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Sample records for residual disease setting

  1. Residual Neuromuscular Blockade in the Critical Care Setting.

    Science.gov (United States)

    Stawicki, Nicole; Gessner, Patty

    2018-01-01

    Residual neuromuscular blockade is a widespread challenge for providers in the acute care setting that, if left unrecognized or untreated, places patients at higher risk for morbidity and mortality. The condition is estimated to occur in 26% to 88% of patients undergoing general anesthesia. The role of the advanced practice nurse in the acute care setting is to facilitate a safe recovery process by identifying early signs of deterioration and supporting the patient until full muscular strength has returned. This article discusses the prevalence of residual neuromuscular blockade and associated complications and patient risk factors. A review is included of the current uses for neuromuscular blockade, pathophysiology of the neuromuscular junction, pharmacologic characteristics of neuromuscular blocking agents (including drug-drug interactions), monitoring modalities, and effectiveness of reversal agents. Treatment recommendations pertinent to residual neuromuscular blockade are outlined. ©2018 American Association of Critical-Care Nurses.

  2. Information sets as permutation cycles for quadratic residue codes

    Directory of Open Access Journals (Sweden)

    Richard A. Jenson

    1982-01-01

    Full Text Available The two cases p=7 and p=23 are the only known cases where the automorphism group of the [p+1,   (p+1/2] extended binary quadratic residue code, O(p, properly contains PSL(2,p. These codes have some of their information sets represented as permutation cycles from Aut(Q(p. Analysis proves that all information sets of Q(7 are so represented but those of Q(23 are not.

  3. The additional benefit of residual spraying and insecticide-treated curtains for dengue control over current best practice in Cuba: Evaluation of disease incidence in a cluster randomized trial in a low burden setting with intensive routine control.

    Science.gov (United States)

    Toledo, Maria Eugenia; Vanlerberghe, Veerle; Rosales, Julio Popa; Mirabal, Mayelin; Cabrera, Pedro; Fonseca, Viviana; Gómez Padrón, Tania; Pérez Menzies, Mirtha; Montada, Domingo; Van der Stuyft, Patrick

    2017-11-01

    Aedes control interventions are considered the cornerstone of dengue control programmes, but there is scarce evidence on their effect on disease. We set-up a cluster randomized controlled trial in Santiago de Cuba to evaluate the entomological and epidemiological effectiveness of periodical intra- and peri-domiciliary residual insecticide (deltamethrin) treatment (RIT) and long lasting insecticide treated curtains (ITC). Sixty three clusters (around 250 households each) were randomly allocated to two intervention (RIT and ITC) and one control arm. Routine Aedes control activities (entomological surveillance, source reduction, selective adulticiding, health education) were applied in the whole study area. The outcome measures were clinical dengue case incidence and immature Aedes infestation. Effectiveness of tools was evaluated using a generalized linear regression model with a negative binomial link function. Despite significant reduction in Aedes indices (Rate Ratio (RR) 0.54 (95%CI 0.32-0.89) in the first month after RIT, the effect faded out over time and dengue incidence was not reduced. Overall, in this setting there was no protective effect of RIT or ITC over routine in the 17months intervention period, with for house index RR of 1.16 (95%CI 0.96-1.40) and 1.25 (95%CI 1.03-1.50) and for dengue incidence RR of 1.43 (95%CI 1.08-1.90) and 0.96 (95%CI 0.72-1.28) respectively. The monthly dengue incidence rate (IR) at cluster level was best explained by epidemic periods (Incidence Rate Ratio (IRR) 5.50 (95%CI 4.14-7.31)), the IR in bordering houseblocks (IRR 1.03 (95%CI 1.02-1.04)) and the IR pre-intervention (IRR 1.02 (95%CI 1.00-1.04)). Adding RIT to an intensive routine Aedes control programme has a transient effect on the already moderate low entomological infestation levels, while ITC did not have any effect. For both interventions, we didn't evidence impact on disease incidence. Further studies are needed to evaluate impact in settings with high Aedes

  4. Minimal residual disease in chronic lymphocytic leukaemia.

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    García Vela, José Antonio; García Marco, José Antonio

    2018-02-23

    Minimal residual disease (MRD) assessment is an important endpoint in the treatment of chronic lymphocytic leukaemia (CLL). It is highly predictive of prolonged progression-free survival (PFS) and overall survival and could be considered a surrogate for PFS in the context of chemoimmunotherapy based treatment. Evaluation of MRD level by flow cytometry or molecular techniques in the era of the new BCR and Bcl-2 targeted inhibitors could identify the most cost-effective and durable treatment sequencing. A therapeutic approach guided by the level of MRD might also determine which patients would benefit from an early stop or consolidation therapy. In this review, we discuss the different MRD methods of analysis, which source of tumour samples must be analysed, the future role of the detection of circulating tumour DNA, and the potential role of MRD negativity in clinical practice in the modern era of CLL therapy. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

  5. Fault tolerant control - a residual based set-up

    DEFF Research Database (Denmark)

    Niemann, Hans Henrik; Poulsen, Niels Kjølstad

    2009-01-01

    A new set-up for fault tolerant control (FTC) for stable systems is presented in this paper. The new set-up is based on a simple implementation of the Youla-Jabr-Bongiorno-Kucera (YJBK) parameterization. This implementation of the YJBK parameterization will allow a direct and simple reconfigurati...

  6. Eliminating Hairy Cell Leukemia Minimal Residual Disease

    Science.gov (United States)

    In this trial, patients with hairy cell leukemia who have disease-related symptoms that require treatment will be randomly assigned to receive cladribine with either concurrent rituximab or rituximab at least 6 months after completing cladribine therapy.

  7. Determine metrics and set targets for soil quality on agriculture residue and energy crop pathways

    Energy Technology Data Exchange (ETDEWEB)

    Ian Bonner; David Muth

    2013-09-01

    There are three objectives for this project: 1) support OBP in meeting MYPP stated performance goals for the Sustainability Platform, 2) develop integrated feedstock production system designs that increase total productivity of the land, decrease delivered feedstock cost to the conversion facilities, and increase environmental performance of the production system, and 3) deliver to the bioenergy community robust datasets and flexible analysis tools for establishing sustainable and viable use of agricultural residues and dedicated energy crops. The key project outcome to date has been the development and deployment of a sustainable agricultural residue removal decision support framework. The modeling framework has been used to produce a revised national assessment of sustainable residue removal potential. The national assessment datasets are being used to update national resource assessment supply curves using POLYSIS. The residue removal modeling framework has also been enhanced to support high fidelity sub-field scale sustainable removal analyses. The framework has been deployed through a web application and a mobile application. The mobile application is being used extensively in the field with industry, research, and USDA NRCS partners to support and validate sustainable residue removal decisions. The results detailed in this report have set targets for increasing soil sustainability by focusing on primary soil quality indicators (total organic carbon and erosion) in two agricultural residue management pathways and a dedicated energy crop pathway. The two residue pathway targets were set to, 1) increase residue removal by 50% while maintaining soil quality, and 2) increase soil quality by 5% as measured by Soil Management Assessment Framework indicators. The energy crop pathway was set to increase soil quality by 10% using these same indicators. To demonstrate the feasibility and impact of each of these targets, seven case studies spanning the US are presented

  8. Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry

    Science.gov (United States)

    Soh, Kah Teong; Tario, Joseph D.; Wallace, Paul K.

    2018-01-01

    Synopsis Plasma cell dyscrasia (PCD) is a heterogeneous disease which has seen a tremendous change in outcomes due to improved therapies. Over the last few decades, multiparametric flow cytometry has played an important role in the detection and monitoring of PCDs. Flow cytometry is a high sensitivity assay for early detection of minimal residual disease (MRD) that correlates well with progression-free survival and overall survival. Before flow cytometry can be effectively implemented in the clinical setting sample preparation, panel configuration, analysis, and gating strategies must be optimized to ensure accurate results. Current consensus methods and reporting guidelines for MRD testing are discussed. PMID:29128071

  9. Sweet potato starch residue as starting material to prepare polyacrylonitrile adsorbent via SI-SET-LRP.

    Science.gov (United States)

    Hao, Zhihai; Wang, Dongju; Chen, Hou; Sun, Jinming; Xu, Yuanyuan

    2014-02-26

    Sweet potato starch residue (SPSR) was used as starting material to prepare an eco-friendly adsorbent. SPSR was modified by bromoacetyl bromide to obtain a macroinitiator for surface-initiated single electron transfer-living radical polymerization (SI-SET-LRP) of acrylonitrile (AN) catalyzed by La(0)/hexamethylenetetramine (HMTA) in N,N-dimethylformamide (DMF) in the presence of ascorbic acid (VC). The amidoxime (AO) adsorbent was prepared by the reaction of the graft copolymer bromoactylated sweet potato starch (BSPS)/polyacrylonitrile (BSPS-g-PAN) with hydroxylamine. The maximum adsorption capacity for Hg(II) was 4.03 mmol·g(-1). This simple method provided a novel approach to recycle and reuse agricultural residues for controlling heavy metal pollution.

