: two different clinical presentations in pediatric patients].

    Science.gov (United States)

    Spada, Julieta; Lequio, Mariana; Pyke, María de los Ángeles; Hernández, Marisa; Chouela, Edgardo

    2011-08-01

    Urticaria pigmentosa (UP) is the most frequent clinical feature of cutaneous mastocytosis. It usually begins in a bimodal way: a peak of incidence from birth to the age of 3 and the other one between 2(nd) and 6(th) decades of life. Darier's sign is constant over the affected skin without affecting the surrounding skin. When UP starts early, it has a good prognosis disappearing into adolescence, while late onset is often associated with persistent or systemic involvement. This article reports two cases of UP, one with the classic description of the disease and the other with an unusual clinical presentation, prompting the pediatrician to incorporate both forms as different manifestations of the same entity.

  2. Clinical Differences Between Monomicrobial and Polymicrobial Vertebral Osteomyelitis.

    Science.gov (United States)

    Issa, Kimona; Pourtaheri, Sina; Stewart, Tyler; Faloon, Michael; Sahai, Nikhil; Mease, Samuel; Sinha, Kumar; Hwang, Ki; Emami, Arash

    2016-11-11

    Little literature exists examining differences in presentation and outcomes between monomicrobial and polymicrobial vertebral infections. Seventy-nine patients treated for vertebral osteomyelitis between 2001 and 2011 were reviewed. Patients were divided into monomicrobial and polymicrobial cohorts based on type of infection. Various characteristics were compared between the 2 groups. The 26 patients with a polymicrobial infection were older and had a higher mortality rate, lower clearance of infection, larger infection, more vertebral instability, higher erythrocyte sedimentation rate at presentation, and longer mean length of stay. There were no significant differences in Oswestry Disability Index scores at final follow-up, but there were differences in presentation and clinical outcomes between monomicrobial and polymicrobial vertebral osteomyelitis. Patients may benefit from counseling regarding their disease type and potential prognosis. [Orthopedics. 201x; xx(x):xx-xx.].

  3. Robot decisions: on the importance of virtuous judgment in clinical decision making.

    Science.gov (United States)

    Gelhaus, Petra

    2011-10-01

    The aim of this article is to argue for the necessity of emotional professional virtues in the understanding of good clinical practice. This understanding is required for a proper balance of capacities in medical education and further education of physicians. For this reason an ideal physician, incarnating the required virtues, skills and knowledge is compared with a non-emotional robot that is bound to moral rules. This fictive confrontation is meant to clarify why certain demands on the personality of the physician are justified, in addition to a rule- and principle-based moral orientation and biomedical knowledge and skills. Philosophical analysis of thought experiments inspired by science fiction literature by Isaac Asimov. Although prima facie a rule-oriented robot seems more reliable and trustworthy, the complexity of clinical judgment is not met by an encompassing and never contradictory set of rules from which one could logically derive decisions. There are different ways how the robot could still work, but at the cost of the predictability of its behaviour and its moral orientation. In comparison, a virtuous human doctor who is also bound to these rules, although less strictly, will more reliably keep at moral objectives, be understandable, be more flexible in case the rules come to their limits, and will be more predictable in these critical situations. Apart from these advantages of the virtuous human doctor referring to her own person, the most problematic deficit of the robot is its lacking deeper understanding of the inner mental events of patients which makes good contact, good communication and good influence impossible. Although an infallibly rule-oriented robot seems more reliable at first view, in situations that require complex decisions like clinical practice the agency of a moral human person is more trustworthy. Furthermore, the understanding of the patient's emotions must remain insufficient for a non-emotional, non-human being. Because

  4. IMPORTANCE OF DIFFERENT MODELS IN DECISION MAKING, EXPLAINING THE STRATEGIC BEHAVIOR IN ORGANIZATIONS

    Directory of Open Access Journals (Sweden)

    Cristiano de Oliveira Maciel

    2006-11-01

    Full Text Available This study is about the different models of decision process analyzing the organizational strategy. The article presents the strategy according to a cognitive approach. The discussion about that approach has three models of decision process: rational actor model, organizational behavior, and political model. These models, respectively, present some improvement in the decision making results, search for a good decision facing the cognitive restrictions of the administrator, and lots of talks for making a decision. According to the emphasis of each model, the possibilities for analyzing the strategy are presented. The article also shows that it is necessary to take into account the three different ways of analysis. That statement is justified once the analysis as well as the decision making become more complex, mainly those which are more important for the organizations.

  5. Performance evaluation of the short-time objective intelligibility measure with different band importance functions

    DEFF Research Database (Denmark)

    Heidemann Andersen, Asger; de Haan, Jan Mark; Tan, Zheng-Hua

    2017-01-01

    , is that all frequency bands are equally weighted in the final measure. This is in contrast to classical methods such as the speech intelligibility index (SII) which employs empirically determined band importance functions (BIFs), specifying the relative contribution of each frequency band to intelligibility....... In this study we investigated the use of BIFs in the STOI measure. BIFs were fitted to several datasets of measured intelligibility. This was done such as to minimize the root-mean-squared prediction error. We then performed a cross-evaluation of the obtained BIFs on all datasets, using three different...... performance measures: root-mean-squared-error, Pearson correlation, and Kendall rank correlation. The results show substantially improved performance when fitting and evaluating on the same dataset. However, this advantage does not necessarily subsist when fitting and evaluating on different datasets. When...

  6. Are complement deficiencies really rare? Overview on prevalence, clinical importance and modern diagnostic approach.

    Science.gov (United States)

    Grumach, Anete Sevciovic; Kirschfink, Michael

    2014-10-01

    Complement deficiencies comprise between 1 and 10% of all primary immunodeficiencies (PIDs) according to national and supranational registries. They are still considered rare and even of less clinical importance. This not only reflects (as in all PIDs) a great lack of awareness among clinicians and general practitioners but is also due to the fact that only few centers worldwide provide a comprehensive laboratory complement analysis. To enable early identification, our aim is to present warning signs for complement deficiencies and recommendations for diagnostic approach. The genetic deficiency of any early component of the classical pathway (C1q, C1r/s, C2, C4) is often associated with autoimmune diseases whereas individuals, deficient of properdin or of the terminal pathway components (C5 to C9), are highly susceptible to meningococcal disease. Deficiency of C1 Inhibitor (hereditary angioedema, HAE) results in episodic angioedema, which in a considerable number of patients with identical symptoms also occurs in factor XII mutations. New clinical entities are now reported indicating disease association with partial complement defects or even certain polymorphisms (factor H, MBL, MASPs). Mutations affecting the regulators factor H, factor I, or CD46 and of C3 and factor B leading to severe dysregulation of the alternative pathway have been associated with renal disorders, such as atypical hemolytic uremic syndrome (aHUS) and - less frequent - with membranoproliferative glomerulonephritis (MPGN). We suggest a multi-stage diagnostic protocol starting based on the recognition of so called warning signs which should aid pediatricians and adult physicians in a timely identification followed by a step-wise complement analysis to characterize the defect at functional, protein and molecular level.

  7. How different can you be and still survive? Homogeneity and difference in clinical nursing education.

    Science.gov (United States)

    Paterson, Barbara L; Osborne, Margaret; Gregory, David

    2004-01-01

    The article focuses on a component of a three-year institutional ethnography regarding the construction of cultural diversity in clinical education. Students in two Canadian schools of nursing described being a nursing student as bounded by unwritten and largely invisible expectations of homogeneity in the context of a predominant discourse of equality and cultural sensitivity. At the same time, they witnessed many incidents, both personally and those directed toward other individuals of the same culture, of clinical teachers problematizing difference and centering on difference as less than the expected norm. This complex and often contradictory experience of difference and homogeneity contributed to their construction of cultural diversity as a problem. The authors provide examples of how the perception of being different affected some students' learning in the clinical setting and their interactions with clinical teachers. They will illustrate that this occurred in the context of macro influences that shaped how both teachers and students experienced and perceived cultural diversity. The article concludes with a challenge to nurse educators to deconstruct their beliefs and assumptions about inclusivity in nursing education.

  8. Management of deep brain stimulator battery failure: battery estimators, charge density, and importance of clinical symptoms.

    Directory of Open Access Journals (Sweden)

    Kaihan Fakhar

    Full Text Available OBJECTIVE: We aimed in this investigation to study deep brain stimulation (DBS battery drain with special attention directed toward patient symptoms prior to and following battery replacement. BACKGROUND: Previously our group developed web-based calculators and smart phone applications to estimate DBS battery life (http://mdc.mbi.ufl.edu/surgery/dbs-battery-estimator. METHODS: A cohort of 320 patients undergoing DBS battery replacement from 2002-2012 were included in an IRB approved study. Statistical analysis was performed using SPSS 20.0 (IBM, Armonk, NY. RESULTS: The mean charge density for treatment of Parkinson's disease was 7.2 µC/cm(2/phase (SD = 3.82, for dystonia was 17.5 µC/cm(2/phase (SD = 8.53, for essential tremor was 8.3 µC/cm(2/phase (SD = 4.85, and for OCD was 18.0 µC/cm(2/phase (SD = 4.35. There was a significant relationship between charge density and battery life (r = -.59, p<.001, as well as total power and battery life (r = -.64, p<.001. The UF estimator (r = .67, p<.001 and the Medtronic helpline (r = .74, p<.001 predictions of battery life were significantly positively associated with actual battery life. Battery status indicators on Soletra and Kinetra were poor predictors of battery life. In 38 cases, the symptoms improved following a battery change, suggesting that the neurostimulator was likely responsible for symptom worsening. For these cases, both the UF estimator and the Medtronic helpline were significantly correlated with battery life (r = .65 and r = .70, respectively, both p<.001. CONCLUSIONS: Battery estimations, charge density, total power and clinical symptoms were important factors. The observation of clinical worsening that was rescued following neurostimulator replacement reinforces the notion that changes in clinical symptoms can be associated with battery drain.

  9. Gender differences in clinical outcomes for cocaine dependence: Randomized clinical trials of behavioral therapy and disulfiram✩

    Science.gov (United States)

    DeVito, Elise E.; Babuscio, Theresa A.; Nich, Charla; Ball, Samuel A.; Carroll, Kathleen M.

    2014-01-01

    Background Despite extensive research on gender differences in addiction, there are relatively few published reports comparing treatment outcomes for women versus men based on evidence-based treatments evaluated in randomized clinical trials. Methods An aggregate sample comprised of data from five randomized clinical trials of treatment for cocaine dependence (N = 434) was evaluated for gender differences in clinical outcomes. Secondary analyses compared gender differences in outcome by medication condition (disulfiram versus no medication) and across multiple behavioral treatment conditions. Results Women, compared with men, had poorer treatment outcomes on multiple measures of cocaine use during treatment and at post-treatment follow-up. These results appear to be primarily accounted for by disulfiram being less effective in women compared with men. There was no evidence of meaningful gender differences in outcome as a function of the behavioral therapies evaluated. Conclusions These findings suggest that women and men may benefit to similar degrees from some empirically validated behavioral treatments for addiction. Conversely, some addiction pharmacotherapies, such as disulfiram, may be associated with poorer outcomes among women relative to men and point to the need for careful assessment of pharmacological treatments in both sexes prior to widespread clinical implementation. PMID:25457739

  10. Three important clinical processes in individual and group interpersonal psychotherapy sessions.

    Science.gov (United States)

    Kivlighan, Dennis M

    2014-03-01

    I describe three clinical processes: (a) bringing the discussion into the here-and-now; (b) making impact disclosures; and (c) creating a corrective emotional experience, derived from interpersonal theory, that occurs in most of my individual and group therapy sessions. For each of these clinical processes, I provide: (a) the theoretical principals that support the clinical process, (b) clinical descriptions and dialogue that demonstrate the process, and (c) a review of some of the research examining the clinical process. Finally, I propose a task model of interpersonal therapy, which illustrates how the three clinical processes come together in interpersonal therapy.

  11. The relative importance of different perceptual-cognitive skills during anticipation.

    Science.gov (United States)

    North, Jamie S; Hope, Ed; Williams, A Mark

    2016-10-01

    We examined whether anticipation is underpinned by perceiving structured patterns or postural cues and whether the relative importance of these processes varied as a function of task constraints. Skilled and less-skilled soccer players completed anticipation paradigms in video-film and point light display (PLD) format. Skilled players anticipated more accurately regardless of display condition, indicating that both perception of structured patterns between players and postural cues contribute to anticipation. However, the Skill×Display interaction showed skilled players' advantage was enhanced in the video-film condition, suggesting that they make better use of postural cues when available during anticipation. We also examined anticipation as a function of proximity to the ball. When participants were near the ball, anticipation was more accurate for video-film than PLD clips, whereas when the ball was far away there was no difference between viewing conditions. Perceiving advance postural cues appears more important than structured patterns when the ball is closer to the observer, whereas the reverse is true when the ball is far away. Various perceptual-cognitive skills contribute to anticipation with the relative importance of perceiving structured patterns and advance postural cues being determined by task constraints and the availability of perceptual information.

  12. Who Sees Human? The Stability and Importance of Individual Differences in Anthropomorphism.

    Science.gov (United States)

    Waytz, Adam; Cacioppo, John; Epley, Nicholas

    2010-05-01

    Anthropomorphism is a far-reaching phenomenon that incorporates ideas from social psychology, cognitive psychology, developmental psychology, and the neurosciences. Although commonly considered to be a relatively universal phenomenon with only limited importance in modern industrialized societies-more cute than critical-our research suggests precisely the opposite. In particular, we provide a measure of stable individual differences in anthropomorphism that predicts three important consequences for everyday life. This research demonstrates that individual differences in anthropomorphism predict the degree of moral care and concern afforded to an agent, the amount of responsibility and trust placed on an agent, and the extent to which an agent serves as a source of social influence on the self. These consequences have implications for disciplines outside of psychology including human-computer interaction, business (marketing and finance), and law. Concluding discussion addresses how understanding anthropomorphism not only informs the burgeoning study of nonpersons, but how it informs classic issues underlying person perception as well. © The Author(s) 2010.

  13. Dispersion of Nanoparticles in Different Media Importantly Determines the Composition of Their Protein Corona

    Science.gov (United States)

    Strojan, Klemen; Leonardi, Adrijana; Bregar, Vladimir B.; Križaj, Igor; Svete, Jurij; Pavlin, Mojca

    2017-01-01

    Protein corona of nanoparticles (NPs), which forms when these particles come in to contact with protein-containing fluids, is considered as an overlooked factor in nanomedicine. Through numerous studies it has been becoming increasingly evident that it importantly dictates the interaction of NPs with their surroundings. Several factors that determine the compositions of NPs protein corona have been identified in recent years, but one has remained largely ignored—the composition of media used for dispersion of NPs. Here, we determined the effect of dispersion media on the composition of protein corona of polyacrylic acid-coated cobalt ferrite NPs (PAA NPs) and silica NPs. Our results confirmed some of the basic premises such as NPs type-dependent specificity of the protein corona. But more importantly, we demonstrated the effect of the dispersion media on the protein corona composition. The differences between constituents of the media used for dispersion of NPs, such as divalent ions and macromolecules were responsible for the differences in protein corona composition formed in the presence of fetal bovine serum (FBS). Our results suggest that the protein corona composition is a complex function of the constituents present in the media used for dispersion of NPs. Regardless of the dispersion media and FBS concentration, majority of proteins from either PAA NPs or silica NPs coronas were involved in the process of transport and hemostasis. Interestingly, corona of silica NPs contained three complement system related proteins: complement factor H, complement C3 and complement C4 while PAA NPs bound only one immune system related protein, α-2-glycoprotein. Importantly, relative abundance of complement C3 protein in corona of silica NPs was increased when NPs were dispersed in NaCl, which further implies the relevance of dispersion media used to prepare NPs. PMID:28052135

  14. Dispersion of Nanoparticles in Different Media Importantly Determines the Composition of Their Protein Corona.

    Science.gov (United States)

    Strojan, Klemen; Leonardi, Adrijana; Bregar, Vladimir B; Križaj, Igor; Svete, Jurij; Pavlin, Mojca

    2017-01-01

    Protein corona of nanoparticles (NPs), which forms when these particles come in to contact with protein-containing fluids, is considered as an overlooked factor in nanomedicine. Through numerous studies it has been becoming increasingly evident that it importantly dictates the interaction of NPs with their surroundings. Several factors that determine the compositions of NPs protein corona have been identified in recent years, but one has remained largely ignored-the composition of media used for dispersion of NPs. Here, we determined the effect of dispersion media on the composition of protein corona of polyacrylic acid-coated cobalt ferrite NPs (PAA NPs) and silica NPs. Our results confirmed some of the basic premises such as NPs type-dependent specificity of the protein corona. But more importantly, we demonstrated the effect of the dispersion media on the protein corona composition. The differences between constituents of the media used for dispersion of NPs, such as divalent ions and macromolecules were responsible for the differences in protein corona composition formed in the presence of fetal bovine serum (FBS). Our results suggest that the protein corona composition is a complex function of the constituents present in the media used for dispersion of NPs. Regardless of the dispersion media and FBS concentration, majority of proteins from either PAA NPs or silica NPs coronas were involved in the process of transport and hemostasis. Interestingly, corona of silica NPs contained three complement system related proteins: complement factor H, complement C3 and complement C4 while PAA NPs bound only one immune system related protein, α-2-glycoprotein. Importantly, relative abundance of complement C3 protein in corona of silica NPs was increased when NPs were dispersed in NaCl, which further implies the relevance of dispersion media used to prepare NPs.

  15. Clinically important features of porphyrin and heme metabolism and the porphyrias.

    Science.gov (United States)

    Besur, Siddesh; Hou, Wehong; Schmeltzer, Paul; Bonkovsky, Herbert L

    2014-11-03

    Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias) and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA), porphobilinogen and porphyrins) are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther's disease) and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow). We also describe salient clinical, laboratory and genetic features of the eight types of porphyria.

  16. Clinically Important Features of Porphyrin and Heme Metabolism and the Porphyrias

    Science.gov (United States)

    Besur, Siddesh; Hou, Weihong; Schmeltzer, Paul; Bonkovsky, Herbert L.

    2014-01-01

    Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias) and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA), porphobilinogen and porphyrins) are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther’s disease) and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow). We also describe salient clinical, laboratory and genetic features of the eight types of porphyria. PMID:25372274

  17. Clinically Important Features of Porphyrin and Heme Metabolism and the Porphyrias

    Directory of Open Access Journals (Sweden)

    Siddesh Besur

    2014-11-01

    Full Text Available Heme, like chlorophyll, is a primordial molecule and is one of the fundamental pigments of life. Disorders of normal heme synthesis may cause human diseases, including certain anemias (X-linked sideroblastic anemias and porphyrias. Porphyrias are classified as hepatic and erythropoietic porphyrias based on the organ system in which heme precursors (5-aminolevulinic acid (ALA, porphobilinogen and porphyrins are chiefly overproduced. The hepatic porphyrias are further subdivided into acute porphyrias and chronic hepatic porphyrias. The acute porphyrias include acute intermittent, hereditary copro-, variegate and ALA dehydratase deficiency porphyria. Chronic hepatic porphyrias include porphyria cutanea tarda and hepatoerythropoietic porphyria. The erythropoietic porphyrias include congenital erythropoietic porphyria (Gűnther’s disease and erythropoietic protoporphyria. In this review, we summarize the key features of normal heme synthesis and its differing regulation in liver versus bone marrow. In both organs, principal regulation is exerted at the level of the first and rate-controlling enzyme, but by different molecules (heme in the liver and iron in the bone marrow. We also describe salient clinical, laboratory and genetic features of the eight types of porphyria.

  18. Cardiac Alpha1-Adrenergic Receptors: Novel Aspects of Expression, Signaling Mechanisms, Physiologic Function, and Clinical Importance

    Science.gov (United States)

    O’Connell, Timothy D.; Jensen, Brian C.; Baker, Anthony J.

    2014-01-01

    Adrenergic receptors (AR) are G-protein-coupled receptors (GPCRs) that have a crucial role in cardiac physiology in health and disease. Alpha1-ARs signal through Gαq, and signaling through Gq, for example, by endothelin and angiotensin receptors, is thought to be detrimental to the heart. In contrast, cardiac alpha1-ARs mediate important protective and adaptive functions in the heart, although alpha1-ARs are only a minor fraction of total cardiac ARs. Cardiac alpha1-ARs activate pleiotropic downstream signaling to prevent pathologic remodeling in heart failure. Mechanisms defined in animal and cell models include activation of adaptive hypertrophy, prevention of cardiac myocyte death, augmentation of contractility, and induction of ischemic preconditioning. Surprisingly, at the molecular level, alpha1-ARs localize to and signal at the nucleus in cardiac myocytes, and, unlike most GPCRs, activate “inside-out” signaling to cause cardioprotection. Contrary to past opinion, human cardiac alpha1-AR expression is similar to that in the mouse, where alpha1-AR effects are seen most convincingly in knockout models. Human clinical studies show that alpha1-blockade worsens heart failure in hypertension and does not improve outcomes in heart failure, implying a cardioprotective role for human alpha1-ARs. In summary, these findings identify novel functional and mechanistic aspects of cardiac alpha1-AR function and suggest that activation of cardiac alpha1-AR might be a viable therapeutic strategy in heart failure. PMID:24368739

  19. Isolation of clinical strains of Pseudomonas aeruginosa harboring different plasmids.

    Science.gov (United States)

    Ranjbar, R; Owlia, P; Saderi, H; Bameri, Z; Izadi, M; Jonaidi, N; Morovvati, S

    2007-09-01

    Aim of this study was to investigate the presence of plasmids among the strains of P. aeruginosa isolated from clinically diagnosed cases in Tehran in 2006. A total of 38 strains of P. aeruginosa were isolated. With the exception of one isolate, all P. aeruginosa strains harbored at least one plasmid band. The electrophoretic analysis of plasmid DNAs showed different number of plasmid bands among the strains tested. The DNA band of 1.4 kbp was evident in 84.2% of the strains. Approximately 71 and 21% of the isolates harbored concomitantly two and three plasmids, respectively. Isolation of strains with diverse types of plasmids suggests the different cluster of P. aeruginosa might be disseminated during the current study period.

  20. Clinical Survival of Rebonded Brackets with Different ARI Scores

    Directory of Open Access Journals (Sweden)

    Mohammad Hossein Ahangar Atashi

    2016-01-01

    Full Text Available Introduction: Bracket debonding is one of the most common events in orthodontics. The aim of the present study was to quantitatively compare clinical survival of rebonded brackets with different ARI scores with new brackets rebonding. Materials and Methods: The subjects in the present study consisted of 74 patients with 76 debonded brackets on maxillary first and second premolars. After refreshing the bracket base of the debonded brackets, they were assigned in two groups: group A with 27 brackets of ARI≥4 and group B with 28 brackets of ARI≤2. In 21 cases, new brackets were used (group C. The frequency of the debonding in each rebonded group during treatment was calculated in intervals of 6,12,18 mounths after onset of bracket rebonding . Chi-squared test was used to compare the frequency of debonded brackets. Results: The frequency of debonded brackets was significantly higher in group B (ARI≤2 than those of groups A (ARI≥4 and C (new brackets. The number of debonded brackets were not significantly different between groups A (ARI≥4 and C (new brackets. Conclusion: Rebonding strength of debonded brackets in those that the failure is presented between adhesive and enamel (ARI≥4 could be clinically acceptable with no need to use new brackets.    Key words: dental bonding; orthodontic brackets; prevalence

  1. Importance of Data Mining with Different Types of Data Applications and Challenging Areas

    Directory of Open Access Journals (Sweden)

    Ms. Aruna J. Chamatkar

    2014-05-01

    Full Text Available Data mining is an increasingly popular set of tools for dealing with large amounts of data, often collected in haphazard fashion with many missing values. This type of huge amount of data’s are available in the form of tera- to peta-bytes which has drastically changed in the areas of science and engineering. To analyze, manage and make a decision of such type of huge amount of data there are need to techniques called the data mining which will transforming in many fields. In Data Mining data sets will be explored to yield hidden and unknown predictions which can be used in future for the efficient decision making. Data Mining that involves pattern recognition, mathematical and statistical techniques to search data Warehouses and help the analyst in recognizing significant trends, facts relationships and anomalies. In this paper we discuss the importance of data mining , different challenging areas and application areas in data mining .

  2. Global patterns of conservation research importance in different countries of the world

    Science.gov (United States)

    Takahara, Teruhiko

    2016-01-01

    Conservation research is essential to help inform the science-based management of environments that support threatened and endangered wildlife; however, research effort is not necessarily uniform across countries globally. Here, we assessed how the research importance of conservation is distributed globally across different countries and what drives this variation. Specifically, we compared the number of conservation/ecological articles versus all scientific articles published for each country in relation to the number of endangered species, the protection status and number of ecosystems, and the economic status of each country (gross domestic product (GDP) per capita). We observed a significant and positive relationship between the proportion of conservation and ecology articles to all scientific articles with respect to the number of endangered species and the proportion of endangered species that are protected in a country, as well as GDP per capita. In conclusion, knowledge about the conservation and economic status of countries should be accounted for when predicting the research importance of conservation and ecology. PMID:27441117

  3. Global patterns of conservation research importance in different countries of the world.

    Science.gov (United States)

    Doi, Hideyuki; Takahara, Teruhiko

    2016-01-01

    Conservation research is essential to help inform the science-based management of environments that support threatened and endangered wildlife; however, research effort is not necessarily uniform across countries globally. Here, we assessed how the research importance of conservation is distributed globally across different countries and what drives this variation. Specifically, we compared the number of conservation/ecological articles versus all scientific articles published for each country in relation to the number of endangered species, the protection status and number of ecosystems, and the economic status of each country (gross domestic product (GDP) per capita). We observed a significant and positive relationship between the proportion of conservation and ecology articles to all scientific articles with respect to the number of endangered species and the proportion of endangered species that are protected in a country, as well as GDP per capita. In conclusion, knowledge about the conservation and economic status of countries should be accounted for when predicting the research importance of conservation and ecology.

  4. Global patterns of conservation research importance in different countries of the world

    Directory of Open Access Journals (Sweden)

    Hideyuki Doi

    2016-07-01

    Full Text Available Conservation research is essential to help inform the science-based management of environments that support threatened and endangered wildlife; however, research effort is not necessarily uniform across countries globally. Here, we assessed how the research importance of conservation is distributed globally across different countries and what drives this variation. Specifically, we compared the number of conservation/ecological articles versus all scientific articles published for each country in relation to the number of endangered species, the protection status and number of ecosystems, and the economic status of each country (gross domestic product (GDP per capita. We observed a significant and positive relationship between the proportion of conservation and ecology articles to all scientific articles with respect to the number of endangered species and the proportion of endangered species that are protected in a country, as well as GDP per capita. In conclusion, knowledge about the conservation and economic status of countries should be accounted for when predicting the research importance of conservation and ecology.

  5. Hidden biodiversity in an ecologically important freshwater amphipod: differences in genetic structure between two cryptic species.

    Directory of Open Access Journals (Sweden)

    Anja Marie Westram

    Full Text Available Cryptic species, i.e. species that are morphologically hard to distinguish, have been detected repeatedly in various taxa and ecosystems. In order to evaluate the importance of this finding, we have to know in how far cryptic species differ in various aspects of their biology. The amphipod Gammarus fossarum is a key invertebrate in freshwater streams and contains several cryptic species. We examined the population genetic structure, genetic diversity and demographic history of two of them (type A and type B using microsatellite markers and asked whether they show significant differences. We present results of population genetic analyses based on a total of 37 populations from the headwaters of two major European drainages, Rhine and Rhone. We found that, in both species, genetic diversity was geographically structured among and within drainages. For type A in the Rhine and type B in the Rhone, we detected significant patterns of isolation by distance. The increase of genetic differentiation with geographical distance, however, was much higher in type A than in type B. This result indicates substantial interspecific differences in population history and/or the extent of current gene flow between populations. In the Rhine, type B does not show evidence of isolation by distance, and population differentiation is relatively low across hundreds of kilometres. The majority of these populations also show signatures of recent bottlenecks. These patterns are consistent with a recent expansion of type B into the Rhine drainage. In summary, our results suggest considerable and previously unrecognized interspecific differences in the genetic structure of these cryptic keystone species.

  6. Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations.

    Science.gov (United States)

    Kim, Hunmin; Hwang, Hee; Cheong, Hae Il; Park, Hye Won

    2011-11-01

    Primary hypokalemic periodic paralysis (HOKPP) is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1Sp.Arg528His and SCN4A p.Arg672His). Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment.

  7. Prevention of clinically important deteriorations in COPD with umeclidinium/vilanterol

    Directory of Open Access Journals (Sweden)

    Singh D

    2016-06-01

    Full Text Available Dave Singh,1 M Reza Maleki-Yazdi,2 Lee Tombs,3 Ahmar Iqbal,4 William A Fahy,5 Ian Naya5 1Medicines Evaluation Unit, University of Manchester, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK; 2Division of Respiratory Medicine, Women’s College Hospital, University of Toronto, ON, Canada; 3Precise Approach LTD, London UK; 4Respiratory Medical Franchise, GSK, Research Triangle Park, NC, USA; 5Respiratory Medicines Development Centre, GSK, Stockley Park, Middlesex, UK Background: Minimizing the risk of disease progression and exacerbations is the key goal of COPD management, as these are well-established indicators of poor COPD prognosis. We developed a novel composite end point assessing three important aspects (lung function, health status, and exacerbations of worsening in COPD. The objective was to determine whether dual bronchodilation with umeclidinium/vilanterol (UMEC/VI reduces clinically important deteriorations (CIDs in COPD versus placebo or bronchodilator monotherapy.  Methods: This study is a post hoc analysis of two 24-week trials comparing UMEC/VI 62.5/25 µg with UMEC 62.5 µg, VI 25 µg, or placebo (Study A; NCT01313650, or UMEC/VI 62.5/25 µg with tiotropium (TIO 18 µg (Study B; NCT01777334 in patients with symptomatic COPD, without a history of frequent exacerbations. Deterioration was assessed as the time to a first CID, a composite measure defined as a decrease of ≥100 mL in trough forced expiratory volume in 1 second or ≥4-unit increase in St George’s Respiratory Questionnaire total score or an on-treatment moderate-to-severe COPD exacerbation.  Results: In Study A, fewer patients experienced a first CID with UMEC/VI (44% versus UMEC (50%, VI (56%, and placebo (75%. The risk of a first CID was reduced with UMEC/VI (hazard ratio [HR]: 0.37 [95% confidence interval, CI: 0.30, 0.45], UMEC (HR: 0.46 [95% CI: 0.38, 0.56], and VI (HR: 0.55 [95% CI: 0.45, 0.66]; all P<0.001 versus placebo

  8. Changes in Heart Rate Variability after Coronary Artery Bypass Grafting and Clinical Importance of These Findings.

    Science.gov (United States)

    Lakusic, Nenad; Mahovic, Darija; Kruzliak, Peter; Cerkez Habek, Jasna; Novak, Miroslav; Cerovec, Dusko

    2015-01-01

    Heart rate variability is a physiological feature indicating the influence of the autonomic nervous system on the heart rate. Association of the reduced heart rate variability due to myocardial infarction and the increased postinfarction mortality was first described more than thirty years ago. Many studies have unequivocally demonstrated that coronary artery bypass grafting surgery generally leads to significant reduction in heart rate variability, which is even more pronounced than after myocardial infarction. Pathophysiologically, however, the mechanisms of heart rate variability reduction associated with acute myocardial infarction and coronary artery bypass grafting are different. Generally, heart rate variability gradually recovers to the preoperative values within six months of the procedure. Unlike the reduced heart rate variability in patients having sustained myocardial infarction, a finding of reduced heart rate variability after coronary artery bypass surgery is not considered relevant in predicting mortality. Current knowledge about changes in heart rate variability in coronary patients and clinical relevance of such a finding in patients undergoing coronary artery bypass grafting are presented.

  9. Binary toxin and its clinical importance in Clostridium difficile infection, Belgium.

    Science.gov (United States)

    Pilate, T; Verhaegen, J; Van Ranst, M; Saegeman, V

    2016-11-01

    Binary toxin-producing Clostridium difficile strains such as ribotypes 027 and 078 have been associated with increased Clostridium difficile infection (CDI) severity. Our objective was to investigate the association between presence of the binary toxin gene and CDI severity and recurrence. We performed a laboratory-based retrospective study including patients between January 2013 and March 2015 whose fecal samples were analyzed by polymerase chain reaction (PCR) for the presence of the genes for toxin B and binary toxin and a deletion in the tcdC gene, specific for ribotype 027. Clinical and epidemiological characteristics were compared between 33 binary toxin-positive CDI patients and 33 binary toxin-negative CDI patients. Subsequently, the characteristics of 66 CDI patients were compared to those of 66 diarrhea patients who were carriers of non-toxigenic C. difficile strains. Fifty-nine of 1034 (5.7 %) fecal samples analyzed by PCR were binary toxin-positive, belonging to 33 different patients. No samples were positive for ribotype 027. Binary toxin-positive CDI patients did not differ from binary toxin-negative CDI patients in terms of disease recurrence, morbidity, or mortality, except for a higher peripheral leukocytosis in the binary toxin-positive group (16.30 × 10(9)/L vs. 11.65 × 10(9)/L; p = 0.02). The second part of our study showed that CDI patients had more severe disease, but not a higher 30-day mortality rate than diarrhea patients with a non-toxicogenic C. difficile strain. In our setting with a low prevalence of ribotype 027, the presence of the binary toxin gene is not associated with poor outcome.

  10. [Clinical analysis of the first patient with imported Middle East respiratory syndrome in China].

    Science.gov (United States)

    Ling, Yun; Qu, Rong; Luo, Yufeng

    2015-08-01

    To report the treatment of the first imported Middle East respiratory syndrome ( MERS ) in China, and to investigate the clinical features and treatment of the patient. On May 28th, 2015, the first patient of imported MERS to China was admitted to Department of Critical Care Medicine of Huizhou Municipal Central Hospital. The clinical features and treatments of this patient were analyzed. (1) A 43 years old male of South Korean nationality was admitted with the complaint of back ache for 7 days and fever 2 days with the following characteristics: back ache 7 days ago, without fever or cough or expectoration. He had been suspected to suffer from infection of Middle East respiratory syndrome coronavirus ( MERS-CoV ) by the Disease Control Department of South Korea, but no specific treatment was given. He had fever for 2 days with maximum body temperature of 39.7 centigrade. He had no chills, cough, expectoration, short of breath, abdominal pain, diarrhea, frequent micturition, or urgency or pain of urination, and no sore throat. The patient had a history of exposure to MERS-CoV patient. He was considered to be a patient of the second batch of South Korean epidemic. (2) Auxiliary examination: 3 copies of throat swab specimens for virus nucleic acid detection were performed by the Disease Prevention Control Center of China ( China CDC ), and they were positive on May 29th, 2015, and also for serum, sputum and stool. Based on the results of whole genome sequence analysis, the virus strains were implicated to be derived from Riyahh and Jeddah regions of Saudi Arabia. On admission, the patient's blood test showed that the white blood cell count was low ( 3.22×10(9)/L ), the proportion of the neutrophils was high ( 0.73 ), and that of the platelet was low ( 81×10(9)/L ). On admission, the patient's chest X-ray showed that a small amount of infiltration in the lung. (3) TREATMENT: a high-flow nasal cannula ( HFNC ) with oxygen concentration of 0.50-0.80 was given, with a

  11. Remarkable anatomic variations in paranasal sinus region and their clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Kantarci, Mecit E-mail: akkanrad@hotmail.com; Karasen, R. Murat; Alper, Fatih; Onbas, Omer; Okur, Adnan; Karaman, Adem

    2004-06-01

    With the advent of functional endoscopic sinus surgery (FESS) and coronal computed tomography (CT) imaging, considerable attention has been directed toward paranasal region anatomy. Detailed knowledge of anatomic variations in paranasal sinus region is critical for surgeons performing endoscopic sinus surgery as well as for the radiologist involved in the preoperative work-up. To be in the known anatomical variants with some accompanying pathologies, directly influence the success of diagnostic and therapeutic management of paranasal sinus diseases. A review of 512 (1024 sides) paranasal sinus tomographic scans was carried out to expose remarkable anatomic variations of this region. We used only coronal sections, but for some cases to clear exact diagnosis, additional axial CT scan, magnetic resonance imaging (MRI) and nasal endoscopy were also performed. In this pictorial essay, rates of remarkable anatomic variations in paranasal region were displayed. The images of some interesting cases were illustrated, such as the Onodi cell in which isolated mucocele caused loss of visual acuity, agger nasi cell, Haller's cell, uncinate bulla, giant superior concha bullosa, inferior concha bullosa, bilateral carotid artery protrusion into sphenoid sinus, maxillary sinus agenesis, bilateral secondary middle turbinate (SMT) and sphenomaxillary plate. The clinical importance of all these variations were discussed under the light of the literature. It was suggested that remarkable anatomic variations of paranasal region and their possible pathologic consequences should be well defined in order to improve success of management strategies, and to avoid potential complications of endoscopic sinus surgery. The radiologist must pay close attention to anatomical variations in the preoperative evaluation.

  12. The biological and clinical importance of epithelial-mesenchymal transition in circulating tumor cells.

    Science.gov (United States)

    Liu, Huiying; Zhang, Xiaofeng; Li, Jun; Sun, Bin; Qian, Haihua; Yin, Zhengfeng

    2015-02-01

    Movement of tumor cells from a primary tumor to a nonadjacent or distant site is a contiguous and complex process. Among the multiple natural cellular programs that promote initiation and progression of tumor metastasis, epithelial-mesenchymal transition (EMT) may play a key role in the ultimate generation of a metastatic foci. Acquisition of the EMT phenotype by tumor cells not only increases their migration and invasion potentials, thereby facilitating their ability to infiltrate blood vessels and to produce circulating tumor cells (CTCs), but also promotes survival of CTCs in the bloodstream and their ability to extravasate out of the circulatory system and invade proximal tissues. In organs distal to the primary tumor, the phenotypic switching mechanism of mesenchymal-epithelial transition (MET) enables CTCs to grow and colonize, enhancing the likelihood of establishing metastasis. In addition, CTCs that have undergone EMT attain increased resistance to chemotherapy and targeted therapy. CTCs with the EMT phenotype have become recognized as an active source of metastases, and targeting EMT/MET processes during the individual steps of tumor metastasis represents a promising new approach for alleviating cancer metastasis and recurrence. In this article, we focus on the biological and clinical importance of EMT and/or MET in CTCs during the individual steps of tumor metastasis, summarizing the recent findings of the regulatory roles played by EMT and/or MET in the generation, survival, and recolonization of CTCs and discussing the EMT-targeting strategies developed for tumor diagnosis as well as their potential for management of metastatic malignant diseases.

  13. Aging and longevity: why knowing the difference is important to nutrition research.

    Science.gov (United States)

    McDonald, Roger B; Ruhe, Rodney C

    2011-03-01

    Life expectancies after the age of 70 and the number of individuals living with age-related chronic conditions that affect daily activities continue to increase. Age-specific nutritional recommendations may help to decrease the incidence or severity of age-related debilitating chronic disorders. However, research in this area has seen limited success in identifying nutrition-related mechanisms that underlie the functional loss and chronic conditions that occur as a function of time. We believe that the limited success in establishing age-specific nutrition recommendations for the older population reflects, at least in part, research designs that fail to consider the evolutionary and biological bases of aging and longevity. Longevity has evolved as a by-product of genes selected for their contribution in helping the organism survive to the age of reproduction. As such, the principle of genetic determinism provides an appropriate underlying theory for research designs evaluating nutritional factors involved with life span. Aging is not a product of evolution and reflects stochastic and/or random events that most likely begin during the early, reproductively-active years. The genetic determinism model by which young (normal, control) are compared to old (abnormal, experimental) groups will not be effective in identifying underlying mechanisms and nutritional factors that impact aging. The purpose of this commentary is to briefly discuss the difference between aging and longevity and why knowing the difference is important to nutrition research and to establishing the most precise nutritional recommendations possible for the older population.

  14. Synergistic effect of different plant cell wall degrading enzymes is important for virulence of Fusarium graminearum.

    Science.gov (United States)

    Paccanaro, Maria Chiara; Sella, Luca; Castiglioni, Carla; Giacomello, Francesca; Martinez-Rocha, Ana Lilia; D'Ovidio, Renato; Schäfer, Wilhelm; Favaron, Francesco

    2017-08-11

    Endo-polygalacturonases (PGs) and xylanases have been shown to play an important role during pathogenesis of some fungal pathogens of dicot plants, whilst their role in monocot pathogens is less defined. Pg1 and xyr1 genes of the wheat pathogen Fusarium graminearum encode the main PG and the major regulator of xylanase production, respectively. Single and double disrupted mutants for these genes were obtained to assess their contribution to fungal infection. Compared to wild-type strain, the ∆pg mutant showed a nearly abolished PG activity, slight reduced virulence on soybean seedlings but no significant difference in disease symptoms on wheat spikes; the ∆xyr mutant was strongly reduced in xylanase activity and moderately reduced in cellulase activity but was as virulent as wild-type on both soybean and wheat plants. Consequently, the ΔpgΔxyr double mutant was impaired in xylanase, PG and cellulase activities, but, differently from single mutants, was significantly reduced in virulence on both plants. These findings demonstrate that the concurrent presence of PG, xylanase and cellulase activities is necessary for full virulence. The observation that the uronides released from wheat cell wall after a F. graminearum PG treatment were largely increased by the fungal xylanases suggests that these enzymes act synergistically in deconstructing the plant cell wall.

  15. Minimal important difference to infer changes in health-related quality of life-a systematic review.

    Science.gov (United States)

    Jayadevappa, Ravishankar; Cook, Ratna; Chhatre, Sumedha

    2017-07-01

    The objective of the study was to assess the usability of minimal important difference (MID) and minimal clinically important difference (MCID) for measuring meaningful changes in disease-specific and generic health-related quality-of-life (HRQoL) outcomes in patient-centered care. We adopted a two-step literature review process. First, we used PubMed and Google scholar to identify a broad range of search terms. Next, we searched OVID Medline, JSTOR, and PubMed for terms "MID," and "MCID." We excluded non-English language studies, articles older than 1995, those not related to generic- and disease-specific HRQoL measures, and protocols of future studies. Studies were grouped according to generic- and disease-specific measures. We assessed MID or MCID calculation methods, effect sizes, estimated values, and significance. Eighty articles satisfied the inclusion criteria. Our synthesis provides a comprehensive assessment of MID or MCID for 10 generic-specific and 80 disease-specific instruments. We observed a lack of consistency in the application of methods for computing MID or MCID for generic and disease-specific HRQoL measures. Only 43 (54%) studies used both anchor and distribution methods to elicit MID or MCID. Thirty-four articles estimated MID values only, whereas 47 articles estimated MCID. The anchor-based method yields conservative estimates of MID or MCID, compared to the distribution-based method. The distribution method does not take into account patient perspectives and should be accompanied by anchor method while computing MID. The MID should be interpreted with caution, and available estimates for a particular instrument must be used. This will help in integrating the MID estimates into the overall research or clinical plan for a specific context. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Clinical differences among PCR-proven dengue serotype infections.