  10. A mind map for managing minimal residual disease in acute myeloid leukemia.

    Science.gov (United States)

    Benton, Christopher B; Ravandi, Farhad

    2017-11-01

    Advances in detecting traces of leukemia that were previously unidentifiable have increasingly led to the incorporation of information about residual disease into clinical decision making for patients with leukemia in both the postinduction and consolidation settings. This review discusses current concepts related to minimal residual disease (MRD), which is defined as submicroscopic disease detected during morphologic complete remission. The focus is on acute myeloid leukemia (AML). Basic methods for detecting MRD include flow cytometry, reverse transcription-polymerase chain reaction, and mutation analysis. Several studies using these assays have demonstrated prognostic implications based on MRD-positive vs MRD-negative status. As our understanding of the biological factors responsible for MRD in AML evolves, residual disease should be evaluated in the context of other prognostic markers. Current therapeutic options for managing MRD in AML are limited, and the clinical implications of a positive MRD test result can be significant. Regarding individual patients, an evidence-based approach must be applied while the institution- and assay-specific differences that currently exist are considered. Challenges associated with MRD assessment, such as the limited standardization of available assays and the paucity of effective agents to eradicate MRD, will need to be overcome before physicians who treat leukemia can use MRD as a tool for clinical management.

  11. Minimal Residual Disease Assessment in Lymphoma: Methods and Applications.

    Science.gov (United States)

    Herrera, Alex F; Armand, Philippe

    2017-12-01

    Standard methods for disease response assessment in patients with lymphoma, including positron emission tomography and computed tomography scans, are imperfect. In other hematologic malignancies, particularly leukemias, the ability to detect minimal residual disease (MRD) is increasingly influencing treatment paradigms. However, in many subtypes of lymphoma, the application of MRD assessment techniques, like flow cytometry or polymerase chain reaction-based methods, has been challenging because of the absence of readily detected circulating disease or canonic chromosomal translocations. Newer MRD detection methods that use next-generation sequencing have yielded promising results in a number of lymphoma subtypes, fueling the hope that MRD detection may soon be applicable in clinical practice for most patients with lymphoma. MRD assessment can provide real-time information about tumor burden and response to therapy, noninvasive genomic profiling, and monitoring of clonal dynamics, allowing for many possible applications that could significantly affect the care of patients with lymphoma. Further validation of MRD assessment methods, including the incorporation of MRD assessment into clinical trials in patients with lymphoma, will be critical to determine how best to deploy MRD testing in routine practice and whether MRD assessment can ultimately bring us closer to the goal of personalized lymphoma care. In this review article, we describe the methods available for detecting MRD in patients with lymphoma and their relative advantages and disadvantages. We discuss preliminary results supporting the potential applications for MRD testing in the care of patients with lymphoma and strategies for including MRD assessment in lymphoma clinical trials.

  12. Current challenges in glioblastoma: intratumour heterogeneity, residual disease and models to predict disease recurrence

    Directory of Open Access Journals (Sweden)

    Hayley Patricia Ellis

    2015-11-01

    Full Text Available Glioblastoma (GB is the most common malignant primary brain tumour, and despite the availability of chemotherapy and radiotherapy to combat the disease, overall survival remains low with a high incidence of tumour recurrence. Technological advances are continually improving our understanding of the disease and in particular our knowledge of clonal evolution, intratumour heterogeneity and possible reservoirs of residual disease. These may inform how we approach clinical treatment and recurrence in GB. Mathematical modelling (including neural networks, and strategies such as multiple-sampling during tumour resection and genetic analysis of circulating cancer cells, may be of great future benefit to help predict the nature of residual disease and resistance to standard and molecular therapies in GB.

  13. Diverticular Disease in the Primary Care Setting

    OpenAIRE

    Wensaas, Knut-Arne; Hungin, Amrit Pali

    2016-01-01

    Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the ...

  14. Diverticular Disease in the Primary Care Setting.

    Science.gov (United States)

    Wensaas, Knut-Arne; Hungin, Amrit Pali

    2016-10-01

    Diverticular disease is a chronic and common condition, and yet the impact of diverticular disease in primary care is largely unknown. The diagnosis of diverticular disease relies on the demonstration of diverticula in the colon, and the necessary investigations are often not available in primary care. The specificity and sensitivity of symptoms, clinical signs and laboratory tests alone are generally low and consequently the diagnostic process will be characterized by uncertainty. Also, the criteria for symptomatic uncomplicated diverticular disease in the absence of macroscopic inflammation are not clearly defined. Therefore both the prevalence of diverticular disease and the incidence of diverticulitis in primary care are unknown. Current recommendations for treatment and follow-up of patients with acute diverticulitis are based on studies where the diagnosis has been verified by computerized tomography. The results cannot be directly transferred to primary care where the diagnosis has to rely on the interpretation of symptoms and signs. Therefore, one must allow for greater diagnostic uncertainty, and safety netting in the event of unexpected development of the condition is an important aspect of the management of diverticulitis in primary care. The highest prevalence of diverticular disease is found among older patients, where multimorbidity and polypharmacy is common. The challenge is to remember the possible contribution of diverticular disease to the patient's overall condition and to foresee its implications in terms of advice and treatment in relation to other diseases.

  15. Minimal residual disease after long-term interferon-alpha2 treatment

    DEFF Research Database (Denmark)

    Utke Rank, Cecilie; Weis Bjerrum, Ole; Larsen, Thomas Stauffer

    2016-01-01

    burden by a highly sensitive quantitative PCR (qPCR) assay appears to be a useful tool for monitoring minimal residual disease (MRD) and evaluating treatment efficacy. This report expands and substantiates existing data, showing that IFN-alpha2 is a highly potent immunomodulating agent capable...... of inducing MRD with low-burden JAK2 V617F, major molecular response (MMR), complete hematological remission (CHR) and complete histomorphological normalization of the bone marrow in a sub-set of patients with ET and PV after long-term treatment (≥ 3.5 years). Furthermore, long-lasting hematological...

  16. Diseases and Organisms in Healthcare Settings

    Science.gov (United States)

    ... MRSA Mycobacterium abscessus Norovirus Pseudomonas aeruginosa Tracking CRPA Staphylococcus aureus Tuberculosis VISA / VRSA Vancomycin-resistant Enterococci (VRE) in Healthcare Settings Preventing HAIs Targeted Assessment for Prevention (TAP) TAP CAUTI Implementation Guide TAP CDI Implementation ...

  17. Minimal residual disease in breast cancer. Clinical significance

    International Nuclear Information System (INIS)

    Kvalheim, G.

    2004-01-01

    Previously we have reported our results on minimal residual disease in breast cancer. Briefly, B M-aspirates were collected from 817 patients at primary surgery. Tumor cells in B M were detected by immunocytochemistry using anticytokeratin-antibodies (A E1/ A E3). Analyses of the primary tumor included histological grading, vascular invasion and immunohistochemical detection of cerbB2, cathepsin D, p53 and ER/PgRexpression. These analyses were compared to clinical outcome. Median follow-up was 49 months. ITC were detected in 13.2% of the patients. The detection rate rose with increasing tumor size (p=0.011) and lymph node involvement (p<0.001). Systemic relapse and death from breast cancer occurred in 31.7% and 26.9% of the B M-positive versus 13.7% and 10.9% of B M-negative patients, respectively (p<0.001). Analyzing node-positive and node-negative patients separately, ITC-positivity was associated with poor prognosis in the node-positive group and in node-negative patients not receiving adjuvant therapy (T1N0). In multivariate analysis, ITC in B M was an independent prognostic factor together with N-, T-, ER/Pg R-status, histological grade and vascular invasion. Combination of several independent prognostic factors can classify subgroups of patients into excellent and high-risk prognosis groups. Like other groups we have investigated the clinical role of monitoring minimal residual disease before and after adjuvant therapy in breast cancer. One hundred and eighteen high risk stage II breast cancer patients entering the Scandinavian Study Group multicenter trial were randomized to 9 cycles of dose escalated and tailored FEC (5-flurouracil, epirubicin, cyclophosphamide) or standard FEC followed by high dose chemotherapy. B M samples at diagnosis and 6 months after completion of chemotherapy were assessed for the presence of I CT. Median observation time for patients was 68 months. ITC positivity in bone marrow was evaluated as a prognostic and predictive marker and