    Science.gov (United States)

    Limkittikul, Kriengsak; Yingsakmongkon, Sangchai; Jittmittraphap, Akanitt; Chuananon, Somchai; Kongphrai, Yuphin; Kowasupathr, Surasak; Rojanawatsirivit, Chaiyaporn; Mammen, Mammen P; Jampangern, Wipawee

    2005-11-01

    The objective of this study was to compare the clinical spectra of the dengue serotypes proven by the PCR technique. This retrospective study reviewed the clinical information of dengue-infected patients who were admitted to northeastern provincial hospitals in Thailand from June to September 2002. Dengue infection and viral serotypes were confirmed by polymerase chain reaction (PCR). Paired anti-dengue immunoglobulin G (IgG) and IgM from paired sera were analyzed by enzyme-linked immunosorbent assay (ELISA). Ninety-nine PCR-proven dengue-infected Thai patients were studied. Their ages ranged from 3-30 years. They were infected with DEN1, DEN2, DEN3 and DEN4 in 21, 55, 12, and 12%, respectively. Twenty-two percent had primary and 78% had secondary infections. Dengue fever was the most common presentation for both primary (77.2%) and secondary infections (46.7%). The ratios of dengue fever:dengue hemorrhagic fever (DF:DHF) and non-dengue shock syndrome:dengue shock syndrome (non-DSS:DSS) for DEN2 was the lowest of the dengue serotypes. There was no difference in the duration of fever, percentage of hepatomegaly and bleeding among the serotypes in both DF and DHF. The trends in the white blood cells, lymphocyte and atypical lymphocyte counts in DEN3 were the highest, while those of DEN1 were the lowest of the dengue serotypes.

  17. Comparisons between the attitudes of medical and dental students toward the clinical importance of gross anatomy and physiology.

    Science.gov (United States)

    Olowo-Ofayoku, Anthony; Moxham, Bernard John

    2014-10-01

    Marked changes are occurring within both the medical and dental curricula and new ways of teaching the basic sciences have been devised and traditional methods (e.g., dissection for gross anatomy and of bench-based animal preparations for physiology) are increasingly no longer the norm. Although there is much anecdotal evidence that students are not in favor of such changes, there is little evidence for this based on quantitative analyses of students' attitudes. Using Thurstone and Chave attitude analyses, we assessed the attitudes of first year medical and dental students at Cardiff University toward gross anatomy and physiology in terms of their perceived clinical importance. In addition, we investigated the appropriateness ("fitness for purpose") of teaching methodologies used for anatomy and physiology. The hypotheses tested recognized the possibility that medical and dental students differed in their opinions, but that they had a preference to being taught gross anatomy through the use of dissection and had no preference for physiology teaching. It was found that both medical and dental students displayed positive attitudes toward the clinical relevance of gross anatomy and that they preferred to be taught by means of dissection. Although both medical and dental students displayed positives attitudes toward the clinical relevance of physiology, this was greater for the medical students. Both medical and dental students showed a preference for being taught physiology through didactic teaching in small groups but the medical students also appreciated being taught by means of practicals. Overall, this study highlights the expectations that students have for the basic science foundation teaching within their professional training and signals a preference for being taught experientially/practically. Differences were discerned between medical and dental students that might reflect the direct association between systems physiology and pathophysiology and the

  18. Important options available - from start to finish -for translating proteomics results to clinical chemistry

    DEFF Research Database (Denmark)

    Heegaard, Niels H H; Ostergaard, Ole; Bahl, Justyna M C

    2015-01-01

    In the realm of clinical chemistry the field of clinical proteomics, i.e., the application of proteomic methods for understanding mechanisms and enabling diagnosis, prediction, measurement of activity, and treatment response in disease, is first and foremost a discovery and research tool that fee...

  19. The importance of evaluation in clinical competence in the presence of college teaching in health

    Directory of Open Access Journals (Sweden)

    Correa-Bautista Jorge Enrique

    2012-04-01

    Full Text Available Competency assessment (CA has renewed the way to determine the clinical performance ofhealth professionals. To this end, the university teaching requires conceptual and methodologicaldomain on the various techniques of formative assessment. This article reports the main technicalcompetency assessment in clinical settings, considering it as a core competency for universityteaching in health.

  20. Automated realtime data import for the i2b2 clinical data warehouse: introducing the HL7 ETL cell.

    Science.gov (United States)

    Majeed, Raphael W; Röhrig, Rainer

    2012-01-01

    Clinical data warehouses are used to consolidate all available clinical data from one or multiple organizations. They represent an important source for clinical research, quality management and controlling. Since its introduction, the data warehouse i2b2 gathered a large user base in the research community. Yet, little work has been done on the process of importing clinical data into data warehouses using existing standards. In this article, we present a novel approach of utilizing the clinical integration server as data source, commonly available in most hospitals. As information is transmitted through the integration server, the standardized HL7 message is immediately parsed and inserted into the data warehouse. Evaluation of import speeds suggest feasibility of the provided solution for real-time processing of HL7 messages. By using the presented approach of standardized data import, i2b2 can be used as a plug and play data warehouse, without the hurdle of customized import for every clinical information system or electronic medical record. The provided solution is available for download at http://sourceforge.net/projects/histream/.

  1. Aging and Longevity: Why Knowing the Difference Is Important to Nutrition Research

    Directory of Open Access Journals (Sweden)

    Roger B. McDonald

    2011-02-01

    Full Text Available Life expectancies after the age of 70 and the number of individuals living with age-related chronic conditions that affect daily activities continue to increase. Age-specific nutritional recommendations may help to decrease the incidence or severity of age-related debilitating chronic disorders. However, research in this area has seen limited success in identifying nutrition-related mechanisms that underlie the functional loss and chronic conditions that occur as a function of time. We believe that the limited success in establishing age-specific nutrition recommendations for the older population reflects, at least in part, research designs that fail to consider the evolutionary and biological bases of aging and longevity. Longevity has evolved as a by-product of genes selected for their contribution in helping the organism survive to the age of reproduction. As such, the principle of genetic determinism provides an appropriate underlying theory for research designs evaluating nutritional factors involved with life span. Aging is not a product of evolution and reflects stochastic and/or random events that most likely begin during the early, reproductively-active years. The genetic determinism model by which young (normal, control are compared to old (abnormal, experimental groups will not be effective in identifying underlying mechanisms and nutritional factors that impact aging. The purpose of this commentary is to briefly discuss the difference between aging and longevity and why knowing the difference is important to nutrition research and to establishing the most precise nutritional recommendations possible for the older population.

  2. The relative importance of different types of rewards for employee motivation and commitment in South Africa

    Directory of Open Access Journals (Sweden)

    Aleeshah Nujjoo

    2012-02-01

    Full Text Available Orientation: Employees’ perceptions of rewards are related to their affective commitment and intrinsic motivation, which have been associated with staff turnover.Research purpose: The study sought to establish the relationship between intrinsic and different extrinsic rewards with intrinsic motivation and affective commitment.Motivation for the study: South African organisations are grappling with employee retention. Literature shows that employees who are more motivated and committed to their organisation are less likely to quit. Rewards management strategies serve to create a motivated and committed workforce. Using the correct types of rewards can thus provide a competitive advantage.Research design, approach and method: A cross-sectional, correlational study was conducted. Questionnaire data of 399 South African employees were analysed using bivariate correlations and multiple regression.Main findings: Three main findings emerged. Firstly, there is a relationship between all types of rewards investigated and the two outcome variables. Secondly, this relationship is stronger for intrinsic than for extrinsic rewards and thirdly, monetary rewards do not account for the variance in intrinsic motivation above that of non-monetary rewards.Practical/managerial implications: Rewards management strategies should focus on job characteristics and designs to increase staff intrinsic rewards and include non-monetary rewards, such as supportive leadership, to encourage employees’ intrinsic motivation and affective commitment.Contribution/value-add: This research demonstrated the important role different rewards, particularly intrinsic non-monetary rewards, play in creating a committed and motivated workforce. The insights gained from this study can promote organisational effectiveness. Suggestions of how to expand on and refine the current study are addressed.

  3. Bacterial endophyte communities of three agricultural important grass species differ in their response towards management regimes

    Science.gov (United States)

    Wemheuer, Franziska; Kaiser, Kristin; Karlovsky, Petr; Daniel, Rolf; Vidal, Stefan; Wemheuer, Bernd

    2017-01-01

    Endophytic bacteria are critical for plant growth and health. However, compositional and functional responses of bacterial endophyte communities towards agricultural practices are still poorly understood. Hence, we analyzed the influence of fertilizer application and mowing frequency on bacterial endophytes in three agriculturally important grass species. For this purpose, we examined bacterial endophytic communities in aerial plant parts of Dactylis glomerata L., Festuca rubra L., and Lolium perenne L. by pyrotag sequencing of bacterial 16S rRNA genes over two consecutive years. Although management regimes influenced endophyte communities, observed responses were grass species-specific. This might be attributed to several bacteria specifically associated with a single grass species. We further predicted functional profiles from obtained 16S rRNA data. These profiles revealed that predicted abundances of genes involved in plant growth promotion or nitrogen metabolism differed between grass species and between management regimes. Moreover, structural and functional community patterns showed no correlation to each other indicating that plant species-specific selection of endophytes is driven by functional rather than phylogenetic traits. The unique combination of 16S rRNA data and functional profiles provided a holistic picture of compositional and functional responses of bacterial endophytes in agricultural relevant grass species towards management practices. PMID:28102323

  4. The minimal important difference for measures of urticaria disease activity: Updated findings.

    Science.gov (United States)

    Mathias, Susan D; Crosby, Ross D; Rosén, Karin E; Zazzali, James L

    2015-01-01

    The Urticaria Patient Daily Diary (UPDD) is a validated patient-reported outcome that captures key measures of urticaria disease activity. To update estimates of the minimal important difference (MID) for urticaria disease activity measures in the UPDD, including the weekly itch severity score, weekly number of hives score, weekly average size of largest hive score, and the composite measure of itch severity and number of hives over 7 days, or urticaria activity score 7 (UAS7). A total of 975 subjects with chronic idiopathic urticaria from three randomized, double-blind, placebo-controlled studies completed the UPDD and other patient-reported outcome assessments (the Dermatology Life Quality Index, Medical Outcomes Study Sleep Scale, the Chronic Urticaria Quality-of-Life Questionnaire, the EuroQoL-5 Dimension Questionnaire) multiple times. MIDs were estimated through a combination of distribution- and anchor-based methods. MID estimates ranged from 4.5 to 5.0 for the weekly itch severity score, 5.0 to 5.5 for weekly hives count score, 9.5 to 10.5 for the UAS7, and 4.0 to 4.5 for the weekly size of the largest hive score. This analysis provided confirmation of the previous MID estimates for the urticaria disease activity measures in the UPDD.

  5. Mercury bioaccumulation in fish of commercial importance from different trophic categories in an Amazon floodplain lake

    Directory of Open Access Journals (Sweden)

    Sandra Beltran-Pedreros

    Full Text Available Thirty-two species of commercially important fish from three trophic levels and nine trophic categories were sampled at a floodplain lake of the Solimões River (Lago Grande de Manacapuru. The fish were analyzed to determine their Hg level and the bioaccumulation, bioconcentration, and biomagnification of this element. The observed increase in mean concentration of mercury (49.6 ng.g-1 for omnivores, 418.3 ng.g-1 for piscivores, and 527.8 ng.g-1 for carnivores/necrophages furnished evidence of biomagnification. Primary, secondary, and tertiary consumers presented biomagnification factors of 0.27, 0.33, and 0.47, respectively. Significant differences in the bioconcentration and concentration of total Hg occurred between the categories of the third trophic level and the other categories. Plagioscion squamosissimus (carnivorous/piscivorous and Calophysus macropterus (carnivorous/ necrophagous showed levels of total Hg above those permitted by Brazilian law (500 ng.g-1. Six other species also posed risks to human health because their Hg levels exceeded 300 ng.g-1. Fifteen species showed bioaccumulation, but only eight presented significant correlations between the concentration of Hg and the length and/or the weight of the fish.

  6. Bacterial endophyte communities of three agricultural important grass species differ in their response towards management regimes

    Science.gov (United States)

    Wemheuer, Franziska; Kaiser, Kristin; Karlovsky, Petr; Daniel, Rolf; Vidal, Stefan; Wemheuer, Bernd

    2017-01-01

    Endophytic bacteria are critical for plant growth and health. However, compositional and functional responses of bacterial endophyte communities towards agricultural practices are still poorly understood. Hence, we analyzed the influence of fertilizer application and mowing frequency on bacterial endophytes in three agriculturally important grass species. For this purpose, we examined bacterial endophytic communities in aerial plant parts of Dactylis glomerata L., Festuca rubra L., and Lolium perenne L. by pyrotag sequencing of bacterial 16S rRNA genes over two consecutive years. Although management regimes influenced endophyte communities, observed responses were grass species-specific. This might be attributed to several bacteria specifically associated with a single grass species. We further predicted functional profiles from obtained 16S rRNA data. These profiles revealed that predicted abundances of genes involved in plant growth promotion or nitrogen metabolism differed between grass species and between management regimes. Moreover, structural and functional community patterns showed no correlation to each other indicating that plant species-specific selection of endophytes is driven by functional rather than phylogenetic traits. The unique combination of 16S rRNA data and functional profiles provided a holistic picture of compositional and functional responses of bacterial endophytes in agricultural relevant grass species towards management practices.

  7. Population Analysis of Adverse Events in Different Age Groups Using Big Clinical Trials Data.

    Science.gov (United States)

    Luo, Jake; Eldredge, Christina; Cho, Chi C; Cisler, Ron A

    2016-10-17

    Understanding adverse event patterns in clinical studies across populations is important for patient safety and protection in clinical trials as well as for developing appropriate drug therapies, procedures, and treatment plans. The objective of our study was to conduct a data-driven population-based analysis to estimate the incidence, diversity, and association patterns of adverse events by age of the clinical trials patients and participants. Two aspects of adverse event patterns were measured: (1) the adverse event incidence rate in each of the patient age groups and (2) the diversity of adverse events defined as distinct types of adverse events categorized by organ system. Statistical analysis was done on the summarized clinical trial data. The incident rate and diversity level in each of the age groups were compared with the lowest group (reference group) using t tests. Cohort data was obtained from ClinicalTrials.gov, and 186,339 clinical studies were analyzed; data were extracted from the 17,853 clinical trials that reported clinical outcomes. The total number of clinical trial participants was 6,808,619, and total number of participants affected by adverse events in these trials was 1,840,432. The trial participants were divided into eight different age groups to support cross-age group comparison. In general, children and older patients are more susceptible to adverse events in clinical trial studies. Using the lowest incidence age group as the reference group (20-29 years), the incidence rate of the 0-9 years-old group was 31.41%, approximately 1.51 times higher (P=.04) than the young adult group (20-29 years) at 20.76%. The second-highest group is the 50-59 years-old group with an incidence rate of 30.09%, significantly higher (Pdata suggest that age-associated adverse events should be considered in planning, monitoring, and regulating clinical trials.

  8. POSITIVE CLINICAL INTERVENTIONS: WHY ARE THEY IMPORTANT AND HOW DO THEY WORK?

    Directory of Open Access Journals (Sweden)

    E.T. Bohlmeijer

    2017-01-01

    Full Text Available In this paper we discuss positive clinical psychology as an emerging field within clinical psychology. Positive clinical psychology is based on research demonstrating that mental health is more than the absence of mental illness, on research showing that wellbeing has buffering effects on the incidence of psychopathology and mental illnesses and on studies demonstrating that positive characteristics, such as positive emotions and gratitude, can predict pathology beyond the predictive power of negative characteristics. In this paper we present three distinct forms of well-being: emotional, psychological and social. In addition we review three types of positive clinical interventions: well-being therapy, positive psychotherapy and acceptance and commitment therapy. The paper ends with a call for a transformation of mental health care in which illness oriented treatments are complemented with well-being oriented treatments.

  9. Lies, damned lies and statistics: Clinical importance versus statistical significance in research.

    Science.gov (United States)

    Mellis, Craig

    2017-02-28

    Correctly performed and interpreted statistics play a crucial role for both those who 'produce' clinical research, and for those who 'consume' this research. Unfortunately, however, there are many misunderstandings and misinterpretations of statistics by both groups. In particular, there is a widespread lack of appreciation for the severe limitations with p values. This is a particular problem with small sample sizes and low event rates - common features of many published clinical trials. These issues have resulted in increasing numbers of false positive clinical trials (false 'discoveries'), and the well-publicised inability to replicate many of the findings. While chance clearly plays a role in these errors, many more are due to either poorly performed or badly misinterpreted statistics. Consequently, it is essential that whenever p values appear, these need be accompanied by both 95% confidence limits and effect sizes. These will enable readers to immediately assess the plausible range of results, and whether or not the effect is clinically meaningful.

  10. [Epidemiology of heart failure in Spain and the importance of adhering to clinical practice guidelines].

    Science.gov (United States)

    Muñiz García, Javier; Crespo Leiro, María G; Castro Beiras, Alfonso

    2006-07-01

    This article focuses on the magnitude of the challenge of heart failure, with particular reference to the disease burden in Spain. The text also deals with the difficulty of estimating the size of the problem, which stems from the fact that heart failure is a common end-point of numerous conditions. The second part of the article presents some reflections on the value of clinical practice guidelines and on the difficulty of incorporating interventions that have proven their efficacy under the controlled conditions of a clinical trial into everyday clinical practice, thereby maximizing their potential benefits. Finally, some suggestions are made on improving both professionals' adherence to clinical practice guidelines and patients' adherence to recommended treatment.

  11. Clinical importance of neutralising antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg; Ross, Christian; Clemmesen, Katja Maria;

    2003-01-01

    Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies.......Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies....

  12. Clinical importance of neutralising antibodies against interferon beta in patients with relapsing-remitting multiple sclerosis

    DEFF Research Database (Denmark)

    Sorensen, Per Soelberg; Ross, Christian; Clemmesen, Katja Maria

    2003-01-01

    Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies.......Interferon beta is the first-line treatment for relapsing-remitting multiple sclerosis, but the drug can induce neutralising antibodies against itself, which might reduce effectiveness. We aimed to assess the clinical effect of neutralising antibodies....

  13. IMPORTANCE OF ENGLISH LANGUAGE CLINICS FOR REMEDIAL TEACHING: CONCEPT, FUNCTIONING AND CHALLENGES

    OpenAIRE

    Ameerchund Maharaj,; Intakhab Alam Khan King

    2017-01-01

    Although EFL students learn English at schools and colleges, the time allotted for their English lessons per day is very limited. Setting up English Language Clinics at EFL colleges/institutes will help students improve and develop their language skills. This paper aims at helping EFL students develop their English language skills by opening English language clinics in schools and colleges. The paper presents the concept and scope of ELC and its usefulness. It also provides an overview of som...

  14. 进口药品注册临床试验的整体策略%Clinical research strategies for imported drugs registration

    Institute of Scientific and Technical Information of China (English)

    康彩练; 高晨燕

    2009-01-01

    The clinical trial requirements for imported drug are under seri-ous discussion. This article gives the answers for the following questions:are the clinical trials absolute necessary if the drugs want to launch on China's market? How to conduct clinical trials to fulfill the regulation re-quirements? Base on ICHE5 guideline, the amount and content of clini-cal trials depend on the "demand". The key point considered to the "de-mand" is the difference of ethnic and clinical practice, which lies on two important aspects: the disease being treated and molecular characters.Invesitegators should analysis the pharmaeokinetic and pharmakcoinetic/pharmacodynamic characters in different ethnics. And invesitegators should also analysis the clinical practice difference on efficacy and safe-ty. Aim at these difference, the investigators design the corresponding clinical trials. This article will give suggestions to the post-marketing clin-ical trials and global multi-national clinical trials too.%本文从进口药注册临床试验的争论入手,回答是否需要开展注册临床试验和需要开展什么样的注册试验.通过对于ICHE5的解读,阐明进口药的注册临床试验要遵循按需开展的原则,从疾病与分子2个方面分析药代动力学、药代动力学/药效、有效性和安全性的不同地区差异,针对这些差异开展相应的进口注册临床试验.本文也对上市后的试验和国际多中心试验举行了阐述.

  15. Assessment of first-year veterinary students' communication skills using an objective structured clinical examination: the importance of context.

    Science.gov (United States)

    Hecker, Kent G; Adams, Cindy L; Coe, Jason B

    2012-01-01

    Communication skills are considered to be a core clinical skill in veterinary medicine and essential for practice success, including outcomes of care for patients and clients. While veterinary schools include communication skills training in their programs, there is minimal knowledge on how best to assess communication competence throughout the undergraduate program. The purpose of this study was to further our understanding of the reliability, utility, and suitability of a communication skills Objective Structured Clinical Examination (OSCE). Specifically we wanted to (1) identify the greatest source of variability (student, rater, station, and track) within a first-year, four station OSCE using exam scores and scores from videotape review by two trained raters, and (2) determine the effect of different stations on students' communication skills performance. Reliability of the scores from both the exam data and the two expert raters was 0.50 and 0.46 respectively, with the greatest amount of variance attributable to student by station. The percentage of variance due to raters in the exam data was 16.35%, whereas the percentage of variance for the two expert raters was 0%. These results have three important implications. First, the results reinforce the need for communication educators to emphasize that use of communication skills is moderated by the context of the clinical interaction. Second, by increasing rater training the amount of error in the scores due to raters can be reduced and inter-rater reliability increases. Third, the communication assessment method (in this case the OSCE checklist) should be built purposefully, taking into consideration the context of the case.

  16. Fine Flounder (Paralichthys adspersus) Microbiome Showed Important Differences between Wild and Reared Specimens

    Science.gov (United States)

    Ramírez, Carolina; Romero, Jaime

    2017-01-01

    The intestinal microbiota is involved in a wide range of biological processes that benefit the host, including providing nutrition and modulating the immune system. Fine flounder (Paralichthys adspersus) is a flatfish of commercial interest that is native to the Chilean coast. The high value of this flatfish has prompted the development of stock enhancement and aquaculture activities. Knowledge of microbiota may help to improve the cultivation of this species; however, few comparative studies have evaluated the intestinal microbiota composition in farmed versus wild fishes. Intestinal contents from wild and aquaculture fish were collected, and DNA was extracted. Subsequently, the V3-region of 16S rRNA was PCR amplified and sequenced using the Ion Torrent platform. The comparison between wild and aquaculture specimens revealed important differences in the composition of the microbiota. The most abundant phylum in wild flounder was Proteobacteria, with an average relative abundance of 68.1 ± 15.4%; in contrast, in aquaculture flounder, this phylum had an average relative abundance of 30.8 ± 24.1%. Reciprocally, the most abundant phylum in flounder aquaculture was Firmicutes, averaging 61.2 ± 28.4%; in contrast, this phylum showed low abundance in wild flounder, in which it averaged 4.7 ± 4%. The phylum Actinobacteria showed greater abundance in wild flounder, ranging from 21.7 ± 18.8%, whereas, it averaged only 2.7 ± 3.8% in aquaculture fish. Specific taxa that were differentially distributed between wild and aquaculture flounder were identified using a statistical approach. At the genus level, a total of four genera were differentially represented between the two conditions. Bacillus and Pseudomonas were more highly represented in aquaculture flounder, whereas Arthrobacter and Psychrobacter were observed in wild flounder. Furthermore, in both cases, predicted functions (metabolic pathways) indicated that those microbiota might provide beneficial effects for

  17. Different DNA End Configurations Dictate Which NHEJ Components Are Most Important for Joining Efficiency.

    Science.gov (United States)

    Chang, Howard H Y; Watanabe, Go; Gerodimos, Christina A; Ochi, Takashi; Blundell, Tom L; Jackson, Stephen P; Lieber, Michael R

    2016-11-18

    The nonhomologous DNA end-joining (NHEJ) pathway is a key mechanism for repairing dsDNA breaks that occur often in eukaryotic cells. In the simplest model, these breaks are first recognized by Ku, which then interacts with other NHEJ proteins to improve their affinity at DNA ends. These include DNA-PKcs and Artemis for trimming the DNA ends; DNA polymerase μ and λ to add nucleotides; and the DNA ligase IV complex to ligate the ends with the additional factors, XRCC4 (X-ray repair cross-complementing protein 4), XLF (XRCC4-like factor/Cernunos), and PAXX (paralog of XRCC4 and XLF). In vivo studies have demonstrated the degrees of importance of these NHEJ proteins in the mechanism of repair of dsDNA breaks, but interpretations can be confounded by other cellular processes. In vitro studies with NHEJ proteins have been performed to evaluate the nucleolytic resection, polymerization, and ligation steps, but a complete system has been elusive. Here we have developed a NHEJ reconstitution system that includes the nuclease, polymerase, and ligase components to evaluate relative NHEJ efficiency and analyze ligated junctional sequences for various types of DNA ends, including blunt, 5' overhangs, and 3' overhangs. We find that different dsDNA end structures have differential dependence on these enzymatic components. The dependence of some end joining on only Ku and XRCC4·DNA ligase IV allows us to formulate a physical model that incorporates nuclease and polymerase components as needed. © 2016 by The American Society for Biochemistry and Molecular Biology, Inc.

  18. Rational use of intensity-modulated radiation therapy: the importance of clinical outcome.

    Science.gov (United States)

    De Neve, Wilfried; De Gersem, Werner; Madani, Indira

    2012-01-01

    During the last 2 decades, intensity-modulated radiation therapy (IMRT) became a standard technique despite its drawbacks of volume delineation, planning, robustness of delivery, challenging quality assurance, and cost as compared with non-IMRT. The theoretic advantages of IMRT dose distributions are generally accepted, but the clinical advantages remain debatable because of the lack of clinical assessment of the effort that is required to overshadow the disadvantages. Rational IMRT use requires a positive advantage/drawback balance. Only 5 randomized clinical trials (RCTs), 3 in the breast and 2 in the head and neck, which compare IMRT with non-IMRT (2-dimensional technique in four fifths of the trials), have been published (as of March 2011), and all had toxicity as the primary endpoint. More than 50 clinical trials compared results of IMRT-treated patients with a non-IMRT group, mostly historical controls. RCTs systematically showed a lower toxicity in IMRT-treated patients, and the non-RCTs confirmed these findings. Toxicity reduction, counterbalancing the drawbacks of IMRT, was convincing for breast and head and neck IMRT. For other tumor sites, the arguments favoring IMRT are weaker because of the inability to control bias outside the randomized setting. For anticancer efficacy endpoints, like survival, disease-specific survival, or locoregional control, the balance between advantages and drawbacks is fraught with uncertainties because of the absence of robust clinical data.

  19. Candida albicans increases tumor cell adhesion to endothelial cells in vitro: intraspecific differences and importance of the mannose receptor.

    Directory of Open Access Journals (Sweden)

    Andoni Ramirez-Garcia

    Full Text Available The dimorphic fungus Candida albicans is able to trigger a cytokine-mediated pro-inflammatory response that increases tumor cell adhesion to hepatic endothelium and metastasis. To check the intraspecific differences in this effect, we used an in vitro murine model of hepatic response against C. albicans, which made clear that tumor cells adhered more to endothelium incubated with blastoconidia, both live and killed, than germ tubes. This finding was related to the higher carbohydrate/protein ratio found in blastoconidia. In fact, destruction of mannose ligand residues on the cell surface by metaperiodate treatment significantly reduced tumor cell adhesion induced. Moreover, we also noticed that the effect of clinical strains was greater than that of the reference one. This finding could not be explained by the carbohydrate/protein data, but to explain these differences between strains, we analyzed the expression level of ten genes (ADH1, APE3, IDH2, ENO1, FBA1, ILV5, PDI1, PGK1, QCR2 and TUF1 that code for the proteins identified previously in a mannoprotein-enriched pro-metastatic fraction of C. albicans. The results corroborated that their expression was higher in clinical strains than the reference one. To confirm the importance of the mannoprotein fraction, we also demonstrate that blocking the mannose receptor decreases the effect of C. albicans and its mannoproteins, inhibiting IL-18 synthesis and tumor cell adhesion increase by around 60%. These findings could be the first step towards a new treatment for solid organ cancers based on the role of the mannose receptor in C. albicans-induced tumor progression and metastasis.

  20. Clinical importance of elevated CK-MB and troponin I levels in congestive heart failure.

    Science.gov (United States)

    Yilmaz, Ahmet; Yalta, Kenan; Turgut, Okan Onur; Yilmaz, Mehmet Birhan; Ozyol, Ali; Kendirlioglu, Omer; Karadas, Filiz; Tandogan, Izzet

    2006-01-01

    Myocyte necrosis has been considered to play a fundamental role in the pathophysiology of congestive heart failure (CHF), which has usually evolved as a consequence of depletion of compensatory mechanisms and contractile reserve of myocardium. Elevated levels of creatine kinase MB (CK-MB) and troponin I (Tn-I) have been regarded as biochemical markers of myocyte necrosis. This study was planned to investigate the specificity and sensitivity of Tn-I and CK-MB in CHF and to examine the correlation of these markers with disease severity. A total of 104 patients (38 female, 66 male; mean age, 66 y [range, 36-89]) with symptoms and signs of heart failure on admission and with a reduced left ventricular ejection fraction (EF; by transthoracic echocardiography) were labeled "the patient group," and 58 patients (40 female,18 male; mean age, 61 y [range, 34-77]) with no signs or symptoms of CHF and with a normal EF detected by transthoracic echocardiography were included in the study as "the control group." Left ventricular EFs, end-diastolic diameters, and end-systolic diameters of patients in both groups were measured. Blood samples were drawn from all patients in both groups on admission, so that levels of CK-MB and Tn-I could be measured. All patients in both groups also underwent coronary angiography. Conditions leading to elevation of CK-MB or Tn-I were considered exclusion criteria. The 2 groups failed to show any significant differences in terms of mean age and the presence of coronary artery disease, hypertension, or diabetes mellitus (P>.05). Mean EF in the patient group was lower than that in the control group (Phypertensive patients were found to have significantly higher mean values of CK-MB than were seen in normotensive patients in the same group (PHeart Association [NYHA]) (group 1), and 52 were considered to be class III-IV (group 2). Group 1, group 2, and the control group did not differ significantly from one another with regard to the presence of

  1. Automated EEG detection algorithms and clinical semiology in epilepsy: importance of correlations.

    Science.gov (United States)

    Hogan, R Edward

    2011-12-01

    With advances in technological innovation, electroencephalography has remained the gold standard for classification and localization of epileptic seizures. Like other diagnostic modalities, technological advances have opened new avenues for assessment of data, and hold great promise to improve interpretive capabilities. However, proper overall interpretation and application of electroencephalographic findings relies on valid correlations of associated clinical semiology. This article addresses interpretation of clinical signs and symptoms in the context of the diagnostic predictive value of electroencephalographic, clinical, and electrographic definitions of seizures, and upcoming challenges of interpreting intracranial high-frequency electroencephalographic data. This article is part of a Supplemental Special Issue entitled The Future of Automated Seizure Detection and Prediction. Copyright © 2011 Elsevier Inc. All rights reserved.

  2. Goats challenged with different members of the Mycobacterium tuberculosis complex display different clinical pictures.

    Science.gov (United States)

    Bezos, J; Casal, C; Díez-Delgado, I; Romero, B; Liandris, E; Álvarez, J; Sevilla, I A; Juan, L de; Domínguez, L; Gortázar, C

    2015-10-15

    Tuberculosis (TB) in goats (Capra hircus) is due to infection with members of the Mycobacterium tuberculosis complex (MTC), mainly Mycobacterium bovis and Mycobacterium caprae. We report a comparative experimental infection of goats with M. bovis, M. caprae and M. tuberculosis strains. We hypothesized that goats experimentally infected with different members of the MTC would display different clinical pictures. Three groups of goats were challenged with either M. bovis SB0134 (group 1, n=5), M. caprae SB0157 (group 2, n=5) and M. tuberculosis SIT58 (group 3, n=4). The highest mean total lesion score was observed in M. bovis challenged goats (mean 15.2, range 9-19), followed by those challenged with M. caprae (10.8, 2-23). The lowest score was recorded in goats challenged with M. tuberculosis (3, 1-6). Culture results coincided with the lesion scores in yielding more positive pools (7/15) in M. bovis challenged goats. By contrast, only three pools were positive from goats challenged M. tuberculosis (3/12) and with M. caprae (3/15), respectively. Differences in the performance of the intradermal and gamma-interferon (IFN-γ) tests depending of the group were observed since all goats from group 1 were diagnosed using intradermal test and these goats reacted earlier to the IFN-γ assay in comparison to the other groups. This study confirmed that goats experimentally infected with different members of the MTC display different clinical pictures and this fact may have implications for MTC maintenance and bacterial shedding.

  3. Sleep clinical record: what differences in school and preschool children?

    Directory of Open Access Journals (Sweden)

    Maria Pia Villa

    2016-02-01

    Full Text Available The sleep clinical record (SCR may be a valid method for detecting children with obstructive sleep apnoea (OSA. This study aimed to evaluate whether there were differences in SCR depending on age and to identify the possible risk factors for OSA development. We enrolled children with sleep disordered breathing between 2013 and 2015, and divided them according to age into preschool- and school-age groups. All patients underwent SCR and polysomnography. OSA was detected in 81.1% and 83.6% of preschool- and school-age groups, respectively. Obesity, malocclusions, nasal septal deviation and inferior turbinate hypertrophy were significantly more prevalent in school-age children (p6.5 had a sensitivity of 74% in predicting OSA in preschool children with positive predictive value of 86% (p=0.0001. Our study confirms the validity of the SCR as a screening tool for patient candidates for a PSG study for suspected OSA, in both school and preschool children.

  4. Immunosuppression by hypoxic cell radiosensitizers: a phenomenon of potential clinical importance

    Energy Technology Data Exchange (ETDEWEB)

    Rockwell, S.; Kapp, D.S.

    1982-06-01

    The nitroimidazoles metronidazole, misonidazol, and desmethyl misonidazole are currently undergoing clinical trials as possible adjuncts to radiotherapy. Ongoing clinical trials are evaluating the effectiveness of these agents and also documenting the pharmacokinetics and toxicities of radiosensitizing doses of these drugs in man. A variety of toxic effects have been noted in man, including anorexia, nausea and vomiting, peripheral neuropathy, central nervous system symptoms, ototoxicity, allergy, and fear. Laboratory studies have also suggested that these agents have potential to be mutagenic, carcinogenic, and teratogenic. In the editorial presented, the author attempts to draw attention to an additional toxic effect of nitroimidazoles - the inhibition of cell-mediated immune responses. (JMT)

  5. The Diagnostic importance of clinical and radiologic features of the Multiple Cemento-osseous dysplasia

    Energy Technology Data Exchange (ETDEWEB)

    Han, M. R.; Kim, Y. H.; Kang, B. C. [College of Dentistry, Chonam National University, Kwangju (Korea, Republic of)

    1998-02-15

    This case was diagnosed as multiple cementoosseous dysplasia on the basis of clinical and radiological features but was diagnosed as ossifying fibroma on the basis of histopathological feature. The histopathologic features of the multiple cementoosseous dysplasia and cementoossifying fibroma have common features of cementum, fibrous network and bone. Multiple cementoosseous dysplasia is reactive lesion and shows restricted lesion size, occurred on anterior and posterior tooth of the mandible and needs no treatment except periodic follow up. But Cementoossifying fibroma is the true neoplasm and grows continuously and needs surgical removal. The final diagnosis of the multiple cementoosseous dysplasia requires good correlation of the clinical histopathological, and radiological features.

  6. The importance of central corneal thickness measurements and decision making in general ophthalmology clinics: a masked observational study

    Directory of Open Access Journals (Sweden)

    Mollan Susan P

    2008-01-01

    Full Text Available Abstract Background To assess the impact of knowing central corneal thickness (CCT on glaucoma management in a United Kingdom district general hospital. Methods A masked observational non-interventional study included 304 eyes of 152 consecutive glaucoma cases attending general clinic. CCT was measured using a hand-held pachymeter. IOP, as measured by the Goldmann applanation tonometer (GAT, was adjusted for CCT using a normogram. Two identical study sheets were retrospectively constructed from each subject's case notes: one included the CCT and adjusted IOP information, the other excluded. Study sheets were randomly presented to a single masked observer to decide glaucoma management. The difference in management decision was noted. Results The mean ± standard deviation CCT was 561.5 ± 35.7 μm, 538.9 ± 41.4 μm, 538.3 ± 40.3 μm for ocular hypertension (OHT, primary open angle glaucoma (POAG and normal pressure glaucoma (NPG subjects respectively. IOP adjustment was greater than ±2 mmHg in 33.9%(103/304 of eyes. CCT and adjusted IOP information led to different treatment option in 37%(55/152. Of the most important changes 20.4%(31/152 cases would have been commenced on additional IOP-lowering medication, 2.0%(3/152 would have been counselled for trabeculectomy surgery and 3.3%(5/152 of the cohort would have been observed rather than treated. Conclusion CCT and adjusted IOP measurement can influence glaucoma management in a clinical context. It helps attribute risk and hence aids patient management decisions.

  7. The Importance of Preparing Medical Students to Manage Different Types of Uncertainty.

    Science.gov (United States)

    Fargason, Crayton A., Jr.; Evans, H. Hughes; Ashworth, Carolyn S.; Capper, Stuart A.

    1997-01-01

    To design effective academic health centers for the future, medical leaders must define the competencies needed by tomorrow's physicians, including the ability to manage the uncertainty associated with creating clinical models and the uncertainty associated with managing care delivery. Currently, focus is on the former, but there is increasing…

  8. Hemispheric activation differences in novice and expert clinicians during clinical decision making.

    Science.gov (United States)

    Hruska, Pam; Hecker, Kent G; Coderre, Sylvain; McLaughlin, Kevin; Cortese, Filomeno; Doig, Christopher; Beran, Tanya; Wright, Bruce; Krigolson, Olav

    2016-12-01

    ) in both novices and experts, interestingly we observed expertise related differences in the regions and hemispheres of PFC activation between these groups for hard clinical cases. Specifically, in novices we observed activations in left hemisphere neural regions associated with factual rule-based knowledge, whereas in experts we observed right hemisphere activation in neural regions associated with experiential knowledge. Importantly, at the neural level, our data highlight differences in so called type 2 clinical decision-making processes related to prior knowledge and experience.

  9. Clinical trial success rates of anti-obesity agents: the importance of combination therapies.

    Science.gov (United States)

    Hussain, H T; Parker, J L; Sharma, A M

    2015-09-01

    The objective of this study was to construct a clinical trial profile assessing the risk of drug failure among anti-obesity agents. Research was conducted by looking at anti-obesity therapies currently on the market or in clinical trials (phases I to III) conducted from 1998 to September 2014, with the exclusion of any drugs whose phase I trial was conducted prior to January 1998. This was completed primarily through a search on http://clinicaltrials.gov where a total of 51 drugs met the search criteria. The transition probabilities were then calculated based on various classifications and compared against industry standards. The transition probability of anti-obesity agents was 8.50% whereas the transition probability of industry standards was 10.40%. Combination therapies had four times the transition probability than monotherapies, 40% and 4.75%, respectively. Therefore, it was determined that 92% of drugs fail during clinical trial testing for this indication and combination therapy appears to improve clinical trial success rates to 10-fold. © 2015 World Obesity.

  10. Small-Fiber Neuropathy: A Diabetic Microvascular Complication of Special Clinical, Diagnostic, and Prognostic Importance.

    Science.gov (United States)

    Körei, A E; Istenes, I; Papanas, N; Kempler, P

    2016-01-01

    Damage of small nerve fibers may lead to a large variety of clinical symptoms. Small-fiber neuropathy underlies the symptoms of painful diabetic neuropathy, which may decrease quality of life. It also contributes to the poor prognosis of diabetic neuropathy because it plays a key role in the pathogenesis of foot ulceration and autonomic neuropathy. Impairment of small nerve fibers is considered the earliest alteration in the course of diabetic neuropathy. Therefore, assessment of functional and morphological abnormalities of small nerve fibers may enable timely diagnosis. The definition, symptoms, and clinical significance of small-fiber neuropathy are considered in the present review. An apparently more complex interaction between small-fiber impairment and microcirculation is extensively discussed. Diagnostic modalities include morphometric and functional methods. Corneal confocal microscopy and punch skin biopsy are considered gold standards, but noninvasive functional tests are also diagnostically useful. However, in routine clinical practice, small-fiber neuropathy is diagnosed by its typical clinical presentation. Finally, prompt treatment should be initiated following diagnosis.

  11. Multicenter epidemiological and clinical study on imported Chagas diseases in Alicante, Spain

    NARCIS (Netherlands)

    Ramos, J.M.; Torrus, D.; Amador, C.; Jover, F.; Perez-Chacon, F.; Ponce, Y.; Arjona, F.J.; Caro, E.; Martinez-Peinado, C.; Gallegos, I.; Cuadrado, J.M.; Tello, A.; Gutierrez, F.

    2012-01-01

    Recently, there has been an increase in the number of patients with Chagas disease outside of areas that are generally considered endemic. The aim of this investigation is to describe the clinical profile of a series of patients with Chagas disease in Alicante, Spain, which is a province located on

  12. Dopamine transporter imaging in clinically unclear cases of parkinsonism and the importance of Scans Without Evidence of Dopaminergic Deficit (SWEDDs

    Directory of Open Access Journals (Sweden)

    Marco A. T. Utiumi

    2012-09-01

    Full Text Available The clinical diagnosis of Parkinson's disease (PD is susceptible to misdiagnosis, especially in the earlier stages of the disease. Recently, in vivo imaging techniques assessing the presynaptic dopamine transporter (DAT have emerged as a useful tool in PD diagnosis, improving its accuracy. OBJECTIVE: It was to illustrate the clinical usefulness of a brain single-photon emission computed tomography (SPECT DAT ligand, and highlight relevant aspects of scans without evidence of dopaminergic deficit (SWEDDs in this context. CASES: We described four representative patients with clinically unclear parkinsonian syndromes who underwent [99mTc]-TRODAT-1 SPECT and reviewed the clinical implications. CONCLUSION: DAT-SPECT is an important, cost-effective, technique for the differential diagnosis of parkinsonian syndromes. Additionally, SWEDD cases present clinical and paraclinical peculiarities that may retrospectively identify them as essential/dystonic tremor. The lack of histopathological data limits further conclusions.

  13. Prevalence of clinically important traumatic brain injuries in children with minor blunt head trauma and isolated severe injury mechanisms.

    Science.gov (United States)

    Nigrovic, Lise E; Lee, Lois K; Hoyle, John; Stanley, Rachel M; Gorelick, Marc H; Miskin, Michelle; Atabaki, Shireen M; Dayan, Peter S; Holmes, James F; Kuppermann, Nathan

    2012-04-01

    To determine the prevalence of clinically important traumatic brain injuries (TBIs) with severe injury mechanisms in children with minor blunt head trauma but with no other risk factors from the Pediatric Emergency Care Applied Research Network (PECARN) TBI prediction rules (defined as isolated severe injury mechanisms). Secondary analysis of a large prospective observational cohort study. Twenty-five emergency departments participating in the PECARN. Children with minor blunt head trauma and Glasgow Coma Scale scores of at least 14. Treating clinicians completed a structured data form that included injury mechanism (severity categories defined a priori). Clinically important TBIs were defined as intracranial injuries resulting in death, neurosurgical intervention, intubation for more than 24 hours, or hospital admission for at least 2 nights. We investigated the rate of clinically important TBIs in children with either severe injury mechanisms or isolated severe injury mechanisms. Of the 42,412 patients enrolled in the overall study, 42,099 (99%) had injury mechanisms recorded, and their data were included for analysis. Of all study patients, 5869 (14%) had severe injury mechanisms, and 3302 (8%) had isolated severe injury mechanisms. Overall, 367 children had clinically important TBIs (0.9%; 95% CI, 0.8%-1.0%). Of the 1327 children younger than 2 years with isolated severe injury mechanisms, 4 (0.3%; 95% CI, 0.1%-0.8%) had clinically important TBIs, as did 12 of the 1975 children 2 years or older (0.6%; 95% CI, 0.3%-1.1%). Children with isolated severe injury mechanisms are at low risk of clinically important TBI, and many do not require emergent neuroimaging.

  14. 77 FR 66848 - Minimum Clinically Important Difference: An Outcome Metric in Orthopaedic Device Science and...

    Science.gov (United States)

    2012-11-07

    ... Technology's Translational Research Institute for Biomedical Engineering and Science ] (TRIBES). The purpose... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF HEALTH AND... in Orthopaedic Device Science and Regulation; Public Workshop AGENCY: Food and Drug Administration...

  15. Direct contact transmission of three different foot-and-mouth disease virus strains in swine demonstrates important strain-specific differences.

    Science.gov (United States)

    Pacheco, Juan M; Tucker, Meghan; Hartwig, Ethan; Bishop, Elizabeth; Arzt, Jonathan; Rodriguez, Luis L

    2012-08-01

    A novel direct contact transmission model for the study of foot-and-mouth disease virus (FMDV) infection of swine was utilized to investigate transmission characteristics of three FMDV strains belonging to serotypes A, O and Asia1. Each strain demonstrated distinct transmission characteristics and required different exposure times to achieve successful contact transmission. While a 4h exposure was sufficient for strain A24 Cruzeiro (A24Cru), both O1 Manisa and Asia1 Shamir transmission required 18 h or more. Viral excretion levels from donors (for all three strains) and virus present in room air (for A24Cru and O1 Manisa) were evaluated and associated with clinical signs and observed transmission pattern. Although all directly inoculated donor animals showed acute FMD, A24Cru had the highest levels of viral shedding in saliva and nasal swabs followed by O1 Manisa and Asia1 Shamir. Virus levels in room air were higher and were detected longer for A24Cru than for O1 Manisa. These results provide direct evidence for important strain-specific variation in transmission characteristics and emphasize the need for thorough evaluation of different FMDV viral strains using a well defined contact transmission methodology. This information is critical for vaccine and biotherapeutic efficacy testing, pathogenesis and disease modeling of FMDV transmission. Published by Elsevier Ltd.

  16. Restenosis after infrapopliteal angioplasty - clinical importance, study update and further directions.

    Science.gov (United States)

    Baumann, Frederic; Diehm, Nicolas

    2013-11-01

    Patients with critical limb ischemia (CLI) represent the most severe form of peripheral arterial disease (PAD) and exhibit high mortality rates. Frequently, PAD in CLI patients involves the infrapopliteal arterial segment challenging endovascular revascularization strategies. Restenosis remains the major drawback of tibial angioplasty encountered in more than two thirds of CLI patients undergoing tibial revascularization. In contrast to earlier observations, tibial patency was recently shown to be essential to attain an optimal clinical outcome in CLI patients subsequent to tibial angioplasty. The exact pathopyhsiological mechanisms of tibial restenosis remains unclear. To date, most of our knowledge on tibial restenosis and its pathophysiology is derived from coronary arteries, based on the similarity of coronary arteries to tibial artery morphology. Nervertheless, multiple antirestenosis concepts are investigated within clinical trials to reduce tibial restenosis.Purpose of the present manuscript is to provide a current update on the pathophysiology of tibial restenosis and potential antirestenosis strategies.

  17. A Rare Variant of the Ulnar Artery with Important Clinical Implications: a Case Report

    OpenAIRE

    Casal Diogo; Pais Diogo; Toscano Tiago; Bilhim Tiago; Rodrigues Luís; Figueiredo Inês; Aradio Sónia; Angélica-Almeida Maria; Goyri-O’Neill João

    2012-01-01

    Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elb...

  18. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy

    DEFF Research Database (Denmark)

    Luk, Adriana; Metawee, Mohammed; Ahn, Eric

    2009-01-01

    . Patient records were reviewed for preoperative clinical diagnoses and other relevant data, including pretransplant endomyocardial biopsy (EMB) results, information regarding left ventricular assist devices and, finally, evidence of disease recurrence in the grafted heart. RESULTS: A shift......, arrhythmogenic right ventricle dysplasia (100%), cardiac sarcoidosis (83%) and iron overload toxicity- associated cardiomyopathy (100%) had been misdiagnosed in pretransplantation investigations. Investigations before transplantation did not include an EMB. Of all 296 patients, 51 patients (17%) were...

  19. Certification of Electronic Health Record systems and the importance of the validation of clinical archetypes.

    Science.gov (United States)

    De Moor, Georges; Kalra, Dipak; Devlies, Jos

    2008-01-01

    If Electronic Health Record (EHR) systems are to provide an effective contribution to healthcare across Europe, a set of benchmarks need to be set to ensure the quality of such systems. This article describes the results of the EU funded QRec- project and emphasizes the need for validation of clinical archetypes to support the semantic interoperability between EHR systems and other interacting eHealth applications.

  20. Clinical Presentation of Klinefelter's Syndrome: Differences According to Age

    Directory of Open Access Journals (Sweden)

    Néstor Pacenza

    2012-01-01

    Full Text Available The aim of the study was to establish the characteristics of presentation of 94 patients with Kinelfelter's syndrome (KS referred to the endocrinologist at different ages. The diagnosis of KS was more frequent in the age group between 11 and 20 years (46.8%. Most of the patients (83.7% showed the classic 47,XXY karyotype and 7.1% showed a 47,XXY/46,XY mosaicism. Half of the patients younger than 18 years presented mild neurodevelopmental disorders. The most frequent clinical findings were cryptorchidism in prepubertal patients, and small testes, cryptorchidism, and gynecomastia in pubertal patients. FSH, LH, AMH, and inhibin B levels were normal in prepubertal patients and became abnormal from midpuberty. Most adults were referred for small testes, infertility, and gynecomastia; 43.6% had sexual dysfunction. Testosterone levels were low in 45%. Mean stature was above the 50th percentile, and 62.5% had BMI ≥25.0 kg/m2. In conclusion, the diagnosis of Klinefelter syndrome seems to be made earlier nowadays probably because pediatricians are more aware that boys and adolescents with neuro-developmental disorders and cryptorchidism are at increased risk. The increasing use of prenatal diagnosis has also decreased the mean age at diagnosis and allowed to get insight into the evolution of previously undiagnosed cases, which probably represent the mildest forms. In adults average height and weight are slightly higher than those in the normal population. Bone mineral density is mildly affected, more at the spine than at the femoral neck level, in less than half of cases.

  1. Clinical Presentation of Klinefelter's Syndrome: Differences According to Age

    Science.gov (United States)

    Pacenza, Néstor; Pasqualini, Titania; Gottlieb, Silvia; Knoblovits, Pablo; Costanzo, Pablo R.; Stewart Usher, Jorge; Rey, Rodolfo A.; Martínez, María P.; Aszpis, Sergio

    2012-01-01

    The aim of the study was to establish the characteristics of presentation of 94 patients with Kinelfelter's syndrome (KS) referred to the endocrinologist at different ages. The diagnosis of KS was more frequent in the age group between 11 and 20 years (46.8%). Most of the patients (83.7%) showed the classic 47,XXY karyotype and 7.1% showed a 47,XXY/46,XY mosaicism. Half of the patients younger than 18 years presented mild neurodevelopmental disorders. The most frequent clinical findings were cryptorchidism in prepubertal patients, and small testes, cryptorchidism, and gynecomastia in pubertal patients. FSH, LH, AMH, and inhibin B levels were normal in prepubertal patients and became abnormal from midpuberty. Most adults were referred for small testes, infertility, and gynecomastia; 43.6% had sexual dysfunction. Testosterone levels were low in 45%. Mean stature was above the 50th percentile, and 62.5% had BMI ≥25.0 kg/m2. In conclusion, the diagnosis of Klinefelter syndrome seems to be made earlier nowadays probably because pediatricians are more aware that boys and adolescents with neuro-developmental disorders and cryptorchidism are at increased risk. The increasing use of prenatal diagnosis has also decreased the mean age at diagnosis and allowed to get insight into the evolution of previously undiagnosed cases, which probably represent the mildest forms. In adults average height and weight are slightly higher than those in the normal population. Bone mineral density is mildly affected, more at the spine than at the femoral neck level, in less than half of cases. PMID:22291701

  2. Difference of clinical features in childhood Mycoplasma pneumoniae pneumonia

    Directory of Open Access Journals (Sweden)

    Kang Jin-Han

    2010-07-01

    Full Text Available Abstract Background M. pneumoniae pneumonia (MP has been reported in 10-40% of community-acquired pneumonia cases. We aimed to evaluate the difference of clinical features in children with MP, according to their age and chest radiographic patterns. Methods The diagnosis of MP was made by examinations at both admission and discharge and by two serologic tests: the indirect microparticle agglutinin assay (≥1:40 and the cold agglutinins titer (≥1:32. A total of 191 children with MP were grouped by age: ≤2 years of age (29 patients, 3-5 years of age (81 patients, and ≥6 years of age (81 patients. They were also grouped by pneumonia pattern: bronchopneumonia group (96 patients and segmental/lobar pneumonia group (95 patients. Results Eighty-six patients (45% were seroconverters, and the others showed increased antibody titers during hospitalization. Among the three age groups, the oldest children showed the longest duration of fever, highest C-reactive protein (CRP values, and the most severe pneumonia pattern. The patients with segmental/lobar pneumonia were older and had longer fever duration and lower white blood cell (WBC and lymphocyte counts, compared with those with bronchopneumonia. The patient group with the most severe pulmonary lesions had the most prolonged fever, highest CRP, highest rate of seroconverters, and lowest lymphocyte counts. Thrombocytosis was observed in 8% of patients at admission, but in 33% of patients at discharge. Conclusions In MP, older children had more prolonged fever and more severe pulmonary lesions. The severity of pulmonary lesions was associated with the absence of diagnostic IgM antibodies at presentation and lymphocyte count. Short-term paired IgM serologic test may be mandatory for early and definitive diagnosis of MP.

  3. Clinical Findings in Patients with Splenic Injuries: Are Injuries to the Left Lower Chest Important?

    Directory of Open Access Journals (Sweden)

    Schneir, Aaron

    2001-07-01

    Full Text Available The purpose of this study was to describe the clinical findings in patients with splenic injury and to determine if isolated left lower chest injury may be the single clinical indicator of splenic injury. The medical records of all adult blunt trauma patients with splenic injury over a 14 month period were reviewed. Significant left lower chest injury was considered present if the patient had left sided pleuritic chest pain with tenderness to ribs 7-12 or if these ribs were visualized as fractured on any imaging study. Patients were considered to have clinical findings suggestive of splenic injury if they had pre-hospital or emergency department hypotension, abdominal pain or tenderness, a Glasgow coma scale < 15, or gross hematuria. Ninety patients had splenic injury. Thirty-nine (43%. 95% CI 33, 54% patients had significant left lower chest injury. In five (6%. 95% CI 2, 12% patients, injury to this portion of the chest was the single indicator of splenic injury. Nearly half the patients with splenic injury will have significant injury to the left lower chest and this finding may be the only indicator of splenic injury.

  4. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    Science.gov (United States)

    Christofides, Elena A

    2016-01-01

    In acromegaly, achieving biochemical control (growth hormone [GH] level acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. PMID:27471378

  5. [Idiopathic mental retardation--importance of clinical diagnostic scores for case selection].

    Science.gov (United States)

    Caba, Lavinia; Rusu, Cristina; Voloşciuc, M; Butnariu, Lăcrămioara; Braha, Elena; Grămescu, Mihaela; Bujoran, C; Gorduza, E V; Covic, M

    2009-01-01

    We present a retrospective study aimed to identify the correlation between de Vries clinical score and the detection of chromosomal abnormalities in mentally retarded (MR) children. We have used the score to identify patients who should be tested by karyotyping and subsequently MLPA (multiplex ligation dependent probe amplification) for subtelomeric rearrangements. Our group is formed of 36 children with variable MR associated with other anomalies. 18 children had chromosomal defects, whereas 18 had normal karyotypes. In the first group, total scores varied between 3 and 7. Chromosomal anomalies identified were: numerical (4) and structural (14). Chromosomes involved were: 1, 4, 5, 7, 8, 9, 17, X. Deletions were the most common and correlate with a greater score (> or = 4). Common clinical features were: short stature, microcephaly, nasal, ear and hand anomalies. In the second group the most frequent clinical feature was hand anomaly (61.2%) and cases with a high score have to be further tested (e.g. using MLPA) in order to identify minor defects. In our opinion a high score indicates the karyotype and then a MLPA testing. In conclusion, we present a retrospective study that proves the use of de Vries diagnostic score in the identification of chromosomal abnormalities in MR children.

  6. Small airway function changes and its clinical significance of asthma patients in different clinical phases

    Institute of Scientific and Technical Information of China (English)

    Yan-Hui Zhou; Jun-Ti Lu

    2016-01-01

    Objective:To observe the small airways function changes of asthmatic patients in different clinical phases and to discuss its clinical significance.Methods:A total of 127 patients diagnosed as asthma were selected randomly and pulmonary function (PF) of them was determined by conventional method. Then they were divided into A, B and C group based on PF results. All 34 patients in A group suffered from acute asthma attack for the first time. All 93 patients in B group had been diagnosed as asthma but in remission phase. C Group was regarded as Control group with 20 healthy volunteers. Then FEV1, FEF50%, FEF75% levels of patients in each group were analyzed, and FEV1, FEF75% and FEF50% levels of patients in each group were compared after bronchial dilation test.Results:It was found that most patients in group A and B had abnormal small airways function, and their small airways function was significantly different compared with that of group C (P<0.01). In addition, except for group C, FEF75%, FEF50% levels in A and B group were improved more significantly than FEV1 levels (P<0.01).Conclusions:Asthma patients in acute phase all have abnormal small airways function. Most asthma patients in remission phase also have abnormal small airways function. After bronchial dilation test, whether patients in acute phase or in remission phase, major and small airways function of them are improved, but improvement of small airways function is weaker than that of major airways. This indicates that asthma respiratory tract symptoms in different phases exists all the time and so therapeutic process is needed to perform step by step.

  7. Sex differences in cognitive trajectories in clinically normal older adults.

    Science.gov (United States)

    McCarrey, Anna C; An, Yang; Kitner-Triolo, Melissa H; Ferrucci, Luigi; Resnick, Susan M

    2016-03-01

    Age effects on cognitive functioning are well-documented, but effects of sex on trajectories of cognitive aging are less clear. We examined cognitive ability across a variety of measures for 1,065 to 2,127 participants (mean baseline age 64.1 to 69.7 years) from the Baltimore Longitudinal Study of Aging who were repeatedly tested over a mean follow-up interval of 3.0 to 9.0 years with a mean of 2.3 to 4.4 assessments. Memory and other cognitive tests were administered at each visit, assessing mental status, verbal learning and memory, figural memory, language, attention, perceptuomotor speed and integration, executive function, and visuospatial ability. Importantly, participants free from cognitive impairment at all time points were used in the analyses. Results showed that for all tests, higher age at baseline was significantly associated with lower scores, and performance declined over time. In addition, advancing age was associated with accelerated longitudinal declines in performance (trend for mental status). After adjusting for age, education, and race, sex differences were observed across most tests of specific cognitive abilities examined. At baseline, males outperformed females on the 2 tasks of visuospatial ability, and females outperformed males in most other tests of cognition. Sex differences in cognitive change over time indicated steeper rates of decline for men on measures of mental status, perceptuomotor speed and integration, and visuospatial ability, but no measures on which women showed significantly steeper declines. Our results highlight greater resilience to age-related cognitive decline in older women compared with men.

  8. Clinical Interdisciplinary Collaboration Models and Frameworks From Similarities to Differences: A Systematic Review

    Science.gov (United States)

    Mahdizadeh, Mousa; Heydari, Abbas; Moonaghi, Hossien Karimi

    2015-01-01

    Introduction: So far, various models of interdisciplinary collaboration in clinical nursing have been presented, however, yet a comprehensive model is not available. The purpose of this study is to review the evidences that had presented model or framework with qualitative approach about interdisciplinary collaboration in clinical nursing. Methods: All the articles and theses published from 1990 to 10 June 2014 which in both English and Persian models or frameworks of clinicians had presented model or framework of clinical collaboration were searched using databases of Proquest, Scopus, pub Med, Science Direct, and Iranian databases of Sid, Magiran, and Iranmedex. In this review, for published articles and theses, keywords according with MESH such as nurse-physician relations, care team, collaboration, interdisciplinary relations and their Persian equivalents were used. Results: In this study contexts, processes and outcomes of interdisciplinary collaboration as findings were extracted. One of the major components affecting on collaboration that most of the models had emphasized was background of collaboration. Most of studies suggested that the outcome of collaboration were improved care, doctors and nurses’ satisfaction, controlling costs, reducing clinical errors and patient’s safety. Conclusion: Models and frameworks had different structures, backgrounds, and conditions, but the outcomes were similar. Organizational structure, culture and social factors are important aspects of clinical collaboration. So it is necessary to improve the quality and effectiveness of clinical collaboration these factors to be considered. PMID:26153158

  9. Age-Related Differences in Clinical Features of Neurocysticercosis

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2006-11-01

    Full Text Available Clinical, radiologic, and inflammatory features of neurocysticercosis (NC in 92 pediatric (<15 years and 114 adult Mexican patients were compared in a study at three hospitals in Mexico City.

  10. Surgical experimentation and clinical trials: differences and related ethical problems

    OpenAIRE

    Carlo Petrini

    2013-01-01

    Surgical techniques are not introduced into clinical practice as the result of randomised clinical trials (RCT), but usually through the gradual evolution of existing techniques or, more rarely, through audacious departures from the norm that are decided by a surgical team on the basis of experience. Sham surgery is held by some to be not only an ethically acceptable procedure but also a perfectly fit and proper one, as it could endow surgical experiments with the strict methodological and st...

  11. The importance of socio-cultural differences and of pathway analysis for understanding local actors' responses

    NARCIS (Netherlands)

    Bruijn, de M.E.; Dijk, van J.W.M.; Dietz, A.J.; Ruben, R.; Verhagen, A.

    2004-01-01

    The enormous diversity of responses to the drought conditions in the Sahel in the last thirty years makes it difficult to formulate general conclusions about people's responses to climate change. It is important to study the pathways of decisionmaking units at the micro-level and even at individual

  12. Multiplex SSR analysis of Phytophthora infestans in different countries and the importance for potato breeding

    NARCIS (Netherlands)

    Li, Y.

    2012-01-01

    Potato is the most important non-cereal crop in the world. Late blight, caused by the oomycete pathogen Phytophthora infestans, is the most devastating disease of potato. In the mid-19th century, P. infestans attacked the European potato fields and this resulted in a widespread famine in Ireland and

  13. The importance of socio-cultural differences and of pathway analysis for understanding local actors' responses

    NARCIS (Netherlands)

    Bruijn, de M.E.; Dijk, van J.W.M.; Dietz, A.J.; Ruben, R.; Verhagen, A.

    2004-01-01

    The enormous diversity of responses to the drought conditions in the Sahel in the last thirty years makes it difficult to formulate general conclusions about people's responses to climate change. It is important to study the pathways of decisionmaking units at the micro-level and even at individual

  14. Multiplex SSR analysis of Phytophthora infestans in different countries and the importance for potato breeding

    NARCIS (Netherlands)

    Li, Y.

    2012-01-01

    Potato is the most important non-cereal crop in the world. Late blight, caused by the oomycete pathogen Phytophthora infestans, is the most devastating disease of potato. In the mid-19th century, P. infestans attacked the European potato fields and this resulted in a widespread famine in Ireland and

  15. [Clinical importance of tympanometry in the diagnosis of chronic secretory otitis].

    Science.gov (United States)

    Spremo, S; Markić, Z; Kurbalija

    1998-01-01

    Secretory otitis media is defined as a fluid in the middle ear without signs or symptoms of infection. As the aetiology and pathogenesis of the disease are unknown, and as it affects children aged from 3 to 12 years, treatment procedures proposed for management of secretory otitis media, are not uniform. Some authors [1, 4, 6] consider that functional or mechanical obstructions of the Eustachian tube could provoke secretory otitis. The purpose of the treatment is to remove exudate from the middle ear and appropriately ventilate it for a longer period. That could instantly normalize the hearing and exclude the appearance of late complications of secretory otitis. Although the disease could heal spontaneously, the treatment should be performed immediately for preventing sequelae of secretory otitis. The aim of the study was to evaluate possible aetiologic factors of secretory otitis in our population, and to evaluate results of lympanometry in children with exudate in the middle ear. There were 65 children, aged from 3 to 12 years (Table 1), who complained of deafness and were examined at the ORL Department in Banja Luka. The clinical examination revealed the integrity and color of tympanic membrane, scars, adhesions and atrophic areas. Audiometry and tympanometry had been performed in addition. Patients who proved to have exudate in the middle ear received nasal decongestants and mucolitics during three months, and were evaluated every three weeks by audiometry and tympanometry. Pathologic findings in the nose and epipharynx were the most common findings: enlarged adenoids in 38 (58%) patients, hypetrophic rhinitis in 15 (23%) and allergic rhinitis in 5 (8%) patients. Frequent relapses of middle ear infection in the first three years of life were found in 26 (40%) patients and early first attacks in the first year of life in 15 (23%) patients (Table 2). Premature onset (15%) and allergy (21%) had also been frequently found. Results of tympanometry and audiometry are

  16. DNA methylation profiles delineate etiologic heterogeneity and clinically important subgroups of bladder cancer.

    Science.gov (United States)

    Wilhelm-Benartzi, C S; Koestler, D C; Houseman, E A; Christensen, B C; Wiencke, John K; Schned, A R; Karagas, M R; Kelsey, K T; Marsit, C J

    2010-11-01

    DNA methylation profiles can be used to define molecular cancer subtypes that may better inform disease etiology and clinical decision-making. This investigation aimed to create DNA methylation profiles of bladder cancer based on CpG methylation from almost 800 cancer-related genes and to then examine the relationship of those profiles with exposures related to risk and clinical characteristics. DNA, derived from formalin-fixed paraffin-embedded tumor samples obtained from incident cases involved in a population-based case-control study of bladder cancer in New Hampshire, was used for methylation profiling on the Illumina GoldenGate Methylation Bead Array. Unsupervised clustering of those loci with the greatest change in methylation between tumor and non-diseased tissue was performed to defined molecular subgroups of disease, and univariate tests of association followed by multinomial logistic regression was used to examine the association between these classes, bladder cancer risk factors and clinical phenotypes. Membership in the two most methylated classes was significantly associated with invasive disease (P class 3 and 4). Male gender (P = 0.04) and age >70 years (P = 0.05) was associated with membership in one of the most methylated classes. Finally, average water arsenic levels in the highest percentile predicted membership in an intermediately methylated class of tumors (P = 0.02 for both classes). Exposures and demographic associated with increased risk of bladder cancer specifically associate with particular subgroups of tumors defined by DNA methylation profiling and these subgroups may define more aggressive disease.

  17. Clinical importance of achieving biochemical control with medical therapy in adult patients with acromegaly

    Directory of Open Access Journals (Sweden)

    Christofides EA

    2016-07-01

    Full Text Available Elena A Christofides Endocrinology Associates, Inc., Columbus, OH, USA Abstract: In acromegaly, achieving biochemical control (growth hormone [GH] level <1.0 ng/mL and age- and sex-normalized levels of insulin-like growth factor 1 [IGF-1] through timely diagnosis and appropriate treatment provides an opportunity to improve patient outcomes. Diagnosis of acromegaly is challenging because it is rooted in observing subtle clinical manifestations, and it is typical for acromegaly to evolve for up to 10 years before it is recognized. This results in chronic exposure to elevated levels of GH and IGF-1 and delay in patients receiving appropriate treatment, which consequently increases mortality risk. In this review, the clinical impact of elevated GH and IGF-1 levels, the effectiveness of current therapies, and the potential role of novel treatments for acromegaly will be discussed. Clinical burden of acromegaly and benefits associated with management of GH and IGF-1 levels will be reviewed. Major treatment paradigms in acromegaly include surgery, medical therapy, and radiotherapy. With medical therapies, such as somatostatin analogs, dopamine agonists, and GH receptor antagonists, a substantial proportion of patients achieve reduced GH and normalized IGF-1 levels. In addition, signs and symptoms, quality of life, and comorbidities have also been reported to improve to varying degrees in patients who achieve biochemical control. Currently, there are several innovative therapies in development to improve patient outcomes, patient use, and access. Timely biochemical control of acromegaly ensures that the patient can ultimately improve morbidity and mortality from this disease and its extensive consequences. Keywords: disease burden, growth hormone, insulin-like growth factor 1, medical therapy, pituitary

  18. Enhanced culture detection of Kingella kingae, a pathogen of increasing clinical importance in pediatrics.

    Science.gov (United States)

    Gené, Amadeu; García-García, Juan-José; Sala, Pere; Sierra, Montse; Huguet, Ramon

    2004-09-01

    Osteoarticular infection and occult bacteremia are the 2 invasive infectious pathologies most frequently associated in childhood with Kingella kingae. We report a series of 11 patients in whom osteomyelitis predominates over septic arthritis, which is the reverse of other series, probably as a consequence of inoculation of samples during surgery on agar media, used in combination with or as an alternative to inoculation into blood culture bottles. Although K. kingae infections usually follow a benign clinical course, we noted 2 patients with mild orthopedic sequelae.

  19. The importance of communication for clinical leaders in mental health nursing: the perspective of nurses working in mental health.

    Science.gov (United States)

    Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry

    2013-11-01

    Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.

  20. Clinical importance of the middle meningeal artery: A review of the literature

    Science.gov (United States)

    Yu, Jinlu; Guo, Yunbao; Xu, Baofeng; Xu, Kan

    2016-01-01

    The middle meningeal artery (MMA) is a very important artery in neurosurgery. Many diseases, including dural arteriovenous fistula (DAVF), pseudoaneurysm, true aneurysm, traumatic arteriovenous fistula (AVF), moyamoya disease (MMD), recurrent chronic subdural hematoma (CSDH), migraine and meningioma, can involve the MMA. In these diseases, the lesions occur in either the MMA itself and treatment is necessary, or the MMA is used as the pathway to treat the lesions; therefore, the MMA is very important to the development and treatment of a variety of neurosurgical diseases. However, no systematic review describing the importance of MMA has been published. In this study, we used the PUBMED database to perform a review of the literature on the MMA to increase our understanding of its role in neurosurgery. After performing this review, we found that the MMA was commonly used to access DAVFs and meningiomas. Pseudoaneurysms and true aneurysms in the MMA can be effectively treated via endovascular or surgical removal. In MMD, the MMA plays a very important role in the development of collateral circulation and indirect revascularization. For recurrent CDSHs, after burr hole irrigation and drainage have failed, MMA embolization may be attempted. The MMA can also contribute to the occurrence and treatment of migraines. Because the ophthalmic artery can ectopically originate from the MMA, caution must be taken to avoid causing damage to the MMA during operations. PMID:27766029

  1. The importance of hydration in wound healing: reinvigorating the clinical perspective.

    Science.gov (United States)

    Ousey, K; Cutting, K F; Rogers, A A; Rippon, M G

    2016-03-01

    Balancing skin hydration levels is important as any disruption in skin integrity will result in disturbance of the dermal water balance. The discovery that a moist environment actively supports the healing response when compared with a dry environment highlights the importance of water and good hydration levels for optimal healing. The benefits of 'wet' or 'hyper-hydrated' wound healing appear similar to those offered by moist over a dry environment. This suggests that the presence of free water may not be detrimental to healing, but any adverse effects of wound fluid on tissues is more likely related to the biological components contained within chronic wound exudate, for example elevated protease levels. Appropriate dressings applied to wounds must not only be able to absorb the exudate, but also retain this excess fluid together with its protease solutes, while concurrently preventing desiccation. This is particularly important in the case of chronic wounds where peri-wound skin barrier properties are compromised and there is increased permeation across the injured skin. This review discusses the importance of appropriate levels of hydration in skin, with a particular focus on the need for optimal hydration levels for effective healing. Declaration of interest: This paper was supported by Paul Hartmann Ltd. The authors have provided consultative services to Paul Hartmann Ltd.

  2. 77 FR 38084 - Importer of Controlled Substances; Notice of Registration; Clinical Supplies Management, Inc.

    Science.gov (United States)

    2012-06-26

    ... the company's physical security systems, verification of the company's compliance with state and local laws, and a review of the company's background and history. Therefore, pursuant to 21 U.S.C. 952(a) and... Sufentanil (9740), a basic class of controlled substance listed in schedule II. The company plans to import...

  3. 78 FR 5497 - Importer of Controlled Substances; Notice of Registration; Fisher Clinical Services, Inc.

    Science.gov (United States)

    2013-01-25

    ... the company's physical security systems, verification of the company's compliance with state and local laws, and a review of the company's background and history. Therefore, pursuant to 21 U.S.C. 952(a) and...), a basic class of controlled substance listed in schedule II. The company plans to import the listed...

  4. A Visitor's Guide to Effect Sizes--Statistical Significance versus Practical (Clinical) Importance of Research Findings

    Science.gov (United States)

    Hojat, Mohammadreza; Xu, Gang

    2004-01-01

    Effect Sizes (ES) are an increasingly important index used to quantify the degree of practical significance of study results. This paper gives an introduction to the computation and interpretation of effect sizes from the perspective of the consumer of the research literature. The key points made are: (1) "ES" is a useful indicator of the…

  5. Name Changes in Medically Important Fungi and Their Implications for Clinical Practice

    DEFF Research Database (Denmark)

    de Hoog, G. Sybren; Chaturvedi, Vishnu; Denning, David W.

    2015-01-01

    Recent changes in the Fungal Code of Nomenclature and developments in molecular phylogeny are about to lead to dramatic changes in the naming of medically important molds and yeasts. In this article, we present a widely supported and simple proposal to prevent unnecessary nomenclatural instability....

  6. Clinical importance and cost of bacteremia caused by nosocomial multi drug resistant acinetobacter baumannii

    Directory of Open Access Journals (Sweden)

    Tugba Arslan Gulen

    2015-09-01

    Conclusion: Our results suggest that the occurrence of MDR A.baumannii bacteremia was related with the usage of the wide spectrum antibiotics, and mortality rates were increased in patients that high SAPS II scores, long term hospitalization. Infection control procedures and limited antibiotic usage are very important for prevent nosocomial infections.

  7. Responsiveness and Minimal Clinically Important Change of the Pain Disability Index in Patients With Chronic Back Pain

    NARCIS (Netherlands)

    Soer, Remko; Reneman, Michiel F.; Vroomen, Patrick C. A. J.; Stegeman, Patrick; Coppes, Maarten H.

    2012-01-01

    Study Design. Prospective cohort study. Objective. The objective of this study was to test the responsiveness and minimal clinically important change (MCIC) of the Pain Disability Index (PDI) in patients with chronic back pain (CBP). Summary of Background Data. Treatment of patients with CBP is prim

  8. Rehabilitation Counselor Educators' Perceptions of Importance, Student Preparedness, and Teaching Proficiency in Clinical Judgment Skill Domains

    Science.gov (United States)

    Austin, Bryan Scott

    2012-01-01

    Given the importance of clinical judgment in rehabilitation counseling (Strohmer & Leierer, 2000), prevalence and consequences of rehabilitation counselor biases (Berven & Rosenthal, 1999), and the emerging trend to educate rehabilitation counselors in evidence-based practice (EBP) (Leahy & Arokiasamy, 2010), the explicit teaching of…

  9. A rare variant of the ulnar artery with important clinical implications: a case report

    Directory of Open Access Journals (Sweden)

    Casal Diogo

    2012-11-01

    Full Text Available Abstract Background Variations in the major arteries of the upper limb are estimated to be present in up to one fifth of people, and may have significant clinical implications. Case presentation During routine cadaveric dissection of a 69-year-old fresh female cadaver, a superficial brachioulnar artery with an aberrant path was found bilaterally. The superficial brachioulnar artery originated at midarm level from the brachial artery, pierced the brachial fascia immediately proximal to the elbow, crossed superficial to the muscles that originated from the medial epicondyle, and ran over the pronator teres muscle in a doubling of the antebrachial fascia. It then dipped into the forearm fascia, in the gap between the flexor carpi radialis and the palmaris longus. Subsequently, it ran deep to the palmaris longus muscle belly, and superficially to the flexor digitorum superficialis muscle, reaching the gap between the latter and the flexor carpi ulnaris muscle, where it assumed is usual position lateral to the ulnar nerve. Conclusion As far as the authors could determine, this variant of the superficial brachioulnar artery has only been described twice before in the literature. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia.

  10. Clinical importance of detection of bacterial vaginosis, trichomonas vaginalis, candida albicans and actinomyces in Papanicolaou smears.

    Science.gov (United States)

    Güdücü, N; Gönenç, G; Işçi, H; Yiğiter, A Başgül; Başsüllü, N; Dünder, I

    2012-01-01

    The aim of this study was to determine the role of Papanicolaou (pap) smears in the diagnosis of lower genital tract infections. A retrospective study was planned by reviewing charts of patients for trichomonas vaginalis, bacterial vaginosis, actinomyces, candida and nonspecific vaginitis. Charts of 9,080 patients were reviewed and 1,733 women had a diagnosis of lower genital tract infection in the pap smear or had had a clinically treated lower genital tract infection. Only 33.5%, 30.4%, 43.3%, and 0% of patients with bacterial vaginosis, trichomonas vaginalis, candida and actinomyces, respectively on pap smear were diagnosed and treated clinically. Postmenopausal patients had a higher rate of trichomonas vaginalis infection and a lower rate of candida infection when compared to women of the reproductive age group. Patients using an intrauterine device for contraception had a statistically significantly increased rate of trichomonas vaginalis and candida infection when compared to women using other contraceptive methods or those who were not using any contraception. Finding trichomonas vaginalis, bacterial vaginosis and actinomyces infections in pap smears might be considered an indication for treatment without performing other diagnostic tests. Treatment of asymptomatic infections can prevent complications in selected patients. Candida can be a commensal bacteria in the vagina, therefore asymptomatic patients may not require treatment. Detection of a higher rate of trichomonas vaginalis and candida infection in IUD users shows that IUDs can increase the risk of vaginal infections and associated complications.

  11. The coxib NSAIDs: potential clinical and pharmacologic importance in veterinary medicine.

    Science.gov (United States)

    Bergh, Mary Sarah; Budsberg, Steven C

    2005-01-01

    Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to control acute and chronic pain as well as to manage oncologic and neurologic diseases in human and veterinary patients. Despite ongoing research and efforts to improve the safety and efficacy of existing drugs, adverse effects such as gastrointestinal irritation, renal and hepatic toxicity, interference with hemostasis, and reproductive problems persist. The true incidence of NSAID-induced adverse effects in animals is unknown, but is likely underestimated, because cats and dogs may be more sensitive than humans to NSAIDs due to alterations in drug metabolism, absorption, and enterohepatic recirculation. NSAIDs produce both analgesia and toxic adverse effects primarily by inhibiting cyclooxygenase (COX), thereby decreasing the production of prostaglandins that signal inflammation and pain as well as mediate physiologic functions such as platelet aggregation, gastric protection, and electrolyte balance in the kidney. The presence of at least 2 COX isoforms may account for variability in NSAID efficacy and toxicity both within and among species. This paper reviews and evaluates the published literature on the safety, pharmacology, uses, and complications of a subclass of COX-1-sparing drugs, the coxibs, in veterinary medicine. Coxibs and other COX-1-sparing drugs provide a clinically useful improvement over traditional NSAIDs, but data are incomplete and more in vivo species-specific, target-tissue, and clinical studies are needed.

  12. QUALITY OF LIFE IN PATIENTS WITH INFLAMMATORY BOWEL DISEASE: importance of clinical, demographic and psychosocial factors

    Directory of Open Access Journals (Sweden)

    Joana MAGALHÃES

    2014-09-01

    Full Text Available Context Inflammatory bowel disease causes physical and psychosocial consequences that can affect the health related quality of life. Objectives To analyze the relationship between clinical and sociodemographic factors and quality of life in inflammatory bowel disease patients. Methods Ninety two patients with Crohn’s disease and 58 with ulcerative colitis, filled in the inflammatory bowel disease questionnaire (IBDQ-32 and a questionnaire to collect sociodemographic and clinical data. The association between categorical variables and IBDQ-32 scores was determined using Student t test. Factors statistically significant in the univariate analysis were included in a multivariate regression model. Results IBDQ-32 scores were significantly lower in female patients (P<0.001, patients with an individual perception of a lower co-workers support (P<0.001 and career fulfillment (P<0.001, patients requiring psychological support (P = 0.010 and pharmacological treatment for anxiety or depression (P = 0.002. A multivariate regression analysis identified as predictors of impaired HRQOL the female gender (P<0.001 and the perception of a lower co-workers support (P = 0.025 and career fulfillment (P = 0.001. Conclusions The decrease in HRQQL was significantly related with female gender and personal perception of disease impact in success and social relations. These factors deserve a special attention, so timely measures can be implemented to improve the quality of life of patients.

  13. Comparison of Different Internal Dosimetry Systems for Selected Radionuclides Important to Nuclear Power Production

    Energy Technology Data Exchange (ETDEWEB)

    Leggett, Richard Wayne [ORNL; Eckerman, Keith F [ORNL; Manger, Ryan P [ORNL

    2013-08-01

    This report compares three different radiation dosimetry systems currently applied by various U.S. Federal agencies and dose estimates based on these three dosimetry systems for a set of radionuclides often identified in power reactor effluents. These dosimetry systems were developed and applied by the International Commission on Radiological Protection at different times over the past six decades. Two primary modes of intake of radionuclides are addressed: ingestion in drinking water and inhalation. Estimated doses to individual organs and to the whole body based on each dosimetry system are compared for each of four age groups: infant, child, teenager, and adult. Substantial differences between dosimetry systems in estimated dose per unit intake are found for some individual radionuclides, but differences in estimated dose per unit intake generally are modest for mixtures of radionuclides typically found in nuclear power plant effluents.

  14. The Racial Wage Gap: The Importance of Labor Force Attachment Differences

    OpenAIRE

    Antecol, Heather; Bedard, Kelly

    2002-01-01

    Labor market attachment differs significantly across black, Mexican and white men; black and Mexican men are more likely to experience unemployment and out of the labor force spells than are white men. While it has long been agreed that potential experience is a poor proxy of actual experience for women, many view it as an acceptable approximation for men. Using the NLSY, this paper documents the substantial difference between potential and actual experience for both black and Mexican men. We...

  15. Attachment disorganization in different clinical groups: What underpins unresolved attachment?

    Directory of Open Access Journals (Sweden)

    Juen Florian

    2013-01-01

    Full Text Available This paper summarizes findings and clinical implications of research on attachment disorganization in diverse clinical groups. Disorganized/unresolved attachment is overrepresented in these groups compared to healthy control participants, but disorder specific characteristics of this attachment pattern are still poorly understood. The focus of this study was to explore defensive processes in participants whose narratives were classified as disorganized/unresolved using the Adult Attachment Projective Picture System (AAP. Besides the predominance of disorganized attachment, clinical participants demonstrated more “segregated system material” especially in stories representing aloneness and more “Personal Experience material” compared to healthy individuals. Within the disorganized/ unresolved clinical individuals, BPD and PTSD patients showed the highest proportion of attachment disorganization and were less able to use other attachment-related defenses to maintain organized. Furthermore, PTSD patients were emotionally overwhelmed by the projective attachment scenes compared to the other clinical groups as indexed by an incapacity to complete sections of the AAP. BPD and addicted patients were characterized by a high degree of self-other boundary confusion. Depressive and schizophrenic patients showed a high overall defensive intensity to remain organized.

  16. Relative importance of sexual and asexual reproduction for range expansion of Spartina alterniflora in different tidal zones on Chinese coast

    Science.gov (United States)

    Liu, Huiyu; Lin, Zhenshan; Zhang, Mingyang; Qi, Xiangzhen

    2017-02-01

    In this paper, based on spatially explicit individual-based model and global sensitivity analysis, the relative importance of sexual and asexual reproduction for range expansion of Spartina alterniflora in different tidal zones during different invasion stages has been revealed. The results showed that: 1) sexual reproduction is thought to accelerate the range expansion in middle and high tidal zones; 2) seed dispersal and adult survival rate are the two most important for range expansion of S. alterniflora during most invasion stages in all tidal zones. However, in high tidal zone, the importance of seed dispersal distance is much less than in low and middle tidal zones, and that of sexual reproduction is also great, which cannot be ignored. In middle tidal zone, the importance of adult survival rate is less important than in high and low tidal zones, and is very close to asexual reproduction. Moreover, there are significant fluctuations among the importance of different parameters except seed dispersal distance, indicating strong interactions. 3) the importance of adult survival rate and asexual reproduction is much greater than seed dispersal distance during early invasion. Especially, their importance is much higher during early and middle invasion stages in high tidal zone. During early invasion stages, the interactions among different parameters are very strong. To enhance the invasion control efficiency, it is necessary to take different control measures according to different tidal zones and invasion stages.

  17. Effective case presentations--an important clinical skill for nurse practitioners.

    Science.gov (United States)

    Coralli, Connie H

    2006-05-01

    Effective case presentations are an important component of the nurse practitioner's skills, yet very little literature exists to guide the development of this skill, and frequently little priority is given to teaching this skill during the education of the nurse practitioner. This report discusses the importance of effective case presentations, describes the organization of the presentation, and outlines the appropriate information to be included. The main components of a case presentation-introduction, history of the present illness, physical examination, diagnostic studies, differential diagnosis, management, and summary of the case-are discussed in detail. Examples of a formal and an informal case presentation are presented and used to illustrate key points in the text.

  18. Chiral separation of the clinically important compounds fucose and pipecolic acid using CE: determination of the most effective chiral selector.

    Science.gov (United States)

    Hadjistasi, Christoforos A; Stavrou, Ioannis J; Stefan-Van Staden, Raluca-Ioana; Aboul-Enein, Hassan Y; Kapnissi-Christodoulou, Constantina P

    2013-09-01

    In this study, simple electrophoretic methods were developed for the chiral separation of the clinically important compounds fucose and pipecolic acid. In recent years, these analytes, and particularly their individual enantiomers, have attracted considerable attention due to their role in biological functions and disorders. The detectability and sensitivity of pipecolic acid and fucose were improved by reacting them with fluorenylmethyloxycarbonyl chloride (FMOC-Cl) and 5-amino-2-naphthalene-sulfonic acid (ANSA), respectively. The enantioseparation conditions were optimized by initially investigating the type of the chiral selector. Different chiral selectors, such as polymeric surfactants and cyclodextrins, were used and the most effective ones were determined with regard to resolution and analysis time. A 10-mM β-cyclodextrin was able to separate the enantiomers of ANSA-DL-fucose and the polymeric surfactant poly(sodium N-undecanoyl-LL-leucine-valinate) was able to separate the enantiomers of FMOC-DL-pipecolic acid, with resolution values of 3.45 and 2.78, respectively. Additional parameters, such as the concentration and the pH of the background electrolyte (BGE), the concentration of the chiral selector, and the addition of modifiers were examined in order to optimize the separations. The addition of the chiral ionic liquid D-alanine tert-butyl ester lactate into the BGE was also investigated, for the first time, in order to improve resolution of the enantiomers.

  19. Clinical importance of carbapenem hypersensitivity in patients with self-reported and documented penicillin allergy.

    Science.gov (United States)

    Prescott, William A; Kusmierski, Kristen A

    2007-01-01

    The risk of carbapenem hypersensitivity in patients with self-reported or documented penicillin allergy needs to be determined so that practitioners can make better-informed decisions regarding antibiotic therapy for this patient population. The risk of cross-reactivity between penicillin and carbapenem antibiotics initially was reported to approach 50%. Recent retrospective studies have suggested that the clinical risk of cross-hypersensitivity between these two drug classes is 9.2-11%, which is significantly lower than initially reported. Patients whose history of penicillin allergy is self-reported and is not type 1 may be at moderate risk for hypersensitivity when treated with a carbapenem antibiotic. The risk of hypersensitivity appears to be higher in patients whose penicillin allergy was documented by a health care provider, those with several antibiotic allergies, and those with a positive penicillin skin test result or a history of type 1 penicillin hypersensitivity.

  20. [Presumptive identification of Candida spp. and other clinically important yeasts: usefulness of Brilliance Candida Agar].