  18. Parkinson's disease: nursing care in emergency settings.

    Science.gov (United States)

    Queen, Vicky

    2017-09-14

    In the UK 127,000 people are diagnosed with Parkinson's disease, many of whom are frequently admited to hospital. However, Parkinson's disease is not usually the primary cause of admission. Emergency department (ED) nurses must be aware of the medication needs of people with Parkinson's disease and how these can be met in emergency setings to ensure the stability of their condition and to prevent the development of neuroleptic malignant syndrome, a potentially fatal condition caused by abrupt omission of Parkinson's medication. This article highlights the importance of ensuring that patients with Parkinson's disease continue their medication regimen while in an ED, even if they are temporarily unable to swallow, and uses a case study to illustrate various ways of achieving this. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  19. Residual set-up errors and margins in on-line image-guided prostate localization in radiotherapy

    DEFF Research Database (Denmark)

    Poulsen, Per Rugaard; Muren, Ludvig; Høyer, Morten

    2007-01-01

    BACKGROUND AND PURPOSE: Image-guided on-line correction of the target position allows radiotherapy of prostate cancer with narrow set-up margins. The present study investigated the residual set-up error after on-line prostate localization and its impact on margins. MATERIALS AND METHODS: Prostate...... localization based on two orthogonal X-ray images of gold markers implanted in the prostate was performed with an on-board imager at four treatment sessions for 90 patients. The set-up error in the sagittal plane residual after couch adjustment was evaluated on lateral verification portal images. RESULTS...

  20. Minimal Residual Disease in Acute Myeloid Leukemia: Still a Work in Progress?

    Directory of Open Access Journals (Sweden)

    Federico Mosna

    2017-06-01

    Full Text Available Minimal residual disease evaluation refers to a series of molecular and immunophenotypical techniques aimed at detecting submicroscopic disease after therapy. As such, its application in acute myeloid leukemia has greatly increased our ability to quantify treatment response, and to determine the chemosensitivity of the disease, as the final product of the drug schedule, dose intensity, biodistribution, and the pharmakogenetic profile of the patient. There is now consistent evidence for the prognostic power of minimal residual disease evaluation in acute myeloid leukemia, which is complementary to the baseline prognostic assessment of the disease. The focus for its use is therefore shifting to individualize treatment based on a deeper evaluation of chemosensitivity and residual tumor burden. In this review, we will summarize the results of the major clinical studies evaluating minimal residual disease in acute myeloid leukemia in adults in recent years and address the technical and practical issues still hampering the spread of these techniques outside controlled clinical trials. We will also briefly speculate on future developments and offer our point of view, and a word of caution, on the present use of minimal residual disease measurements in “real-life” practice. Still, as final standardization and diffusion of the methods are sorted out, we believe that minimal residual disease will soon become the new standard for evaluating response in the treatment of acute myeloid leukemia.

  1. Low-residue and low-fiber diets in gastrointestinal disease management.

    Science.gov (United States)

    Vanhauwaert, Erika; Matthys, Christophe; Verdonck, Lies; De Preter, Vicky

    2015-11-01

    Recently, low-residue diets were removed from the American Academy of Nutrition and Dietetics' Nutrition Care Manual due to the lack of a scientifically accepted quantitative definition and the unavailability of a method to estimate the amount of food residue produced. This narrative review focuses on defining the similarities and/or discrepancies between low-residue and low-fiber diets and on the diagnostic and therapeutic values of these diets in gastrointestinal disease management. Diagnostically, a low-fiber/low-residue diet is used in bowel preparation. A bowel preparation is a cleansing of the intestines of fecal matter and secretions conducted before a diagnostic procedure. Therapeutically, a low-fiber/low-residue diet is part of the treatment of acute relapses in different bowel diseases. The available evidence on low-residue and low-fiber diets is summarized. The main findings showed that within human disease research, the terms "low residue" and "low fiber" are used interchangeably, and information related to the quantity of residue in the diet usually refers to the amount of fiber. Low-fiber/low-residue diets are further explored in both diagnostic and therapeutic situations. On the basis of this literature review, the authors suggest redefining a low-residue diet as a low-fiber diet and to quantitatively define a low-fiber diet as a diet with a maximum of 10 g fiber/d. A low-fiber diet instead of a low-residue diet is recommended as a diagnostic value or as specific therapy for gastrointestinal conditions. © 2015 American Society for Nutrition.

  2. Residual rotational set-up errors after daily cone-beam CT image guided radiotherapy of locally advanced cervical cancer

    International Nuclear Information System (INIS)

    Laursen, Louise Vagner; Elstrøm, Ulrik Vindelev; Vestergaard, Anne; Muren, Ludvig P.; Petersen, Jørgen Baltzer; Lindegaard, Jacob Christian; Grau, Cai; Tanderup, Kari

    2012-01-01

    Purpose: Due to the often quite extended treatment fields in cervical cancer radiotherapy, uncorrected rotational set-up errors result in a potential risk of target miss. This study reports on the residual rotational set-up error after using daily cone beam computed tomography (CBCT) to position cervical cancer patients for radiotherapy treatment. Methods and materials: Twenty-five patients with locally advanced cervical cancer had daily CBCT scans (650 CBCTs in total) prior to treatment delivery. We retrospectively analyzed the translational shifts made in the clinic prior to each treatment fraction as well as the residual rotational errors remaining after translational correction. Results: The CBCT-guided couch movement resulted in a mean translational 3D vector correction of 7.4 mm. Residual rotational error resulted in a target shift exceeding 5 mm in 57 of the 650 treatment fractions. Three patients alone accounted for 30 of these fractions. Nine patients had no shifts exceeding 5 mm and 13 patients had 5 or less treatment fractions with such shifts. Conclusion: Twenty-two of the 25 patients have none or few treatment fractions with target shifts larger than 5 mm due to residual rotational error. However, three patients display a significant number of shifts suggesting a more systematic set-up error.

  3. Low-Residue and Low-Fiber Diets in Gastrointestinal Disease Management12

    Science.gov (United States)

    Vanhauwaert, Erika; Matthys, Christophe; Verdonck, Lies; De Preter, Vicky

    2015-01-01

    Recently, low-residue diets were removed from the American Academy of Nutrition and Dietetics’ Nutrition Care Manual due to the lack of a scientifically accepted quantitative definition and the unavailability of a method to estimate the amount of food residue produced. This narrative review focuses on defining the similarities and/or discrepancies between low-residue and low-fiber diets and on the diagnostic and therapeutic values of these diets in gastrointestinal disease management. Diagnostically, a low-fiber/low-residue diet is used in bowel preparation. A bowel preparation is a cleansing of the intestines of fecal matter and secretions conducted before a diagnostic procedure. Therapeutically, a low-fiber/low-residue diet is part of the treatment of acute relapses in different bowel diseases. The available evidence on low-residue and low-fiber diets is summarized. The main findings showed that within human disease research, the terms “low residue” and “low fiber” are used interchangeably, and information related to the quantity of residue in the diet usually refers to the amount of fiber. Low-fiber/low-residue diets are further explored in both diagnostic and therapeutic situations. On the basis of this literature review, the authors suggest redefining a low-residue diet as a low-fiber diet and to quantitatively define a low-fiber diet as a diet with a maximum of 10 g fiber/d. A low-fiber diet instead of a low-residue diet is recommended as a diagnostic value or as specific therapy for gastrointestinal conditions. PMID:26567203

  4. [Investigation of the relationship between chronic diseases and residual symptoms of benign paroxysmal positional vertigo].

    Science.gov (United States)

    Zhou, Fengjie; Fu, Min; Zhang, Nan; Xu, Ye; Ge, Ying

    2015-09-01

    To investigate the prognosis-related influence factors of the residual symptoms after the canalith repositioning procedure (CRP) for the benign paroxysmal positional vertigo (BPPV) in the second affiliated hospital of dalian medical university. Among patients who were diagnosed with BPPV and treated by CRP, the one that still show residual symptoms were enrolled in our study, then make a follow-up irregularly about the tendency of their residual symptoms' self-healing,and respectively record in their gender, age and chronic diseases and so on. Single-factor analysis and multi-factors analysis was utilized to investigate the residual symptoms' related influencing factors. In this study, 149 cases of patients were in record, for the residual symptoms, 71 patients can go to self-healing, 78 patients can not; age is 23-88, 30 cases in the young group, 46 cases in the middle aged group, 47 cases in the young elderly group, 26 cases in the elderly group; patients suffering from high blood pressure are 76 cases, 76 cases had diabetes, 47 cases had hyperlipidemia, 110 cases had heart disease, 43 cases had ischemic encephalopathy. The residual symptoms in the elderly females patients and patients suffering from the hypertension, diabetes, heart disease patients and ischemic encephalopathy are not easy to heal by itself, in which, the older and the fact suffering from the hypertension and diabetes are the risk factors influencing the prognosis of the residual symptoms.

  5. Priority Settings in patients with Chronic Diseases and Cancer

    DEFF Research Database (Denmark)

    Arreskov, Anne Beiter; Graungaard, Anette Hauskov; Søndergaard, Jens

    Priority setting in patients with cancer and comorbidities Background and aim As both the cancer incidence and the number of patients diagnosed with chronic diseases are increasing, a growing population of cancer survivors will also deal with comorbid chronic diseases. The period after completed...... cancer treatment, where patients are transitioning to survivorship, might be a vulnerable time. Uncertainty about health status, physical- and emotional symptoms from cancer disease and treatment, and perhaps uncertainty about which doctor to consult, might influence patients’ priorities and attention...... to comorbidities. Some studies show that participation in regular follow-up consultations concerning comorbid chronic diseases and lifestyle are lower among cancer survivors than non-cancer patients. This could be explained by changes in the patient’s priority setting or in the doctor’s priority and attempt...

  6. How to preserve residual renal function in patients with chronic kidney disease and on dialysis?

    NARCIS (Netherlands)

    Krediet, Raymond T.

    2006-01-01

    A review is given on various aspects of GFR in patients with chronic kidney disease and in dialysis patients. These include the measurement of GFR, measures to preserve GFR in chronic kidney disease and dialysis, the importance of residual GFR in dialysis patients and factors that influence GFR in

  7. Residual herniated disc material following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease.

    Science.gov (United States)

    Roach, W J; Thomas, M; Weh, J M; Bleedorn, J; Wells, K

    2012-01-01

    To evaluate the presence of residual disc material within the vertebral canal following hemilaminectomy in chondrodystrophic dogs with thoracolumbar intervertebral disc disease. Forty dogs were treated by hemilaminectomy. Computed tomography was performed preoperatively and immediately postoperatively. The vertebral canal height, width, area, and herniated disc material area were measured. Maximum filling percentage (MFP), residual disc percentage (RDP), maximum residual filling percentage (MRFP), and residual filling percentage (RFP) were calculated. Clinical outcome was determined by telephone interviews. Residual disc material was present in 100% of the dogs. Mean MFP = 55.4% (range 25.9-82.3%; median 56.9%). Mean RDP = 50.3% (range 2.6-155.8%; median 47.9%). Mean MRFP = 30.8% (range 4.9-60%; median 30.1%). Mean RFP = 19.8% (range 4.8-45%; median 19.0%). All dogs were ambulatory with voluntary urination at the long-term follow-up (range: 88-735 days). Residual disc was present in all dogs following hemilaminectomy for intervertebral disc disease. Residual disc was not associated with failure to achieve functional recovery in these cases.

  8. Detection of gunshot primer residue on bone in an experimental setting-an unexpected finding.

    Science.gov (United States)

    Berryman, Hugh E; Kutyla, Alicja K; Russell Davis, J

    2010-03-01

    Pork ribs with intact muscle tissue were used in an experimental attempt to identify bullet wipe on bone at distances from 1 to 6 feet with 0.45 caliber, full metal jacket ammunition. This resulted in the unexpected finding of primer-derived gunshot residue (GSR) deep within the wound tract. Of significance is the fact that the GSR was deposited on the bone, under the periosteum, after the bullet passed through a Ziploc bag and c. 1 inch of muscle tissue. It is also important to note that the GSR persisted on the bone after the periosteum was forcibly removed. The presence of primer-derived GSR on bone provides the potential to differentiate gunshot trauma from blunt trauma when the bone presents an atypical gunshot wound. In this study, the presence of gunshot primer residue at a distance of 6 feet demonstrates the potential for establishing maximum gun-to-target distance for remote shootings.

  9. Automated detection of residual cells after sex-mismatched stem-cell transplantation – evidence for presence of disease-marker negative residual cells

    Directory of Open Access Journals (Sweden)

    Johannes Tilman

    2009-05-01

    Full Text Available Abstract Background A new chimerism analysis based on automated interphase fluorescence in situ hybridization (FISH evaluation was established to detect residual cells after allogene sex-mismatched bone marrow or blood stem-cell transplantation. Cells of 58 patients were characterized as disease-associated due to presence of a bcr/abl-gene-fusion or a trisomy 8 and/or a simultaneous hybridization of gonosome-specific centromeric probes. The automatic slide scanning platform Metafer with its module MetaCyte was used to analyse 3,000 cells per sample. Results Overall 454 assays of 58 patients were analyzed. 13 of 58 patients showed residual recipient cells at one stage of more than 4% and 12 of 58 showed residual recipient cells less than 4%, respectively. As to be expected, patients of the latter group were associated with a higher survival rate (48 vs. 34 month. In only two of seven patients with disease-marker positive residual cells between 0.1–1.3% a relapse was observed. Besides, disease-marker negative residual cells were found in two patients without relapse at a rate of 2.8% and 3.3%, respectively. Conclusion The definite origin and meaning of disease-marker negative residual cells is still unclear. Overall, with the presented automatic chimerism analysis of interphase FISH slides, a sensitive method for detection of disease-marker positive residual cells is on hand.

  10. Computational design, construction, and characterization of a set of specificity determining residues in protein-protein interactions.

    Science.gov (United States)

    Nagao, Chioko; Izako, Nozomi; Soga, Shinji; Khan, Samia Haseeb; Kawabata, Shigeki; Shirai, Hiroki; Mizuguchi, Kenji

    2012-10-01

    Proteins interact with different partners to perform different functions and it is important to elucidate the determinants of partner specificity in protein complex formation. Although methods for detecting specificity determining positions have been developed previously, direct experimental evidence for these amino acid residues is scarce, and the lack of information has prevented further computational studies. In this article, we constructed a dataset that is likely to exhibit specificity in protein complex formation, based on available crystal structures and several intuitive ideas about interaction profiles and functional subclasses. We then defined a "structure-based specificity determining position (sbSDP)" as a set of equivalent residues in a protein family showing a large variation in their interaction energy with different partners. We investigated sequence and structural features of sbSDPs and demonstrated that their amino acid propensities significantly differed from those of other interacting residues and that the importance of many of these residues for determining specificity had been verified experimentally. Copyright © 2012 Wiley Periodicals, Inc.

  11. Control of postharvest diseases of fruit by heat and fungicides: efficacy, residue levels, and residue persistence. A review.

    Science.gov (United States)

    Schirra, Mario; D'Aquino, Salvatore; Cabras, Paolo; Angioni, Alberto

    2011-08-24

    Extensive research has been done in recent years to reduce the heavy dependence on chemical fungicides to control postharvest diseases and disorders of horticultural crops. Alternative strategies were based on improved cultural practices, biological control, plant-defense promoters, and physical treatments such as UV illumination, radiofrequency treatment, heat therapy, and storage technologies. Among these, postharvest heat treatments such as hot water dips, short hot water rinsing and brushing, and hot air conditioning have reduced rot development and enhanced fruit resistance to chilling injury in sensitive cultivars while retaining fruit quality during cold storage and shelf life. Additive or synergistic increases in effectiveness were observed by integrating heat therapy with various chemical compounds, thus leading to significant reductions in the application of active ingredients to protect produce from decay. This paper highlights the knowledge on this topic with emphasis on heat therapy effects and factors affecting the uptake, persistence, and performance of fungicide residues when they are applied in combination with hot water.

  12. Competitive PCR for quantification of minimal residual disease in acute lymphoblastic leukaemia

    DEFF Research Database (Denmark)

    Nyvold, C; Madsen, H O; Ryder, L P

    2000-01-01

    A very precise and reproducible polymerase chain reaction (PCR) method was developed in order to quantify minimal residual disease (MRD) in children with acute lymphoblastic leukaemia (ALL). A clone-specific competitor was constructed by introducing a restriction site in a PCR product identical...... under identical conditions. After restriction enzyme cleavage, the PCR products originating from the competitor and the malignant clone can be distinguished by size in a gel electrophoresis step and the amount of residual disease can be determined. The method is very sensitive with a detection limit...