    Science.gov (United States)

    Alfonso, Claudia; López, Mónica; Arechavala, Alicia; Perrone, María Del Carmen; Guelfand, Liliana; Bianchi, Mario

    2010-06-30

    Fungal infections caused by yeasts have increased during the last decades and invasive forms represent a serious problem for human health. Candida albicans is the species most frequently isolated from clinical samples. However, other emerging yeast pathogens are increasingly responsible for mycotic infections, and some of them are resistant to some antifungal drugs. Consequently, it is necessary to have methods that can provide a rapid presumptive identification at species level. Numerous chromogenic agar media have been shown to be of value as diagnostic tools. We have compared a chromogenic medium, Brilliance Candida Agar, with CHROMagar Candida, the chromogenic medium most used in our country. A multicentre study was conducted in 16 Hospitals belonging to the Mycology Net of Buenos Aires City Government. A total of 240 yeast isolates were included in this research. The new chromogenic agar showed results very similar to those obtained with CHROMagar Candida. Copyright 2009 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.

  1. Cannabidiol for neurodegenerative disorders: important new clinical applications for this phytocannabinoid?

    Science.gov (United States)

    Fernández-Ruiz, Javier; Sagredo, Onintza; Pazos, M Ruth; García, Concepción; Pertwee, Roger; Mechoulam, Raphael; Martínez-Orgado, José

    2013-02-01

    Cannabidiol (CBD) is a phytocannabinoid with therapeutic properties for numerous disorders exerted through molecular mechanisms that are yet to be completely identified. CBD acts in some experimental models as an anti-inflammatory, anticonvulsant, anti-oxidant, anti-emetic, anxiolytic and antipsychotic agent, and is therefore a potential medicine for the treatment of neuroinflammation, epilepsy, oxidative injury, vomiting and nausea, anxiety and schizophrenia, respectively. The neuroprotective potential of CBD, based on the combination of its anti-inflammatory and anti-oxidant properties, is of particular interest and is presently under intense preclinical research in numerous neurodegenerative disorders. In fact, CBD combined with Δ(9)-tetrahydrocannabinol is already under clinical evaluation in patients with Huntington's disease to determine its potential as a disease-modifying therapy. The neuroprotective properties of CBD do not appear to be exerted by the activation of key targets within the endocannabinoid system for plant-derived cannabinoids like Δ(9)-tetrahydrocannabinol, i.e. CB(1) and CB(2) receptors, as CBD has negligible activity at these cannabinoid receptors, although certain activity at the CB(2) receptor has been documented in specific pathological conditions (i.e. damage of immature brain). Within the endocannabinoid system, CBD has been shown to have an inhibitory effect on the inactivation of endocannabinoids (i.e. inhibition of FAAH enzyme), thereby enhancing the action of these endogenous molecules on cannabinoid receptors, which is also noted in certain pathological conditions. CBD acts not only through the endocannabinoid system, but also causes direct or indirect activation of metabotropic receptors for serotonin or adenosine, and can target nuclear receptors of the PPAR family and also ion channels. © 2012 The Authors. British Journal of Clinical Pharmacology © 2012 The British Pharmacological Society.

  2. What do evidence-based secondary journals tell us about the publication of clinically important articles in primary healthcare journals?

    Directory of Open Access Journals (Sweden)

    Wilczynski Nancy L

    2004-09-01

    Full Text Available Abstract Background We conducted this analysis to determine i which journals publish high-quality, clinically relevant studies in internal medicine, general/family practice, general practice nursing, and mental health; and ii the proportion of clinically relevant articles in each journal. Methods We performed an analytic survey of a hand search of 170 general medicine, general healthcare, and specialty journals for 2000. Research staff assessed individual articles by using explicit criteria for scientific merit for healthcare application. Practitioners assessed the clinical importance of these articles. Outcome measures were the number of high-quality, clinically relevant studies published in the 170 journal titles and how many of these were published in each of four discipline-specific, secondary "evidence-based" journals (ACP Journal Club for internal medicine and its subspecialties; Evidence-Based Medicine for general/family practice; Evidence-Based Nursing for general practice nursing; and Evidence-Based Mental Health for all aspects of mental health. Original studies and review articles were classified for purpose: therapy and prevention, screening and diagnosis, prognosis, etiology and harm, economics and cost, clinical prediction guides, and qualitative studies. Results We evaluated 60,352 articles from 170 journal titles. The pass criteria of high-quality methods and clinically relevant material were met by 3059 original articles and 1073 review articles. For ACP Journal Club (internal medicine, four titles supplied 56.5% of the articles and 27 titles supplied the other 43.5%. For Evidence-Based Medicine (general/family practice, five titles supplied 50.7% of the articles and 40 titles supplied the remaining 49.3%. For Evidence-Based Nursing (general practice nursing, seven titles supplied 51.0% of the articles and 34 additional titles supplied 49.0%. For Evidence-Based Mental Health (mental health, nine titles supplied 53.2% of the

  3. Screening of different Trichoderma species against agriculturally important foliar plant pathogens.

    Science.gov (United States)

    Prabhakaran, Narayanasamy; Prameeladevi, Thokala; Sathiyabama, Muthukrishnan; Kamil, Deeba

    2015-01-01

    Different isolates of Trichoderma were isolated from soil samples which were collected from different part of India. These isolates were grouped into four Trichoderma species viz., Trichoderma asperellum (Ta), T. harzianum (Th), T. pseudokoningii (Tp) and T. longibrachiatum (Tl) based on their morphological characters. Identification of the above isolates was also confirmed through ITS region analysis. These Trichoderma isolates were tested for in vitro biological control of Alternaria solani, Bipolaris oryzae, Pyricularia oryzae and Sclerotinia scierotiorum which cause serious diseases like early blight (target spot) of tomato and potato, brown leaf spot disease in rice, rice blast disease, and white mold disease in different plants. Under in vitro conditions, all the four species of Trichoderma (10 isolates) proved 100% potential inhibition against rice blast pathogen Pyracularia oryzae. T. harzianum (Th-01) and T. asperellum (Ta-10) were effective with 86.6% and 97.7%, growth inhibition of B. oryzae, respectively. Among others, T. pseudokoningii (Tp-08) and T. Iongibrachiatum (Tl-09) species were particularly efficient in inhibiting growth of S. sclerotiorum by 97.8% and 93.3%. T. Iongibrachiatum (TI-06 and TI-07) inhibited maximum mycelial growth of A. solani by 87.6% and 84.75. However, all the T. harzianum isolates showed significantly higher inhibition against S. sclerotiorum (CD value 9.430), causing white mold disease. This study led to the selection of potential Trichoderma isolates against rice blast, early blight, brown leaf spot in rice and white mold disease in different crops.

  4. Relative importance of urbanicity, ethnicity and socioeconomic factors regarding area mortality differences.

    NARCIS (Netherlands)

    Reijneveld, S.A.; Verheij, R.A.; Bakker, D.H. de

    1999-01-01

    A higher mortality rate in areas with increased socioeconomic deprivation has been found in many studies. Results are difficult to compare, however, because different indicators of area deprivation have been used. USA-based studies mostly use income to measure area deprivation, whereas UK-based stud

  5. Relative importance of urbanicity, ethnicity and socioeconomic factors regarding area mortality differences.

    NARCIS (Netherlands)

    Reijneveld, S.A.; Verheij, R.A.; Bakker, D.H. de

    1999-01-01

    A higher mortality rate in areas with increased socioeconomic deprivation has been found in many studies. Results are difficult to compare, however, because different indicators of area deprivation have been used. USA-based studies mostly use income to measure area deprivation, whereas UK-based

  6. The Importance of Managing Interference for Second Language Reading Ability: An Individual Differences Investigation

    Science.gov (United States)

    Yamasaki, Brianna L.; Prat, Chantel S.

    2014-01-01

    Research on individual differences in second language (L2) reading ability has primarily focused on factors known to contribute to first language (L1) reading ability, with little consideration of factors mediating interference between languages. In an exploratory analysis, we compared the degree to which the linguistic interference that readers…

  7. Relative importance of different secondary successional pathways in an Alaskan boreal forest

    Science.gov (United States)

    Thomas A. Kurkowski; Daniel H. Mann; T. Scott Rupp; David L. Verbyla

    2008-01-01

    Postfire succession in the Alaskan boreal forest follows several different pathways, the most common being self-replacement and species-dominance relay. In self-replacement, canopy-dominant tree species replace themselves as the postfire dominants. It implies a relatively unchanging forest composition through time maintained by trees segregated within their respective...

  8. Determination of Some Ethnomedicinally Important Constituents of Aegle marmelos Fruit During Different Stages of Ripening

    Institute of Scientific and Technical Information of China (English)

    Nisha Yadav; Parul Singh; Ranjana Mehrotra

    2011-01-01

    AIM: Aegle marmelos is a medicinal herb belonging to the Rutacae family. The fruit of A. marmelos at each stage of ripening is used as ethnomedicine to cure various diseases. The aim of the present study was to determine the components contributing to the medicinal value of the A. marmelos fruit at different stages of ripening. METHODS: High-performance liquid chromatography (HPLC) was used to determine polyphenol, vitamins, organic acids and sugars in A. marmelos fruit at different stages of ripening. RESULTS: Tannin, a polyphenol responsible for astringent and antimicrobial properties of A. marmelos fruit was found to increase during ripening. Riboflavin, a vital medicinal component was detected in traceable amount only in full-ripe A. marmelos fruit. Ribofla-vin contributes towards body growth, reproduction and red cell production. The content of ascorbic acid (vitamin C) which is useful in preventing scurvy decreased significantly as fruit ripens. CONCLUSIONS: The difference in the medicinal effect of A. marmelos fruit at each stage of ripening might be due to the presence of different amount of polyphenol, vitamins and organic acids.

  9. Differences in Clinical Experiences of ADN and BSN Students.

    Science.gov (United States)

    Oermann, Marilyn H.

    1998-01-01

    In a study of 211 associate degree (AD) and 204 baccalaureate nursing students, AD students reported significantly higher stress in clinical practice. Stress for both groups increased as they progressed. Instructors were the predominant source of stress. Students had the most difficulty coping with the demands of patient care and the clinical…

  10. Sex differences in clinical characteristics and outcomes after myocardial infarction

    DEFF Research Database (Denmark)

    Lam, Carolyn S P; McEntegart, Margaret; Claggett, Brian;

    2015-01-01

    BACKGROUND: We examined the association of sex with clinical characteristics and outcomes in patients following myocardial infarction (MI) in the Valsartan in Acute Myocardial Infarction Trial (VALIANT). METHODS AND RESULTS: A total of 4570 women and 10 133 men with heart failure (HF), left ventr...

  11. Conflict Predispositions: Differences between Happy and Clinical Couples.

    Science.gov (United States)

    Yelsma, Paul

    1981-01-01

    Suggests that intrapersonal and interpersonal conflicts are influential in marital relationships. Results indicate happy couples had predispositions for productively managing conflict; clinical couples had higher aggressiveness predispositions. Happy couples also had more loyalty to their communities, more energy for tasks, and more positive…

  12. PCR-RFLP on β-tubulin gene for rapid identification of the most clinically important species of Aspergillus.

    Science.gov (United States)

    Nasri, Tuba; Hedayati, Mohammad Taghi; Abastabar, Mahdi; Pasqualotto, Alessandro C; Armaki, Mojtaba Taghizadeh; Hoseinnejad, Akbar; Nabili, Mojtaba

    2015-10-01

    Aspergillus species are important agents of life-threatening infections in immunosuppressed patients. Proper speciation in the Aspergilli has been justified based on varied fungal virulence, clinical presentations, and antifungal resistance. Accurate identification of Aspergillus species usually relies on fungal DNA sequencing but this requires expensive equipment that is not available in most clinical laboratories. We developed and validated a discriminative low-cost PCR-based test to discriminate Aspergillus isolates at the species level. The Beta tubulin gene of various reference strains of Aspergillus species was amplified using the universal fungal primers Bt2a and Bt2b. The PCR products were subjected to digestion with a single restriction enzyme AlwI. All Aspergillus isolates were subjected to DNA sequencing for final species characterization. The PCR-RFLP test generated unique patterns for six clinically important Aspergillus species, including Aspergillus flavus, Aspergillus fumigatus, Aspergillus nidulans, Aspergillus terreus, Aspergillus clavatus and Aspergillus nidulans. The one-enzyme PCR-RFLP on Beta tubulin gene designed in this study is a low-cost tool for the reliable and rapid differentiation of the clinically important Aspergillus species.

  13. Complete Genome Sequences of Three Important Methicillin-Resistant Clinical Isolates of Staphylococcus pseudintermedius

    Science.gov (United States)

    Riley, Matthew C.; Bemis, David A.

    2016-01-01

    We report the first complete genome sequences of three predominant clones (ST68, ST71, and ST84) of methicillin-resistant Staphylococcus pseudintermedius in North America. All strains were isolated from canine infections and have different SCCmec elements and antibiotic resistance gene patterns. PMID:27795289

  14. Ossification of caroticoclinoid ligament and its clinical importance in skull-based surgery

    Directory of Open Access Journals (Sweden)

    Srijit Das

    Full Text Available CONTEXT: The medial end of the posterior border of the sphenoid bone presents the anterior clinoid process (ACP, which is usually accessed for operations involving the clinoid space and the cavernous sinus. The ACP is often connected to the middle clinoid process (MCP by a ligament known as the caroticoclinoid ligament (CCL, which may be ossified, forming the caroticoclinoid foramen (CCF. Variations in the ACP other than ossification are rare. The ossified CCL may have compressive effects on the internal carotid artery. Thus, anatomical and radiological knowledge of the ACP and the clinoid space is also important when operating on the internal carotid artery. Excision of the ACP may be required for many skull-based surgical procedures, and the presence of any anomalies such as ossified CCL may pose a problem for neurosurgeons. CASE REPORT: We observed the presence of ossified CCL in a skull bone. A detailed radiological study of the CCL and the CCF was conducted. Morphometric measurements were recorded and photographs were taken. The ACP was connected to the MCP and was converted into a CCF. Considering the fact that standard anatomy textbooks do not provide morphological descriptions and radiological evaluations of the CCL, the present study may be important for neurosurgeons operating in the region of the ACP.

  15. The importance of understanding individual differences in Down syndrome [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Annette Karmiloff-Smith

    2016-03-01

    Full Text Available In this article, we first present a summary of the general assumptions about Down syndrome (DS still to be found in the literature. We go on to show how new research has modified these assumptions, pointing to a wide range of individual differences at every level of description. We argue that, in the context of significant increases in DS life expectancy, a focus on individual differences in trisomy 21 at all levels—genetic, cellular, neural, cognitive, behavioral, and environmental—constitutes one of the best approaches for understanding genotype/phenotype relations in DS and for exploring risk and protective factors for Alzheimer’s disease in this high-risk population.

  16. The relative importance of different types of rewards for employee motivation and commitment in South Africa

    OpenAIRE

    Aleeshah Nujjoo; Ines Meyer

    2012-01-01

    Orientation: Employees’ perceptions of rewards are related to their affective commitment and intrinsic motivation, which have been associated with staff turnover.Research purpose: The study sought to establish the relationship between intrinsic and different extrinsic rewards with intrinsic motivation and affective commitment.Motivation for the study: South African organisations are grappling with employee retention. Literature shows that employees who are more motivated and committed to ...

  17. The importance of detailed epigenomic profiling of different cell types within organs.

    Science.gov (United States)

    Stueve, Theresa Ryan; Marconett, Crystal N; Zhou, Beiyun; Borok, Zea; Laird-Offringa, Ite A

    2016-06-01

    The human body consists of hundreds of kinds of cells specified from a single genome overlaid with cell type-specific epigenetic information. Comprehensively profiling the body's distinct epigenetic landscapes will allow researchers to verify cell types used in regenerative medicine and to determine the epigenetic effects of disease, environmental exposures and genetic variation. Key marks/factors that should be investigated include regions of nucleosome-free DNA accessible to regulatory factors, histone marks defining active enhancers and promoters, DNA methylation levels, regulatory RNAs, and factors controlling the three-dimensional conformation of the genome. Here we use the lung to illustrate the importance of investigating an organ's purified cell epigenomes, and outline the challenges and promise of realizing a comprehensive catalog of primary cell epigenomes.

  18. The importance of the different kinds of energy sources for energy future of Turkey

    Science.gov (United States)

    Kaplan, Yusuf Alper; Aladağ, Canan

    2016-11-01

    Nowadays, the need of energy has been increasing day by day with the population growth and the advancements of technology. In this study, the current state of nuclear, wind and solar energy on the worldwide has been generally investigated. The general assessments have been made based on Turkey's energy potential and the evaluation situation of this potential. The current political structures of countries are generally assessed and under this policy, the last situation and the latest implemented innovations are given. Turkey's energy demand is constantly increasing and Turkey is a country that needs to energy imports. This is a need for new energy sources to meet the growing need for energy. Nuclear, wind and solar energy are the new sources of energy to the fore in our country recently. In this study is given general information on the usage of energy sources of making and some deficiencies were been emphasized by political considerations in this regard.

  19. Sorption of phenanthrene and benzene on differently structural kerogen: important role of micropore-filling.

    Science.gov (United States)

    Zhang, Yulong; Ma, Xiaoxuan; Ran, Yong

    2014-02-01

    Shale was thermally treated to obtain a series of kerogen with varied maturation. Their chemical, structural and porous properties were related to the sorption and/or desorption behaviors of phenanthrene and benzene. As the treatment temperature increases, aliphatic and carbonyl carbon of the kerogen samples decrease, while their aromaticity and maturation increase. Meanwhile, the isothermal nonlinearity of phenanthrene and benzene increases whereas the sorption capacity and micropore adsorption volumes (Vo,d) initially increase and then decrease. The Vo,d of benzene is significantly correlated with, but higher than that of phenanthrene, suggesting similar micropore filling mechanism and molecular sieve effect. The benzene desorption exhibits hysteresis, which is related to the pore deformation of the kerogen and the entrapment of solute in the kerogen matrix. The Vo,d of phenanthrene and benzene on the kerogen samples accounts for 23-46% and 36-65% of the maximum sorption volumes, respectively, displaying the importance of the micropore filling.

  20. Neuroimaging in clinical studies of craving: importance of reward and control networks.

    Science.gov (United States)

    Thayer, Rachel E; Hutchison, Kent E

    2013-06-01

    Research on neurobiological mechanisms, especially the function of networks that underlie reward and cognitive control, may offer an opportunity to explore how existing treatments work and provide means for developing new treatments for substance use disorders. In this respect, the special issue of Psychology of Addictive Behaviors highlights efforts to integrate translational neuroimaging with clinical research by actively linking neuroimaging measures with psychosocial treatment mechanisms. Based on several of the articles in this special issue, mindfulness-based approaches appear poised to make rapid progress in terms of integrating neuroimaging with research on mechanisms that mediate treatment success. This commentary briefly discusses research on incentive salience and cognitive control networks in the context of addiction, followed by a discussion of specific studies within this special issue that address the integration of neuroimaging assessments in the context of mindfulness approaches. Future work may be able to leverage measures of changes in networks and regions that underlie reward processing and cognitive control to better understand how treatments work, especially for mindfulness-based approaches. 2013 APA, all rights reserved

  1. Anatomical variations within the deep posterior compartment of the leg and important clinical consequences.

    Science.gov (United States)

    Hislop, M; Tierney, P

    2004-09-01

    The management of musculoskeletal conditions makes up a large part of a sports medicine practitioner's practice. A thorough knowledge of anatomy is an essential component of the armament necessary to decipher the large number of potential conditions that may confront these practitioners. To cloud the issue further, anatomical variations may be present, such as supernumerary muscles, thickened fascial bands or variant courses of nerves and blood vessels, which can themselves manifest as acute or chronic conditions that lead to significant morbidity or limitation of activity. There are a number of contentious areas within the literature surrounding the anatomy of the leg, particularly involving the deep posterior compartment. Conditions such as chronic exertional compartment syndrome, tibial periostitis (shin splints), peripheral nerve entrapment and tarsal tunnel syndrome may all be affected by subtle anatomical variations. This paper primarily focuses on the deep posterior compartment of the leg and uses the gross dissection of cadaveric specimens to describe definitively the anatomy of the deep posterior compartment. Variant fascial attachments of flexor digitorum longus are documented and potential clinical sequelae such as chronic exertional compartment syndrome and tarsal tunnel syndrome are discussed.

  2. [Monogenic obesity - current status of molecular genetic research and clinical importance].

    Science.gov (United States)

    Aldhoon-Hainerová, Irena; Včelák, Josef; Zamrazilová, Hana

    2014-01-01

    Obesity and its comorbidities represent one of the major health problems worldwide. A positive energy balance due to inappropriate life-style changes plays a key role in the current obesity epidemic. The influence of genetic factors is also significant - several studies concluded that genes contribute to the development of obesity by 40-70%. Genetic variability predisposes an individual to tendency or resistance to increase body weight in obesogenic environment. Polygenic type of inheritance is responsible in most of obese individuals. However, an intensive research of the past 20 years has led to an identification of several genes causing monogenic forms of obesity. To date, several monogenic genes (leptin, leptin receptor, prohormon convertase 1, proopiomelanocortin, melanocortin 4 receptor, single-minded homolog 1, brain-derived neurotrophic factor, neurotrophic tyrosine kinase receptor type 2) that are either involved in the neuronal differentiation of the paraventricular nucleus or in the leptin-melanocortin pathway are known to cause obesity. Mutation carriers apart from severe early onset obesity manifest with additional phenotypic characteristics as adrenal insufficiency, impaired immunity and impaired fertility. This review provides an overview of molecular-genetic and clinical research in the field of monogenic obesities including therapeutical approaches.

  3. Importance of clinical posting for awareness on bio-medical waste in medical and paramedical students

    Directory of Open Access Journals (Sweden)

    Jemil S Makadia

    2014-10-01

    Full Text Available Background: The management of health care waste is the subject of considerable concern to public health. Unscientific disposal of health care waste may lead to the transmission of communicable disease which is a risk for health care professionals. Objective: The main objective of this study was to assess the awareness in the medical and paramedical students about bio-medical waste (BMW hazards and management and to see the impact of clinical posting in knowledge regarding BMW handling. Materials and Methods: This was a cross-sectional type of study. A total of 240 subjects was enrolled, 60 each from 1 st year students of MBBS, BDS, nursing, and MLT. They were interviewed for health care waste management practices. Results: Study shows overall awareness regarding BMW in nursing and MLT students were better than MBBS and BDS students. We found that about the infection like HIV almost all the students were equally aware but awareness about hepatitis B infection was more in MBBS and BDS students and also in nursing students compared with MLT students. All the students from four groups were almost vaccinated for tetanus toxoid but only 50% students were vaccinated for hepatitis B. Conclusion: The nursing and MLT students comparatively were having better knowledge and attitude than BDS and MBBS students in many aspects. However, overall knowledge of 1 st year students from all the groups was not satisfactory and number of students those who were vaccinated for hepatitis B was also low which put them at risk.

  4. Measuring natural pest suppression at different spatial scales affects the importance of local variables.

    Science.gov (United States)

    Bennett, A B; Gratton, C

    2012-10-01

    The role biodiversity plays in the provision of ecosystem services is widely recognized, yet few ecological studies have identified characteristics of natural systems that support and maintain ecosystem services. The purpose of this study was to identify landscape variables correlated with natural pest suppression carried out by arthropod natural enemies, predators and parasitoids. We conducted two field experiments, one observational and one experimental, where landscape variables at broad and local scales were measured and related to natural pest suppression. The first experiment measured natural pest suppression at 16 sites across an urban to rural landscape gradient in south central Wisconsin. We found natural enemy diversity positively affected natural pest suppression, whereas flower diversity negatively affected pest suppression. No relationship was found between natural pest suppression and broad scale variables, which measured the percentage of different land cover classes in the surrounding landscape. In the second experiment, we established small (2- by 3-m) replicated plots that experimentally varied flower diversity (0, 1, or 7 species) within a plot. We found no significant relationship between natural pest suppression and the different levels of flower diversity. The fact that we only found differences in natural pest suppression in our first experiment, which measured natural pest suppression at sites separated by larger distances than our second experiment, suggests the more appropriate scale for measuring ecosystem services performed by mobile organisms like insects, is across broad spatial scales where variation in natural enemies communities and the factors that affect them become more apparent.

  5. Adhesive systems: important aspects related to their composition and clinical use

    OpenAIRE

    SOUZA JUNIOR, Mario Honorato Silva e; Karina Gama Kato Carneiro; Marcelo Figueiredo Lobato; Patrícia de Almeida Rodrigues Silva e Souza; Mário Fernando de Góes

    2010-01-01

    This literature review article addresses the types and the main components of different etch-and-rinse and self-etch adhesive systems available in the market, and relates them to their function, possible chemical interactions and influence of handling characteristics. Scanning electron microscopy (SEM) images are presented to characterize the interface between adhesives and dentin. Adhesive systems have been recently classified according to their adhesion approaches in etch-and-rinse, self-et...

  6. Clinical characteristics of importance to outcome in patients with axial spondyloarthritis

    DEFF Research Database (Denmark)

    Andreasen, Rikke Asmussen; Kristensen, Lars Erik; Ellingsen, Torkell

    2017-01-01

    the PDQ and other phenotypical patient characteristics are prognostically important for response to biological therapy according to established response criteria like 50% improvement in the Bath Ankylosing Spondylitis Disease Activity Index (50%) and Ankylosing Spondylitis Disease Activity Score. ETHICS......INTRODUCTION: Spondyloarthritis (SpA) is a heterogeneous spectrum of rheumatic diseases with either predominantly axial inflammatory symptoms of the spine and sacroiliac joints or predominantly peripheral arthritis. The two main entities of axial SpA (axSpA) are ankylosing spondylitis or non......-radiographic axSpA (nr-axSpA). Tumour necrosis factor-α inhibitors have revolutionised the treatment of patients with axSpA who failed to respond to non-steroidal anti-inflammatory drugs and physical therapy. Chronic pain is common in patients with SpA and may still persist despite the lack of signs...

  7. The impact and importance of clinical learning experience in supporting nursing students in end-of-life care: cluster analysis.

    Science.gov (United States)

    Chow, Susan Ka Yee; Wong, Lina T W; Chan, Yik Kam; Chung, Tin Yu

    2014-09-01

    Nursing students are often expected to provide end-of-life care to patients during clinical practice. Little research has been conducted to examine the heterogeneity of the students and how learning outcomes are affected by their education experience and other demographic factors. The aim of this study was to identify and compare groups of nursing students based on their demographics, clinical experience, knowledge, perceived competency, and attitude towards end-of-life care. A group of 253 nursing students was asked to complete a cross-sectional survey to explore their clinical experience, knowledge, attitude, and perceived competency towards end-of-life care. Cluster analysis was used to determine whether specific groups of students could be identified within the study cohort. Three distinct clusters were identified. Students from the three clusters showed no significant differences in end-of-life knowledge. Significant differences were identified in clinical experience amongst the three clusters and in attitude and perceived competency within the clusters. The cluster of students that had greater clinical experience demonstrated higher perceived competency and a more positive attitude towards end-of-life care. Clinical experience was found to be crucial in enhancing the perceived competency and attitude of nursing students in end-of-life care. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Hematological and plasma biochemical reference ranges of Alaskan seabirds: Their ecological significance and clinical importance

    Science.gov (United States)

    Newman, S.H.; Piatt, J.F.; White, J.

    1997-01-01

    Blood was analyzed from 151 pelagic marine birds to establish reference ranges for hematological and plasma biochemical parameters from healthy, wild populations of Pacific seabirds. Of the 13 species examined, 9 were from the Family Alcidae (N = 122 individuals) and the remainder (N = 29) from the Families Phalacrocoracidae, Laridae, and Procellariidae. Three of 8 hematological parameters (total white blood cell count, lymphocyte count and eosinophil count) differed significantly among species, as did 9 of 13 plasma biochemical parameters (alkaline phosphatase, aspartate aminotransferase, creatine kinase, cholesterol, glucose, lactate dehydrogenase, total bilirubin, total protein and field total protein). There were no differences among species for packed cell volume, buffy coat, cell counts of heterophils, monoqtes and basophils, or for concentrations of alanine aminotransferase, triglycerides, uric acid and calcium. Plasma calcium concentration, triglyceride levels and field total protein varied significantly between sexes, with females having higher mean concentrations of all 3 parameters. However, no significant relationships between measures of breeding condition (brood patch size, subcutaneous and mesenteric fat deposits, or ovarian follicle size and ovary weight) and calcium or alkaline phosphatase concentrations in female birds could be identified. Alanine aminotransferase and uric acid were the only analytes which did not differ significantly between species or sexes.

  9. Super champions, champions and almosts: Important differences and commonalities on the rocky road

    Directory of Open Access Journals (Sweden)

    Dave eCollins

    2016-01-01

    Full Text Available The real-world experiences of young athletes follow a non-linear and dynamic trajectory and there is growing recognition that facing and overcoming a degree of challenge is desirable for aspiring elites and as such, should be recognized and employed. However, there are some misunderstandings of this talent needs trauma perspective with some research focusing excessively or incorrectly on the incidence of life and sport challenge as a feature of effective talent development. The objective of the study was to examine what factors associated with such trauma experiences may or may not discriminate between high, medium and low achievers in sport, classified as super-champions, champions or almosts. A series of retrospective interviews were used with matched triads (i.e., super-champions, champions or almosts of performers (N = 54 from different sports. Data collection was organized in three phases. In the first phase, a graphic time line of each performer’s career was developed. The second phase explored the specific issues highlighted by each participant in a chronological sequence. The third phase was a retrospective reflection on traumatic motivators, coach/significant other inputs and psychological challenges experienced and skills employed. Data suggested qualitative differences between categories of performers, relating to several perceptual and experiential features of their development. No evidence was found for the necessity of major trauma as a feature of development. There was a lack of discrimination across categories of performers associated with the incidence of trauma and, more particularly, life or non-sport trauma. These findings suggest that differences between levels of adult achievement relate more to what performers bring to the challenges than what they experience. A periodized and progressive set of challenge, preceded and associated with specific skill development, would seem to offer the best pathway to success for the

  10. The importance of plant-soil interactions for N mineralisation in different soil types

    Science.gov (United States)

    Murphy, Conor; Paterson, Eric; Baggs, Elizabeth; Morley, Nicholas; Wall, David; Schulte, Rogier

    2013-04-01

    The last hundred years has seen major advancements in our knowledge of nitrogen mineralisation in soil, but key drivers and controls remain poorly understood. Due to an increase in the global population there is a higher demand on food production. To accommodate this demand agriculture has increased its use of N based fertilizers, but these pose risks for water quality and GHG emissions as N can be lost through nitrate leaching, ammonia volatilization, and denitrification processes (Velthof, et al., 2009). Therefore, understanding the underlying processes that determine the soils ability to supply N to the plant is vital for effective optimisation of N-fertilisation with crop demand. Carbon rich compounds exuded from plant roots to the rhizosphere, which are utilized by the microbial biomass and support activities including nutrient transformations, may be a key unaccounted for driver of N mineralisation. The main aim of this study was to study the impact of root exudates on turnover of C and N in soil, as mediated by the microbial community. Two soil types, known to contrast in N-mineralisation capacity, were used to determine relationships between C inputs, organic matter mineralisation (priming effects) and N fluxes. 15N and 13C stable isotope approaches were used to quantify the importance of rhizosphere processes on C and N mineralisation. Gross nitrogen mineralisation was measured using 15N pool dilution. Total soil CO2 efflux was measured and 13C isotope partitioning was applied to quantify SOM turnover and microbial biomass respiration. Also, 13C was traced through the microbial biomass (chloroform fumigation) to separate pool-substitution effects (apparent priming) from altered microbial utilisation of soil organic matter (real priming effects). Addition of labile carbon resulted in an increase in N-mineralisation from soil organic matter in both soils. Concurrent with this there was an increase in microbial biomass size, indicating that labile C elicited

  11. Refeeding syndrome in children with different clinical aetiology.

    Science.gov (United States)

    Lenicek Krleza, J; Misak, Z; Jadresin, O; Skaric, I

    2013-08-01

    Refeeding syndrome (RFS) is a well-described state of the series of metabolic and biochemical changes that can occur during the feeding of malnourished persons. The shifts in fluids and electrolytes can lead to complications during artificial feeding, which if not recognised and untreated can lead to death. Although the physiology and pathophysiology of RFS is well known, the circumstances under which the RFS appears, clinical manifestations and management of these patients are less clear. There are few published studies describing the occurrence of RFS in children. We describe two cases of RFS in children. The first case is a boy with unrecognised coeliac disease and second case is a girl with cerebral palsy. In both cases, the RFS has developed without clinical symptoms and it was shown only through laboratory findings. Electrolyte disturbances have been successfully corrected and treatment of the underlying disease continued.

  12. Surgical experimentation and clinical trials: differences and related ethical problems

    Directory of Open Access Journals (Sweden)

    Carlo Petrini

    Full Text Available Surgical techniques are not introduced into clinical practice as the result of randomised clinical trials (RCT, but usually through the gradual evolution of existing techniques or, more rarely, through audacious departures from the norm that are decided by a surgical team on the basis of experience. Sham surgery is held by some to be not only an ethically acceptable procedure but also a perfectly fit and proper one, as it could endow surgical experiments with the strict methodological and statistical precision typically associated with RCTs. This article first briefly examines some of the methodological aspects of both RCTs and surgical experiments and then offers a few considerations regarding the ethical issues raised by sham surgery.

  13. Surgical experimentation and clinical trials: differences and related ethical problems.

    Science.gov (United States)

    Petrini, Carlo

    2013-01-01

    Surgical techniques are not introduced into clinical practice as the result of randomised clinical trials (RCT), but usually through the gradual evolution of existing techniques or, more rarely, through audacious departures from the norm that are decided by a surgical team on the basis of experience. Sham surgery is held by some to be not only an ethically acceptable procedure but also a perfectly fit and proper one, as it could endow surgical experiments with the strict methodological and statistical precision typically associated with RCTs. This article first briefly examines some of the methodological aspects of both RCTs and surgical experiments and then offers a few considerations regarding the ethical issues raised by sham surgery.

  14. Modelling clinical systemic lupus erythematosus: similarities, differences and success stories.

    Science.gov (United States)

    Celhar, Teja; Fairhurst, Anna-Marie

    2016-12-24

    Mouse models of SLE have been indispensable tools to study disease pathogenesis, to identify genetic susceptibility loci and targets for drug development, and for preclinical testing of novel therapeutics. Recent insights into immunological mechanisms of disease progression have boosted a revival in SLE drug development. Despite promising results in mouse studies, many novel drugs have failed to meet clinical end points. This is probably because of the complexity of the disease, which is driven by polygenic predisposition and diverse environmental factors, resulting in a heterogeneous clinical presentation. Each mouse model recapitulates limited aspects of lupus, especially in terms of the mechanism underlying disease progression. The main mouse models have been fairly successful for the evaluation of broad-acting immunosuppressants. However, the advent of targeted therapeutics calls for a selection of the most appropriate model(s) for testing and, ultimately, identification of patients who will be most likely to respond.

  15. Modelling clinical systemic lupus erythematosus: similarities, differences and success stories

    Science.gov (United States)

    Celhar, Teja

    2017-01-01

    Abstract Mouse models of SLE have been indispensable tools to study disease pathogenesis, to identify genetic susceptibility loci and targets for drug development, and for preclinical testing of novel therapeutics. Recent insights into immunological mechanisms of disease progression have boosted a revival in SLE drug development. Despite promising results in mouse studies, many novel drugs have failed to meet clinical end points. This is probably because of the complexity of the disease, which is driven by polygenic predisposition and diverse environmental factors, resulting in a heterogeneous clinical presentation. Each mouse model recapitulates limited aspects of lupus, especially in terms of the mechanism underlying disease progression. The main mouse models have been fairly successful for the evaluation of broad-acting immunosuppressants. However, the advent of targeted therapeutics calls for a selection of the most appropriate model(s) for testing and, ultimately, identification of patients who will be most likely to respond. PMID:28013204

  16. Different clinical applications of bondable reinforcement ribbond in pediatric dentistry.

    Science.gov (United States)

    Tuloglu, Nuray; Bayrak, Sule; Tunc, Emine Sen

    2009-10-01

    Ribbond is a bondable, biocompatible, esthetic, translucent and easy-to-use reinforced ribbon. By virtue of its wide spectrum of intended properties, it enjoys various applications in clinical dentistry. This case report demonstrates usage of Ribbond as a space maintainer, a fixed partial denture with a natural tooth pontic, an endodontic post and cores and a splint material in children. Ribbond can be used as an alternative to conventional treatment in pediatric dentistry.

  17. Different Clinical Applications of Bondable Reinforcement Ribbond in Pediatric Dentistry

    Science.gov (United States)

    Tuloglu, Nuray; Bayrak, Sule; Tunc, Emine Sen

    2009-01-01

    Ribbond is a bondable, biocompatible, esthetic, translucent and easy-to-use reinforced ribbon. By virtue of its wide spectrum of intended properties, it enjoys various applications in clinical dentistry. This case report demonstrates usage of Ribbond as a space maintainer, a fixed partial denture with a natural tooth pontic, an endodontic post and cores and a splint material in children. Ribbond can be used as an alternative to conventional treatment in pediatric dentistry. PMID:19826607

  18. Gender, Parenthood and Wage Differences: The Importance of Time-Consuming Job Characteristics.

    Science.gov (United States)

    Magnusson, Charlotta; Nermo, Magnus

    2017-01-01

    Using data from the Swedish Level of Living Survey (2000, 2010), we investigate how the gender wage gap varies with occupational prestige and family status and also examine the extent to which this gap is explained by time-consuming working conditions. In addition, we investigate whether there is an association between parenthood, job characteristics and wage (as differentiated by gender). The analyses indicate that there are gender differences regarding prestige-based pay-offs among parents that are partly explained by fathers' greater access to employment characterized by time-consuming conditions. Separate analyses for men and women demonstrate the presence of a marriage wage premium for both genders, although only men have a parenthood wage premium. This fatherhood premium is however only present in high-prestigious occupations. Compared with childless men, fathers are also more advantaged in terms of access to jobs with time-consuming working conditions, but the wage gap between fathers and childless men is not explained by differences in access to such working conditions.

  19. The importance and the differences of bone morphogenetic proteins for osteoporotic hip fractures.

    Science.gov (United States)

    Dincel, V Ercan; Sepici-Dincel, Aylin

    2014-06-01

    Bone morphogenetic proteins (BMPs), major contributors to tissue repair, have become one of the most exciting fields in rheumatic and orthopaedic research. In our study we aimed to evaluate the relationship between osteoporotic hip fractures and the serum levels of BMPs to reveal their potential roles in the diagnosis of patients. The study group included 62 patients with osteoporotic hip fracture (Group 1; intertrochanteric fracture, Group 2; collum femoris fracture) and the control group. All fractures were due to low energy trauma, simple falls. For all subjects BMD measurements were in agreement for osteoporosis and no significant differences were observed between the two fracture groups. Biochemical markers; BMP-4 and BMP-7 (pg/mL) were determined by commercial Elisa kits from the serum samples. The mean and standard error values of serum samples for BMP-4 and BMP-7 in Group 1 (100.70 +/- 10.03, 74.41 +/- 6.31 respectively) and in Group 2 (112.34 +/- 11.52, 81.91 +/- 10.14 respectively) were not statistically different however for both groups only BMP-7 values increased statistically when compared to the control group. BMP-7 measurements may not only serve as potential biochemical markers for determining disease severity but also the increased levels, an osteogenic factor and bone stimulating agent in vivo, after trauma elevated levels are adaptive or protective and therefore may reduce the severity of the fracture.

  20. A generalized analytic solution to the win ratio to analyze a composite endpoint considering the clinical importance order among components.

    Science.gov (United States)

    Dong, Gaohong; Li, Di; Ballerstedt, Steffen; Vandemeulebroecke, Marc

    2016-09-01

    A composite endpoint consists of multiple endpoints combined in one outcome. It is frequently used as the primary endpoint in randomized clinical trials. There are two main disadvantages associated with the use of composite endpoints: a) in conventional analyses, all components are treated equally important; and b) in time-to-event analyses, the first event considered may not be the most important component. Recently Pocock et al. (2012) introduced the win ratio method to address these disadvantages. This method has two alternative approaches: the matched pair approach and the unmatched pair approach. In the unmatched pair approach, the confidence interval is constructed based on bootstrap resampling, and the hypothesis testing is based on the non-parametric method by Finkelstein and Schoenfeld (1999). Luo et al. (2015) developed a close-form variance estimator of the win ratio for the unmatched pair approach, based on a composite endpoint with two components and a specific algorithm determining winners, losers and ties. We extend the unmatched pair approach to provide a generalized analytical solution to both hypothesis testing and confidence interval construction for the win ratio, based on its logarithmic asymptotic distribution. This asymptotic distribution is derived via U-statistics following Wei and Johnson (1985). We perform simulations assessing the confidence intervals constructed based on our approach versus those per the bootstrap resampling and per Luo et al. We have also applied our approach to a liver transplant Phase III study. This application and the simulation studies show that the win ratio can be a better statistical measure than the odds ratio when the importance order among components matters; and the method per our approach and that by Luo et al., although derived based on large sample theory, are not limited to a large sample, but are also good for relatively small sample sizes. Different from Pocock et al. and Luo et al., our approach is a

  1. Import and visualization of clinical medical imagery into multiuser VR environments

    Science.gov (United States)

    Mehrle, Andreas H.; Freysinger, Wolfgang; Kikinis, Ron; Gunkel, Andreas; Kral, Florian

    2005-03-01

    The graphical representation of three-dimensional data obtained from tomographic imaging has been the central problem since this technology is available. Neither the representation as a set of two-dimensional slices nor the 2D projection of three-dimensional models yields satisfactory results. In this paper a way is outlined which permits the investigation of volumetric clinical data obtained from standard CT, MR, PET, SPECT or experimental very high resolution CT-scanners in a three dimensional environment within a few worksteps. Volumetric datasets are converted into surface data (segmentation process) using the 3D-Slicer software tool and saved as .vtk files and exported as a collection of primitives in any common file format (.iv, .pfb). Subsequently this files can be displayed and manipulated in the CAVE virtual reality center. The CAVE is a multiuser walkable virtual room consisting of several walls on which stereoscopic images are projected by rear panel beamers. Adequate tracking of the head position and separate image calculation for each eye yields a vivid impression for one or several users. With the use of a seperately tracked 6D joystick manipulations such as rotation, translation, zooming, decomposition or highlighting can be done intuitively. The usage of the CAVE technology opens new possibilities especially in surgical training ("hands-on-effect") and as an educational tool (availability of pathological data). Unlike concurring technologies the CAVE permits a walk-through into the virtual scene but preserves enough physical perception to allow interaction between multiple users, e.g. gestures and movements. By training in a virtual environment on one hand the learning process of students in complex anatomic findings may be improved considerably and on the other hand unaccustomed views such as the one through a microscope or endoscope can be trained in advance. The availability of low-cost PC based CAVE-like systems and the rapidly decreasing price

  2. Importance of high-throughput cell separation technologies for genomics/proteomics-based clinical diagnostics

    Science.gov (United States)

    Leary, James F.; Szaniszlo, Peter; Prow, Tarl W.; Reece, Lisa M.; Wang, Nan; Asmuth, David M.

    2002-06-01

    be about 100 times more sensitive than they are now to be able to do many biologically and biomedically meaningful experiments and clinical tests.

  3. Paying for Joint or Single Audits? The Importance of Auditor Pairings and Differences in Technology Efficiency

    DEFF Research Database (Denmark)

    Holm, Claus; Thinggaard, Frank

    2016-01-01

    In the first theoretical paper on joint audits, Deng et al. predict that the audit fees for joint audits will be lower than those from single audits. However, the prediction depends on the combination of audit firms involved in the joint audit and on their technology efficiency as well...... as on the liability involved. This paper is the first to empirically test the predictions. Our findings from Denmark do not indicate any general difference in audit fees when two audit firms – regardless of combination and technology efficiency – conduct the statutory audit compared to a single Big audit firm....... The results indicate the existence of fixed coordination costs in joint audits. We do, however, find higher audit fees in Big-Small joint audits when the Small audit firm has a share of less than 25 per cent. This may reflect free-riding concerns....