  13. Subclass mapping: identifying common subtypes in independent disease data sets.

    Directory of Open Access Journals (Sweden)

    Yujin Hoshida

    Full Text Available Whole genome expression profiles are widely used to discover molecular subtypes of diseases. A remaining challenge is to identify the correspondence or commonality of subtypes found in multiple, independent data sets generated on various platforms. While model-based supervised learning is often used to make these connections, the models can be biased to the training data set and thus miss inherent, relevant substructure in the test data. Here we describe an unsupervised subclass mapping method (SubMap, which reveals common subtypes between independent data sets. The subtypes within a data set can be determined by unsupervised clustering or given by predetermined phenotypes before applying SubMap. We define a measure of correspondence for subtypes and evaluate its significance building on our previous work on gene set enrichment analysis. The strength of the SubMap method is that it does not impose the structure of one data set upon another, but rather uses a bi-directional approach to highlight the common substructures in both. We show how this method can reveal the correspondence between several cancer-related data sets. Notably, it identifies common subtypes of breast cancer associated with estrogen receptor status, and a subgroup of lymphoma patients who share similar survival patterns, thus improving the accuracy of a clinical outcome predictor.

  14. Challenges in reducing group B Streptococcus disease in African settings.

    Science.gov (United States)

    Nishihara, Yo; Dangor, Ziyaad; French, Neil; Madhi, Shabir; Heyderman, Robert

    2017-01-01

    Group B Streptococcus (GBS) is a leading cause of neonatal sepsis and meningitis in high-income settings and is associated with high rates of neonatal mortality and morbidity. There is now increasing evidence to suggest that there is a high GBS disease burden in resource-limited countries, and it is therefore critically important to identify suitable and practical preventive strategies. In Europe and North America, intrapartum antibiotic prophylaxis (IAP) has led to a dramatic reduction of early-onset GBS disease. However, the methods for identifying pregnant women who should receive IAP and how to reduce late-onset GBS disease are not without controversy and are challenging for most sub-Saharan African countries. GBS vaccines are approaching phase III trials but are still under development. This review aims to explore the current evidence related to strategies for reducing invasive GBS disease in an African setting, the development of a GBS vaccine and whether preventative measures against GBS disease can be practically implemented. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  15. Compiled data set of exact NOE distance limits, residual dipolar couplings and scalar couplings for the protein GB3

    Directory of Open Access Journals (Sweden)

    Beat Vögeli

    2015-12-01

    Full Text Available We compiled an NMR data set consisting of exact nuclear Overhauser enhancement (eNOE distance limits, residual dipolar couplings (RDCs and scalar (J couplings for GB3, which forms one of the largest and most diverse data set for structural characterization of a protein to date. All data have small experimental errors, which are carefully estimated. We use the data in the research article Vogeli et al., 2015, Complementarity and congruence between exact NOEs and traditional NMR probes for spatial decoding of protein dynamics, J. Struct. Biol., 191, 3, 306–317, doi:10.1016/j.jsb.2015.07.008 [1] for cross-validation in multiple-state structural ensemble calculation. We advocate this set to be an ideal test case for molecular dynamics simulations and structure calculations.

  16. Minimal Residual Disease Diagnostics and Chimerism in the Post-Transplant Period in Acute Myeloid Leukemia

    Directory of Open Access Journals (Sweden)

    Ulrike Bacher

    2011-01-01

    Full Text Available In acute myeloid leukemia (AML, the selection of poor-risk patients for allogeneic hematopoietic stem cell transplantation (HSCT is associated with rather high post-transplant relapse rates. As immunotherapeutic intervention is considered to be more effective before the cytomorphologic manifestation of relapse, post-transplant monitoring gains increasing attention in stem cell recipients with a previous diagnosis of AML. Different methods for detection of chimerism (e.g., microsatellite analysis or quantitative real-time PCR are available to quantify the ratio of donor and recipient cells in the post-transplant period. Various studies demonstrated the potential use of mixed chimerism kinetics to predict relapse of the AML. CD34+-specific chimerism is associated with a higher specificity of chimerism analysis. Nevertheless, a decrease of donor cells can have other causes as well. Therefore, efforts continue to introduce minimal residual disease (MRD monitoring based on molecular mutations in the post-transplant period. The NPM1 (nucleophosmin mutations can be monitored by sensitive quantitative real-time PCR in subsets of stem cell recipients with AML, but for approximately 20% of patients, suitable molecular mutations for post-transplant MRD monitoring are not available so far. This emphasizes the need for an expansion of the panel of MRD markers in the transplant setting.

  17. Hepatocytes Contribute to Residual Glucose Production in a Mouse Model for Glycogen Storage Disease Type Ia

    NARCIS (Netherlands)

    Hijmans, Brenda S.; Boss, Andreas; van Dijk, Theo H.; Soty, Maud; Wolters, Henk; Mutel, Elodie; Groen, Albert K.; Derks, Terry G. J.; Mithieux, Gilles; Heerschap, Arend; Reijngoud, Dirk-Jan; Rajas, Fabienne; Oosterveer, Maaike H.

    2017-01-01

    It is a long-standing enigma how glycogen storage disease (GSD) type I patients retain a limited capacity for endogenous glucose production despite the loss of glucose-6-phosphatase activity. Insight into the source of residual endogenous glucose production is of clinical importance given the risk

  18. Stability of PCR Targets for Monitoring Minimal Residual Disease in Neuroblastoma

    NARCIS (Netherlands)

    Stutterheim, Janine; Zappeij-Kannegieter, Lily; Ora, Ingrid; van Sluis, Peter G.; Bras, Johannes; den Ouden, Emmy; Versteeg, Rogier; Caron, Huib N.; van der Schoot, C. Ellen; Tytgat, Godelieve A. M.

    2012-01-01

    In neuroblastoma (NB) patients, minimal residual disease (MRD) can be detected by real-time quantitative PCR (qPCR) using NB-specific target genes, such as PHOX2B and TH. However, it is unknown whether the mRNA levels of these targets vary either during treatment or at relapse. If marker genes are

  19. Minimal residual disease diagnostics in acute lymphoblastic leukemia: Need for sensitive, fast, and standardized technologies

    NARCIS (Netherlands)

    J.J.M. van Dongen (Jacques); V.H.J. van der Velden (Vincent); M. Brüggemann (Monika); A. Orfao (Alberto)

    2015-01-01

    textabstractMonitoring of minimal residual disease (MRD) has become routine clinical practice in frontline treatment of virtually all childhood acute lymphoblastic leukemia (ALL) and in many adult ALL patients. MRD diagnostics has proven to be the strongest prognostic factor, allowing for risk group

  20. Prognostic value of minimal residual disease in acute lymphoblastic leukaemia in childhood

    NARCIS (Netherlands)

    van Dongen, JJM; Seriu, T; Panzer-Grumayer, ER; Biondi, A; Pongers-Willemse, MJ; Corral, L; Stolz, F; Schrappe, M; Masera, G; Kamps, WA; Gadner, H; van Wering, ER; Ludwig, WD; Basso, G; de Bruijn, MAC; Cazzaniga, G; Hettinger, A; van der Does-van den Berg, A; Hop, WCJ; Riehm, H; Bartram, CR

    1998-01-01

    Background Sensitive techniques for detection of minimal residual disease (MRD) at degrees of one leukaemic cell per 10(3)-10(6) cells (10(-3)-10(-6)) during follow-up of children with acute lymphoblastic leukaemia (ALL) can provide insight into the effectiveness of cytotoxic treatment. However, it

  1. Iron storage in liver, bone marrow and splenic Gaucheroma reflects residual disease in type 1 Gaucher disease patients on treatment.

    Science.gov (United States)

    Regenboog, Martine; Bohte, Anneloes E; Akkerman, Erik M; Stoker, Jaap; Hollak, Carla E M

    2017-11-01

    Gaucher disease (GD) is a lysosomal storage disorder characterized by the storage of glycosphingolipids in macrophages. Despite effective therapy, residual disease is present in varying degrees and may be associated with late complications, such as persistent bone or liver disease and increased cancer risk. Gaucher macrophages are capable of storing iron and locations of residual disease may thus be detectable with iron imaging. Forty type 1 GD (GD1) patients and 40 matched healthy controls were examined using a whole-body magnetic resonance imaging protocol consisting of standard sequences, allowing analysis of iron content per organ, expressed as R2* (Hz). Median R2* values were significantly elevated in GD1 patients as compared to healthy controls in liver [41 Hz (range 29-165) vs. 38 Hz (range 28-53), P iron levels in liver and bone marrow, which may carry a risk for liver fibrosis and cancer. © 2017 John Wiley & Sons Ltd.

  2. Prognostic significance of residual disease after radiation therapy of stage III breast cancer

    International Nuclear Information System (INIS)

    Fodor, J.; Toth, J.; Szentirmay, Z.; Gyenes, G.

    1987-01-01

    239 Consecutive women with stage III carcinoma of the breast were treated by primary radiation therapy (RT) from 1977 to 1985. The response rate was 89%, the 5-year survival 40% and the local-regional tumor control (LTC) 59%. For the 27 non-responders, postirradiation chemotherapy was initiated but they died within 3 years. 105 Patients were subjected to mastectomy and axillary dissection after RT. In 107 cases, the RT was not followed by surgery. Systemic treatment consisted of hormonal therapy in both groups. The RT plus surgery group had better survival rate, 58% vs. 35% at 5 years. However, the incidence of less favorable cases was higher in the RT alone group. Histological findings in the operated group are analysed to determine prognostic significance of residual disease. No residual or only damaged microscopic disease was found in the breast in 36% of the cases. The axillary lymph nodes (ALN) were free of disease in 42% of the women. Patients with negative ALN after RT had significantly better 5-year survival (82% vs. 43%) and LTC (85% vs. 60%) rates. Decreased chest wall recurrence rate was associated with no residual or damaged microscopic disease in the breast (5% vs. 21%). The disease-free ALN were more common after 50-80 Gy telecobalt than after 40-50 Gy kV irradiation (51% vs. 33%). Primary tumor size ( 5 cm) had no significant impact on histological findings or on prognosis. Residual disease is mainly a marker of tumor-host relationship which indicates the biological aggressiveness of the disease. 20 refs.; 4 figs.; 2 tabs

  3. Breast MR imaging for the assessment of residual disease following initial surgery for breast cancer with positive margins

    Energy Technology Data Exchange (ETDEWEB)

    Krammer, Julia [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany); Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Price, Elissa R. [University of California, San Francisco, Department of Radiology and Biomedical Imaging, Division of Women' s Imaging, San Francisco, CA (United States); Jochelson, Maxine S.; Watson, Elizabeth; Morris, Elizabeth A. [Memorial Sloan-Kettering Cancer Center, Breast Imaging Section, Department of Radiology, New York, NY (United States); Murray, Melissa P. [Memorial Sloan-Kettering Cancer Center, Department of Pathology, New York, NY (United States); Schoenberg, Stefan O. [University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Institute of Clinical Radiology and Nuclear Medicine, Mannheim (Germany)

    2017-11-15

    To determine the accuracy of post-operative MR in predicting residual disease in women with positive margins, emphasizing the size thresholds at which residual disease can be confidently identified. This IRB-approved HIPAA-compliant retrospective study included 175 patients with MR after positive margins following initial surgery for breast cancer. Two expert readers independently re-evaluated MR images for evidence of residual disease at the surgical cavity and multifocal/multicentric disease. All patients underwent definitive surgery and MR findings were correlated to histopathology. 139/175 (79.4%) patients had residual disease at surgery. Average overall sensitivity, specificity, PPV and NPV for residual disease at the surgical cavity were 73%, 72%, 91% and 45%, respectively. The readers identified 42/45 (93%, reader 1) and 43/45 (95%, reader 2) patients with residual invasive disease at the cavity of ≥5 mm and 22/22 (100%, both readers) patients with disease ≥10 mm. Average sensitivity, specificity, PPV and NPV for unknown multifocal/multicentric disease were 90%, 96%, 93% and 86%, respectively. Post-operative breast MR can accurately depict ≥5-mm residual disease at the surgical cavity and unsuspected multifocal/multicentric disease. These findings have the potential to lead to more appropriate selection of second surgical procedures in women with positive margins. (orig.)

  4. Frequent Attenders with Chronic Respiratory Diseases in Primary Care Settings.

    Science.gov (United States)

    Kurpas, Donata; Szwamel, Katarzyna; Mroczek, Bożena

    2016-01-01

    Governments struggle to fund health services and there is a growing interest in the cost, clinical characteristics, and interventions for high utilizers of care, such as persistent frequent attenders to primary care. The purpose of this study was to determine the components shaping the phenomenon of frequent attendance in patients with chronic respiratory diseases in primary care settings. We examined 200 adult patients with chronic diseases (median age 65, range 18-90) recruited from 126 general practitioners. We conclude that, in patients with chronic respiratory diseases, frequent attendance can be expected among those with a low level of satisfaction with their quality of health, a low level of QoL in the physical domain as much as QoL in the social relationships domain, making multiple visits to a doctor (more than 4 visits), taking more than five drugs, being treated for more than three chronic diseases, waiting at the doctor's office for no more than 30 min, receiving a greater number of primary care services, and requiring the assistance of a district nurse. Such patients may need social support interventions and monitoring of their clinical status.

  5. Surface wipe sampling for antineoplastic (chemotherapy) and other hazardous drug residue in healthcare settings: Methodology and recommendations.

    Science.gov (United States)

    Connor, Thomas H; Zock, Matthew D; Snow, Amy H

    2016-09-01

    Surface wipe sampling for various hazardous agents has been employed in many occupational settings over the years for various reasons such as evaluation of potential dermal exposure and health risk, source determination, quality or cleanliness, compliance, and others. Wipe sampling for surface residue of antineoplastic and other hazardous drugs in healthcare settings is currently the method of choice to determine surface contamination of the workplace with these drugs. The purpose of this article is to review published studies of wipe sampling for antineoplastic and other hazardous drugs, to summarize the methods in use by various organizations and researchers, and to provide some basic guidance for conducting surface wipe sampling for these drugs in healthcare settings.  Recommendations on wipe sampling methodology from several government agencies and organizations were reviewed. Published reports on wipe sampling for hazardous drugs in numerous studies were also examined. The critical elements of a wipe sampling program and related limitations were reviewed and summarized.  Recommendations and guidance are presented concerning the purposes of wipe sampling for antineoplastic and other hazardous drugs in the healthcare setting, technical factors and variables, sampling strategy, materials required, and limitations. The reporting and interpretation of wipe sample results is also discussed.  It is recommended that all healthcare settings where antineoplastic and other hazardous drugs are handled consider wipe sampling as part of a comprehensive hazardous drug "safe handling" program. Although no standards exist for acceptable or allowable surface concentrations for these drugs in the healthcare setting, wipe sampling may be used as a method to characterize potential occupational dermal exposure risk and to evaluate the effectiveness of implemented controls and the overall safety program. A comprehensive safe-handling program for antineoplastic drugs may

  6. The Influence of Repeat Surgery and Residual Disease on Recurrence After Breast-Conserving Surgery

    DEFF Research Database (Denmark)

    Bodilsen, Anne; Bjerre, Karsten; Offersen, Birgitte V

    2015-01-01

    BACKGROUND: A significant proportion of women who have breast-conserving surgery (BCS) subsequently undergo re-excision or proceed to mastectomy. This study aimed to identify factors associated with residual disease after repeat surgery and to determine their effect on ipsilateral breast tumor...... recurrence (IBTR) and survival. METHODS: The study cohort was identified within the national population-based registry of the Danish Breast Cancer Cooperative Group, including women who underwent BCS for unilateral invasive breast cancer between 2000 and 2009. RESULTS: The study investigated 12,656 women...... interval (CI) 1.57-5.62] or DCIS (HR, 2.58; 95 % CI 1.50-4.45). However, no difference was seen in overall survival comparing patients receiving one excision with those having repeat surgery with or without residual disease (p = 0.96). CONCLUSION: A higher risk of IBTR seen after re-excision was associated...