  4. Determining minimally important score differences in scales of the Copenhagen Psychosocial Questionnaire

    DEFF Research Database (Denmark)

    Pejtersen, Jan Hyld; Bjorner, Jakob Bue; Hasle, Peter

    2010-01-01

    the following MID values for the COPSOQ scales: ''Quantitative demands'', 0.3 SD; ''Influence'', 0.2 SD; ''Predictability'', 0.3 SD; ''Social support from colleagues'', 0.3 SD; ''Social support from supervisor'', 0.7 SD; and ''Job satisfaction'', 0.4 SD. For all other COPSOQ scales, where we do not have anchor......). On the basis of the population survey, the MID for each COPSOQ scale was calculated as one-half of a standard deviation (0.5 SD). For the core COPSOQ scales on ''Quantitative demands'', ''Influence at work'', ''Predictability'', ''Social support (from colleagues and supervisors, respectively)'', and ''Job...... satisfaction'', the MIDs were evaluated in the intervention study, where score differences for the scales were linked to the respondents' global self-evaluation of the impact of the interventions. The scales were scored from 0 to 100 in both studies. RESULTS: The MIDs calculated as 0.5 SD were, on average, 9...

  5. The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities.

    Science.gov (United States)

    Klein, Michael C; Kaczorowski, Janusz; Hall, Wendy A; Fraser, William; Liston, Robert M; Eftekhary, Sahba; Brant, Rollin; Mâsse, Louise C; Rosinski, Jessica; Mehrabadi, Azar; Baradaran, Nazli; Tomkinson, Jocelyn; Dore, Sharon; McNiven, Patricia C; Saxell, Lee; Lindstrom, Kathie; Grant, Jalana; Chamberlaine, Aoife

    2009-09-01

    Collaborative, interdisciplinary care models have the potential to improve maternity care. Differing attitudes of maternity care providers may impede this process. We sought to examine the attitudes of Canadian maternity care practitioners towards labour and birth. We performed a cross-sectional web- and paper-based survey of 549 obstetricians, 897 family physicians (400 antepartum only, 497 intrapartum), 545 nurses, 400 midwives, and 192 doulas. Participants responded to 43 Likert-type attitudinal questions. Nine themes were identified: electronic fetal monitoring, epidural analgesia, episiotomy, doula roles, Caesarean section benefits, factors decreasing Caesarean section rates, maternal choice, fear of vaginal birth, and safety of birth mode and place. Obstetrician scores reflected positive attitudes towards use of technology, in contrast to midwives' and doulas' scores. Family physicians providing only antenatal care had attitudinal scores similar to obstetricians; family physicians practising intrapartum care and nurses had intermediate scores on technology. Obstetricians' scores indicated that they had the least positive attitudes towards home birth, women's roles in their own births, and doula care, and they were the most concerned about the consequences of vaginal birth. Midwives' and doulas' scores reflected opposing views on these issues. Although 71% of obstetricians supported regulated midwifery, 88.9% were against home birth. Substantial numbers of each group held attitudes similar to dominant attitudes from other disciplines. To develop effective team practice, efforts to reconcile differing attitudes towards labour and birth are needed. However, the overlap in attitudes between disciplines holds promise for a basis upon which to begin shared problem solving and collaboration.

  6. [Dehydroepiandrosterone (DHEA)--structure, clinical importance and the role in human body].

    Science.gov (United States)

    Zdrojewicz, Z; Ciszko, B

    2001-01-01

    DHEA and DHEA-S are hormones synthetized primarily by the adrenal cortex. The levels oh this hormones are systematically decreased, beginning from the fourth life decade. The levels of this hormones are also abberrated as a consequence of divorce systematical diseases like cardiovascular diseases, skeletal diseases, diabetes mellitus or obesity. This hormones, probably, have antiaheromatic facilities. There are also data suggesting their influence on stimulation of immunological system. It is already confirmed that the levels of this hormones are modified in congenital function disorders that are present in different diseases, like Alzheimer diseases, and oral administration of DHEA can improves the memory. Presumably DHEA-S have also anticarcinogenic facilities. The levels of this hormones can be also a marker monitoring the course of pregnancy. There are still a lot of discrepancies between results of different studies and it is very difficult to describe their role in human body. Because their levels are decreased with ageing process, this observation makes the researchers call them as the "youth hormones".

  7. Atomic Force Microscopy Reveals Important Differences in Axonal Resistance to Injury

    Science.gov (United States)

    Magdesian, Margaret H.; Sanchez, Fernando S.; Lopez, Monserratt; Thostrup, Peter; Durisic, Nela; Belkaid, Wiam; Liazoghli, Dalinda; Grütter, Peter; Colman, David R.

    2012-01-01

    Axonal degeneration after traumatic brain injury and nerve compression is considered a common underlying cause of temporary as well as permanent disability. Because a proper functioning of neural network requires phase coherence of all components, even subtle changes in circuitry may lead to network failure. However, it is still not possible to determine which axons will recover or degenerate after injury. Several groups have studied the pressure threshold for axonal injury within a nerve, but difficulty accessing the injured region; insufficient imaging methods and the extremely small dimensions involved have prevented the evaluation of the response of individual axons to injury. We combined microfluidics with atomic force microscopy and in vivo imaging to estimate the threshold force required to 1), uncouple axonal transport without impairing axonal survival, and 2), compromise axonal survival in both individual and bundled axons. We found that rat hippocampal axons completely recover axonal transport with no detectable axonal loss when compressed with pressures up to 65 ± 30 Pa for 10 min, while dorsal root ganglia axons can resist to pressures up to 540 ± 220 Pa. We investigated the reasons for the differential susceptibility of hippocampal and DRG axons to mechanical injury and estimated the elasticity of live axons. We found that dorsal root ganglia axons have a 20% lower elastic modulus than hippocampal axons. Our results emphasize the importance of the integrity of the axonal cytoskeleton in deciding the axonal fate after damage and open up new avenues to improve injury diagnosis and to identify ways to protect axons. PMID:22947856

  8. Situational judgment tests reliably measure professional attributes important for clinical practice

    Directory of Open Access Journals (Sweden)

    Petty-Saphon K

    2016-12-01

    Full Text Available Katie Petty-Saphon,1 Kim A Walker,2 Fiona Patterson,3,4 Vicki Ashworth,4 Helena Edwards4 1Medical Schools Council, London, UK; 2United Kingdom Foundation Programme Office, Birmingham, UK; 3Department of Psychology, University of Cambridge, Cambridge, UK; 4Work Psychology Group, Derby, UK Abstract: Over the course of more than 40 years, international research has consistently shown situational judgment tests (SJTs to be a reliable and valid selection method for assessing a range of professional attributes. However, SJTs still represent a relatively new selection method within the medical profession, and as such it is to be expected that applicant reactions will vary. In this Expert Opinion piece, we respond to Najim et al’s article “The situational judgement test: a student’s worst nightmare” by highlighting three key clarifications. We outline that 1 the UK Foundation Programme’s SJT deliberately measures only a subset (five of the nine professional attributes important for the role of Foundation Trainee doctor, 2 these attributes are measured in addition to academic attainment, and 3 the SJT represents a cost-effective approach to selection rather than attempting to interview approximately 8,000 candidates each year, which would be logistically impossible. We present these points to inform future research and encourage debate, and conclude that the SJT is an appropriate and fair measurement method to be used as one part of selection to the UK Foundation Programme. Keywords: situational judgment test, reliability, validity, fairness, candidate perceptions

  9. Use of goal attainment scaling in measuring clinically important change in the frail elderly.

    Science.gov (United States)

    Rockwood, K; Stolee, P; Fox, R A

    1993-10-01

    The selection of appropriate outcome measures is important in evaluating specialized geriatric programs, but how the various measures compare, and which are most appropriate, are matters still largely unexplored. We compared several outcome measures, including goal attainment scaling, to assess their sensitivity to changes in the health status of frail elderly patients admitted to two geriatric medicine wards. GAS is a measurement approach which accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-five patients (mean age 81 years, 30 females) received comprehensive assessments. GAS yielded a mean 5 goals per patient. The mean gain in the GAS score was 22 points (SD = 7) which was compared with the change in the Barthel Index (r = 0.59), the Functional Independence Measure (r = 0.45), the Physical Self-Maintenance Scale (r = 0.54), the Katz Activities of Daily Living Index (r = 0.49) and the Spitzer Quality of Life Index (r = 0.38). The inter-rater reliability of scoring the GAS follow-up guides was 0.91. Using a relative efficiency statistic, GAS proved more efficient than any other measure. The effect size statistic also demonstrated an increased responsiveness to change of GAS compared with standard measures. GAS is an individualized measurement approach which shows promise as a responsive measure in frail elderly patients.

  10. Zika virus infections imported to Italy: clinical, immunological and virological findings, and public health implications.

    Science.gov (United States)

    Zammarchi, Lorenzo; Stella, Giulia; Mantella, Antonia; Bartolozzi, Dario; Tappe, Dennis; Günther, Stephan; Oestereich, Lisa; Cadar, Daniel; Muñoz-Fontela, César; Bartoloni, Alessandro; Schmidt-Chanasit, Jonas

    2015-02-01

    We report the first two cases of laboratory confirmed Zika virus (ZIKV) infections imported into Italy from French Polynesia. Both patients presented with low grade fever, malaise, conjunctivitis, myalgia, arthralgia, ankle oedema, and axillary and inguinal lymphadenopathy. One patient showed leukopenia with relative monocytosis and thrombocytopenia. The diagnosis was based on ZIKV seroconversion in both cases and on ZIKV RNA detection in one patient from acute serum sample. Sera from both patients exhibited cross-reactivity with dengue virus antigens. Our immunological analysis demonstrated that recovery from ZIKV infection is associated with restoration of normal numbers of immune cells in the periphery as well as with normal function of antigen-presenting cells. ZIKV is an emerging arbovirus, which has recently spread extensively in tourist destinations on several West Pacific islands. Returning viremic travelers may ignite autochthonous infections in countries like Italy, which are infested by Aedes albopictus, a suitable vector for ZIKV. The role of clinicians is crucial and includes early diagnosis and timely notification of public health authorities in order to quickly implement adequate focal vector control measurements.

  11. Clinical trials and systematic reviews addressing similar interventions for the same condition do not consider similar outcomes to be important: a case study in HIV/AIDS.

    Science.gov (United States)

    Saldanha, Ian J; Li, Tianjing; Yang, Cui; Owczarzak, Jill; Williamson, Paula R; Dickersin, Kay

    2017-04-01

    The usefulness of clinical trials and systematic reviews is compromised when they report different outcomes. We compared outcomes in reviews of HIV/AIDS and the trials included in the reviews. We examined all Cochrane reviews of HIV/AIDS (as of June 2013) that included ≥1 trial and the trials that the reviews included. We compared outcomes within subgroups defined by type of intervention: clinical management, biomedical prevention, behavioral prevention, and health services. We included 84 reviews that encompassed 524 trials. Although the median number of outcomes per trial (8) and per review (7.5) was similar, the trials reported a considerably greater number of unique outcomes than the reviews (779 vs. 218), ranging from 2.3 times greater (clinical management) to 5.4 times greater (behavioral prevention). High proportions of trial outcomes were not in any review: 68% (clinical management) to 83% (behavioral prevention). Lower proportions of review outcomes were not in any trial: 11% (clinical management) to 39% (health services). Outcomes in trials and reviews are not well aligned for appropriate inclusion of trial results in reviews and meta-analyses. Differences in perspectives, goals, and constraints between trialists and reviewers may explain differences in outcomes they consider important. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  12. African Americans and participation in clinical trials: differences in beliefs and attitudes by gender.

    Science.gov (United States)

    BeLue, R; Taylor-Richardson, K D; Lin, J; Rivera, A T; Grandison, D

    2006-12-01

    To explore gender differences in perceptions of 1) barriers and motivators to participation in clinical trials and perceived need of clinical trials and 2) perceptions of risks and benefits of participation in clinical trials in African American men and women. Focus groups were conducted among African American participants by gender. A total of 67 African American participated in the focus groups. All focus groups were audio-taped and transcribed verbatim. Data analysis was performed by combining the key elements of grounded theory and content analysis with the assistance of the qualitative software ATLAS.ti 5.0. Different themes emerged for men versus women. The business and economic of research were important to male participants. The researcher-participant relationship emerged as one of the strongest themes related to potential female participation in research. Focus group results indicate that African American men and women present different preferences, beliefs and barriers to participation. Men expressed the desire to know information on funding issues, financial benefit and impact of the research. Women expressed the desire to be treated respectfully and as an individual as opposed to just a study subject. Integrating gender preferences into researcher-participant interactions, advertisement, informed consent delivery and advertisement of research studies may lead to increased participation rates. Discussing and presenting relevant information on clinical research funding mechanisms, and the business of clinical research with potential participants may be helpful in building trust with the researcher and the research team. Creating a process for information exchange and methods to minimize the power imbalance between the researcher and participant may also build trust and help participants feel more comfortable to participate in research.

  13. [Sagittal Balance of the Spine--Clinical Importance and Radiographic Assessment].

    Science.gov (United States)

    Decker, S; Müller, C W; Omar, M; Krettek, C; Schwab, F; Trobisch, P D

    2016-04-01

    Sagittal deformities of the spine frequently result in back pain, as patients have to expend much energy in compensation. The sagittal alignment of the spine is defined by its curvatures (lordosis and kyphosis) relative to the position of the pelvis. Diagnostic assessment is based on full spine a. p. and lateral X-rays. The sagittal balance is primarily described by different angles that can be measured, e.g. lumbar lordosis, pelvic incidence, pelvic tilt and thoracic kyphosis. The quality of life can best be estimated by subtracting lumbar lordosis from the pelvic incidence. However, initial evaluation of the sagittal balance can also be based on the sagittal vertical axis. The severity of imbalance can be described by the sagittal vertical axis and the pelvic tilt, but surgical therapy necessitates a more profound analysis, which can be based on the SRS-Schwab classification. Georg Thieme Verlag KG Stuttgart · New York.

  14. Partitioning of metals in different binding phases of tropical estuarine sediments: importance of metal chemistry.

    Science.gov (United States)

    Chakraborty, Parthasarathi; Chakraborty, Sucharita; Vudamala, Krushna; Sarkar, Arindam; Nath, B Nagender

    2016-02-01

    Distribution of metals in different binding phases of estuarine sediments provides chemically significant description of metal-sediment interactions. This study describes the influences of ligand field stabilization energy (LFSE), Jahn-Teller effect, and water exchange rate (k-w) on metal distribution in different binding phases of estuarine sediments. It was found that Cu had highest affinity for organic binding phases in the studied sediments followed by Ni and Pb. However, Pb showed strong association with Fe/Mn oxide phases followed by Ni and Cu. Faster k-w of Cu (II) (1 × 10(9) s(-1)) increased the rate of complex formation of Cu(2+) ion with ligand in the organic phases. The Cu-ligand (from organic phase) complexes gained extra stability by the Jahn-Teller effect. The combined effects of these two phenomena and high ionic potential increased the association of Cu with the organic phases of the sediments than Ni and Pb. The smaller ionic radii of Ni(2+) (0.72 Å) than Pb(2+) (1.20 Å) increase the stability of Ni-ligand complexes in the organic phase of the sediments. High LFSE of Ni(II) (compared with Pb(2+) ions) also make Ni-organic complexes increasingly stable than Pb. High k-w (7 × 10(9) s(-1)) of Pb did not help it to associate with organic phases in the sediments. The high concentration of Pb in the Fe/Mn oxyhydroxide binding phase was probably due to co-precipitation of Pb(2+) and Fe(3+). High surface area or site availability for Pb(2+) ion on Fe oxyhydroxide phase was probably responsible for the high concentration of Pb in Fe/Mn oxyhydroxide phase. Increasing concentrations of Cu in organic phases with the increasing Cu loading suggest that enough binding sites were available for Cu in the organic binding phases of the sediments. This study also describes the influence of nature of sedimentary organic carbon (terrestrial and marine derived OC) in controlling these metal distribution and speciation in marine sediment.

  15. Demonstrating the importance of phytochemical profile of different teas on antioxidant and anti-inflammatory capacities

    Directory of Open Access Journals (Sweden)

    Xiu-Min Chen

    2017-06-01

    Full Text Available Background:Indigenous or traditional aqueous plant extractsare commonly used by nearly80% of the world’s population for primary health needs.Accordingly,teas such as Camellia sinensisand herbal teaswere characterized fortheirphytochemical content and potential to offerspecific bioactivities that could benefit human health by mitigating oxidative stress andinflammation.Methods:In the present study, we comparedthe phytochemical profiles, antioxidant,and anti-inflammatory activities of four Camellia sinensisteas,including white, green, oolong, black, andtwo herbal teassuch as Rooibos and Yerba mate,which are producedand consumed by different populationsworldwide. We alsostudied the impact oftheRooibos tea on the production of inflammatory mediators, including nitric oxide(NO, inducible nitric oxide synthase (iNOS, cyclooxygenase 2 (COX-2,and different cytokinesin Raw 264.7 cells, bothwith or without interferon γ (IFN-γand lipopolysaccharide (LPSstimulation.Results:White tea hadthe highest total phenolic content(TPCand antioxidantactivity among the six teasthat wereexamined. In contrast, Rooibos tea hadthe lowest TPC,antioxidant,and anti-inflammatory activities. Yerba mate tea exhibitedthe greatest potential to inhibit NO production in IFN-γ and LPS-induced Raw 264.7 cells.The anti-inflammatory activity of teas was discoveredto be correlated withantioxidant activity and phytochemical composition.Among thesix teasexamined, only Rooibos tea was found to induce NO in unstimulated Raw 264.7 cells. Under basal conditions, Rooibos tea inducedinterleukin-1α (IL-1α, IL-1β, IL-6, IL-10, granulocyte-colony stimulating factor (G-CSF, granulocyte macrophage colony-stimulating factor (GM-CSF,tumor necrosis factor-alpha (TNF-α,iNOS,and COX-2 production. However, Rooibos tea alsodemonstrateda dose-dependent inhibition of IL-6, IL-10, iNOS,and COX-2 expression in stimulated Raw 264.7 cells. Although a high concentration of Rooibos tea was effective in

  16. [Anaesthetists learn--do institutions also learn? Importance of institutional learning and corporate culture in clinics].

    Science.gov (United States)

    Schüpfer, G; Gfrörer, R; Schleppers, A

    2007-10-01

    In only a few contexts is the need for substantial learning more pronounced than in health care. For a health care provider, the ability to learn is essential in a changing environment. Although individual humans are programmed to learn naturally, organisations are not. Learning that is limited to individual professions and traditional approaches to continuing medical education is not sufficient to bring about substantial changes in the learning capacity of an institution. Also, organisational learning is an important issue for anaesthesia departments. Future success of an organisation often depends on new capabilities and competencies. Organisational learning is the capacity or processes within an organisation to maintain or improve performance based on experience. Learning is seen as a system-level phenomenon as it stays in the organisation regardless of the players involved. Experience from other industries shows that learning strategies tend to focus on single loop learning, with relatively little double loop learning and virtually no meta-learning or non-learning. The emphasis on team delivery of health care reinforces the need for team learning. Learning organisations make learning an intrinsic part of their organisations and are a place where people continually learn how to learn together. Organisational learning practice can help to improve existing skills and competencies and to change outdated assumptions, procedures and structures. So far, learning theory has been ignored in medicine, due to a wide variety of complex political, economic, social, organisational culture and medical factors that prevent innovation and resist change. The organisational culture is central to every stage of the learning process. Learning organisations move beyond simple employee training into organisational problem solving, innovation and learning. Therefore, teamwork and leadership are necessary. Successful organisations change the competencies of individuals, the systems

  17. Expression of IAP family proteins and its clinical importance in breast cancer patients.

    Science.gov (United States)

    Pluta, P; Jeziorski, A; Cebula-Obrzut, A Pluta B; Wierzbowska, A; Piekarski, J; Smolewski, P

    2015-01-01

    Inhibitor of apoptosis (IAP) family proteins is involved in mechanisms of resistance to apoptosis in various cancer cells. The aim of this study was to assess the expression of selected IAP proteins such as XIAP, cIAP-1, cIAP-2 and survivin in breast cancer patients and evaluates their relationship with the prognostic and predictive factors and their impact to overall survival (OS) and progression free survival (PFS). The study was conducted with the use of tissue samples prospectively collected from 92 previously untreated female breast cancer patients. The control encompassed 10 fibroadenoma patients. The expression of XIAP, cIAP-1, cIAP-2 and survivin was assessed using flow multicolor cytometry. XIAP expression was present in 99 % of the breast cancer patients (91/92) with the median expression 13.65% (range 1-66.8%). Expression of XIAP in breast cancer was significantly higher compared to the control group (p=0.006). Median expression of cIAP-1, cIAP-2 and survivin in the study group was 25.95% (range 0.8-83.7%), 16.7% (range 1-53.2%) and 4.6% (range 0-43%) respectively. In the rank Spearman test, strong correlations (pproteins and survival. However, low expression of XIAP in breast cancer showed trend to longer PFS (p=0.08). XIAP, cIAP-1 cIAP-2 and survivin participate in antiapoptotic mechanisms in breast cancer and XIAP and survivin seem to have the most significant prognostic importance. Further studies are needed to establish more complete prognostic and predictive values of IAP family proteins in breast cancer patients.

  18. Tasks of research in forensic medicine - different study types in clinical research and forensic medicine.

    Science.gov (United States)

    Madea, Burkhard; Saukko, Pekka; Musshoff, Frank

    2007-01-17

    In the last years the research output of forensic medicine has sometimes been regarded as insufficient and as of poor quality, especially when parameters as impact factors and external funding were taken into account. However, forensic medicine has different tasks compared to clinical medicine. The main difference between basic subjects, clinical and forensic medicine is not a lack of scientific efficiency in forensic medicine but is a result of the questions asked, the available methods and specific aims. In contrast to natural-scientific research, forensic science has furthermore important intersections with arts and socio-scientific disciplines. Etiologic and pathogenetic research is of only limited relevance in forensic medicine. Thus, forensic medicine is excluded from these research fields, which are mainly supported by external funding. In forensic medicine research mainly means applied research regarding findings, the probative value and reconstruction as well as examination at different points of intersection between medicine and law. Clinical types of research such as controlled randomised, prospective cross-sectional, cohort or case-control studies can only rarely be applied in forensic medicine due to the area specific research fields (e.g. thantatology, violent death, vitality, traffic medicine, analytical toxicology, hemogenetics and stain analysis). The types of studies which are successfully established in forensic medicine are comparison of methods, sensitivity studies, validation of methods, kinetic examinations etc. Tasks of research in forensic medicine and study types, which may be applied will be addressed.

  19. Hypokalemic periodic paralysis; two different genes responsible for similar clinical manifestations

    Directory of Open Access Journals (Sweden)

    Hunmin Kim

    2011-11-01

    Full Text Available Primary hypokalemic periodic paralysis (HOKPP is an autosomal dominant disorder manifesting as recurrent periodic flaccid paralysis and concomitant hypokalemia. HOKPP is divided into type 1 and type 2 based on the causative gene. Although 2 different ion channels have been identified as the molecular genetic cause of HOKPP, the clinical manifestations between the 2 groups are similar. We report the cases of 2 patients with HOKPP who both presented with typical clinical manifestations, but with mutations in 2 different genes (CACNA1S p.Arg528His and SCN4A p.Arg672His. Despite the similar clinical manifestations, there were differences in the response to acetazolamide treatment between certain genotypes of SCN4A mutations and CACNA1S mutations. We identified p.Arg672His in the SCN4A gene of patient 2 immediately after the first attack through a molecular genetic testing strategy. Molecular genetic diagnosis is important for genetic counseling and selecting preventive treatment.

  20. Antifungal activity of different neem leaf extracts and the nimonol against some important human pathogens

    Directory of Open Access Journals (Sweden)

    D.A Mahmoud

    2011-09-01

    Full Text Available This study was conducted to evaluate the effect of aqueous, ethanolic and ethyl acetate extracts from neem leaves on growth of some human pathogens (Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Aspergillus terreus, Candida albicans and Microsporum gypseum in vitro. Different concentrations (5, 10, 15 and 20% prepared from these extracts inhibited the growth of the test pathogens and the effect gradually increased with concentration. The 20% ethyl acetate extract gave the strongest inhibition compared with the activity obtained by the same concentration of the other extracts. High Performance Liquid Chromatography (HPLC analysis of ethyl acetate extract showed the presence of a main component (nimonol which was purified and chemically confirmed by Nuclear Magnetic Resonance (NMR spectroscopic analysis. The 20% ethyl acetate extract lost a part of its antifungal effect after pooling out the nimonol and this loss in activity was variable on test pathogens. The purified nimonol as a separate compound did not show any antifungal activity when assayed against all the six fungal pathogens.

  1. Different types of inks having certain medicolegal importance: Deciphering the faded and physically erased handwriting

    Directory of Open Access Journals (Sweden)

    Manal Abd-ElAziz Abd-ElZaher

    2014-06-01

    Full Text Available Disappearing ink is a type of ink which could be used to forge documents as it will fade away without any trace within 40–65 h. Erasable ink is another type of ink easily removed by certain rubbers incorporated in each pen. Both types of inks were applied separately on different types of papers (checks, standard white foolscap, and plain white A4 paper. For vanishing ink, it was observed visually in the first 6 h and then every 6 h. It was found that the vanishing ink disappeared completely within 2 h on checks, 36 h on standard white foolscap paper, and 40 h on plain white A4 paper. For erasable ink, the written strokes were manipulated manually using the incorporated eraser. Deciphering the faded writing failed by the conventional methods, but oblique light can reveal the indentation marks. The faded writing became visible when treated with weak alkaline (NaOH solutions. Erasable ink was deciphered with the aid of infra-red radiation combined with VSC-6000 as clear white traces against red fluorescence. It was concluded that the use of a weak (NaOH solution is an effective method for revealing the faded writing, and the infra-red illumination is also effective.

  2. Antifungal activity of different neem leaf extracts and the nimonol against some important human pathogens

    Science.gov (United States)

    Mahmoud, D.A.; Hassanein, N.M.; Youssef, K.A.; Abou Zeid, M.A.

    2011-01-01

    This study was conducted to evaluate the effect of aqueous, ethanolic and ethyl acetate extracts from neem leaves on growth of some human pathogens (Aspergillus flavus, Aspergillus fumigatus, Aspergillus niger, Aspergillus terreus, Candida albicans and Microsporum gypseum) in vitro. Different concentrations (5, 10, 15 and 20%) prepared from these extracts inhibited the growth of the test pathogens and the effect gradually increased with concentration. The 20% ethyl acetate extract gave the strongest inhibition compared with the activity obtained by the same concentration of the other extracts. High Performance Liquid Chromatography (HPLC) analysis of ethyl acetate extract showed the presence of a main component (nimonol) which was purified and chemically confirmed by Nuclear Magnetic Resonance (NMR) spectroscopic analysis. The 20% ethyl acetate extract lost a part of its antifungal effect after pooling out the nimonol and this loss in activity was variable on test pathogens. The purified nimonol as a separate compound did not show any antifungal activity when assayed against all the six fungal pathogens. PMID:24031718

  3. Individualism: a valid and important dimension of cultural differences between nations.

    Science.gov (United States)

    Schimmack, Ulrich; Oishi, Shigehiro; Diener, Ed

    2005-01-01

    Oyserman, Coon, and Kemmelmeier's (2002) meta-analysis suggested problems in the measurement of individualism and collectivism. Studies using Hofstede's individualism scores show little convergent validity with more recent measures of individualism and collectivism. We propose that the lack of convergent validity is due to national differences in response styles. Whereas Hofstede statistically controlled for response styles, Oyserman et al.'s meta-analysis relied on uncorrected ratings. Data from an international student survey demonstrated convergent validity between Hofstede's individualism dimension and horizontal individualism when response styles were statistically controlled, whereas uncorrected scores correlated highly with the individualism scores in Oyserman et al.'s meta-analysis. Uncorrected horizontal individualism scores and meta-analytic individualism scores did not correlate significantly with nations' development, whereas corrected horizontal individualism scores and Hofstede's individualism dimension were significantly correlated with development. This pattern of results suggests that individualism is a valid construct for cross-cultural comparisons, but that the measurement of this construct needs improvement.

  4. Individualization of psychological training and its importance at different stages of many years’ perfection in tennis

    Directory of Open Access Journals (Sweden)

    Vysochina N.L.

    2015-08-01

    Full Text Available Purpose: to determine significance of individualized approach during psychological training at different stages of many years’ perfection in tennis. The tasks of the research were studying of place and role of psychological component in general system of tennis players’ sport training as well as determination of specificities of individualized approach during 14-15 years old and elite tennis players’ psychological training. Material: In the research 24 experts, coaches of combined teams and clubs, elite tennis players took part. Results: Role of psychological training in general system of many years’ perfection has been determined. We also found out that individualization of psychological training in modern tennis is not paid sufficient attention to at present. Most of the questioned respondents pointed, that such training is conducted mainly with elite sportsmen (42%. Only 14% noted that individual psychological training is carried out at basic stages of many years’ perfection. Conclusions: Principle of individualization is a determining one in the course of sportsmen’s training at stages of many years’ perfection. About 86% of experts stressed on significance of application of individualized approach in work with tennis players. Consideration of tennis players’ individual features during psychological training is a compulsory matter in increasing of effectiveness of sportsmen’s training and competition functioning.

  5. A reappraisal of the prevalence and clinical importance of left ventricular false tendons in children and adults.

    OpenAIRE

    1986-01-01

    The prevalence and clinical importance of false tendons were studied in 488 consecutive patients referred for echocardiography. Two hundred and eighty three (58%) patients had acquired heart disease, 91 (19%) had congenital heart disease, and 114 (23%) had normal hearts. Sixty six patients with normal hearts had innocent systolic murmurs and one had recurrent ventricular tachycardia. The overall prevalence of false tendons was 25% compared with 1.6% in a retrospective analysis of 763 cross se...

  6. 2-(Nitroaryl)benzothiazole and benzoxazole derivatives as fluorogenic substrates for the detection of nitroreductase activity in clinically important microorganisms.

    Science.gov (United States)

    Cellier, Marie; Gignoux, Amandine; James, Arthur L; Orenga, Sylvain; Perry, John D; Robinson, Shaun N; Stanforth, Stephen P; Turnbull, Graeme

    2015-12-15

    A series of carboxy-substituted 2-(nitroaryl)benzothiazole derivatives and carboxy-substituted 2-(nitroaryl)benzoxazole derivatives were prepared and evaluated as potential nitroreductase substrates for the purpose of detecting clinically important microorganisms. Several of the substrates produced highly fluorescent colonies with the majority of a panel of 10 Gram-negative bacteria and also with two of a panel of 8 Gram-positive bacteria.

  7. Laboratory diagnosis, clinical manifestations, epidemiological situation and public health importance of cutaneous leishmaniasis in Shushtar County, Southwestern Iran

    Institute of Scientific and Technical Information of China (English)

    Hamid Kassiri; Ali kassiri; Masoud Lotfi; Parvaneh Farajifard; Elnaz Kassiri

    2014-01-01

    Objective:To investigate as a descriptive and cross sectional study on epidemiology, the laboratory diagnosis and clinical manifestation ofCutaneousLeishmaniasis(CL) inShushtar County.Methods:The investigation was carried out on referrals from different districts of ShushtarCounty and was diagnosed based on their ulcer clinical manifestations withCL using laboratory method.This study was actively developed over the period of2008 to2010.Surface of a clean slide was pressed on to the scraped part of the lesions and moved along to produce a smear on the slide.The slides were fixed with methanol, stained with standardGiemsa, and examined carefully under high magnification for an hour or more to look for amastigotes by a trained person.Two smears were prepared and examined from each patient and data were collected using different correlative patients characteristics to analyze information.The essential records including residential area, type and location of lesion, age, sex, the number of ulcers, season, and the history of traveling to endemic areas for this disease were carefully gathered. Results:Parasites presumed to beLeishmania major (L. major) based on the existence of a large vacuole in the cytoplasm.Totally206 patients were referred to the central laboratory and their manifestation lesions were clinically examined.Of these,64 cases(31.1%) were female and142 cases(68.9%) were male.The findings documented that the rate of incidence ofCL was in fall61 cases(29/6%) and winter80 cases(38/8%), which is one of the most important characteristics of zoonoticCL.Sixty-eight cases(33%) had ulcers on hands,63 cases(30.6%) on feet and30 cases (14.6%) on hands and feet.A total of120 patients(58.3%) had only one ulcer.But70 cases(34%) had2 ulcers.The highest incidence was found among patients with two age groups of20-29 years old(43.2%) and10-19 years old(18%).The most cases resided in rural areas with164 cases(79.6%). Conclusions:Analyzing of the composed results revealed

  8. Differences in stress and challenge in clinical practice among ADN and BSN students in varying clinical courses.

    Science.gov (United States)

    Oermann, M H; Standfest, K M

    1997-05-01

    There is limited research on student perceptions of their clinical experiences particularly in different clinical courses and settings. The purpose of this study was to examine the degree of stress, challenge, and threat associated with clinical practice experiences among ADN and BSN nursing students enrolled in various clinical courses and settings. The Pagana Clinical Stress Questionnaire was used to assess the clinical experiences of 416 undergraduate nursing students from 10 randomly selected associate degree (ADN) and baccalaureate (BSN) programs in the midwest. Significant differences were found across clinical courses (F[5,399] = 9.58, p < .0001) and settings (F[2,386] = 4.63, p = .01) in terms of students' stress. Stress was highest for students enrolled in pediatric nursing courses. ANOVA indicated significant differences across clinical courses in the degree of challenge and threat experienced by students. There were no differences in any of the variables studied when students had faculty from the nursing program or preceptors from the clinical setting as their teachers.

  9. Male adolescent birth control behavior: the importance of developmental factors and sex differences.

    Science.gov (United States)

    Cohen, D D; Rose, R D

    1984-06-01

    A survey of sex and birth control behavior of 51 male adolescents aged 15-17 was conducted utilizing a structured interview protocol. The sample was drawn from 3 community agencies. The respondents resided in a major northeastern metropolitan part of Pennsylvania. The purpose of the study was to describe male adolescent birth control behavior incorporating developmental issues, and to interpret the findings in light of what is known about female birth control behavior. Based on research with teenage females, 3 social influences were examined for their possible impact on male birth control behavior. An interview schedule was undertaken to form the basis of the demographic items, the description of the social network, history of sex and birth control behavior, pregnancy history and communication about sex and birth control. A questionnaire, designed to measure the influence of significant others on females' birth control behavior, formed the basis of the items concerning the expectations of others about contraceptive behavior. Thirdly, questions on perceived power relations with girlfriends were used to determin the influence of teenage females' self-perceptions of power in dyadic relationships on their own contraceptive usage. A new operational definition of male effective birth control usage involving the effectiveness of the method and the consistency of its usage was developed. Findings similar to those obtained in the research on females suggest that adolescent sexual partners may be the only direct social influence on adolescents' birth control usage. Results indicating differences from research with females suggest that in general: male birth control behavior is primarily self-oriented, males are more likely to be effective contraceptors with casual partners than with girlfriends, males are more likely to communicate about sex and birth control with similar age peers than with family members and/or other adults, and that teen males view sex and birth control

  10. [THE CONDITION AND TENDENCIES OF DEVELOPMENT OF CLINICAL AND SANITARY MICROBIOLOGY IN THE RUSSIAN FEDERATION AND PROBLEM OF IMPORT SUBSTITUTION].

    Science.gov (United States)

    Dyatlov, I A; Mironov, A Yu; Shepelin, A P; Aleshkin, V A

    2015-08-01

    The import substitution becomes one of the strategic tasks of national economy as a result of prolongation of economic sanctions concerning the Russian Federation of part of the USA, EU countries, Japan and number of other countries. It is not proper to be limited in import substitution only by goods because in conditions ofsanctions when access toforeign technologies is complicated Russia is needed to substitute foreign technologies by national designs in faster manner One of directions of effective import substitution is localization of production of laboratory equipment and consumables for clinical and sanitary microbiology on the territory ofthe Russian Federation and countries of Customs union. In Russia, in the field ofdiagnostic of dangerous and socially significant infections, all components for import substitution to implement gene diagnostic, immune diagnostic. bio-sensory and biochip approaches, isolation and storage of live microbial cultures, implementation of high-tech methods of diagnostic are available. At the same time, national diagnostic instrument-making industry for microbiology is factually absent. The few devices of national production more than on 50% consist of import components. The microbiological laboratories are to be equipped only with import devices of open type for applying national components. The most perspective national designs to be implemented are multiplex polimerase chain reaction test-systems and biochips on the basis of national plotters and readers. The modern development of diagnostic equipment and diagnostic instruments requires supplement of national collections of bacterial and viral pathogens and working-through of organizational schemes of supplying collections with strains. The presented data concerning justification of nomenclature of laboratory equipment and consumables permits to satisfy in fill scope the needs of clinical and sanitary microbiology in devices, growth mediums, consumables of national production

  11. Deep brain stimulation may reduce the relative risk of clinically important worsening in early stage Parkinson's disease.

    Science.gov (United States)

    Hacker, Mallory L; Tonascia, James; Turchan, Maxim; Currie, Amanda; Heusinkveld, Lauren; Konrad, Peter E; Davis, Thomas L; Neimat, Joseph S; Phibbs, Fenna T; Hedera, Peter; Wang, Lily; Shi, Yaping; Shade, David M; Sternberg, Alice L; Drye, Lea T; Charles, David

    2015-10-01

    The Vanderbilt pilot trial of deep brain stimulation (DBS) in early Parkinson's disease (PD) enrolled patients on medications six months to four years without motor fluctuations or dyskinesias. We conducted a patient-centered analysis based on clinically important worsening of motor symptoms and complications of medical therapy for all subjects and a subset of subjects with a more focused medication duration. Continuous outcomes were also analyzed for this focused cohort. A post hoc analysis was conducted on all subjects from the pilot and a subset of subjects taking PD medications 1-4 years at enrollment. Clinically important worsening is defined as both a ≥ 3 point increase in UPDRS Part III and a ≥ 1 point increase in Part IV. DBS plus optimal drug therapy (DBS + ODT) subjects experienced a 50-80% reduction in the relative risk of worsening after two years. The DBS + ODT group was improved compared to optimal drug therapy (ODT) at each time point on Total UPDRS and Part III (p = 0.04, p = 0.02, respectively, at 24 months). Total UPDRS, Part IV, and PDQ-39 scores significantly worsened in the ODT group after two years (p early PD may reduce the risk of clinically important worsening. These findings further confirm the need to determine if DBS + ODT is superior to medical therapy for managing symptoms, reducing the complications of medications, and improving quality of life. The FDA has approved the conduct of a large-scale, pivotal clinical trial of DBS in early stage PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. The clinical and pathomorphological diagnosis of mycotoxicosis in different swine categories

    Directory of Open Access Journals (Sweden)

    Prodanov Jasna Z.

    2009-01-01

    Full Text Available The issue of mycotoxins and mycotoxicosis in veterinary medicine is directly connected to the usage of mouldy and/or adversely stored grains (corn, wheat, barley used in animal feed. In swine production, in our geographical region, the most common are mycotoxicosis caused by zearalenon (F-2 toxin, but aflatoxins, ochratoxin and trichothecenes can also be found. For the known mycotoxins of clinical importance, the response is usually subacute or chronic and the presenting clinical signs are often vague. Mostly the problems are expressed only as alterations of the reproductive cycle, reduced feed intake and slow growth. However, if we consider the clinical signs and pathomorphological picture of mycotoxicosis in different swine categories (breeding animals, suckling and weaned piglets, fatteners, the age dependent changes can be found. Some mycotoxins have hepatotoxic, nephrotoxic and immunosuppressive effects, which further complicate the clinical and pathomorphological picture and diagnosis of mycotoxicosis in swine. The material for this research included the samples provided from ten swine farms. In different swine categories health disorders, resembling to the problem with mycotoxins were detected. The applied research methods included clinical evaluation and pathomorphological examination and laboratory microbiological feed testing, in order to examine the presence of fungi and some mycotoxins (aflatoxins, zearalenon, ochratoxin A and trichothecenes. On the basis of the obtained results, it may be concluded that the most frequently detected mycotoxin in the examined feed samples was zearalenon. The presence of mycotoxin in feed was directly connected to the reproductive failures and diagnosed health disorders in the examined swine categories (vulvovaginitis, skin necrosis, pneumonia, gastroenteritis.

  13. The Clinical, Radiographic and Histological evaluation of three different concentrations of Formocresol as a pulpotomy agent.

    Science.gov (United States)

    Goyal, Swati; Abuwala, Tasnima; Joshi, Keyur; Mehta, Jahnvi; Indushekar, K R; Hallikerimath, Seema

    2014-04-01

    Formocresol, though the center of much controversy is still the most widely used medicament for primary teeth pulpotomy and an intracanal medicament which has undergone a lengthy evolution to shorten the formocresol application time and reduce the concentration of formocresol exposure to the pulp tissue. Hence, the determination of the actual effective dose and concentration of formocresol for clinical application in primary teeth is an important area of research and a thorough clinical, radiographic and histological investigation in human subjects is very much needed. The study was conducted on 45 primary molars for the Clinical, Radiographic study and 45 premolars orthodontically indicated for extraction for the Histological study. The samples were randomly and equally divided into 3 groups of 15 each for pulpotomy with full strength formocresol, 1:5 diluted formocresol and 1:25 diluted formocresol respectively. The pulpotomized primary molars were clinically evaluated at 1st, 3rd, 6th and 9th month while the pulpotomized premolars were subjected for histological evaluation after extraction. Obtained by chi-square test revealed that all the pulpotomized primary molars were asymptomatic till the end of the study period; suggesting 100% clinical and radiographic success while histologically, the three concentrations of formocresol showed decreased severity of fixation of the pulp tissue with decreasing concentration of formocresol. It can be inferred that the diluted formulations (1:5 and 1:25) of formocresol are equally efficient when compared to full-strength formocresol and thus, can be recommended for pulpotomy in primary teeth. How to cite the article: Goyal S, Abuwala T, Joshi K, Mehta J, Indushekar KR, Hallikerimath S. The Clinical, Radiographic and Histological evaluation of three different concentrations of Formocresol as a pulpotomy agent. J Int Oral Health 2014;6(2):118-25.

  14. Sex differences in dental caries experience: clinical evidence, complex etiology.

    Science.gov (United States)

    Lukacs, John R

    2011-10-01

    A sex difference in oral health has been widely documented through time and across cultures. Women's oral health declines more rapidly than men's with the onset of agriculture and the associated rise in fertility. The magnitude of this disparity in oral health by sex increases during ontogeny: from childhood, to adolescence, and through the reproductive years. Representative studies of sex differences in caries, tooth loss, and periodontal disease are critically reviewed. Surveys conducted in Hungary, India, and in an isolated traditional Brazilian sample provide additional support for a significant sex bias in dental caries, especially in mature adults. Compounding hormonal and reproductive factors, the sex difference in oral health in India appears to involve social and religious causes such as son preference, ritual fasting, and dietary restrictions during pregnancy. Like the sex difference in caries, tooth loss in women is greater than in men and has been linked to caries and parity. Results of genome wide association studies have found caries susceptible and caries protective loci that influence variation in taste, saliva, and enamel proteins, affecting the oral environment and the micro-structure of enamel. Genetic variation, some of which is X-linked, may partly explain how sex differences in oral health originate. A primary, but neglected, factor in explaining the sex differential in oral health is the complex and synergistic changes associated with female sex hormones, pregnancy, and women's reproductive life history. Caries etiology is complex and impacts understanding of the sex difference in oral health. Both biological (genetics, hormones, and reproductive history) and anthropological (behavioral) factors such culture-based division of labor and gender-based dietary preferences play a role.

  15. Cell host response to infection with novel human coronavirus EMC predicts potential antivirals and important differences with SARS coronavirus.

    Science.gov (United States)

    Josset, Laurence; Menachery, Vineet D; Gralinski, Lisa E; Agnihothram, Sudhakar; Sova, Pavel; Carter, Victoria S; Yount, Boyd L; Graham, Rachel L; Baric, Ralph S; Katze, Michael G

    2013-04-30

    A novel human coronavirus (HCoV-EMC) was recently identified in the Middle East as the causative agent of a severe acute respiratory syndrome (SARS) resembling the illness caused by SARS coronavirus (SARS-CoV). Although derived from the CoV family, the two viruses are genetically distinct and do not use the same receptor. Here, we investigated whether HCoV-EMC and SARS-CoV induce similar or distinct host responses after infection of a human lung epithelial cell line. HCoV-EMC was able to replicate as efficiently as SARS-CoV in Calu-3 cells and similarly induced minimal transcriptomic changes before 12 h postinfection. Later in infection, HCoV-EMC induced a massive dysregulation of the host transcriptome, to a much greater extent than SARS-CoV. Both viruses induced a similar activation of pattern recognition receptors and the interleukin 17 (IL-17) pathway, but HCoV-EMC specifically down-regulated the expression of several genes within the antigen presentation pathway, including both type I and II major histocompatibility complex (MHC) genes. This could have an important impact on the ability of the host to mount an adaptive host response. A unique set of 207 genes was dysregulated early and permanently throughout infection with HCoV-EMC, and was used in a computational screen to predict potential antiviral compounds, including kinase inhibitors and glucocorticoids. Overall, HCoV-EMC and SARS-CoV elicit distinct host gene expression responses, which might impact in vivo pathogenesis and could orient therapeutic strategies against that emergent virus. Identification of a novel coronavirus causing fatal respiratory infection in humans raises concerns about a possible widespread outbreak of severe respiratory infection similar to the one caused by SARS-CoV. Using a human lung epithelial cell line and global transcriptomic profiling, we identified differences in the host response between HCoV-EMC and SARS-CoV. This enables rapid assessment of viral properties and the

  16. Gender differences in the neural response to acupuncture: Clinical implications

    NARCIS (Netherlands)

    Yeo, S.; Rosen, B.; Bosch, M.P.C.; Noort, M.W.M.L. van den; Lim, S.

    2016-01-01

    Objective: To examine gender differences and similarities in the psychophysical and brain responses to acupuncture at GB34, a point that is frequently used to treat motor function issues in Traditional Chinese Medicine. Methods: Functional MRI (fMRI) was used to measure brain activation in response

  17. Gender differences in the neural response to acupuncture: Clinical implications

    NARCIS (Netherlands)

    Yeo, S.; Rosen, B.; Bosch, M.P.C.; Noort, M.W.M.L. van den; Lim, S.

    2016-01-01

    Objective: To examine gender differences and similarities in the psychophysical and brain responses to acupuncture at GB34, a point that is frequently used to treat motor function issues in Traditional Chinese Medicine. Methods: Functional MRI (fMRI) was used to measure brain activation in response

  18. Clinical gender differences among adult pathological gamblers seeking treatment.

    Science.gov (United States)

    Echeburúa, Enrique; González-Ortega, Itxaso; de Corral, Paz; Polo-López, Rocío

    2011-06-01

    This study aimed to examine the gender-related differences in demographics, gambling measures, psychological functioning, and motivation for therapy in an outpatient sample of pathological gamblers seeking treatment. Participants in this multisite study included 103 adult outpatients (51 women and 52 men) meeting current DSM-IV-TR criteria for PG. Logistic regression was used to examine if gender was related together to categorical and continuous independent variables. Female gamblers were older than men and more likely to be divorced or widowed and to have a lower annual income. Women became more dependent on bingo and men on slot machines. Gambling motivation and the course of illness for both sexes were also different. Female gamblers were more anxious and with a poorer self-esteem than male gamblers and more affected by depressive symptoms; in turn, men were more impulsive and higher sensation seekers than women and more affected by drug/alcohol abuse. The 68.6% of female gamblers reported being victims of intimate partner violence. There were no gender differences about the motivation for treatment. Future research should examine gambling behaviors and psychological functioning and suggest treatment approaches to address specific goals according to these gender-related differences.

  19. Different clinical allergological features of Taenia solium infestation

    OpenAIRE

    Minciullo, Paola Lucia; Cascio, Antonio; Isola, Stefania; Gangemi, Sebastiano

    2016-01-01

    The tapeworm Taenia (T.) solium can be responsible for two different conditions: taeniasis and cysticercosis. Helminth infections in human host cause an immune response associated with elevated levels of IgE, tissue eosinophilia and mastocytosis, and with the presence of CD4+ T cells that preferentially produce IL-4, IL-5, and IL-13. Individuals exposed to helminth infections may have allergic inflammatory responses to parasites and parasite antigens. PubMed search of human cases of allergic ...

  20. [Confidence interval or p-value--similarities and differences between two important methods of statistical inference of quantitative studies].

    Science.gov (United States)

    Harari, Gil

    2014-01-01

    Statistic significance, also known as p-value, and CI (Confidence Interval) are common statistics measures and are essential for the statistical analysis of studies in medicine and life sciences. These measures provide complementary information about the statistical probability and conclusions regarding the clinical significance of study findings. This article is intended to describe the methodologies, compare between the methods, assert their suitability for the different needs of study results analysis and to explain situations in which each method should be used.

  1. Quantitative proteomic view associated with resistance to clinically important antibiotics in Gram-positive bacteria: A systematic review

    Directory of Open Access Journals (Sweden)

    Chang-Ro eLee

    2015-08-01

    Full Text Available The increase of methicillin-resistant Staphylococcus aureus (MRSA and vancomycin-resistant Enterococcus (VRE poses a worldwide and serious health threat. Although new antibiotics, such as daptomycin and linezolid, have been developed for the treatment of infections of Gram-positive pathogens, the emergence of daptomycin-resistant and linezolid-resistant strains during therapy has now increased clinical treatment failures. In the past few years, studies using quantitative proteomic methods have provided a considerable progress in understanding antibiotic resistance mechanisms. In this review, to understand the resistance mechanisms to four clinically important antibiotics (methicillin, vancomycin, linezolid, and daptomycin used in the treatment of Gram-positive pathogens, we summarize recent advances in studies on resistance mechanisms using quantitative proteomic methods, and also examine proteins playing an important role in the bacterial mechanisms of resistance to the four antibiotics. Proteomic researches can identify proteins whose expression levels are changed in the resistance mechanism to only one antibiotic, such as LiaH in daptomycin resistance and PrsA in vancomycin resistance, and many proteins simultaneously involved in resistance mechanisms to various antibiotics. Most of resistance-related proteins, which are simultaneously associated with resistance mechanisms to several antibiotics, play important roles in regulating bacterial envelope biogenesis or compensating for the fitness cost of antibiotic resistance. Therefore,

  2. DOES A DIFFERENT YEAR OF STUDY MEANS DIFFERENT IMPORTANT CREDIBILITY DIMENSIONS? A STUDY ON THE DIMENSIONS OF CREDIBILITY OF ONLINE SALES WEBSITES

    Directory of Open Access Journals (Sweden)

    Oana ŢUGULEA

    2014-12-01

    Full Text Available Web sites credibility is an important e-marketing issue that influences consumer behavior and buying intention. Two sub-samples were investigated in this study. The purpose of study is to identify differences in perception of the two sub-samples on dimensions of credibility of online sales Website. The aims are: (1 to identify dimensions significantly differently evaluated by the two categories of respondents; (2 to identify important dimensions from the perspective of one of the groups; (3 to identify important dimensions from the other group’s perspective. While students in second year of study (the first sub-sample consider five dimensions to be important (detailed information, relationship – communication, expertise, framing adverts and personal experience, third year of study students (the second sub-sample put a special emphasis on two dimensions (real world feel and expertise. We notice that both categories of students consider the dimension of expertise to be important. Different year of study means different professional experience due to certain courses.

  3. Paediatric rheumatology clinic population in Southeast Asia: are we different?

    Science.gov (United States)

    Arkachaisri, Thaschawee; Tang, Swee-Ping; Daengsuwan, Tassalapa; Phongsamart, Gun; Vilaiyuk, Soamarat; Charuvanij, Sirirat; Hoh, Sook Fun; Tan, Justin Hung Tiong; Das, Lena; Ang, Elizabeth; Lim, Wendy; Chan, Yiong Huak; Bernal, Christine B

    2017-03-01

    To examine the descriptive epidemiology of the patient population referred to paediatric rheumatology centres (PRCs) in Southeast Asia (SEA) and to compare the frequency of conditions encountered with other PRC populations. A web-based Registry for Childhood Onset Paediatric Rheumatic Diseases was established in 2009 and seven PRCs in four SEA countries, where paediatric rheumatologists are available, participated in a prospective 24 month data collection (43 months for Singapore). The number of patients analysed was 4038 (788 from Malaysia, 711 from the Philippines, 1943 from Singapore and 596 from Thailand). Over 70% of patients evaluated in PRCs in Malaysia, the Philippines and Thailand had rheumatic diseases (RDs), as compared with one-half of the proportion seen in Singaporean PRCs, which was similar to the Western PRC experience. Among RDs diagnosed (n = 2602), JIA was the most common disease encountered in Malaysia (41%) and Thailand (61%) as compared with systemic vasculitides in the Philippines (37%) and Singapore (35%) among which Henoch-Schönlein purpura was the most prevalent. SLE and related diseases were more common, but idiopathic pain syndrome and abnormal immunological laboratory tests were rarer than those seen in the West. JIA subtype distributions were different among countries. Among non-RDs (n = 1436), orthopaedic and related conditions predominated (21.7-59.4%). The frequencies of RDs seen by SEA PRCs were different from those in the West. Systemic vasculitides and SLE were common in addition to JIA. Paediatric rheumatologist availability and healthcare accessibility partially explain these observed discrepancies.

  4. The minimal important difference of the hospital anxiety and depression scale in patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Büchi Stefan

    2008-07-01

    Full Text Available Abstract Background Interpretation of the Hospital Anxiety and Depression Scale (HADS, commonly used to assess anxiety and depression in COPD patients, is unclear. Since its minimal important difference has never been established, our aim was to determine it using several approaches. Methods 88 COPD patients with FEV1 ≤ 50% predicted completed the HADS and other patient-important outcome measures before and after an inpatient respiratory rehabilitation. For the anchor-based approach we determined the correlation between the HADS and the anchors that have an established minimal important difference (Chronic Respiratory Questionnaire [CRQ] and Feeling Thermometer. If correlations were ≥ 0.5 we performed linear regression analyses to predict the minimal important difference from the anchors. As distribution-based approach we used the Effect Size approach. Results Based on CRQ emotional function and mastery domain as well as on total scores, the minimal important difference was 1.41 (95% CI 1.18–1.63 and 1.57 (1.37–1.76 for the HADS anxiety score and 1.68 (1.48–1.87 and 1.60 (1.38–1.82 for the HADS total score. Correlations of the HADS depression score and CRQ domain and Feeling Thermometer scores were Conclusion The minimal important difference of the HADS is around 1.5 in COPD patients corresponding to a change from baseline of around 20%. It can be used for the planning and interpretation of trials.

  5. Do drivers of biodiversity change differ in importance across marine and terrestrial systems - Or is it just different research communities' perspectives?

    Science.gov (United States)

    Knapp, Sonja; Schweiger, Oliver; Kraberg, Alexandra; Asmus, Harald; Asmus, Ragnhild; Brey, Thomas; Frickenhaus, Stephan; Gutt, Julian; Kühn, Ingolf; Liess, Matthias; Musche, Martin; Pörtner, Hans-O; Seppelt, Ralf; Klotz, Stefan; Krause, Gesche

    2017-01-01

    Cross-system studies on the response of different ecosystems to global change will support our understanding of ecological changes. Synoptic views on the planet's two main realms, the marine and terrestrial, however, are rare, owing to the development of rather disparate research communities. We combined questionnaires and a literature review to investigate how the importance of anthropogenic drivers of biodiversity change differs among marine and terrestrial systems and whether differences perceived by marine vs. terrestrial researchers are reflected by the scientific literature. This included asking marine and terrestrial researchers to rate the relevance of different drivers of global change for either marine or terrestrial biodiversity. Land use and the associated loss of natural habitats were rated as most important in the terrestrial realm, while the exploitation of the sea by fishing was rated as most important in the marine realm. The relevance of chemicals, climate change and the increasing atmospheric concentration of CO2 were rated differently for marine and terrestrial biodiversity respectively. Yet, our literature review provided less evidence for such differences leading to the conclusion that while the history of the use of land and sea differs, impacts of global change are likely to become increasingly similar. Copyright © 2016 Office national des forêts. Published by Elsevier B.V. All rights reserved.

  6. Growth hormone receptor exon 3 isoforms may have no importance in the clinical setting of multiethnic Brazilian acromegaly patients.

    Science.gov (United States)

    de Oliveira Machado, Evelyn; Lima, Carlos Henrique Azeredo; Ogino, Liana Lumi; Kasuki, Leandro; Gadelha, Mônica R

    2016-08-01

    Acromegaly is associated with significant morbidity and increased mortality, but has a variable severity phenotype. The presence of the exon 3-deleted isoform of the growth hormone receptor (d3-GHR) may influence the disease phenotype and treatment outcomes, including the frequency of biochemical discordance after medical treatment. The objective of this study was to analyze the influence of the d3-GHR isoform on clinical and biochemical characteristics and in the treatment outcomes of Brazilian multiethnic acromegaly patients. We retrospectively analyzed our acromegaly outpatient clinic databank and collected demographic, clinical, biochemical and treatment outcome data from those patients who agreed to participate in the study. A blood sample was collected from all patients, the DNA was extracted and the GHR isoforms were evaluated by PCR, with the full length (fl)-GHR represented by a 935-bp fragment and the d3-GHR represented by a 532-bp fragment. A total of 121 patients were included. Fifty-six patients (46.3 %) were full-length homozygous (fl/fl), 48 (39.7 %) were heterozygous (fl/d3) and 17 (14.0 %) were d3-GHR homozygous (d3/d3). There was no difference between patients homozygous for the fl isoform and those harboring at least one d3-GHR allele in the demographic, clinical and biochemical data or in the treatment outcomes, including somatostatin receptor ligands (SRL) monotherapy, combination therapy with SRL and cabergoline and pegvisomant treatment. There was also no difference between the groups for the frequency of GH and IGF-I discordance after medical treatment. GHR exon 3 genotyping appears to have no clinical significance, at least in Brazilian acromegaly patients.

  7. Relative importance of mangroves as feeding habitat for juvenile fish: a comparative study on mangrove habitats with different settings

    NARCIS (Netherlands)

    Lugendo, B.; Nagelkerken, I.; Kruitwagen, G.; Velde, G. van der; Mgaya, Y.D.

    2007-01-01

    The importance of mangroves as feeding grounds for fish and other macrozoob-enthos in the Indian Ocean and elsewhere has been a subject of debate. This could partly be due to the fact that studies describing this role have been conducted in mangrove systems that differed in their settings. By using

  8. Different clinical allergological features of Taenia solium infestation.

    Science.gov (United States)

    Minciullo, Paola Lucia; Cascio, Antonio; Isola, Stefania; Gangemi, Sebastiano

    2016-01-01

    The tapeworm Taenia (T.) solium can be responsible for two different conditions: taeniasis and cysticercosis. Helminth infections in human host cause an immune response associated with elevated levels of IgE, tissue eosinophilia and mastocytosis, and with the presence of CD4+ T cells that preferentially produce IL-4, IL-5, and IL-13. Individuals exposed to helminth infections may have allergic inflammatory responses to parasites and parasite antigens. PubMed search of human cases of allergic reactions occurring during T. solium infestation was performed combining the terms (allergy, urticaria, angioedema, asthma, anaphylaxis) with T. solium. A study was considered eligible for inclusion in the review if it reported data on patients with T. solium infestation who had signs or symptoms of allergy. In literature we found six articles reporting the association between an allergic reaction and T. solium infestation: two cases of urticaria, two cases of relapsing angioedema, one case of asthma and two cases of anaphylaxis. Despite the large diffusion of T. solium infestation, we found only a few cases of concomitant allergic reaction and the presence of Taenia in the host. The association between T. solium infestation and allergic manifestations has never been clearly demonstrated, and in absence of a well-documented causality the hypotheses are merely speculative. Therefore, the association between Taenia infection and allergy needs to be thoroughly studied to better clarify if this association may really exist and which is the pathogenetic mechanism supported.

  9. Clinical impact of IMPORT HIGH trial (CRUK/06/003) on breast radiotherapy practices in the United Kingdom

    Science.gov (United States)

    Ciurlionis, Laura; Kirby, Anna M; Locke, Imogen; Venables, Karen; Yarnold, John R; Titley, Jenny; Bliss, Judith; Coles, Charlotte E

    2015-01-01

    Objective: IMPORT HIGH is a multicentre randomized UK trial testing dose-escalated intensity-modulated radiotherapy (IMRT) after tumour excision in females with early breast cancer and higher than average local recurrence risk. A survey was carried out to investigate the impact of this trial on the adoption of advanced breast radiotherapy (RT) techniques in the UK. Methods: A questionnaire was sent to all 26 IMPORT HIGH recruiting RT centres to determine whether the trial has influenced non-trial breast RT techniques in terms of volume delineation, dosimetry, treatment delivery and verification. In order to compare the clinical practice of breast RT between IMPORT HIGH and non–IMPORT HIGH centres, parts of the Royal College of Radiologists (RCR) breast RT audit result were used in this study. Results: 26/26 participating centres completed the questionnaire. After joining the trial, the number of centres routinely using tumour bed clips to guide whole-breast RT rose from 5 (19%) to 21 (81%). 20/26 (77%) centres now contour target volumes and organs at risk (OARs) in some or all patients compared with 14 (54%) before the trial. 14/26 (54%) centres offer inverse-planned IMRT for selected non-trial patients with breast cancer, and 10/14 (71%) have adopted the IMPORT HIGH trial protocol for target volume and OARs dose constraints. Only 2/26 (8%) centres used clip information routinely for breast treatment verification prior to IMPORT HIGH, a minority that has since risen to 7/26 (27%). Data on 1386 patients was included from the RCR audit. This suggested that more cases from IMPORT HIGH centres had surgical clips implanted (83 vs 67%), were treated using CT guided planning with full three-dimensional dose compensation (100 vs 75%), and were treated with photon boost RT (30 vs 8%). Conclusion: The study suggests that participation in the IMPORT HIGH trial has played an important part in providing the guidance and support networks needed for the safe integration of

  10. Gorlin syndrome: Importance of clinical signs and danger of delayed diagnosis - A case report with eight years follow-up

    Directory of Open Access Journals (Sweden)

    Erica Dorigatti de-Avila

    2015-02-01

    Full Text Available Nevoid basal cell carcinoma (NBCCS or Gorlin-Goltz syndrome (GS is a multidisciplinary problem, the early diagnosis of which allows secondary prophylaxis that follows an appropriate regimen to delay progression of the syndrome. The aim of this study was to present a case of delayed diagnosis of GS in a young patient who received multidisciplinary treatment 5 years after onset. The patient presented for evaluation with painless swelling of the left maxilla. Histological examination confirmed the diagnosis of a keratocyst odontogenic tumor (KOT that was enucleated. On presentation, the patient's symptoms and clinical signs were not related to complications of GS, and the possibility of GS was initially rejected, as he did not have a family history of the syndrome. Four years after the first surgery to remove the lesion, the patient came to our clinic with a brown, pigmented lesion. Computed tomography revealed ectopic lamellar calcification of the falx cerebri, which was the conclusive factor for the diagnosis of GS. It is important that clinicians recognize the clinical signs of GS, which mainly manifests itself as multiple basal cell carcinomas in the skin. [Arch Clin Exp Surg 2015; 4(1.000: 49-53

  11. An imported case of severe falciparum malaria with prolonged hemolytic anemia clinically mimicking a coinfection with babesiosis.

    Science.gov (United States)

    Na, Young Ju; Chai, Jong-Yil; Jung, Bong-Kwang; Lee, Hyun Jung; Song, Ji Young; Je, Ji Hye; Seo, Ji Hye; Park, Sung Hun; Choi, Ji Seon; Kim, Min Ja

    2014-12-01

    While imported falciparum malaria has been increasingly reported in recent years in Korea, clinicians have difficulties in making a clinical diagnosis as well as in having accessibility to effective anti-malarial agents. Here we describe an unusual case of imported falciparum malaria with severe hemolytic anemia lasting over 2 weeks, clinically mimicking a coinfection with babesiosis. A 48-year old Korean man was diagnosed with severe falciparum malaria in France after traveling to the Republic of Benin, West Africa. He received a 1-day course of intravenous artesunate and a 7-day course of Malarone (atovaquone/proguanil) with supportive hemodialysis. Coming back to Korea 5 days after discharge, he was readmitted due to recurrent fever, and further treated with Malarone for 3 days. Both the peripheral blood smears and PCR test were positive for Plasmodium falciparum. However, he had prolonged severe hemolytic anemia (Hb 5.6 g/dl). Therefore, 10 days after the hospitalization, Babesia was considered to be potentially coinfected. A 7-day course of Malarone and azithromycin was empirically started. He became afebrile within 3 days of this babesiosis treatment, and hemolytic anemia profiles began to improve at the completion of the treatment. He has remained stable since his discharge. Unexpectedly, the PCR assays failed to detect DNA of Babesia spp. from blood. In addition, during the retrospective review of the case, the artesunate-induced delayed hemolytic anemia was considered as an alternative cause of the unexplained hemolytic anemia.

  12. Impact of routine real-time PCR testing of imported malaria over 4 years of implementation in a clinical laboratory.

    Science.gov (United States)

    Shokoples, Sandra; Mukhi, Shamir N; Scott, Allison N; Yanow, Stephanie K

    2013-06-01

    In clinical laboratories, diagnosis of imported malaria is commonly performed by microscopy. However, the volume of specimens is generally low and maintaining proficiency in reading blood smears, particularly at the species level, is challenging in this setting. To address this problem, the Provincial Laboratory for Public Health (ProvLab) in Alberta, Canada, implemented real-time PCR for routine confirmation of all smear-positive samples in the province. Here we report our experience over a 4-year period (2008 to 2012) with this new diagnostic algorithm. While detection of Plasmodium falciparum by microscopy alone was accurate, real-time PCR served as an important adjunct to microscopy for the identification of non-falciparum species. In 18% of cases, the result was reported as non-falciparum or the species could not be identified by microscopy alone, and in all cases, the species was resolved by real-time PCR. In another 4% of cases, the species was misidentified by microscopy. To enhance surveillance for malaria, we integrated our demographic, clinical, and laboratory data into a new system developed by the Canadian Network for Public Health Intelligence, called the Malaria System for Online Surveillance (SOS). Using this application, we characterized our patient populations and travel history to identify risk factors associated with malaria infection abroad.

  13. Recurrence Incidence in Differentiated Thyroid Cancers and the Importance of Diagnostic Iodine-131 Scintigraphy in Clinical Follow-up

    Directory of Open Access Journals (Sweden)

    Filiz Hatipoğlu

    2016-06-01

    Full Text Available Objective: Differentiated thyroid cancers (DTC are tumors with good prognosis. However, local recurrence or distant metastasis can be observed. In our study, we aimed to investigate the incidence of recurrence and the importance of diagnostic iodine-131 whole body scan (WBS in clinical follow-up in patients with DTC. Methods: The clinical data of 217 patients with DTC who were followed-up more than 3 years were reviewed retrospectively. The incidence of recurrence was investigated in a group of patients who had radioactive iodine (RAI treatment and showed no sign of residual thyroid tissue or metastasis with diagnostic WBS that was performed at 6-12 months after therapy and had a thyroglobulin (Tg level lower than 2 ng/dl. Results: At the time of diagnosis, ten cases had thyroid capsule invasion, 25 cases had extra-thyroid soft tissue invasion, 11 patients showed lymph node metastasis and four patients had distant organ metastasis. One hundred forty-five patients had RAI treatment at ablation dose (75-100 mCi, whereas 35 patients had RAI treatment at metastasis dose (150-200 mCi. Thirty-seven patients with papillary microcarcinoma did not receive RAI treatment. In 12 (%7.5 of the 160 patients who were considered as “successful ablation”, a recurrence was identified. Recurrence was detected by diagnostic WBS in all cases and stimulated Tg level was <2 ng/dL with the exception of the two cases who had distant metastasis. Conclusion: Identification of pathological findings with WBS in patients who developed local recurrence in the absence of elevated Tg highlights the importance of diagnostic WBS in clinical follow-up.

  14. Clinical evaluation of the Uni-Yeast-Tek system for rapid presumptive identification of medically important yeasts.

    Science.gov (United States)

    Cooper, B H; Johnson, J B; Thaxton, E S

    1978-04-01

    The results of over 400 tests for identification of clinical yeast isolates as to species using the Uni-Yeast-Tek (UYT) system in comparison with a more conventional system are reported. The conventional system utilized a total of 23 individual tests, including both fermentation and assimilation tests, whereas the UYT system included only 11 separate tests. In the initial phase of the study, coded unknown isolates were evaluated by each of two technologists using both methods independently. After this initial evaluation, the two methods were used in parallel for routine testing of yeast isolates as they were obtained from clinical specimens. A further evaluation of the UYT system was carried out by retrospectively analyzing the species reported from a clinical mycology laboratory during two separate time periods in which different approaches to yeast identification were employed. A total of 92% of the isolates tested with the UYT system were correctly reported within 72 h, 96% were correctly named after 1 week of incubation, and 97% were correctly reported after 2 weeks of incubation of UYT plates at 30 degrees C when results of the two phases of the study were analyzed together. With the conventional system, 88% of the isolates were correctly reported at 72 h, 96% at 1 week, and 98% after 2 weeks of incubation of biochemical tests. Retrospective analysis of laboratory records revealed no major changes in species reported after adoption of the UYT system for routine testing of clinical isolates. The data presented in this report suggest that the UYT system can be expected to yield rapid presumptive identification of clinical yeast isolates with reasonable confidence when certain minor limitations that are discussed in the text are taken into account.

  15. Molecular screening of 246 Portuguese Aspergillus isolates among different clinical and environmental sources.

    Science.gov (United States)

    Sabino, Raquel; Veríssimo, Cristina; Parada, Helena; Brandão, João; Viegas, Carla; Carolino, Elisabete; Clemons, Karl V; Stevens, David A

    2014-07-01

    Clinical and environmental samples from Portugal were screened for the presence of Aspergillus and the distributions of the species complexes were determined in order to understand how their distributions differ based on their source. Fifty-seven Aspergillus isolates from clinical samples were collected from 10 health institutions. Six species complexes were detected by internal transcribed spacer sequencing; Fumigati, Flavi, and Nigri were found most frequently (50.9%, 21.0%, and 15.8%, respectively). β-tubulin and calmodulin sequencing resulted in seven cryptic species (A. awamorii, A. brasiliensis, A. fructus, A. lentulus, A. sydowii, A. tubingensis, Emericella echinulata) being identified among the 57 isolates. Thirty-nine isolates of Aspergillus were recovered from beach sand and poultry farms, 31 from swine farms, and 80 from hospital environments, for a total 189 isolates. Eleven species complexes were found in these 189 isolates, and those belonging to the Versicolores species complex were found most frequently (23.8%). There was a significant association between the different environmental sources and distribution of the species complexes; the hospital environment had greater variability of species complexes than other environmental locations. A high prevalence of cryptic species within the Circumdati complex was detected in several environments; from the isolates analyzed, at least four cryptic species were identified, most of them growing at 37ºC. Because Aspergillus species complexes have different susceptibilities to antifungals, knowing the species-complex epidemiology for each setting, as well as the identification of cryptic species among the collected clinical isolates, is important. This may allow preventive and corrective measures to be taken, which may result in decreased exposure to those organisms and a better prognosis. © The Author 2014. Published by Oxford University Press on behalf of The International Society for Human and Animal

  16. Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics\\ud

    OpenAIRE

    Waite, Polly; Creswell, Catharine

    2014-01-01

    Background Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. Method...

  17. Importance of clinical examination in diagnostics of Osgood-Schlatter Disease in boys playing soccer or basketball

    Directory of Open Access Journals (Sweden)

    Amela Halilbasic

    2012-04-01

    Full Text Available Introduction: Osgood–Schlatter disease is an irritation of the patellar tendon at the tibial tubercle. Sports with jumps, running, and repeated contractions of knee extension apparatus are considered to be importantexternal risk-factors which could cause Osgood–Schlatter disease.Objectives of the study are to draw attention to the importance of clinical examination in diagnostics of Osgood–Schlatter disease in boys playing soccer or basketball.Methods: The research included data obtained from 120 boys, average age of 14 years. Examinees were split into two groups, one with young athletes which regularly have soccer or basketball trainings and thesecond one with boys who do not participating in sports. We performed anthropological measurements and clinical examinations of both knees and hips for both groups. For the statistical analysis we used pointbiserialcorrelation coefficient.Results: Based on clinical examination, Osgood–Schlatter disease was diagnosed in 51 examinees (42.5%. In “athletic group” Osgood–Schlatter disease had 31 boys or 52%, comparing with “non-athletic group” wherewe found 20 adolescents with disease (33%. Number of boys with Osgood–Schlatter disease was higher for 19% in “athletic group” comparing with “non-athletic group”. Comparing incidence rate for boys in both groups with diagnosed II and III level of Osgood–Schlatter disease we found that rate is higher in “athletic group” 2.25 times comparing with “non-athletic group”.Conclusions: Clinical examination is critical method in the process of diagnosing Osgood–Schlatter disease especially for identifying II and III level of this disease.

  18. What Matters Most to Whom: Racial, Ethnic, and Language Differences in the Health Care Experiences Most Important to Patients.

    Science.gov (United States)

    Collins, Rebecca L; Haas, Ann; Haviland, Amelia M; Elliott, Marc N

    2017-09-19

    Some aspects of patient experience are more strongly related to overall ratings of care than others, reflecting their importance to patients. However, little is known about whether the importance of different aspects of this experience differs across subgroups. To determine whether the aspects of health care most important to patients differ according to patient race, ethnicity, and language preference. In response to the 2013 Medicare Consumer Assessment of Health Plans Study (CAHPS) survey, patients rated their overall health care and completed items measuring five patient experience domains. We estimated a linear regression model to assess associations between overall rating of care and the 5 domains, testing for differences in these relationships for race/ethnicity/language groups, controlling for covariates. In total 242,782 Medicare beneficiaries, age 65 years or older. Overall rating of health care, composite patient experience scores for: doctor communication, getting needed care, getting care quickly, customer service, and care coordination. A joint test of the interactions between the composite scores and the 5 largest racial/ethnic/language subgroups was statistically significant (P <0.0001), suggesting the importance of domains varied across subgroups. Doctor communication had the strongest relationship with care ratings for non-Hispanic whites and English-preferring Hispanics. Getting needed care had the strongest relationship for Spanish-preferring Hispanics and Asian/Pacific Islanders. Doctor communication and getting care quickly were strongest for African Americans. Tailoring quality improvement programs to the factors most important to the racial, ethnic, and language mix of the patient population of the practice, hospital, or plan may more efficiently reduce disparities and improve quality.

  19. Differences in the importance of weather and weather-based decisions among campers in Ontario parks (Canada)

    Science.gov (United States)

    Hewer, Micah J.; Scott, Daniel J.; Gough, William A.

    2017-05-01

    Parks and protected areas represent an important resource for tourism in Canada, in which camping is a common recreational activity. The important relationship between weather and climate with recreation and tourism has been widely acknowledged within the academic literature. Howbeit, the need for activity-specific assessments has been identified as an on-going need for future research in the field of tourism climatology. Furthermore, very little is known about the interrelationships between personal characteristics and socio-demographics with weather preferences and behavioural thresholds. This study uses a stated climate preferences approach (survey responses) to explore differences in the importance of weather and related weather-based decisions among summer campers in Ontario parks. Statistically significant differences were found among campers for each of the four dependent variables tested in this study. Physically active campers placed greater importance on weather but were still more tolerant of adverse weather conditions. Older campers placed greater importance on weather. Campers travelling shorter distances placed greater importance on weather and were more likely to leave the park early due to adverse weather. Campers staying for longer periods of time were less likely to leave early due to weather and were willing to endure longer durations of adverse weather conditions. Beginner campers placed greater importance on weather, were more likely to leave early due to weather and recorded lower temporal weather thresholds. The results of this study contribute to the study of tourism climatology by furthering understanding of how personal characteristics such as gender, age, activity selection, trip duration, distance travelled, travel experience and life cycles affect weather preferences and decisions, focusing this time on recreational camping in a park tourism context.

  20. When students from different professions are co-located: the importance of interprofessional rapport for learning to work together.

    Science.gov (United States)

    Croker, Anne; Fisher, Karin; Smith, Tony

    2015-01-01

    With increasing interest and research into interprofessional learning, there is scope to more deeply understand what happens when students from different professions live and study in the same location. This study aimed to explore the issue of co-location and its effects on how students learn to work with other professions. The setting for this study was a rural health education facility in Australia with close links to local health care and community services. Philosophical hermeneutics informed the research method. Interviews were undertaken with 29 participants, including students, academic educators and clinical supervisors in diagnostic radiography, medicine, nursing, nutrition and dietetics, pharmacy, physiotherapy, occupational therapy, and speech pathology. Photo-elicitation was used to facilitate participant engagement with the topic. The findings foreground the value of interprofessional rapport building opportunities for students learning to work together. Enabled by the proximity of different professions in shared educational, clinical and social spaces, interprofessional rapport building was contingent on contextual conditions (balance of professions, shared spaces and adequate time) and individual's interpersonal capabilities (being interested, being inclusive, developing interpersonal bonds, giving and receiving respect, bringing a sense of own profession and being patient-centred). In the absence of these conditions and capabilities, negative professional stereotypes may be inadvertently re-enforced. From these findings suggestions are made for nurturing interprofessional rapport building opportunities to enable students of different professions to learn to work together.

  1. A 3.5 year diary study: Remembering and life story importance are predicted by different event characteristics.

    Science.gov (United States)

    Thomsen, Dorthe Kirkegaard; Jensen, Thomas; Holm, Tine; Olesen, Martin Hammershøj; Schnieber, Anette; Tønnesvang, Jan

    2015-11-01

    Forty-five participants described and rated two events each week during their first term at university. After 3.5 years, we examined whether event characteristics rated in the diary predicted remembering, reliving, and life story importance at the follow-up. In addition, we examined whether ratings of life story importance were consistent across a three year interval. Approximately 60% of events were remembered, but only 20% of these were considered above medium importance to life stories. Higher unusualness, rehearsal, and planning predicted whether an event was remembered 3.5 years later. Higher goal-relevance, importance, emotional intensity, and planning predicted life story importance 3.5 years later. There was a moderate correlation between life story importance rated three months after the diary and rated at the 3.5 year follow-up. The results suggest that autobiographical memory and life stories are governed by different mechanisms and that life story memories are characterized by some degree of stability. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Clinical features of adult patients with Eisenmenger syndrome associated with different types of congenital heart disease

    Institute of Scientific and Technical Information of China (English)

    陈果

    2013-01-01

    Objective To explore the clinical features and hemodynamics of adult patients with Eisenmenger syndrome in different types of congenital heart diseases (CHD) .Methods Patients with Eisenmenger syndrome with different types of CHD diagnosed by right heart

  3. Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes

    Directory of Open Access Journals (Sweden)

    Mehrfam Khoshkhounejad

    2015-11-01

    Full Text Available Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA and BiodentineTM as coronal barriers and different irrigants, which led to different clinical outcomes.

  4. Regenerative Endodontic Treatment: Report of Two Cases with Different Clinical Management and Outcomes.

    Science.gov (United States)

    Khoshkhounejad, Mehrfam; Shokouhinejad, Noushin; Pirmoazen, Salma

    2015-06-01

    Endodontic intervention in necrotic immature permanent teeth is usually a clinical challenge. With appropriate case selection, regenerative treatment can be effective, providing a desirable outcome. However, there is still no consensus on the optimal disinfection protocol or the method to achieve predictable clinical outcome. This article presents two cases of regenerative treatment in necrotic immature teeth, using mineral trioxide aggregate (MTA) and Biodentine(TM) as coronal barriers and different irrigants, which led to different clinical outcomes.

  5. Importance of time in therapeutic range on bleeding risk prediction using clinical risk scores in patients with atrial fibrillation.

    Science.gov (United States)

    Rivera-Caravaca, José Miguel; Roldán, Vanessa; Esteve-Pastor, María Asunción; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y H; Marín, Francisco

    2017-09-21

    Bleeding risk with vitamin K antagonists (VKAs) is closely related to the quality of anticoagulation in atrial fibrillation (AF) patients, reflected by time in therapeutic range (TTR). Here we compared the discrimination performance of different bleeding risk scores and investigated if adding TTR would improve their predictive value and clinical usefulness. We included 1361 AF patients stables on VKA for at least 6 months. Bleeding risk was assessed by the HAS-BLED, ATRIA, ORBIT and HEMORR2HAGES scores. Major bleeding events were recorded after a median of 6.5 years follow-up. In this period 250 patients suffered major bleeds. Comparison of receiver operating characteristic (ROC) curves demonstrated that HAS-BLED had the best discrimination performance, but adding the 'labile INR' criteria (i.e. TTR <65%) to ATRIA, ORBIT and HEMORR2HAGES increased their ability of discrimination and predictive value, with significant improvements in reclassification and discriminatory performance. Decision curve analyses (DCA) showed improvements of the clinical usefulness and a net benefit of the modified risk scores. In summary, in AF patients taking VKAs, the HAS-BLED score had the best predictive ability. Adding 'labile INR' to ATRIA, ORBIT and HEMORR2HAGES improved their predictive value for major bleeding leading to improved clinical usefulness compared to the original scores.

  6. Importance of crown architecture for leaf area index of different Populus genotypes in a high-density plantation.

    Science.gov (United States)

    Broeckx, L S; Verlinden, M S; Vangronsveld, J; Ceulemans, R

    2012-10-01

    Crown architecture is an important determinant of biomass production and yield of any bio-energy plantation since it determines leaf area display and hence light interception. Four Populus genotypes-of different species and hybrids and with contrasting productivity and leaf area-were examined in terms of their branch characteristics in relation to crown architecture during the first and second growing seasons after plantation establishment. The trees were planted at high density (8000 ha(-1)) on two different former land use types, cropland and pasture. We documented significant differences in branch architecture among the genotypes and for the first year among the former land use types. Land use effects only affected factors not related to canopy closure and wood production, and decreased after the first growing season. This suggested that both former land use types were equally suited for the establishment success of a poplar bio-energy plantation. Tree height and branch dimensions-branch diameter and branch length-were the most important determinants of wood production and maximum leaf area index. Despite the secondary importance of the number of sylleptic branches, these branches contributed significantly to the total leaf area in three out of the four studied genotypes. This indicated that enhanced syllepsis accelerates leaf area development and hence carbon assimilation, especially in the early stages of a high-density plantation with poplar.

  7. Does Gender Matter in Non-Hodgkin Lymphoma? Differences in Epidemiology, Clinical Behavior, and Therapy

    Directory of Open Access Journals (Sweden)

    Nurit Horesh

    2014-10-01

    Full Text Available Non-Hodgkin lymphoma (NHL is one of the most common hematologic malignancies worldwide. The incidence of NHL has been rising for several decades; however, in the last 20 years, it reached a plateau. NHL incidence among males is significantly higher than in females. In addition to gender itself, gravidity has a protective role against NHL occurrence. Gender also matters in terms of NHL clinical characteristics. For example, female predominance was found in three extra-nodal sites (the breast, thyroid, and the respiratory system occasionally involved in NHL. The diagnosis of NHL during pregnancy is associated with a unique clinical behavior. It is usually diagnosed in the second or third trimester and in advanced stage. Furthermore, the histological subtype is highly aggressive, and reproductive organ involvement is common. The reduced rate of NHL among females may be explained by direct effects of estrogens on lymphoma cell proliferation or by its effect on anti-tumor immune response. Gender has an important role in responsiveness to standard B cell NHL treatment. Among older adults, women benefited more from the addition of the anti-CD20 antibody rituximab to standard chemotherapy regimens. This phenomenon can be explained by the difference in clearance rate of rituximab that was found to be significantly lower among older females than older males. In mantle cell lymphoma, women receiving lenalidomide have higher rates of response. An understanding of the mechanisms responsible for gender-associated NHL differences will ultimately improve the clinical approach, allowing for a more accurate assessment of prognosis and patient-tailored treatment.

  8. Minimal clinically important improvement (MCII) and patient-acceptable symptom state (PASS) in total hip arthroplasty (THA) patients 1 year postoperatively

    DEFF Research Database (Denmark)

    Paulsen, Aksel; Roos, Ewa M.; Pedersen, Alma B;

    2013-01-01

    Background and purpose - The increased use of patient-reported outcomes (PROs) in orthopedics requires data on estimated minimal clinically important improvements (MCIIs) and patient-acceptable symptom states (PASSs). We wanted to find cut-points corresponding to minimal clinically important PRO ...

  9. Florid cemento-osseous dysplasia: review of an uncommon fibro-osseous lesion of the jaw with important clinical implications.

    Science.gov (United States)

    Fenerty, Sarah; Shaw, Wei; Verma, Rahul; Syed, Ali B; Kuklani, Riya; Yang, Jie; Ali, Sayed

    2017-05-01

    Florid cemento-osseous dysplasia (FCOD) is a rare, benign, multifocal fibro-osseous dysplastic process affecting tooth-bearing areas of the jaw, characterized by replacement of normal trabecular bone with osseous tissue and dense acellular cementum in a fibrous stroma. It is one clinicopathologic variant in a spectrum of related non-neoplastic fibro-osseous lesions known as cemento-osseous dysplasias (CODs), thought to arise from elements of the periodontal ligament. Diagnosis primarily relies upon radiographic and clinical findings; unnecessary biopsy should be avoided, as inoculation with oral pathogens may precipitate chronic infection in these hypovascular lesions. Appropriate management of uncomplicated FCOD consists of periodic radiographic follow-up. Accordingly, it is important that both radiologists and clinicians performing endodontic interventions possess familiarity with this entity in order to prevent misdiagnosis and inappropriate intervention, which may result in a protracted clinical course. Lesions are usually asymptomatic in the absence of infection, typically discovered on routine dental radiographs or imaging performed for unrelated indications. Radiographically, the condition typically manifests as widespread non-expansile intraosseous masses of varying internal lucency and sclerosis that surround the root apices of vital teeth or edentulous areas in the posterior jaw. While all CODs share similar microscopic features, FCOD is distinguished by its multifocal distribution, involving two or more quadrants of the maxilla and mandible, often in a bilateral symmetric fashion. The vast majority of cases are sporadic, though few exhibit an autosomal dominant familial inheritance pattern. In this pictorial review, we discuss the radiologic characteristics of this entity, pertinent clinical and histologic features, differential diagnoses, and management options.

  10. [Serum uric acid is associated with disease severity and an important predictor for clinical outcome in patients with pulmonary hypertension].

    Science.gov (United States)

    Luo, D L; Zhang, C J; Huang, Y G; Huang, T; Li, H Z

    2017-06-24

    Objective: The growing body of literature showed a link between uric acid and pulmonary hypertension (PH), but the impact of hyperuremia on outcome of patients with PH has not been well defined. Therefore, the present study was performed to analyze the impact of uric acid on outcome of PH patients. Methods: One hundred seventy-three PH patients (112 females, mean age 38 years old), who were hospitalized in our department between January 2010 and December 2015, were included in our study, the PH diagnosis was made based on right heart catheterization examination result (mean pulmonary artery pressure≥25 mmHg(1 mmHg=0.133 kPa)). PH patients were divided into mild to moderate PH group (Rp/Rs≤0.6, n=97) and severe PH group (Rp/Rs>0.6, n=76). Fifty-one patients (33 females, mean age 45 years old) without PH based on right heart catheterization were included as control subjects. All participants were followed up for a median of 24 months(6-71 months). Clinical endpoints were defined as cardiogenic death or heart-and-lung transplantation. Results: Uric acid was positively correlated with pulmonary vascular resistance(r=0.398, Puric acid level was significantly higher in patients with severe PH than in patients with mild-to-moderate PH and the control subjects (both Puric acid level to predict the outcome of PH patients (sensitivity 50%, specificity 72%). During follow-up, patients with higher level of uric acid (>425.5 μmol/L) were linked with poorer clinical outcome compared to patients with uric acid uric acid is associated with the severity of PH and higher uric acid level serves as an important predictor for poor clinical outcome of PH patients.