  7. Minimal residual disease after surgery of HPV 16-associated tumours as target for immunotherapy

    Czech Academy of Sciences Publication Activity Database

    Bubeník, Jan; Reiniš, Milan; Šímová, Jana

    2006-01-01

    Roč. 18, Supplement 1 (2006), - ISSN 1107-3756. [World Congress on Advances in Oncology /11./ and International Symposium on Molecular Medicine /9./. 12.10.2006-14.10.2006, Hersonissos] R&D Projects: GA MZd(CZ) NR7807; GA ČR(CZ) GA301/04/0492; GA AV ČR(CZ) IAA500520605 Institutional research plan: CEZ:AV0Z50520514 Keywords : minimal residual disease * HPV16 * immunotherapy Subject RIV: EB - Genetics ; Molecular Biology

  8. Depletion of Treg cells inhibits minimal residual disease after surgery of HPV16-associated tumours

    Czech Academy of Sciences Publication Activity Database

    Šímová, Jana; Bubeník, Jan; Bieblová, Jana; Rosalia, Rodney Alexander; Frič, Jan; Reiniš, Milan

    2006-01-01

    Roč. 29, č. 6 (2006), s. 1567-1571 ISSN 1019-6439 R&D Projects: GA ČR(CZ) GA301/04/0492 EU Projects: European Commission(XE) 18933 - CLINIGENE Grant - others:Liga proti rakovině(CZ) XX Institutional research plan: CEZ:AV0Z50520514 Keywords : HPV16 * residual tumour disease * Treg cells Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 2.556, year: 2006

  9. HPV16-associated tumours: Therapy of surgical minimal residual disease with dendritic cell-based vaccines

    Czech Academy of Sciences Publication Activity Database

    Reiniš, Milan; Indrová, Marie; Mendoza, Luis; Mikyšková, Romana; Bieblová, Jana; Bubeník, Jan; Šímová, Jana

    2004-01-01

    Roč. 25, č. 4 (2004), s. 1165-1170 ISSN 1019-6439 R&D Projects: GA MZd NC7148; GA ČR GA301/04/0492; GA ČR GA301/01/0985; GA AV ČR IAA5052203 Institutional research plan: CEZ:AV0Z5052915 Keywords : HPV 16 * minimal residual tumour disease * dendritic cells Subject RIV: EC - Immunology Impact factor: 3.056, year: 2004

  10. Minimal residual disease as the target for immunotherapy and gene therapy of cancer (Review)

    Czech Academy of Sciences Publication Activity Database

    Bubeník, Jan; Šímová, Jana

    2005-01-01

    Roč. 14, č. 5 (2005), s. 1377-1380 ISSN 1021-335X R&D Projects: GA MZd(CZ) NR7807; GA MZd(CZ) NR8004; GA ČR(CZ) GA301/04/0492 Institutional research plan: CEZ:AV0Z50520514 Keywords : residual tumour disease * gene therapy * cytokines Subject RIV: EC - Immunology Impact factor: 1.572, year: 2005

  11. Food residue granuloma mimicking metastatic disease on FDG-PET/CT.

    Science.gov (United States)

    Crucitti, Antonio; Grossi, Ugo; Leccisotti, Lucia; Maggi, Fabio; Ricci, Riccardo; Mazzari, Andrea; Tomaiuolo, Pasquina M C; Giordano, Alessandro

    2013-05-01

    A 31-year-old woman presenting with acute abdomen underwent an emergency Hartmann's procedure for fecal peritonitis due to perforated adenocarcinoma of the left colon. Shortly after a 7-month course of adjuvant chemotherapy, follow-up contrast-enhanced CT showed multiple peritoneal and hepatic nodules, showing focal intense and homogeneous FDG uptake on FDG-PET/CT, highly suspected for recurrence of disease. Excisional biopsy of the nodules revealed foreign body granulomas made up of alimentary materials surrounded by a fibrous wall. We report a unique case of a false-positive finding secondary to food residues mimicking metastatic disease on FDG-PET in a patient with colon cancer.

  12. Prevalence of chronic kidney disease in Peruvian primary care setting.

    Science.gov (United States)

    Herrera-Añazco, Percy; Taype-Rondan, Alvaro; Lazo-Porras, María; Alberto Quintanilla, E; Ortiz-Soriano, Victor Manuel; Hernandez, Adrian V

    2017-07-19

    Chronic Kidney Disease (CKD) is a worldwide public health problem. There are few studies in Latin America, especially in primary care settings. Our objective was to determine the prevalence, stages, and associated factors of CKD in primary care setting. We did a retrospective secondary analysis of a database from the Diabetes and Hypertension Primary Care Center of the Peruvian Social Security System (EsSalud) in Lima, Peru. We defined CKD as the presence of eGFR 30 mg/day in 24 h, according to Kidney Disease: Improving Global Outcomes (KDIGO). Factors associated with CKD were evaluated with Poisson Regression models; these factors included age, gender, type 2 diabetes mellitus (DM2), hypertension (HTN), body mass index (BMI), and uric acid. Associations were described as crude and adjusted prevalence ratios (PR) and their 95% confidence intervals (95% CI). We evaluated 1211 patients (women [59%], mean age 65.8 years [SD: 12.7]). Prevalence of CKD was 18%. Using the estimated glomerular filtration rate (eGFR), the prevalence was 9.3% (95% CI 5.3 - 13.3) in patients without HTN or DM2; 20.2% (95% CI 17.6 - 22.8) in patients with HTN, and 23.9% (95% CI 19.4 - 28.4) in patients with DM2. The most common stages were 1 and 2 with 41.5% and 48%, respectively. Factors associated with CKD in the adjusted analysis were: age in years (PR = 1.03, 95% CI 1.01 - 1.04), DM2 (PR = 3.37, 95% CI 1.09 - 10.39), HTN plus DM2 (PR = 3.90, 95% CI 1.54 - 9.88), and uric acid from 5 to DM2, older age and hyperuricemia have higher prevalence of CKD.

  13. Pre-transplantation minimal residual disease with cytogenetic and molecular diagnostic features improves risk stratification in acute myeloid leukemia.

    Science.gov (United States)

    Oran, Betül; Jorgensen, Jeff L; Marin, David; Wang, Sa; Ahmed, Sairah; Alousi, Amin M; Andersson, Borje S; Bashir, Qaiser; Bassett, Roland; Lyons, Genevieve; Chen, Julianne; Rezvani, Katy; Popat, Uday; Kebriaei, Partow; Patel, Keyur; Rondon, Gabriela; Shpall, Elizabeth J; Champlin, Richard E

    2017-01-01

    Our aim was to improve outcome prediction after allogeneic hematopoietic stem cell transplantation in acute myeloid leukemia by combining cytogenetic and molecular data at diagnosis with minimal residual disease assessment by multicolor flow-cytometry at transplantation. Patients with acute myeloid leukemia in first complete remission in whom minimal residual disease was assessed at transplantation were included and categorized according to the European LeukemiaNet classification. The primary outcome was 1-year relapse incidence after transplantation. Of 152 patients eligible, 48 had minimal residual disease at the time of their transplant. Minimal residual disease-positive patients were older, required more therapy to achieve first remission, were more likely to have incomplete recovery of blood counts and had more adverse risk features by cytogenetics. Relapse incidence at 1 year was higher in patients with minimal residual disease (32.6% versus 14.4%, P=0.002). Leukemia-free survival (43.6% versus 64%, P=0.007) and overall survival (48.8% versus 66.9%, P=0.008) rates were also inferior in patients with minimal residual disease. In multivariable analysis, minimal residual disease status at transplantation independently predicted 1-year relapse incidence, identifying a subgroup of intermediate-risk patients, according to the European LeukemiaNet classification, with a particularly poor outcome. Assessment of minimal residual disease at transplantation in combination with cytogenetic and molecular findings provides powerful independent prognostic information in acute myeloid leukemia, lending support to the incorporation of minimal residual disease detection to refine risk stratification and develop a more individualized approach during hematopoietic stem cell transplantation. Copyright© Ferrata Storti Foundation.

  14. Microbial aerosol liberation from soiled textiles isolated during routine residuals handling in a modern health care setting.