  11. Importance of epigenetic changes in cancer etiology, pathogenesis, clinical profiling, and treatment: what can be learned from hematologic malignancies?

    Science.gov (United States)

    Vecchio, Lorella; Seke Etet, Paul Faustin; Kipanyula, Maulilio John; Krampera, Mauro; Nwabo Kamdje, Armel Hervé

    2013-08-01

    Epigenetic alterations represent a key cancer hallmark, even in hematologic malignancies (HMs) or blood cancers, whose clinical features display a high inter-individual variability. Evidence accumulated in recent years indicates that inactivating DNA hypermethylation preferentially targets the subset of polycomb group (PcG) genes that are regulators of developmental processes. Conversely, activating DNA hypomethylation targets oncogenic signaling pathway genes, but outcomes of both events lead in the overexpression of oncogenic signaling pathways that contribute to the stem-like state of cancer cells. On the basis of recent evidence from population-based, clinical and experimental studies, we hypothesize that factors associated with risk for developing a HM, such as metabolic syndrome and chronic inflammation, trigger epigenetic mechanisms to increase the transcriptional expression of oncogenes and activate oncogenic signaling pathways. Among others, signaling pathways associated with such risk factors include pro-inflammatory nuclear factor κB (NF-κB), and mitogenic, growth, and survival Janus kinase (JAK) intracellular non-receptor tyrosine kinase-triggered pathways, which include signaling pathways such as transducer and activator of transcription (STAT), Ras GTPases/mitogen-activated protein kinases (MAPKs)/extracellular signal-related kinases (ERKs), phosphatidylinositol 3-kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR), and β-catenin pathways. Recent findings on epigenetic mechanisms at work in HMs and their importance in the etiology and pathogenesis of these diseases are herein summarized and discussed. Furthermore, the role of epigenetic processes in the determination of biological identity, the consequences for interindividual variability in disease clinical profile, and the potential of epigenetic drugs in HMs are also considered.

  12. The different functions and clinical significances of caveolin-1 in human adenocarcinoma and squamous cell carcinoma

    Science.gov (United States)

    Fu, Pin; Chen, Fuchun; Pan, Qi; Zhao, Xianda; Zhao, Chen; Cho, William Chi-Shing; Chen, Honglei

    2017-01-01

    Caveolin-1 (Cav-1), a major structural protein of caveolae, is an integral membrane protein which plays an important role in the progression of carcinoma. However, whether Cav-1 acts as a tumor promoter or a tumor suppressor still remains controversial. For example, the tumor-promoting function of Cav-1 has been found in renal cancer, prostate cancer, tongue squamous cell carcinoma (SCC), lung SCC and bladder SCC. In contrast, Cav-1 also plays an inhibitory role in esophagus adenocarcinoma, lung adenocarcinoma and cutaneous SCC. The role of Cav-1 is still controversial in thyroid cancer, hepatocellular carcinoma, gastric adenocarcinoma, colon adenocarcinoma, breast cancer, pancreas cancer, oral SCC, laryngeal SCC, head and neck SCC, esophageal SCC and cervical SCC. Besides, it has been reported that the loss of stromal Cav-1 might predict poor prognosis in breast cancer, gastric cancer, pancreas cancer, prostate cancer, oral SCC and esophageal SCC. However, the accumulation of stromal Cav-1 has been found to be promoted by the progression of tongue SCC. Taken together, Cav-1 seems playing a different role in different cancer subtypes even of the same organ, as well as acting differently in the same cancer subtype of different organs. Thus, we hereby explore the functions of Cav-1 in human adenocarcinoma and SCC from the perspective of clinical significances and pathogenesis. We envision that novel targets may come with the further investigation of Cav-1 in carcinogenesis. PMID:28243118

  13. Understanding sex differences in form and function of bird song: The importance of studying song learning processes

    Directory of Open Access Journals (Sweden)

    Katharina eRiebel

    2016-06-01

    Full Text Available Birdsong is a culturally transmitted mating signal. Due to historical and geographical biases, song (learning has been predominantly studied in the temperate zones, where female song is rare. Consequently, mechanisms and function of song learning have been almost exclusively studied in male birds and under the premise that inter- and intrasexual selection favoured larger repertoires and complex songs in males. However, female song is not rare outside the temperate zones and song in both sexes probably is the ancestral state in songbirds. Some song dimorphisms seen today might therefore be manifestations of secondary losses of female song. What selection pressures have favoured such losses and other sexual dimorphisms in song? Combined mapping of phylogenetic and ecological correlates of sex differences in song structure and function might provide important clues to the evolution of male and female song. This requires parameterization of the degree of sexual dimorphism. Simple comparison of male-female song might not provide enough resolution, because the same magnitude of difference (e.g. repertoire overlap could result from different processes: the sexes could differ in how well they learn (‘copying fidelity’ or from whom they learn (‘model selection’. Different learning mechanisms might provide important pointers towards different selection pressures. Investigating sex-specific learning could therefore help to identify the social and ecological selection pressures contributing to sex differences in adult song. The study of female song learning in particular could be crucial to our understanding of i song function in males and females and ii the evolution of sex-specific song.

  14. Identification of cultured isolates of clinically important yeast species using fluorescent fragment length analysis of the amplified internally transcribed rRNA spacer 2 region

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    Muylaert An

    2002-07-01

    Full Text Available Abstract Background The number of patients with yeast infection has increased during the last years. Also the variety of species of clinical importance has increased. Correct species identification is often important for efficient therapy, but is currently mostly based on phenotypic features and is sometimes time-consuming and depends largely on the expertise of technicians. Therefore, we evaluated the feasibility of PCR-based amplification of the internally transcribed spacer region 2 (ITS2, followed by fragment size analysis on the ABI Prism 310 for the identification of clinically important yeasts. Results A rapid DNA-extraction method, based on simple boiling-freezing was introduced. Of the 26 species tested, 22 could be identified unambiguously by scoring the length of the ITS2-region. No distinction could be made between the species Trichosporon asteroides and T. inkin or between T. mucoides and T. ovoides. The two varieties of Cryptococcus neoformans (var. neoformans and var. gattii could be differentiated from each other due to a one bp length difference of the ITS2 fragment. The three Cryptococcus laurentii isolates were split into two groups according to their ITS2-fragment lengths, in correspondence with the phylogenetic groups described previously. Since the obtained fragment lengths compare well to those described previously and could be exchanged between two laboratories, an internationally usable library of ITS2 fragment lengths can be constructed. Conclusions The existing ITS2 size based library enables identification of most of the clinically important yeast species within 6 hours starting from a single colony and can be easily updated when new species are described. Data can be exchanged between laboratories.

  15. Colony-level behavioral variation correlates with differences in expression of the foraging gene in red imported fire ants.

    Science.gov (United States)

    Bockoven, Alison A; Coates, Craig J; Eubanks, Micky D

    2017-09-13

    Among social insects, colony-level variation is likely to be widespread and have significant ecological consequences. Very few studies, however, have documented how genetic factors relate to behavior at the colony level. Differences in expression of the foraging gene have been associated with differences in foraging and activity of a wide variety of organisms. We quantified expression of the red imported fire ant foraging gene (sifor) in workers from 21 colonies collected across the natural range of Texas fire ant populations, but maintained under standardized, environmentally controlled conditions. Colonies varied significantly in their behavior. The most active colonies had up to 10 times more active foragers than the least active colony and more than 16 times as many workers outside the nest. Expression differences among colonies correlated with this colony-level behavioral variation. Colonies with higher sifor expression in foragers had, on average, significantly higher foraging activity, exploratory activity, and recruitment to nectar than colonies with lower expression. Expression of sifor was also strongly correlated with worker task (foraging versus working in the interior of the nest). These results provide insight into the genetic and physiological processes underlying collective differences in social behavior. Quantifying variation in expression of the foraging gene may provide an important tool for understanding and predicting the ecological consequences of colony-level behavioral variation. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  16. Clinical epidemiology of Alzheimer’s disease: assessing sex and gender differences

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    Mielke MM

    2014-01-01

    Full Text Available Michelle M Mielke,1,2 Prashanthi Vemuri,3 Walter A Rocca1,2 1Department of Health Sciences Research, 2Department of Neurology, 3Department of Radiology, Mayo Clinic, Rochester, MN, USA Abstract: With the aging of the population, the burden of Alzheimer's disease (AD is rapidly expanding. More than 5 million people in the US alone are affected with AD and this number is expected to triple by 2050. While men may have a higher risk of mild cognitive impairment (MCI, an intermediate stage between normal aging and dementia, women are disproportionally affected with AD. One explanation is that men may die of competing causes of death earlier in life, so that only the most resilient men may survive to older ages. However, many other factors should also be considered to explain the sex differences. In this review, we discuss the differences observed in men versus women in the incidence and prevalence of MCI and AD, in the structure and function of the brain, and in the sex-specific and gender-specific risk and protective factors for AD. In medical research, sex refers to biological differences such as chromosomal differences (eg, XX versus XY chromosomes, gonadal differences, or hormonal differences. In contrast, gender refers to psychosocial and cultural differences between men and women (eg, access to education and occupation. Both factors play an important role in the development and progression of diseases, including AD. Understanding both sex- and gender-specific risk and protective factors for AD is critical for developing individualized interventions for the prevention and treatment of AD. Keywords: Alzheimer’s disease, dementia, sex, gender, risk factors, dimorphic medicine

  17. The importance of distinguishing between the different eating disorders (sub)types when assessing emotion regulation strategies.

    Science.gov (United States)

    Danner, Unna N; Sternheim, Lot; Evers, Catharine

    2014-03-30

    People with eating disorders (ED) have difficulties regulating their emotions adaptively. Little is known about differences and similarities between different types of ED and how these regulation difficulties relate to other emotional problems. The present study examines maladaptive (suppression) and adaptive (cognitive reappraisal) emotion regulation strategies in women with different ED and relationships with anxiety and depression levels. In 32 women with AN restrictive subtype (ANR), 32 with AN binge-purge subtype (ANBP), 30 with bulimia nervosa (BN), 29 with binge eating disorder (BED), and 64 healthy women, the ERQ (emotion regulation) as well as STAI-T (anxiety), BDI-SF (depression), and EDDS (eating pathology) were administered. Women across different ED subtypes were inclined to suppress emotions and lacked the capacity to reappraise emotions (except women with ANBP). Correlational relations of suppression and reappraisal with anxiety and depression levels differed across ED groups. Emotion regulation problems were found across ED subtypes. However, the types of emotion regulation problems, and the effect of coexisting other emotional problems such as anxiety and depression may differ across ED subtypes. These findings illustrate the importance to of considering ED subtypes in emotion regulation research rather than consider ED as a whole. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  18. Different Perspectives Between Product and Marketing Division towards Product Critical Success Factors and Its Strategic Importance in Telecommunication Sectors

    Directory of Open Access Journals (Sweden)

    Rachmi Rida Utami

    2013-12-01

    Full Text Available Todays situations force telecomunication company to continuously evaluate, select and prioritize its product portfolio in order to determine the strategically important products. An analysis of critical success factors that determine product’s strategic importance acts as a good introduction to review and manage the product portfolio as well as to seek ways to develop the product. To achieve this, the company is required to have good alliances and collaborations between departments, develop a clear focus and seek innovative ways of doing business, particularly between marketing and product divisions. This study analyzed the alignment between product and marketing divisions of a telecommunication company in Indonesia, in determining the company’s strategic products. The results indicated that both divisions agreed on using financial performance and revenue as the most important criteria and sub-criteria for identifying strategic product. However, the divisions also faced some different visions in selecting alternative criteria. The Product divisions were more focused on technical spesification of product, while the Marketing division were more oriented on customer and market conditions. The study reported the consequences of these difference in practice.

  19. The importance of neutral and niche processes for bacterial community assembly differs between habitat generalists and specialists.

    Science.gov (United States)

    Liao, Jingqiu; Cao, Xiaofeng; Zhao, Lei; Wang, Jie; Gao, Zhe; Wang, Michael Cai; Huang, Yi

    2016-11-01

    The mechanisms of community assembly are a central focus in the field of microbial ecology. However, to what extent these mechanisms differ in importance by traits of groups is poorly understood. Here we quantified the importance of neutral and niche processes in community assembly for bacteria, habitat specialists and generalists in 21 plateau lakes of China. Results showed that both neutral and niche processes played a critical role in the assembly of entire bacterial communities, shaping a unique biogeographical pattern. A few habitat generalists and many specialists were identified. Interestingly, habitat specialists were only governed by niche process, with seven significant environmental variables-salinity, dissolved oxygen, water transparency, total phosphorus, ammonium-nitrogen, temperature and total nitrogen-independently explaining 40.3% of the biological variation. By contrast, habitat generalists were strongly driven by neutral process, with 50.9% of the variation of detection frequency explained in neutral community model. Only three environmental variables-salinity, total nitrogen and dissolved oxygen-significantly affected the distribution of habitat generalists, independently explaining 13.6% of the variation. Governed by different assembly mechanisms, habitat specialists and generalists presented disparate biogeographical patterns. Our result emphasizes the importance of investigating the bacterial community assembly at more refined levels than entire communities.

  20. The first imported case of Rift Valley fever in China reveals a genetic reassortment of different viral lineages

    Science.gov (United States)

    Liu, Jingyuan; Sun, Yulan; Shi, Weifeng; Tan, Shuguang; Pan, Yang; Cui, Shujuan; Zhang, Qingchao; Dou, Xiangfeng; Lv, Yanning; Li, Xinyu; Li, Xitai; Chen, Lijuan; Quan, Chuansong; Wang, Qianli; Zhao, Yingze; lv, Qiang; Hua, Wenhao; Zeng, Hui; Chen, Zhihai; Xiong, Haofeng; Jiang, Chengyu; Pang, Xinghuo; Zhang, Fujie; Liang, Mifang; Wu, Guizhen; Gao, George F; Liu, William J; Li, Ang; Wang, Quanyi

    2017-01-01

    We report the first imported case of Rift Valley fever (RVF) in China. The patient returned from Angola, a non-epidemic country, with an infection of a new reassortant from different lineages of Rift Valley fever viruses (RVFVs). The patient developed multiorgan dysfunction and gradually recovered with continuous renal replacement therapy and a short regimen of methylprednisolone treatment. The disordered cytokines and chemokines in the plasma of the patient revealed hypercytokinemia, but the levels of protective cytokines were low upon admission and fluctuated as the disease improved. Whole-genome sequencing and phylogenetic analysis revealed that the imported strain was a reassortant comprising the L and M genes from lineage E and the S gene from lineage A. This case highlights that RVFV had undergone genetic reassortment, which could potentially alter its biological properties, cause large outbreaks and pose a serious threat to global public health as well as the livestock breeding industry. PMID:28096531

  1. Gender differences in the clinical characteristics and psychiatric comorbidity in patients with antisocial personality disorder.

    Science.gov (United States)

    Sher, Leo; Siever, Larry J; Goodman, Marianne; McNamara, Margaret; Hazlett, Erin A; Koenigsberg, Harold W; New, Antonia S

    2015-10-30

    Gender is an important variable in the study of mental health because of the actual and perceived differences between men and women. Relatively little is known how males and females differ in their manifestations of antisocial personality disorder (ASPD). Demographic and clinical features of 323 participants with ASPD were assessed and recorded. Women had fewer episodes of antisocial behavior involving or not involving police, higher scores on the Childhood Trauma Questionnaire (CTQ) and on Emotional Abuse and Sexual Abuse subscales of the CTQ compared to men. CTQ scores positively correlated with the number of episodes of antisocial behavior involving police in men but not in women. The percentage of patients with comorbid borderline and histrionic personality disorders was higher and the percentage of participants with cocaine use disorder was lower among women compared to men. Comorbid alcohol use disorder was frequent in both groups, while a higher percentage of women had comorbid mood disorders compared to men. Logistic regression analysis demonstrates that CTQ scores, histrionic personality disorder, and antisocial behavior involving the police drive the difference between the groups. Our findings indicate that treatment of individuals with ASPD should focus on the management of comorbid psychiatric disorders.

  2. Meta-analysis on continuous outcomes in minimal important difference units: an application with appropriate variance calculations.

    Science.gov (United States)

    Shrier, Ian; Christensen, Robin; Juhl, Carsten; Beyene, Joseph

    2016-12-01

    To compare results from meta-analyses for mean differences in minimal important difference (MID) units (MDMID), when MID is treated as a random variable vs. a constant. Meta-analyses of published data. We calculated the variance of MDMID as a random variable using the delta method and as a constant. We assessed performance under different assumptions. We compare meta-analysis results from data originally used to present the MDMID and data from osteoarthritis studies using different domain instruments. Depending on the data set and depending on the values of rho and coefficient of variation of the MID (CoVMID), estimates of treatment effect and P-values between an approach considering the MID as a constant vs. as a random variable may differ appreciably. Using our data sets, we provide examples of the potential magnitude. When rho = 0.5 and CoVMID = 0.8, considering MID as a constant overestimated the treatment effect by 33-110% and decreased the P-value for heterogeneity from above 0.95 to below 0.08. When rho = 0.8 and CoVMID = 0.5, the magnitude of the effects was similar. Considering MID as a random variable avoids unrealistic assumptions and provides more appropriate treatment effect estimates. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Gender differences in sagittal standing alignment before pubertal peak growth: the importance of subclassification and implications for spinopelvic loading.

    Science.gov (United States)

    Dolphens, Mieke; Cagnie, Barbara; Vleeming, Andry; Vanderstraeten, Guy; Danneels, Lieven

    2013-12-01

    The aim of this study was to analyze gender differences in sagittal standing alignment at pre-peak height velocity age thereby applying a scientifically sound and practically oriented classification scheme for overall standing balance. The study population consisted of healthy boys (n = 639) and girls (n = 557) before pubertal peak growth. During subjects' habitual standing, sagittal plane measures of the spine, pelvis and lower limbs were collected using a clinical screening protocol. With each subject classified as one of three postural types (neutral, sway-back, or leaning-forward), differences in sagittal plane alignment were analyzed between sexes. The results revealed clear differences between genders in each of the postural types. Within the neutral and sway-back postural subgroups, boys presented more forward inclination of the trunk, more thoracic kyphosis and more pelvis backtilt compared with girls. Within the leaning-forward category, girls displayed more forward trunk lean, less thoracic kyphosis and more pelvic anteversion. A state of lumbar segmental hyperextension appeared to exist in female leaning-forward subjects. Our results reveal for the first time that sagittal standing alignment is different between prepubescent boys and girls when subjects are appropriately subclassified, and conversely represent a 'wash-out effect' when pooled. When the classification system is applied, gender-specificity in gravity line position is suggested, implying gender-related differences in lever arms and thus load. Present findings may add to our understanding of gender-specific biomechanical challenges posed by habitual posture, and may shed new light on sagittal standing alignment as a possible contributory factor in developmental spinal-pelvic disorders.

  4. Stability Constants of Some Biologically Important Pyrazoles and Their Ni2+ Complexes in Different Dielectric Constant of Medium

    Directory of Open Access Journals (Sweden)

    S. D. Deosarkar

    2012-01-01

    Full Text Available The proton-ligand stability constants of some biologically important new pyrazoles and formation constants of their complexes with Ni(II were determined at 0.1 mol dm-3 ionic strength and at 303.15 K in different dielectric constant of dioxane-water mixture by potentiometric method. The Calvin-Bjerrum's pH-titration technique as used by Irving and Rossotti was used for determination of stability constants. The results enabled to study the electrostatic forces of attraction between metal ion and ligand with changes in dielectric constant of the medium.

  5. Differences in the structure of copepod assemblages in four tropical estuaries: Importance of pollution and the estuary hydrodynamics.

    Science.gov (United States)

    Araujo, Adriana V; Dias, Cristina O; Bonecker, Sérgio L C

    2017-02-15

    We examined the relationship between pollution and structure of copepod assemblages in estuaries, using sampling standardization of salinity range to reduce the effects of "Estuarine Quality Paradox". Copepod assemblages were analyzed in four Southeast Brazilian estuaries with different water quality levels and different hydrodynamic characteristics. The pollution negatively impacted the descriptors of the assemblage structure. The distribution of structure of copepod assemblages also showed a main separation trend between the most polluted estuaries and those less polluted. Temperature was the main factor affecting the assemblage structuring in the four estuaries. This factor acted in synergism with the effects of pollution impact and physical characteristics of the estuaries on the structure of copepod assemblages, supporting the potential vulnerability of coastal environments due to nutrient enrichment associated with climate change. Our study demonstrated the importance of sampling standardization of the salinity range in estuaries for reliable analysis of pollution effects on biota. Copyright © 2016 Elsevier Ltd. All rights reserved.

  6. On the relative importance of different microphysics on the D-type expansion of galactic HII regions

    CERN Document Server

    Haworth, Thomas J; Acreman, David M; Bisbas, Thomas G

    2015-01-01

    Radiation hydrodynamics (RHD) simulations are used to study many astrophysical phenomena, however they require the use of simplified radiation transport and thermal prescriptions to reduce computational cost. In this paper we present a systematic study of the importance of microphysical processes in RHD simulations using the example of D-type HII region expansion. We compare the simplest hydrogen-only models with those that include: ionisation of H, He, C, N, O, S and Ne, different gas metallicity, non-LTE metal line blanketed stellar spectral models of varying metallicity, radiation pressure, dust and treatment of photodissociation regions. Each of these processes are explicitly treated using modern numerical methods rather than parameterisation. In line with expectations, changes due to microphysics in either the effective number of ionising photons or the thermal structure of the gas lead to differences in D-type expansion. In general we find that more realistic calculations lead to the onset of D-type exp...

  7. Gender differences in the management and clinical outcome of stable angina.

    NARCIS (Netherlands)

    Daly, C.A.; Clemens, F.; Lopez Sendon, J.L.; Tavazzi, L.; Boersma, E.; Danchin, N.; Delahaye, F.; Gitt, A.; Julian, D.; Mulcahy, D.; Ruzyllo, W.; Thygesen, K.; Verheugt, F.W.A.; Fox, K.M.

    2006-01-01

    BACKGROUND: We sought to examine the impact of gender on the investigation and subsequent management of stable angina and to assess gender differences in clinical outcome at 1 year. METHODS AND RESULTS: The Euro Heart Survey of Stable Angina enrolled patients with a clinical diagnosis of stable angi

  8. Global priorities for research and the relative importance of different research outcomes: an international Delphi survey of malaria research experts.

    Science.gov (United States)

    Mulligan, Jo-Ann; Conteh, Lesong

    2016-12-06

    As global research investment increases, attention inevitably turns to assessing and measuring the outcomes and impact from research programmes. Research can have many different outcomes such as producing advances in scientific knowledge, building research capacity and, ultimately, health and broader societal benefits. The aim of this study was to test the use of a Delphi methodology as a way of gathering views from malaria research experts on research priorities and eliciting relative valuations of the different types of health research impact. An international Delphi survey of 60 malaria research experts was used to understand views on research outcomes and priorities within malaria and across global health more widely. The study demonstrated the application of the Delphi technique to eliciting views on malaria specific research priorities, wider global health research priorities and the values assigned to different types of research impact. In terms of the most important past research successes, the development of new anti-malarial drugs and insecticide-treated bed nets were rated as the most important. When asked about research priorities for future funding, respondents ranked tackling emerging drug and insecticide resistance the highest. With respect to research impact, the panel valued research that focuses on health and health sector benefits and informing policy and product development. Contributions to scientific knowledge, although highly valued, came lower down the ranking, suggesting that efforts to move research discoveries to health products and services are valued more highly than pure advances in scientific knowledge. Although the Delphi technique has been used to elicit views on research questions in global health this was the first time it has been used to assess how a group of research experts value or rank different types of research impact. The results suggest it is feasible to inject the views of a key stakeholder group into the research

  9. Parents' agendas in paediatric clinical trial recruitment are different from researchers' and often remain unvoiced: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Kerry Woolfall

    Full Text Available Ensuring parents make an informed decision about their child's participation in a clinical trial is a challenge for practitioners as a parent's comprehension of a trial may differ from that intended by the practitioners responsible for recruitment. We explored what issues parents consider important when making a decision about participation in a paediatric clinical trial and their comprehension of these issues to inform future recruitment practice. This qualitative interview and observational study examined recruitment in four placebo-controlled, double-blind randomised clinical trials of medicines for children. Audio-recorded trial recruitment discussions between practitioners and parents (N = 41 were matched with semi-structured interviews with parents (N = 41. When making a decision about trial entry parents considered clinical benefit, child safety, practicalities of participation, research for the common good, access to medication and randomisation. Within these prioritised issues parents had specific misunderstandings, which had the potential to influence their decisions. While parents had many questions and concerns about trial participation which influenced their decision-making, they rarely voiced these during discussions about the trials with practitioners. Those involved in the recruitment of children to clinical trials need to be aware of parents' priorities and the sorts of misunderstandings that can arise with parents. Providing trial information that is tailored to what parents consider important in making a decision about a clinical trial may improve recruitment practice and ultimately benefit evidence-based paediatric medicine.

  10. Parents' agendas in paediatric clinical trial recruitment are different from researchers' and often remain unvoiced: a qualitative study.

    Science.gov (United States)

    Woolfall, Kerry; Shilling, Valerie; Hickey, Helen; Smyth, Rosalind L; Sowden, Emma; Williamson, Paula R; Young, Bridget

    2013-01-01

    Ensuring parents make an informed decision about their child's participation in a clinical trial is a challenge for practitioners as a parent's comprehension of a trial may differ from that intended by the practitioners responsible for recruitment. We explored what issues parents consider important when making a decision about participation in a paediatric clinical trial and their comprehension of these issues to inform future recruitment practice. This qualitative interview and observational study examined recruitment in four placebo-controlled, double-blind randomised clinical trials of medicines for children. Audio-recorded trial recruitment discussions between practitioners and parents (N = 41) were matched with semi-structured interviews with parents (N = 41). When making a decision about trial entry parents considered clinical benefit, child safety, practicalities of participation, research for the common good, access to medication and randomisation. Within these prioritised issues parents had specific misunderstandings, which had the potential to influence their decisions. While parents had many questions and concerns about trial participation which influenced their decision-making, they rarely voiced these during discussions about the trials with practitioners. Those involved in the recruitment of children to clinical trials need to be aware of parents' priorities and the sorts of misunderstandings that can arise with parents. Providing trial information that is tailored to what parents consider important in making a decision about a clinical trial may improve recruitment practice and ultimately benefit evidence-based paediatric medicine.

  11. Clinical importance of cine-MRI assessment of small bowel motility in patients with chronic intestinal pseudo-obstruction: a retrospective study of 33 patients.

    Science.gov (United States)

    Fuyuki, Akiko; Ohkubo, Hidenori; Higurashi, Takuma; Iida, Hiroshi; Inoh, Yumi; Inamori, Masahiko; Nakajima, Atsushi

    2017-05-01

    Although chronic intestinal pseudo-obstruction (CIPO) is a rare and extremely severe functional digestive disorder, its clinical course and severity show various patterns. We assessed small bowel peristalsis in CIPO patients using cine-MRI (video-motion MRI) and their clinical characteristics to evaluate the clinical importance of performing cine-MRI in patients with this intractable disease. The medical records of 131 patients referred to our institution with a suspected diagnosis of CIPO between 2010 and 2015 were retrospectively evaluated. Thirty-three patients (22 female/11 male; age range 16-79 years) who met the criteria for CIPO and underwent cine-MRI were enrolled. Mean luminal diameter (MLD), contraction ratio (CR), and contraction cycle (CC) were determined and compared with these parameters in healthy volunteers. Clinical outcomes in patients with CIPO were also evaluated. The median follow-up time was 25.2 months (range, 1-65 months). Of the 33 patients with CIPO, 23 (70 %) showed apparently disturbed small intestinal peristalsis, whereas 10 (30 %) did not. The percentage of patients requiring intravenous alimentation was significantly higher (p = 0.03), and the mean serum albumin level was significantly lower (p = 0.04), in patients with than without impaired small intestinal peristalsis. Although both cine-MRI and CT findings in the latter ten cases were within the normal range, MLD and CR differed significantly from healthy volunteers. Cine-MRI is useful in predicting severe clinical features in patients with CIPO, and in detecting slightly impaired small contractility that cannot be detected on CT.

  12. Self-discrepancy: structural differences between clinical and non-clinical populations evaluated with MCMI-II

    Directory of Open Access Journals (Sweden)

    Ângela Brandão

    2014-10-01

    Full Text Available This research addresses the personality as a complex and dynamic structure and it relates the self-discrepancy theory with Millon's theory of personality. Self-discrepancy theory predicts that Ideal and Ought discrepancies originate different negative emotions. Millon's bipsychosocial theoty emphasizes the interaction between organism, environment and social learning, making salient the circularity of the interaction. The present study refers to the Real-Self (RS, Ideal-Self (IS and Ought-Self (OS discrepancies, evaluated using the MCMI-II in two different samples (clinical and non-clinical. The RSs results are different in the two samples and they were analized scale by scale. The RS-IS and RS-OS discrepancies results for each trait scale analyzes were mixed. It was given greater emphasis to RS-RI discrepancies and implications for personality theories and case conceptualization are taken into consideration.

  13. Clinical importance and representation of toxigenic and non-toxigenic Clostridium difficile cultivated from stool samples of hospitalized patients

    Directory of Open Access Journals (Sweden)

    Predrag Stojanovic

    2012-03-01

    Full Text Available The aim of this study was to fortify the clinical importance and representation of toxigenic and non-toxigenic Clostridium difficile isolated from stool samples of hospitalized patients. This survey included 80 hospitalized patients with diarrhea and positive findings of Clostridium difficile in stool samples, and 100 hospitalized patients with formed stool as a control group. Bacteriological examination of a stool samples was conducted using standard microbiological methods. Stool sample were inoculated directly on nutrient media for bacterial cultivation (blood agar using 5% sheep blood, Endo agar, selective Salmonella Shigella agar, Selenite-F broth, CIN agar and Skirrow's medium, and to selective cycloserine-cefoxitin-fructose agar (CCFA (Biomedics, Parg qe tehnicologico, Madrid, Spain for isolation of Clostridium difficile. Clostridium difficile toxin was detected by ELISA-ridascreen Clostridium difficile Toxin A/B (R-Biopharm AG, Germany and ColorPAC ToxinA test (Becton Dickinson, USA. Examination of stool specimens for the presence of parasites (causing diarrhea was done using standard methods (conventional microscopy, commercial concentration test Paraprep S Gold kit (Dia Mondial, France and RIDA®QUICK Cryptosporidium/Giardia Combi test (R-Biopharm AG, Germany. Examination of stool specimens for the presence of fungi (causing diarrhea was performed by standard methods. All stool samples positive for Clostridium difficile were tested for Rota, Noro, Astro and Adeno viruses by ELISA - ridascreen (R-Biopharm AG, Germany. In this research we isolated 99 Clostridium difficile strains from 116 stool samples of 80 hospitalized patients with diarrhea. The 53 (66.25% of patients with diarrhea were positive for toxins A and B, one (1.25% were positive for only toxin B. Non-toxigenic Clostridium difficile isolated from samples of 26 (32.5% patients. However, other pathogenic microorganisms of intestinal tract cultivated from samples of 16 patients

  14. Using time-varying global sensitivity analysis to understand the importance of different uncertainty sources in hydrological modelling

    Science.gov (United States)

    Pianosi, Francesca; Wagener, Thorsten

    2016-04-01

    Simulations from environmental models are affected by potentially large uncertainties stemming from various sources, including model parameters and observational uncertainty in the input/output data. Understanding the relative importance of such sources of uncertainty is essential to support model calibration, validation and diagnostic evaluation, and to prioritize efforts for uncertainty reduction. Global Sensitivity Analysis (GSA) provides the theoretical framework and the numerical tools to gain this understanding. However, in traditional applications of GSA, model outputs are an aggregation of the full set of simulated variables. This aggregation of propagated uncertainties prior to GSA may lead to a significant loss of information and may cover up local behaviour that could be of great interest. In this work, we propose a time-varying version of a recently developed density-based GSA method, called PAWN, as a viable option to reduce this loss of information. We apply our approach to a medium-complexity hydrological model in order to address two questions: [1] Can we distinguish between the relative importance of parameter uncertainty versus data uncertainty in time? [2] Do these influences change in catchments with different characteristics? The results present the first quantitative investigation on the relative importance of parameter and data uncertainty across time. They also provide a demonstration of the value of time-varying GSA to investigate the propagation of uncertainty through numerical models and therefore guide additional data collection needs and model calibration/assessment.

  15. The similarity between N-terminal targeting signals for protein import into different organelles and its evolutionary relevance

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    Markus eKunze

    2015-09-01

    Full Text Available The proper distribution of proteins between the cytosol and various membrane-bound compartments is crucial for the functionality of eukaryotic cells. This requires the cooperation between protein transport machineries that translocate diverse proteins from the cytosol into these compartments and targeting signal(s encoded within the primary sequence of these proteins that define their cellular destination. The mechanisms exerting protein translocation differ remarkably between the compartments, but the predominant targeting signals for mitochondria, chloroplasts and the ER share the N-terminal position, an α-helical structural element and the removal from the core protein by intraorganellar cleavage. Interestingly, similar properties have been described for the peroxisomal targeting signal type 2 mediating the import of a fraction of soluble peroxisomal proteins, whereas other peroxisomal matrix proteins encode the type 1 targeting signal residing at the extreme C-terminus. The structural similarity of N-terminal targeting signals poses a challenge to the specificity of protein transport, but allows the generation of ambiguous targeting signals that mediate dual targeting of proteins into different compartments. Dual targeting might represent an advantage for adaptation processes that involve a redistribution of proteins, because it circumvents the hierarchy of targeting signals. Thus, the co-existence of two equally functional import pathways into peroxisomes might reflect a balance between evolutionary constant and flexible transport routes.

  16. Importância da avaliação genético-clínica na hidrocefalia Importance of the clinical genetics evaluation on hydrocephalus

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    Marta Wey-Vieira

    2004-06-01

    hydrocephalus and reinforce the importance of dysmphology evaluation as an important complementary investigation.

  17. Infectious pancreatic necrosis virus causing clinical and subclinical infections in Atlantic salmon have different genetic fingerprints

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    Stephen Mutoloki

    2016-08-01

    Full Text Available Infectious pancreatic necrosis virus (IPNV is the causative agent of IPN, an important disease of salmonids. IPNV infections result in either sub-clinical or overt disease and the basis of this difference is not well understood. The objective of the present study was to determine the VP2 gene of the virus associated with the different forms of clinical manifestation. Groups of Atlantic salmon (Salmo salar L. reared in farms located in different IPN disease pressures were monitored from brood stock until grow-out over a 3 year period. Hatcheries A1 and B1 as well as cooperating seawater farms were located in a low disease risk area while hatcheries A2 and B2 as well as their cooperating seawater farms were in high IPN risk areas. Samples including eggs, milt, whole fry, kidney depending on the stage of production were collected during outbreaks or in apparently healthy populations where no outbreaks occurred. The virus was re-isolated in CHSE cells and the VP2 gene amplified by RT-PCR followed by sequencing. During the freshwater stage, there were no disease outbreaks at hatcheries A1, A2 and B1 (except in one fish group that originated from hatchery B2, although IPNV was isolated from some of the fish groups at all 3 hatcheries. By contrast, all fish groups at hatchery B2 suffered IPN outbreaks. In seawater, only groups of fish originating from hatchery A1 had no IPN outbreaks albeit virus being isolated from the fish. On the other hand, fish originating from hatcheries A2, B1 and B2 experienced outbreaks in seawater. The VP2 amino acid fingerprint of the virus associated with subclinical infections from A1 and co-operating seawater sites was V64A137P217T221A247N252S281D282E319. By contrast, all virus isolates associated with clinical infections had the motif I64T137T217A221T247V252T281N282A319, where underlined amino acids represent the avirulent and highly virulent motif, respectively. Phylogenetic analysis of amino acid sequences showed 2

  18. Infectious Pancreatic Necrosis Virus Causing Clinical and Subclinical Infections in Atlantic Salmon Have Different Genetic Fingerprints

    Science.gov (United States)

    Mutoloki, Stephen; Jøssund, Trude B.; Ritchie, Gordon; Munang'andu, Hetron M.; Evensen, Øystein

    2016-01-01

    Infectious pancreatic necrosis virus (IPNV) is the causative agent of IPN, an important disease of salmonids. IPNV infections result in either sub-clinical or overt disease and the basis of this difference is not well-understood. The objective of the present study was to determine the VP2 gene of the virus associated with the different forms of clinical manifestation. Groups of Atlantic salmon (Salmo salar L.) reared in farms located in different IPN disease pressures were monitored from brood stock until grow-out over a 3 year period. Hatcheries A1 and B1 as well as cooperating seawater farms were located in a low disease risk area while hatcheries A2 and B2 as well as their cooperating seawater farms were in high IPN risk areas. Samples including eggs, milt, whole fry, kidney depending on the stage of production were collected during outbreaks or in apparently healthy populations where no outbreaks occurred. The virus was re-isolated in CHSE cells and the VP2 gene amplified by RT-PCR followed by sequencing. During the freshwater stage, there were no disease outbreaks at hatcheries A1, A2, and B1 (except in one fish group that originated from hatchery B2), although IPNV was isolated from some of the fish groups at all 3 hatcheries. By contrast, all fish groups at hatchery B2 suffered IPN outbreaks. In seawater, only groups of fish originating from hatchery A1 had no IPN outbreaks albeit virus being isolated from the fish. On the other hand, fish originating from hatcheries A2, B1, and B2 experienced outbreaks in seawater. The VP2 amino acid fingerprint of the virus associated with subclinical infections from A1 and co-operating seawater sites was V64A137P217T221A247N252S281D282E319. By contrast, all virus isolates associated with clinical infections had the motif I64T137T217A221T247V252T281N282A319, where underlined amino acids represent the avirulent and highly virulent motif, respectively. Phylogenetic analysis of amino acid sequences showed 2 clades, one of

  19. Urban riverine environment is a source of multidrug-resistant and ESBL-producing clinically important Acinetobacter spp.

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    Maravić, Ana; Skočibušić, Mirjana; Fredotović, Željana; Šamanić, Ivica; Cvjetan, Svjetlana; Knezović, Mia; Puizina, Jasna

    2016-02-01

    Some Acinetobacter species have emerged as very important opportunistic pathogens in humans. We investigated Acinetobacter spp. from the polluted urban riverine environment in Croatia in regard to species affiliation, antibiotic resistance pattern, and resistance mechanisms. Considerable number of isolates produced acquired extended-spectrum β-lactamase(s) (ESBLs), CTX-M-15 solely or with TEM-116. By Southern blot hybridization, bla TEM-116 was identified on plasmids ca. 10, 3, and 1.2 kb in Acinetobacter junii, A. gandensis, and A. johnsonii. The bla TEM-116-carrying plasmid in A. gandensis was successfully transferred by conjugation to azide-resistant Escherichia coli J53. A. radioresistens isolate also carried an intrinsic carbapenemase gene bla OXA-133 with ISAba1 insertion sequence present upstream to promote its expression. Majority of ESBL-producing isolates harbored integrases intI1 and/or intI2 and the sulfamethoxazole resistance gene sul1. Almost all isolates had overexpressed resistance-nodulation-cell division (RND) efflux system, indicating that this mechanism may have contributed to multidrug resistance phenotypes. This is the first report of environmental CTX-M-15-producing Acinetobacter spp. and the first identification of CTX-M-15 in A. johnsonii, A. junii, A. calcoaceticus, A. gandensis, A. haemolyticus, and A. radioresistens worldwide. We identified, also for the first time, the environmental Acinetobacter-producing TEM ESBLs, highlighting the potential risk for human health, and the role of these bacteria in maintenance and dissemination of clinically important antibiotic resistance genes in community through riverine environments.

  20. Pattern of rheumatic diseases in two outpatient clinics in Iran: Similarities with some different features

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    Owlia Mohammad Bagher

    2011-01-01

    Full Text Available Background: Rheumatic diseases are among the most prevalent diseases recognized in the world. Musculoskeletal disorders are one of the main causes of disability around the world and expend a large amount of health care and social resources and have a substantial impact on the quality of life of those affected. To identify preventable risk factors and to gain insights into the burden of the diseases, it is important to know the prevalence and demographics of them. Herein we are to describe the pattern of different rheumatic disorders and characteristics of the patients attending in rheumatology clinics in Yazd, Iran, with addressing some different points of views in this regards. Materials and Methods:In this retrospective study, medical records of all patients referred to two main referral rheumatology clinics in Yazd from March 2009 to February 2010 were reviewed. A questionnaire including sex, age, chief complaint, diagnoses, and co-morbid diseases was used for gathering the data. Results:All medical records were reviewed, of whom 5187 patients had specific diagnoses. The mean age of the patients was 38.57 year ± 19.4 SD. 70.81% were females and 29.19% were males. The most common diagnoses were: degenerative joint disease (58.33%, autoimmune disorders (17.88%, and soft tissue rheumatism (12.47%. The most frequent complaints were knee pain (32%. 55.6% of the patients were overweight (BMI >29 and 923 (17.8 % of the patients had diabetes mellitus. Conclusion: Our findings were similar to other studies from Iran and the other countries in most features. The prevalence of autoimmune disorders was rather higher than the other studies; this is perhaps due to our belief that some of periarthritis conditions were part of systemic autoimmune diseases by careful history taking and using pertinent laboratory investigations.

  1. Survival in macaroni penguins and the relative importance of different drivers: individual traits, predation pressure and environmental variability.

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    Horswill, Catharine; Matthiopoulos, Jason; Green, Jonathan A; Meredith, Michael P; Forcada, Jaume; Peat, Helen; Preston, Mark; Trathan, Phil N; Ratcliffe, Norman

    2014-09-01

    Understanding the demographic response of free-living animal populations to different drivers is the first step towards reliable prediction of population trends. Penguins have exhibited dramatic declines in population size, and many studies have linked this to bottom-up processes altering the abundance of prey species. The effects of individual traits have been considered to a lesser extent, and top-down regulation through predation has been largely overlooked due to the difficulties in empirically measuring this at sea where it usually occurs. For 10 years (2003-2012), macaroni penguins (Eudyptes chrysolophus) were marked with subcutaneous electronic transponder tags and re-encountered using an automated gateway system fitted at the entrance to the colony. We used multistate mark-recapture modelling to identify the different drivers influencing survival rates and a sensitivity analysis to assess their relative importance across different life stages. Survival rates were low and variable during the fledging year (mean = 0·33), increasing to much higher levels from age 1 onwards (mean = 0·89). We show that survival of macaroni penguins is driven by a combination of individual quality, top-down predation pressure and bottom-up environmental forces. The relative importance of these covariates was age specific. During the fledging year, survival rates were most sensitive to top-down predation pressure, followed by individual fledging mass, and finally bottom-up environmental effects. In contrast, birds older than 1 year showed a similar response to bottom-up environmental effects and top-down predation pressure. We infer from our results that macaroni penguins will most likely be negatively impacted by an increase in the local population size of giant petrels. Furthermore, this population is, at least in the short term, likely to be positively influenced by local warming. More broadly, our results highlight the importance of considering multiple causal effects across

  2. The nociceptin receptor (NOPR) and its interaction with clinically important agonist molecules: a membrane molecular dynamics simulation study.

    Science.gov (United States)

    Kothandan, Gugan; Gadhe, Changdev G; Balupuri, Anand; Ganapathy, Jagadeesan; Cho, Seung Joo

    2014-12-01

    The nociceptin receptor (NOPR) is an orphan G protein-coupled receptor that contains seven transmembrane helices. NOPR has a distinct mechanism of activation, though it shares a significant homology with other opioid receptors. Previously there have been reports on homology modeling of NOPR and also molecular dynamics simulation studies for a short period. Recently the crystal structure of NOPR was reported. In this study, we analyzed the time dependent behavior of NOPR docked with clinically important agonist molecules such as NOP (natural agonist) peptide and compound 10 (SCH-221510 derivative) using molecular dynamics simulations (MDS) for 100 ns. Molecular dynamics simulations of NOPR-agonist complexes allowed us to refine the system and to also identify stable structures with better binding modes. Structure activity relationships (SAR) for SCH221510 derivatives were investigated and reasons for the activities of these derivatives were determined. Our molecular dynamics trajectory analysis of NOPR-peptide and NOPR-compound 10 complexes found residues to be crucial for binding. Mutagenesis studies on the residues identified from our analysis could prove useful. Our results could also provide useful information in the structure-based drug design of novel and potent agonists targeting NOPR.

  3. Relative importance of modularity and other morphological attributes on different types of lithic point weapons: assessing functional variations.

    Science.gov (United States)

    González-José, Rolando; Charlin, Judith

    2012-01-01

    The specific using of different prehistoric weapons is mainly determined by its physical properties, which provide a relative advantage or disadvantage to perform a given, particular function. Since these physical properties are integrated to accomplish that function, examining design variables and their pattern of integration or modularity is of interest to estimate the past function of a point. Here we analyze a composite sample of lithic points from southern Patagonia likely formed by arrows, thrown spears and hand-held points to test if they can be viewed as a two-module system formed by the blade and the stem, and to evaluate the degree in which shape, size, asymmetry, blade: stem length ratio, and tip angle explain the observed variance and differentiation among points supposedly aimed to accomplish different functions. To do so we performed a geometric morphometric analysis on 118 lithic points, departing from 24 two-dimensional landmark and semi landmarks placed on the point's contour. Klingenberg's covariational modularity tests were used to evaluate different modularity hypotheses, and a composite PCA including shape, size, asymmetry, blade: stem length ratio, and tip angle was used to estimate the importance of each attribute to explaining variation patterns. Results show that the blade and the stem can be seen as "near decomposable units" in the points integrating the studied sample. However, this modular pattern changes after removing the effects of reduction. Indeed, a resharpened point tends to show a tip/rest of the point modular pattern. The composite PCA analyses evidenced three different patterns of morphometric attributes compatible with arrows, thrown spears, and hand-held tools. Interestingly, when analyzed independently, these groups show differences in their modular organization. Our results indicate that stone tools can be approached as flexible designs, characterized by a composite set of interacting morphometric attributes, and evolving

  4. Relative importance of modularity and other morphological attributes on different types of lithic point weapons: assessing functional variations.

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    Rolando González-José

    Full Text Available The specific using of different prehistoric weapons is mainly determined by its physical properties, which provide a relative advantage or disadvantage to perform a given, particular function. Since these physical properties are integrated to accomplish that function, examining design variables and their pattern of integration or modularity is of interest to estimate the past function of a point. Here we analyze a composite sample of lithic points from southern Patagonia likely formed by arrows, thrown spears and hand-held points to test if they can be viewed as a two-module system formed by the blade and the stem, and to evaluate the degree in which shape, size, asymmetry, blade: stem length ratio, and tip angle explain the observed variance and differentiation among points supposedly aimed to accomplish different functions. To do so we performed a geometric morphometric analysis on 118 lithic points, departing from 24 two-dimensional landmark and semi landmarks placed on the point's contour. Klingenberg's covariational modularity tests were used to evaluate different modularity hypotheses, and a composite PCA including shape, size, asymmetry, blade: stem length ratio, and tip angle was used to estimate the importance of each attribute to explaining variation patterns. Results show that the blade and the stem can be seen as "near decomposable units" in the points integrating the studied sample. However, this modular pattern changes after removing the effects of reduction. Indeed, a resharpened point tends to show a tip/rest of the point modular pattern. The composite PCA analyses evidenced three different patterns of morphometric attributes compatible with arrows, thrown spears, and hand-held tools. Interestingly, when analyzed independently, these groups show differences in their modular organization. Our results indicate that stone tools can be approached as flexible designs, characterized by a composite set of interacting morphometric

  5. Relative Importance of Modularity and Other Morphological Attributes on Different Types of Lithic Point Weapons: Assessing Functional Variations

    Science.gov (United States)

    González-José, Rolando; Charlin, Judith

    2012-01-01

    The specific using of different prehistoric weapons is mainly determined by its physical properties, which provide a relative advantage or disadvantage to perform a given, particular function. Since these physical properties are integrated to accomplish that function, examining design variables and their pattern of integration or modularity is of interest to estimate the past function of a point. Here we analyze a composite sample of lithic points from southern Patagonia likely formed by arrows, thrown spears and hand-held points to test if they can be viewed as a two-module system formed by the blade and the stem, and to evaluate the degree in which shape, size, asymmetry, blade: stem length ratio, and tip angle explain the observed variance and differentiation among points supposedly aimed to accomplish different functions. To do so we performed a geometric morphometric analysis on 118 lithic points, departing from 24 two-dimensional landmark and semi landmarks placed on the point's contour. Klingenberg's covariational modularity tests were used to evaluate different modularity hypotheses, and a composite PCA including shape, size, asymmetry, blade: stem length ratio, and tip angle was used to estimate the importance of each attribute to explaining variation patterns. Results show that the blade and the stem can be seen as “near decomposable units” in the points integrating the studied sample. However, this modular pattern changes after removing the effects of reduction. Indeed, a resharpened point tends to show a tip/rest of the point modular pattern. The composite PCA analyses evidenced three different patterns of morphometric attributes compatible with arrows, thrown spears, and hand-held tools. Interestingly, when analyzed independently, these groups show differences in their modular organization. Our results indicate that stone tools can be approached as flexible designs, characterized by a composite set of interacting morphometric attributes, and

  6. The importance of clinical mistletoe cancer therapy and korean mistletoe pharmacopuncture preparation development and application possibility for oriental medicine

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    Ok-Byung Choi

    2009-03-01

    Full Text Available Objectives : Mistletoe extracts have been in use for around 85 years, predominantly in the area of cancer therapy. Today mistletoe preparations are among the most prescribed drugs in cancer medicine, thus constituting a standard biological therapy in the area of oncology. The purpose of this study is to analyze the practical implications of mistletoe cancer therapy, their clinical status, their preparation techniques and companies. Contents : Mistletoe therapy for cancer has been developed within the context of anthroposophical medicine. One major effect of mistletoe extract is that it stimulates the immune system and cancer defences. In Germany, a total of eight different mistletoe preparations are available, five developed by Anthroposophic Medicine and three evolved from research in phytotherapy. Therapy always consists of an introductory phase in order to test the patient′s tolerance, find the right dosage and choose the most suitable preparation. This paper covers the background of mistletoe medical plant materials, mistletoe therapy for cancer, the anthroposophical medicine and clinical research, the practical regulation of treatment, preparation of mistletoe drugs. Result & suggestion : Mistletoe extracts are a complementary teratment of cancer, widely used in intergrative cancer care. The study of the integration of korean mistletoe extracts to oriental cancer medicine, its development and feasibility in Korea are urgently needed. The products, substances, compositions of european mistletoe drugs are very similar to those of oriental medicine theory. Applying the mistletoe cancer therapy and its preparation techniques to oriental medicine, the herbal acupuncture preparation should be modernized and korean mistletoe products are to be developed. To this end, government and herbal acupuncture society need to interact each other for the development of oriental mistletoe cancer medicine.

  7. The clinical importance of myeloid antigen coexpression and TEL-AML1 mutation in patients with childhood acute lymphoblastic leukemia

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    Ayşen Türedi Yıldırım

    2013-03-01

    Full Text Available Objective: In this study, we aim to investigate the relationship,if any, between clinical features, prognosis, and thecoexpressions and TEL-AML1 mutation in patients withacute lymphoblastic leukemia (ALL.Methods: Eigthy-three patients with acute lymphoblasticleukemia were retrospectively examined. Age, gender,White blood cell count, hemoglobin level, platelet count,ALL subtypei (B or T ALL, risk groups, surface antigensdeteceted by flow cytometry, existence of TEL-AML1 mutations,response, remission and relapse status at 8., 15.ve 33. Days of treatment were recorded and analyzed.Results: 15 (18% out of 83 were identified with aberrantantigen expression. Of these patients, twelve (14.4%had myeloid antigen coexpression (CD13 and/or CD33,two with B cell ALL had CD2 and CD7 coexpressions respectively,one with T cell ALL had CD19 coexpression.No significant differences were found between patientswith and without myeloid antigen coexpression in terms ofhemoglobin levels, white blood cells and platelet counts,responses given on the 8th, 15th, and 30th days on the treatment,risk groups, and relapse (p>0.05. Myeloid antigencoexpression was found in 4 of 13 patients who were identifiedwith TEL-AML1 mutation. No significant relationshipwas found between this mutation and coexpressions. Norelapse and exitus were observed in four patients with coexpressionand TEL-AML1.Conclusion: The prognosis and clinical features showsno statistically significant relationship with the presence ofneither Myeloid antigen expression nor TEL-AML1 mutation.We believe, however, the future studies involving biggersample sizes will prove to be useful in terms of moreconvincing results. J Clin Exp Invest 2013; 4(1: 90-94Key words: Acute lenfoblastic leukemia, coexpression,TEL-AML1 mutation, prognosis

  8. Differences in clinical presentation of ankylosing spondylitis in men and women

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    Hossain Soleymani Salehabadi

    2016-10-01

    Full Text Available Background: Ankylosing spondylitis (AS is an inflammatory disease that mainly affects axial skeleton of the body and ankylosing spondylitis ligaments around the spine at the junction of the spine are inflamed, because the disease is progressive and can lead to significantly cause of disability and the studies could provide a mechanism for the early detection of the disease or help determine when to start treatment, the difference in clinical presentations of AS in men and women is indicative of potential effect of gender on severity of the disease. This study was conducted with the aim to investigate the effect of gender on severity of AS. Methods: In a cross-sectional study, one hundred and fifteen patients with ankylosing spondylitis who referred to Yazd Rheumatology Clinic between 2001 and 2013 were evaluated. Sampling was performed using non-random convenient method. The most important variables studied included demographic data, clinical presentation, radiographic stage of sacroiliac involvement, and laboratory data extracted from patients’ files and recorded in questionnaires. Results: Both groups according to age at diagnosis, presence of enteritis, peripheral joint involvement and laboratory data such as C-reactive protein (CRP, erythrocyte sedimentation rate (ESR and hemoglobin were matched. Inflammatory neck pain was more prevalent in men than in women (77.2% against 51.8%; P< 0.05. Sacroiliac radiographic study revealed stage 1 involvement in 11.3% of men and 37% of women (P= 0.009, and stage 4 in 27.2% of men and 3.7% of women (P< 0.001, with a significant difference. Conclusion: According to the results of the study, the time between age of onset and age at diagnosis, inflammatory pain in the neck and advanced stage in men than in women was higher. Although these findings suggest that gender may have an impact on the pattern and severity of AS but the time delay in diagnosis as a disease affecting the intensity and pattern should

  9. Reading Disability and Quality of Life Based on Both Self- and Parent-Reports:Importance of Gender Differences

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    Judit Balazs

    2016-12-01

    Full Text Available Purpose: The aim of this study is to investigate self- and parent-rated quality of life (QoL in children with a reading disability (RD and the impact of comorbid psychopathology, with special focus on age and gender differences.Methods: Using the Dyslexia Differential Diagnosis Maastricht-Hungarian standard test, 127 children (aged < 18 were included in the RD group and 81 in the control group. To measure comorbid psychopathology, the Strengths and Difficulties Questionnaire (SDQ was administered. To evaluate the children’s QoL self- and parent-rated versions of the Measure of Quality of Life for Children and Adolescents (ILK were used. Group differences in QoL and psychopathology were assessed using Mann-Whitney U tests. Moderated mediational models were tested in which comorbid psychopathology mediated the relationship between group membership and self- and parent-rated QoL, which was dependent on gender. Child’s age and parents’ level of education were included as covariates.Results: The RD group showed lower QoL than the controls in several domains, according to the parent-report, while no differences between the two groups were found, according to self-report. In boys, results revealed conditional and indirect effects of group membership on self- and parent-rated QoL through comorbid psychopathology (-.046, BCa 95%CI: -.135 −.043 and .064, BCa 95%CI: .024−.111, respectively as well as a conditional direct effect of group membership on parent-reported (-.098, BCa 95%CI: .012−.184, but not self-rated, QoL. No relationship was found for girls. Conclusions: This study highlights the importance of measuring QoL and comorbid psychopathology in children with RDs from more sources and accounting for gender and age differences.

  10. [Liver metastases from colon and rectal cancer in terms of differences in their clinical parameters].

    Science.gov (United States)

    Liška, V; Emingr, M; Skála, M; Pálek, R; Troup, O; Novák, P; Vyčítal, O; Skalický, T; Třeška, V

    2016-02-01

    From the clinical point of view, rectal cancer and colon cancer are clearly different nosological units in their progress and treatment. The aim of this study was to analyse and clarify the differences between the behaviour of liver metastases from colon and rectal cancer. The study of these factors is important for determining an accurate prognosis and indication of the most effective surgical therapy and oncologic treatment of colon and rectal cancer as a systemic disease. 223 patients with metastatic disease of colorectal carcinoma operated at the Department of Surgery, University Hospital in Pilsen between January 1, 2006 and January 31, 2012 were included in our study. The group of patients comprised 145 men (65%) and 117 women (35%). 275 operations were performed. Resection was done in 177 patients and radiofrequency ablation (RFA) in the total of 98 cases. Our sample was divided into 3 categories according to the location of the primary tumor to C (colon), comprising 58 patients, S (c. sigmoideum) in 61 patients, and R (rectum), comprising 101 patients. Significance analysis of the studied factors (age, gender, staging [TNM classification], grading, presence of mucinous carcinoma, type of operation) was performed using ANOVA test. Overall survival (OS), disease-free interval (DFI) or no evidence of disease (NED) were estimated using Kaplan-Meier curves, which were compared with the log-rank and Wilcoxon tests. As regards the comparison of primary origin of colorectal metastases in liver regardless of their treatment (resection and RFA), our study indicated that rectal liver metastases showed a significantly earlier recurrence than colon liver metastases (shorter NED/DFI). Among other factors, a locally advanced finding, further R2 resection of liver metastases and positivity of lymph node metastases were statistically significant for the prognosis of an early recurrence of the primary colon and sigmoid tumor. Furthermore, we proved that in patients with

  11. Students’ performance in the different clinical skills assessed in OSCE: what does it reveal?

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    Joong Hiong Sim

    2015-02-01

    Full Text Available Introduction: The purpose of this study was to compare students’ performance in the different clinical skills (CSs assessed in the objective structured clinical examination. Methods: Data for this study were obtained from final year medical students’ exit examination (n=185. Retrospective analysis of data was conducted using SPSS. Means for the six CSs assessed across the 16 stations were computed and compared. Results: Means for history taking, physical examination, communication skills, clinical reasoning skills (CRSs, procedural skills (PSs, and professionalism were 6.25±1.29, 6.39±1.36, 6.34±0.98, 5.86±0.99, 6.59±1.08, and 6.28±1.02, respectively. Repeated measures ANOVA showed there was a significant difference in the means of the six CSs assessed [F(2.980, 548.332=20.253, p<0.001]. Pairwise multiple comparisons revealed significant differences between the means of the eight pairs of CSs assessed, at p<0.05. Conclusions: CRSs appeared to be the weakest while PSs were the strongest, among the six CSs assessed. Students’ unsatisfactory performance in CRS needs to be addressed as CRS is one of the core competencies in medical education and a critical skill to be acquired by medical students before entering the workplace. Despite its challenges, students must learn the skills of clinical reasoning, while clinical teachers should facilitate the clinical reasoning process and guide students’ clinical reasoning development.

  12. In vitro effects of citrus oils against Mycobacterium tuberculosis and non-tuberculous Mycobacteria of clinical importance.

    Science.gov (United States)

    Crandall, Philip G; Ricke, Steven C; O'Bryan, Corliss A; Parrish, Nicole M

    2012-01-01

    We evaluated the in vitro activity of citrus oils against Mycobacterium tuberculosis and other non-tuberculous Mycobacterium species. Citrus essential oils were tested against a variety of Mycobacterium species and strains using the BACTEC radiometric growth system. Cold pressed terpeneless Valencia oil (CPT) was further tested using the Wayne model of in vitro latency. Exposure of M. tuberculosis and M. bovis BCG to 0.025 % cold pressed terpeneless Valencia orange oil (CPT) resulted in a 3-log decrease in viable counts versus corresponding controls. Inhibition of various clinical isolates of the M. avium complex and M. abscessus ranged from 2.5 to 5.2-logs. Some species/strains were completely inhibited in the presence of CPT including one isolate each of the following: the M. avium complex, M. chelonae and M. avium subsp. paratuberculosis. CPT also inhibited the growth of BCG more than 99 % in an in vitro model of latency which mimics anaerobic dormancy thought to occur in vivo. The activity of CPT against drug-resistant strains of the M. avium complex and M. abscessus suggest that the mechanism of action for CPT is different than that of currently available drugs. Inhibition of latently adapted bacilli offers promise for treatment of latent infections of MTB. These results suggest that the antimycobacterial properties of CPT warrant further study to elucidate the specific mechanism of action and clarify the spectrum of activity.

  13. New Lesions Detected by Single Nucleotide Polymorphism Array–Based Chromosomal Analysis Have Important Clinical Impact in Acute Myeloid Leukemia

    Science.gov (United States)

    Tiu, Ramon V.; Gondek, Lukasz P.; O'Keefe, Christine L.; Huh, Jungwon; Sekeres, Mikkael A.; Elson, Paul; McDevitt, Michael A.; Wang, Xiao Fei; Levis, Mark J.; Karp, Judith E.; Advani, Anjali S.; Maciejewski, Jaroslaw P.

    2009-01-01

    Purpose Cytogenetics is the primary outcome predictor in acute myeloid leukemia (AML). Metaphase cytogenetics (MC) detects an abnormal karyotype in only half of patients with AML, however. Single nucleotide polymorphism arrays (SNP-A) can detect acquired somatic uniparental disomy (UPD) and other cryptic defects, even in samples deemed normal by MC. We hypothesized that SNP-A will improve detection of chromosomal defects in AML and that this would enhance the prognostic value of MC. Patients and Methods We performed 250K and 6.0 SNP-A analyses on 140 patients with primary (p) and secondary (s) AML and correlated the results with clinical outcomes and Flt-3/nucleophosmin (NPM-1) status. Results SNP-A is more sensitive than MC in detecting unbalanced lesions (pAML, 65% v 39%, P = .002; and sAML, 78% v 51%, P = .003). Acquired somatic UPD, not detectable by MC, was common in our AML cohort (29% in pAML and 35% in sAML). Patients with SNP-A lesions including acquired somatic UPD exhibited worse overall survival (OS) and event-free survival (EFS) in pAML with normal MC and in pAML/sAML with abnormal MC. SNP-A improved the predictive value of Flt-3 internal tandem duplication/NPM-1 status, with inferior survival seen in patients with additional SNP-A defects. Multivariate analyses confirmed the independent predictive value of SNP-A defects for OS (hazard ratio [HR] = 2.52; 95% CI, 1.29 to 5.22; P = .006) and EFS (HR = 1.72; 95% CI, 1.12 to 3.48; P = .04). Conclusion SNP-A analysis allows enhanced detection of chromosomal abnormalities and provides important prognostic impact in AML. PMID:19770377

  14. The clinical importance of the thyroid nodules during anti-tumor necrosis factor therapy in patients with axial spondyloarthritis.

    Science.gov (United States)

    Terlemez, Rana; Akgün, Kenan; Palamar, Deniz; Boz, Sinan; Sarı, Hidayet

    2017-03-30

    The clinical importance of the thyroid nodules in patients with axial spondyloarthritis (ax-SpA) rests with the need to exclude thyroid malignancy. The aim of this study is to assess the risk of thyroid malignancy in ax-SpA patients receiving anti-TNF therapy. From September 2015 until December 2015, 70 patients diagnosed with ax-SpA were included in the research. Forty of the patients had received anti-TNF therapy, and 30 of the patients were anti-TNF naive. All cases were screened for the presence of nodules in the thyroid gland with ultrasound. Of the patients that received anti-TNF therapy, 15 (37.5%); and of the anti-TNF naive patients, 11 (36.7%) had thyroid nodule(s). Four patients from the anti-TNF group underwent fine needle aspiration biopsy of the nodules, and two of them were diagnosed with papillary thyroid carcinoma. None of the nodules in anti-TNF naive patients required biopsy. When compared to the normal population, the standardized incidence ratio (SIR) was found to be increased in both male (SIR 2.03, 95% CI 1.9 to 18) and female (SIR 2.7, 95% CI 2.6 to 24) cases. It is not yet established whether the development of cancer during the treatment process is the effect of the treatment or if it is a part of the natural course of the disease or if it is coincidental. We saw a mild increase in thyroid malignancies in ax-SpA patients who received anti-TNF therapy. Therefore, we believe that the thyroid gland should also be taken into consideration while screening for malignancy before anti-TNF therapy.

  15. Importance of stress-response genes to the survival of airborne Escherichia coli under different levels of relative humidity.

    Science.gov (United States)

    Ng, Tsz Wai; Chan, Wing Lam; Lai, Ka Man

    2017-12-01

    Other than the needs for infection control to investigate the survival and inactivation of airborne bacterial pathogens, there has been a growing interest in exploring bacterial communities in the air and the effect of environmental variables on them. However, the innate biological mechanism influencing the bacterial viability is still unclear. In this study, a mutant-based approach, using Escherichia coli as a model, was used to prove the concept that common stress-response genes are important for airborne survival of bacteria. Mutants with a single gene knockout that are known to respond to general stress (rpoS) and oxidative stress (oxyR, soxR) were selected in the study. Low relative humidity (RH), 30-40% was more detrimental to the bacteria than high RH, >90%. The log reduction of ∆rpoS was always higher than that of the parental strain at all RH levels but the ∆oxyR had a higher log reduction than the parental strain at intermediate RH only. ∆soxR had the same viability compared to the parental strain at all RH levels. The results hint that although different types and levels of stress are produced under different RH conditions, stress-response genes always play a role in the bacterial viability. This study is the first reporting the association between stress-response genes and viability of airborne bacteria.

  16. Reading Disability and Quality of Life Based on Both Self- and Parent-Reports: Importance of Gender Differences

    Science.gov (United States)

    Balazs, Judit; Miklosi, Monika; Toro, Krisztina T.; Nagy-Varga, Diana

    2016-01-01

    Purpose: The aim of this study is to investigate self- and parent-rated quality of life (QoL) in children with a reading disability (RD) and the impact of comorbid psychopathology, with special focus on age and gender differences. Methods: Using the Dyslexia Differential Diagnosis Maastricht-Hungarian standard test, 127 children (aged boys, results revealed conditional and indirect effects of group membership on self- and parent-rated QoL through comorbid psychopathology (−0.046, BCa 95% CI: −0.135 to 0.043 and 0.064, BCa 95% CI: 0.024–0.111, respectively) as well as a conditional direct effect of group membership on parent-reported (−0.098, BCa 95% CI: 0.012–0.184), but not self-rated, QoL. No relationship was found for girls. Conclusions: This study highlights the importance of measuring QoL and comorbid psychopathology in children with RDs from more sources and accounting for gender and age differences. PMID:28018276

  17. Differences in citation frequency of clinical and basic science papers in cardiovascular research

    NARCIS (Netherlands)

    Opthof, Tobias

    2011-01-01

    In this article, a critical analysis is performed on differences in citation frequency of basic and clinical cardiovascular papers. It appears that the latter papers are cited at about 40% higher frequency. The differences between the largest number of citations of the most cited papers are even lar

  18. Differences in citation frequency of clinical and basic science papers in cardiovascular research

    NARCIS (Netherlands)

    Opthof, Tobias

    2011-01-01

    In this article, a critical analysis is performed on differences in citation frequency of basic and clinical cardiovascular papers. It appears that the latter papers are cited at about 40% higher frequency. The differences between the largest number of citations of the most cited papers are even lar

  19. A randomised, controlled clinical study on total hip arthroplasty using 4 different bearings

    DEFF Research Database (Denmark)

    Borgwardt, Arne; Zerahn, Bo; Fabricius, Sandra D

    2017-01-01

    PURPOSE: To compare 4 different bearings in total hip arthroplasty (THA) in a randomised controlled clinical study on clinical performance. METHODS: 393 patients with osteoarthritis of the hip or avascular necrosis were included and allocated to 1 of the head-and-cup couples zirconia-on-polyethyl......PURPOSE: To compare 4 different bearings in total hip arthroplasty (THA) in a randomised controlled clinical study on clinical performance. METHODS: 393 patients with osteoarthritis of the hip or avascular necrosis were included and allocated to 1 of the head-and-cup couples zirconia...... cumulated prosthesis survival percentages and 95% confidence interval after 10 years were: group A 84.6 (75.8-93.4); group B 95.0 (89.5-100); group C 93.2 (86.7-99.7); group D 66.1 (54.5-77.7). The patients' physical function was significantly improved and remained equally good in all 4 groups, however...

  20. Importance of different types of prior knowledge in selecting genome-wide findings for follow-up.

    Science.gov (United States)

    Minelli, Cosetta; De Grandi, Alessandro; Weichenberger, Christian X; Gögele, Martin; Modenese, Mirko; Attia, John; Barrett, Jennifer H; Boehnke, Michael; Borsani, Giuseppe; Casari, Giorgio; Fox, Caroline S; Freina, Thomas; Hicks, Andrew A; Marroni, Fabio; Parmigiani, Giovanni; Pastore, Andrea; Pattaro, Cristian; Pfeufer, Arne; Ruggeri, Fabrizio; Schwienbacher, Christine; Taliun, Daniel; Pramstaller, Peter P; Domingues, Francisco S; Thompson, John R

    2013-02-01

    Biological plausibility and other prior information could help select genome-wide association (GWA) findings for further follow-up, but there is no consensus on which types of knowledge should be considered or how to weight them. We used experts' opinions and empirical evidence to estimate the relative importance of 15 types of information at the single-nucleotide polymorphism (SNP) and gene levels. Opinions were elicited from 10 experts using a two-round Delphi survey. Empirical evidence was obtained by comparing the frequency of each type of characteristic in SNPs established as being associated with seven disease traits through GWA meta-analysis and independent replication, with the corresponding frequency in a randomly selected set of SNPs. SNP and gene characteristics were retrieved using a specially developed bioinformatics tool. Both the expert and the empirical evidence rated previous association in a meta-analysis or more than one study as conferring the highest relative probability of true association, whereas previous association in a single study ranked much lower. High relative probabilities were also observed for location in a functional protein domain, although location in a region evolutionarily conserved in vertebrates was ranked high by the data but not by the experts. Our empirical evidence did not support the importance attributed by the experts to whether the gene encodes a protein in a pathway or shows interactions relevant to the trait. Our findings provide insight into the selection and weighting of different types of knowledge in SNP or gene prioritization, and point to areas requiring further research.

  1. Assessing cycling-friendly environments for children: are micro-environmental factors equally important across different street settings?

    Science.gov (United States)

    Ghekiere, Ariane; Van Cauwenberg, Jelle; Mertens, Lieze; Clarys, Peter; de Geus, Bas; Cardon, Greet; Nasar, Jack; Salmon, Jo; De Bourdeaudhuij, Ilse; Deforche, Benedicte

    2015-05-02

    As physical activity levels decrease as children age, sustainable and accessible forms of physical activity are needed from a young age. Transportation cycling is one such physical activity and has been associated with many benefits. The aims of the study were to identify whether manipulating micro-environmental factors (e.g. speed limits, evenness of cycle path) within a photographed street influences the perceived supportiveness for transportation cycling; and whether changing these micro-environmental factors has the same effect across different street settings. We recruited 305 fifth and sixth grade children and their parents from twelve randomly selected primary schools in Flanders, Belgium. They completed a web-based questionnaire including 12 choice-based conjoint tasks, in which they had to choose between two possible routes depicted on manipulated photographs, which the child would cycle along. The routes differed in four attributes: general street setting (enclosed, half open, open), evenness of cycle path (very uneven, moderately uneven, even), speed limit (70 km/h, 50 km/h, 30 km/h) and degree of separation between a cycle path and motorised traffic (no separation, curb, hedge). Hierarchical Bayes analyses revealed the relative importance of each micro-environmental attribute across the three street settings. For each attribute, children and their parents chose routes that had the best alternative (i.e. open street setting, even cycle path, 30 km/h, a hedge separating the cycle path from motorised traffic). The evenness of the cycle path and lower speed limit had the largest effect for the children, while the degree of separation and lower speed limit had the largest effect for their parents. Interactions between micro-scale and macro-scale factors revealed differences in the magnitude but not direction of their effects on route choice. The results held across the different kinds of street settings tested. Improving micro-scale attributes may increase

  2. Methodology and Psychotechnics of reconstruction of the Self in clinical disease of different spectra

    Directory of Open Access Journals (Sweden)

    Maksimenko K.S.

    2014-09-01

    Full Text Available In the article on a representative material of the modern Russian theory and practice of psychotherapy, we show that the psychological aspect of physical suffering, although recognized by modern medicine, is traditionally treated as a minor and one that defies prediction and algoritmisation. We conducted a metatheoretic analysis of domestic and foreign concepts in the practice of somatic patients psychotherapy, analyzed the practical effectiveness of different models of person-centered psychotherapy of patients with personality disorders of nonpsychotic genesis. We allocated specific scope of clinical psychologists and psychotherapists, namely personality-oriented psychotherapy in patients with non-psychotic personality disorders or uncomfortable psychological conditions manifested by chronic physical illness. Reflective metatheoretical analysis of existing theory and practice of psychotherapeutic work with these patients allows to clearly define and identify the range of issues, signs of a disorder, i.e. formulate an indicative basis for this particular set of problems and, most importantly, provide appropriate space for the most effective psychotherapeutic intervention aimed at enhancing the adaptive resources of the Self.

  3. Minimally important differences for Patient Reported Outcomes Measurement Information System pain interference for individuals with back pain

    Directory of Open Access Journals (Sweden)

    Amtmann D

    2016-04-01

    Full Text Available Dagmar Amtmann,1 Jiseon Kim,1 Hyewon Chung,2 Robert L Askew,3 Ryoungsun Park,4 Karon F Cook5 1Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA; 2Department of Education, Chungnam National University, Daejeon, Republic of Korea; 3Department of Psychology, Stetson University, Deland, FL, USA; 4Theoretical and Behavioral Foundations Division, Wayne State University, Detroit, MI, USA; 5Department of Medical Social Science, Northwestern University, Chicago, IL, USA Background: The minimally important difference (MID refers to the smallest change that is sufficiently meaningful to carry implications for patients' care. MIDs are necessary to guide the interpretation of scores. This study estimated MID for the Patient Reported Outcomes Measurement Information System (PROMIS pain interference (PI. Methods: Study instruments were administered to 414 people who participated in two studies that included treatment with low back pain (LBP; n=218 or depression (n=196. Participants with LBP received epidural steroid injections and participants with depression received antidepressants, psychotherapy, or both. MIDs were estimated for the changes in LBP. MIDs were included only if a priori criteria were met (ie, sample size ≥10, Spearman correlation ≥0.3 between anchor measures and PROMIS-PI scores, and effect size range =0.2–0.8. The interquartile range (IQR of MID estimates was calculated. Results: The IQR ranged from 3.5 to 5.5 points. The lower bound estimate of the IQR (3.5 was greater than mean of standard error of measurement (SEM both at time 1 (SEM =2.3 and at time 2 (SEM =2.5, indicating that the estimate of MID exceeded measurement error. Conclusion: Based on our results, researchers and clinicians using PROMIS-PI can assume that change of 3.5 to 5.5 points in comparisons of mean PROMIS-PI scores of people with LBP can be considered meaningful. Keywords: minimally important differences, pain interference, back pain

  4. Indirect composite restorations luted with two different procedures: A ten years follow up clinical trial

    Science.gov (United States)

    Preti, Alessandro; Vano, Michele; Derchi, Giacomo; Mangani, Francesco; Cerutti, Antonio

    2015-01-01

    Objectives: The aim of this clinical trial was to evaluate posterior indirect composite resin restoration ten years after placement luted with two different procedures. Study Design: In 23 patients 22 inlays/onlays (Group A) were luted using a dual-cured resin composite cement and 26 inlays/onlays (Group B) were luted using a light cured resin composite for a total of 48 Class I and Class II indirect composite resin inlays and onlays. The restorations were evaluated at 2 time points: 1) one week after placement (baseline evaluation) and 2) ten years after placement using the modified USPHS criteria. The Mann-Whitney and the Wilcoxon tests were used to examine the difference between the results of the baseline and 10 years evaluation for each criteria. Results: Numerical but not statistically significant differences were noted on any of the recorded clinical parameters (p>0.05) between the inlay/onlays of Group A and Group B. 91% and 94 % of Group A and B respectively were rated as clinically acceptable in all the evaluated criteria ten years after clinical function. Conclusions: Within the limits of the study the results showed after ten years of function a comparable clinical performance of indirect composite resin inlays/onlays placed with a light cure or dual cure luting procedures. Key words:Light curing composite, dual curing composite, indirect composite restoration, inlays/onlays, clinical trial. PMID:25810842

  5. Ethnic and social disparities in different types of examinations in undergraduate pre-clinical training.

    Science.gov (United States)

    Stegers-Jager, K M; Brommet, F N; Themmen, A P N

    2016-12-01

    Medical schools are increasingly faced with a more diverse student population. Generally, ethnic minority students are reported to underperform compared with those from the ethnic majority. However, there are inconsistencies in findings in different types of examinations. Additionally, little is known about the performance of first-generation university students and about performance differences across ethnic minority groups. This study aimed to investigate underperformance across ethnic minority groups and by first-generation university students in different types of written tests and clinical skills examinations during pre-clinical training. A longitudinal prospective cohort study of progress on a 3-year Dutch Bachelor of Medicine course was conducted. Participants included 2432 students who entered the course over a consecutive 6-year period (2008-2013). Compared with Dutch students, the three non-Western ethnic minority groups (Turkish/Moroccan/African, Surinamese/Antillean and Asian) underperformed in the clinical problem solving tests, the language test and the OSCEs. Findings on the theoretical end-of-block tests and writing skills tests, and results for Western minority students were less consistent. Age, gender, pre-university grade point average and additional socio-demographic variables (including first-generation university student, first language, and medical doctor parent) could explain the ethnicity-related differences in theoretical examinations, but not in language, clinical and writing skills examinations. First-generation university students only underperformed in the language test. Apparently, underperformance differs both across ethnic subgroups and between different types of written and clinical examinations. Medical schools should ensure their assessment strategies create a level playing field for all students and explore reasons for underperformance in the clinical and writing skills examinations.

  6. The regenerative medicine in oral and maxillofacial surgery: the most important innovations in the clinical application of mesenchymal stem cells.

    Science.gov (United States)

    Tatullo, Marco; Marrelli, Massimo; Paduano, Francesco

    2015-01-01

    Regenerative medicine is an emerging field of biotechnology that combines various aspects of medicine, cell and molecular biology, materials science and bioengineering in order to regenerate, repair or replace tissues. The oral surgery and maxillofacial surgery have a role in the treatment of traumatic or degenerative diseases that lead to a tissue loss: frequently, to rehabilitate these minuses, you should use techniques that have been improved over time. Since 1990, we started with the use of growth factors and platelet concentrates in oral and maxillofacial surgery; in the following period we start to use biomaterials, as well as several type of scaffolds and autologous tissues. The frontier of regenerative medicine nowadays is represented by the mesenchymal stem cells (MSCs): overcoming the ethical problems thanks to the use of mesenchymal stem cells from adult patient, and with the increasingly sophisticated technology to support their manipulation, MSCs are undoubtedly the future of medicine regenerative and they are showing perspectives unimaginable just a few years ago. Most recent studies are aimed to tissues regeneration using MSCs taken from sites that are even more accessible and rich in stem cells: the oral cavity turned out to be an important source of MSCs with the advantage to be easily accessible to the surgeon, thus avoiding to increase the morbidity of the patient. The future is the regeneration of whole organs or biological systems consisting of many different tissues, starting from an initial stem cell line, perhaps using innovative scaffolds together with the nano-engineering of biological tissues.

  7. Clinical Implications of Human Population Differences in Genome-wide Rates of Functional Genotypes

    Directory of Open Access Journals (Sweden)

    Ali eTorkamani

    2012-11-01

    Full Text Available There have been a number of recent successes in the use of whole genome sequencing and sophisticated bioinformatics techniques to identify pathogenic DNA sequence variants responsible for individual idiopathic congenital conditions. However, the success of this identification process is heavily influenced by the ancestry or genetic background of a patient with an idiopathic condition. This is so because potential pathogenic variants in a patient’s genome must be contrasted with variants in a reference set of genomes made up of other individuals’ genomes of the same ancestry as the patient. We explored the effect of ignoring the ancestries of both an individual patient and the individuals used to construct reference genomes. We pursued this exploration in two major steps. We first considered variation in the per-genome number and rates likely functional derived (i.e., non-ancestral, based on the chimp genome single nucleotide variants and small indels in 52 individual whole human genomes sampled from 10 different global populations. We took advantage of a suite of computational and bioinformatics techniques to predict the functional effect of over 24 million genomic variants, both coding and non-coding, across these genomes. We found that the typical human genome harbors ~5.5-6.1 million total derived variants, of which ~12,000 are likely to have a functional effect (~5000 coding and ~7000 non-coding. We also found that the rates of functional genotypes per the total number of genotypes in individual whole genomes differ dramatically between human populations. We then created tables showing how the use of comparator or reference genome panels comprised of genomes from individuals that do not have the same ancestral background as a patient can negatively impact pathogenic variant identification. Our results have important implications for clinical sequencing initiatives.

  8. Effects of different factors influencing clinical compliance of Chinese patients with chronic periodontitis.

    Science.gov (United States)

    Si, Wei; Wang, Hongyan; Li, Qian; Zhao, Xida; Pan, Yaping

    2016-01-01

    The aims of this study were to determine the relationship between compliance in patients with chronic periodontitis and the efficacy of nonsurgical periodontal treatment as well as to investigate the factors that influence the compliance of patients with chronic periodontitis. These aims may be useful for determining the prognosis and improving the efficacy of treatment. Four hundred patients with chronic periodontitis were classified into three groups: the complete compliance group (S1), the erratic compliance group (S2), and the failing compliance group (S3). The patients who were in group S1 received supportive periodontal therapy (SPT) on time: they presented for their appointments within 2 months of the scheduled date; the patients who missed their appointments by more than 2 months or who completely missed a return visit one or more times, were placed in group S2; and the patients who never returned to receive SPT were assigned to group S3. They completed a questionnaire about compliance and underwent a clinical periodontal examination. SPSS 13.0 was used for the statistical analysis. Groups S2 (49.4%) and S3 (34.1%) were significantly different from group S1 (87.0%) (P periodontal disease is always associated with other diseases. The analysis of severe pain during the treatment revealed significant differences (P periodontitis and comfort during treatment are important factors influencing patient compliance. The distance of the patient's residence from the hospital, working hours, and attitudes of family members also affect patient compliance. Doctors should educate patients about oral health and manage their patients' comfort as much as possible during treatment, thereby enhancing patient compliance and achieving better treatment efficacy.

  9. Comparison of Hemagglutination and Hemolytic Activity of Various Bacterial Clinical Isolates Against Different Human Blood Groups

    Science.gov (United States)

    HRV, Rajkumar; Devaki, Ramakrishna

    2016-01-01

    Among the various pathogenic determinants shown by microorganisms hemagglutination and hemolysin production assume greater significance in terms of laboratory identification. This study evaluated the hemagglutination and hemolytic activity of various bacterial isolates against different blood groups. One hundred and fifty bacterial strains, isolated from clinical specimens like urine, pus, blood, and other body fluids were tested for their hemagglutinating and hemolytic activity against human A, B, AB, and O group red blood cells. Among the 150 isolates 81 were Escherichia coli, 18 were Klebsiella pneumoniae, 19 were Pseudomonas aeruginosa, 10 were Pseudomonas spp, six were Proteus mirabilis, and the rest 16 were Staphylococcus aureus. Nearly 85% of the isolates agglutinated A group cells followed by B and AB group (59.3% and 60.6% respectively). Least number of isolates agglutinated O group cells (38.0%). When the hemolytic activity was tested, out of these 150 isolates 79 (52.6%) hemolyzed A group cells, 61 (40.6%) hemolyzed AB group cells, 46 (30.6%) hemolyzed B group cells, and 57 (38.6%) isolates hemolyzed O group cells. Forty-six percent of the isolates exhibited both hemagglutinating and hemolytic property against A group cells, followed by B and AB group cells (28.6% and 21.3% respectively). Least number of isolates i.e., 32 (21.3%) showed both the properties against O group cells. The isolates showed wide variation in their hemagglutination and hemolytic properties against different combinations of human blood group cells. The study highlights the importance of selection of the type of cells especially when human RBCs are used for studying the hemagglutination and hemolytic activity of bacterial isolates because these two properties are considered as characteristic of pathogenic strains. PMID:27014523

  10. Different doses of ibuprofen in the treatment of patent ductus arteriosus: a randomized clinical trial

    Directory of Open Access Journals (Sweden)

    E Amini

    2012-11-01

    Full Text Available Background: Patent ductus arteriosus (PDA is a common finding among premature or low-birth-weight infants and it often does not close. Nowadays, drugs used for its treatment include indomethacin and more commonly ibuprofen. Oral ibuprofen was recently shown to be as effective and have several important advantages in preterm infants. Studies performed to find the best dose of ibuprofen for PDA treatment are limited; hence, we compared the effects of two different doses of ibuprofen in this interventional study.Methods: In this randomized controlled clinical trial, we randomly divided 60 patients with echocardiographically confirmed PDA into two groups of 30. This study was done in NICU of Valiasr hospital in 1387-89 years. In the first group, we administered a loading dose of 10 mg/kg ibuprofen on the first day, followed by two doses of 5 mg/kg in the next two days. In the second group, we administered a loading dose of 15 mg/kg ibuprofen on the first day followed by two doses of 7.5 mg/kg in next two days. Eventually, we compared PDA closure rates and complications of therapy between the two groups. Results: Thirty (100% patients in 15-mg/kg group and 23 (76.7% patients in 10 mg/kg group had successful PDA closure with no need for surgery. The two groups had a statistically significant difference (P=0.011 and the highest response to treatment was seen within the first 24 hours of treatment.Conclusion: We may conclude that higher doses of ibuprofen (15 and 2×7.5 mg/kg would offer better outcomes for PDA closure without gastrointestinal or renal complications and less need for surgery.

  11. Post-kala-azar dermal Leishmaniasis in two different clinical contexts*

    Science.gov (United States)

    Barroso, Daniel Holanda; Silva, Claúdia Elise Ferraz; Vasconcelos, Ana Carolina Depes Perdigao e; Cavalcanti, Silvana Maria de Morais; de Brito, Maria Edileuza Felinto; Medeiros, Angela Cristina Rapela

    2015-01-01

    In Brazil, visceral Leishmaniasis is caused by Leishmania chagasi. The development of cutaneous lesions in visceral leishmaniasis patients has been described in two different clinical contexts. Patients with compromised immunity can develop skin lesions as a direct consequence of a current visceral disease. Equally, patients with a history of kala-azar and progressive, immune improvement occasionally develop skin lesions as a consequence of immune reconstitution infl ammatory synd