    Science.gov (United States)

    Handorean, Alina; Robertson, Charles E; Harris, J Kirk; Frank, Daniel; Hull, Natalie; Kotter, Cassandra; Stevens, Mark J; Baumgardner, Darrel; Pace, Norman R; Hernandez, Mark

    2015-12-09

    A wide variety of specialty textiles are used in health care settings for bedding, clothing, and privacy. The ability of textiles to host or otherwise sequester microbes has been well documented; however, their reciprocal potential for liberating airborne bacteria remains poorly characterized. In response, a multi-season survey of bacterial bioaerosols was conducted in the origin and terminus of residual paths which are specifically designed to isolate soiled hospital textiles as they are moved to laundering. This survey used conventional optical particle counting which incorporated multi-channel fluorescence in conjunction with molecular phylogenetic analyses to characterize the bioaerosols liberated during soiled textile storage--immediately before and after the occupation of a modern hospital. Although outfitted with a HEPA filtration system, the number of airborne particles presenting fluorescing optical signatures consistent with airborne bacteria and fungi significantly increased in textile holding rooms soon after the hospital's commissioning, even though these isolated residual areas rarely host personnel. The bioaerosol liberated during textile storage was characterized using Illumina MiSeq sequencing of bacterial 16S ribosomal ribonucleic acid (rRNA) genes. Gene copies recovered by quantitative PCR from aerosol collected in co-located impingers were consistent with fluorescence gated optical particle counting. The relative abundance patterns of proximal bacterial bioaerosol were such that the air in the origin and terminus of textile storage rooms could not be differentiated once the hospital began processing soiled linens. Genes from microbes typically associating with human skin, feces, and hair--Staphylococcus, Propionibacteria, Corynebacteria, Lactobacillus, and Streptococcus spp.--dominated the aerosol abundance profiles in textile holding rooms, which were generally far less diverse than communities recovered from surfaces in patient rooms. These

  15. Residual Salivary Secretion Ability May Be a Useful Marker for Differential Diagnosis in Autoimmune Diseases

    Directory of Open Access Journals (Sweden)

    Etsuko Maeshima

    2014-01-01

    Full Text Available Background. We have elucidated decreased resting salivary flow in approximately 60% of patients with autoimmune diseases not complicated by Sjögren syndrome (SjS. In this study, salivary stimulation tests using capsaicin were performed to examine residual salivary secretion ability in patients with autoimmune diseases. Materials and Methods. Fifty-eight patients were divided into three groups: patients with primary or secondary SjS (SjS group, patients with systemic sclerosis not complicated by SjS (SSc group, and patients with other autoimmune diseases (non-SjS/non-SSc group. Simple filter paper and filter paper containing capsaicin were used to evaluate salivary flow rates. Results. Resting salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group but did not differ significantly between the SjS and SSc groups. Capsaicin-stimulated salivary flow rates were significantly lower in the SjS and SSc groups than in the non-SjS/non-SSc group, but not significantly different between the SjS and SSc groups. In the non-SjS/non-SSc group, salivary flow rates increased after capsaicin stimulation to the threshold level for determination of salivary gland dysfunction, whereas no improvement was observed in the SjS and SSc groups. Conclusion. Residual salivary secretion ability may be a useful marker for differential diagnosis in autoimmune diseases.

  16. Diagnosis of preclinical Alzheimer's disease in a clinical setting.

    Science.gov (United States)

    Visser, P J; Verhey, F R; Ponds, R W; Jolles, J

    2001-12-01

    The aim of the study was to investigate whether the preclinical stage of Alzheimer's disease (AD) can be diagnosed in a clinical setting. To this end we investigated whether subjects with preclinical AD could be differentiated from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. Twenty-three subjects with preclinical AD, 44 subjects with nonprogressive mild cognitive impairment, and 25 subjects with very mild AD-type dementia were selected from a memory clinic population. Variables that were used to differentiate the groups were demographic variables, the Mini-Mental State Examination score, performance on cognitive tests, measures of functional impairment, and measures of noncognitive symptomatology. Age and the scores for the delayed recall task could best discriminate between subjects with preclinical AD and subjects with nonprogressive mild cognitive impairment. The overall accuracy was 87%. The score on the Global Deterioration Scale and a measure of intelligence could best discriminate between subjects with preclinical AD and subjects with very mild AD-type dementia. The overall accuracy was 85%. Subjects with preclinical AD can be distinguished from subjects with nonprogressive mild cognitive impairment and from subjects with very mild AD-type dementia. This means that preclinical AD is a diagnostic entity for which clinical criteria should be developed.

  17. Postural stability in vestibular neuritis: age, disease duration, and residual vestibular function.

    Science.gov (United States)

    Fujimoto, Chisato; Egami, Naoya; Kinoshita, Makoto; Sugasawa, Keiko; Yamasoba, Tatsuya; Iwasaki, Shinichi

    2014-04-01

    To assess the influence of factors that can affect postural instability in vestibular neuritis (VN). Retrospective data collection study. Foam posturography was performed in 58 VN patients. We examined six variables: the velocity of movement of the center of pressure and the envelopment area in eyes closed/foam rubber condition, Romberg's ratios of velocity and area with foam rubber, and the foam ratios of velocity and area with eyes closed. Multiple regression analyses were performed to explore the relationship between these variables and the following independent variables: gender, age, canal paresis (CP) percentage, and disease duration. All six variables were positively associated with age, CP percentage, and a disease duration of 10 days or less (P  .05). VN patients show poor postural performance, which is affected by age, residual vestibular function, and disease duration. Once a VN patient passes the acute phase of the vertigo attack, it is likely that age and residual vestibular function make a greater contribution to postural control. 3b. © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

  18. A multigene array for measurable residual disease detection in AML patients undergoing SCT

    Science.gov (United States)

    Goswami, M; McGowan, K S; Lu, K; Jain, N; Candia, J; Hensel, N F; Tang, J; Calvo, K R; Battiwalla, M; Barrett, A J; Hourigan, C S

    2015-01-01

    AML is a diagnosis encompassing a diverse group of myeloid malignancies. Heterogeneous genetic etiology, together with the potential for oligoclonality within the individual patient, have made the identification of a single high-sensitivity marker of disease burden challenging. We developed a multiple gene measurable residual disease (MG-MRD) RQ–PCR array for the high-sensitivity detection of AML, retrospectively tested on 74 patients who underwent allo-SCT at the NHLBI in the period 1994–2012. MG-MRD testing on peripheral blood samples prior to transplantation demonstrated excellent concordance with traditional BM-based evaluation and improved risk stratification for post-transplant relapse and OS outcomes. Pre-SCT assessment by MG-MRD predicted all clinical relapses occurring in the first 100 days after allo-SCT compared with 57% sensitivity using WT1 RQ–PCR alone. Nine patients who were negative for WT1 prior to transplantation were correctly reclassified into a high-risk MG-MRD-positive group, associated with 100% post-transplant mortality. This study provides proof of principle that a multiple gene approach may be superior to the use of WT1 expression alone for AML residual disease detection. PMID:25665046

  19. SU-F-R-25: Automatic Identification of Suspicious Recurrent/residual Disease Regions After Prostatectomy

    Energy Technology Data Exchange (ETDEWEB)

    Parra, N A; Abramowitz, M; Pollack, A; Stoyanova, R [University of Miami, Miami, FL (United States)

    2016-06-15

    Purpose: To automatically identify and outline suspicious regions of recurrent or residual disease in the prostate bed using Dynamic Contrast Enhanced-MRI (DCE-MRI) in patients after prostatectomy. Methods: Twenty-two patients presenting for salvage radiotherapy and with identified Gross Tumor Volume (GTV) in the prostate bed were retrospectively analyzed. The MRI data consisted of Axial T2weighted-MRI (T2w) of the pelvis: resolution 1.25×1.25×2.5 mm; Field of View (FOV): 320×320 mm; slice thickness=2.5mm; 72 slices; and Dynamic Contrast Enhanced MRI (DCE-MRI)–12 series of T1w with identical spatial resolution to T2w and at 30–34s temporal resolution. Unsupervised pattern recognition was used to decompose the 4D DCE data as the product W.H of weights W of k patterns H. A well-perfused pattern Hwp was identified and the weight map Wwp associated to Hwp was used to delineate suspicious volumes. Threshold of Wwp set at mean(Wwp)+S*std(Wwp), S=1,1.5,2 and 2.5 defined four volumes labeled as DCE1.0 to DCE2.5. These volumes were displayed on T2w and, along with GTV, were correlated with the highest pre-treatment PSA values, and with pharmacokinetic analysis constants. Results: GTV was significantly correlated with DCE2.0(ρ= 0.60, p<0.003), and DCE 2.5 (ρ=0.58, p=0.004)). Significant correlation was found between highest pre-treatment PSA and GTV(ρ=0.42, p<0.049), DCE2.0(ρ= 0.52, p<0.012), and DCE 2.5 (ρ=0.67, p<<0.01)). Kruskal-Wallis analysis showed that Ktrans median value was statistically different between non-specific prostate bed tissue NSPBT and both GTV (p<<0.001) and DCE2.5 (p<<0.001), but while median Ve was statistically different between DCE2.5 and NSPBT (p=0.002), it was not statistically different between GTV and NSPBT (p=0.054), suggesting that automatic volumes capture more accurately the area of malignancy. Conclusion: Software developed for identification and visualization of suspicions regions in DCE-MRI from post-prostatectomy patients has

  20. Hepatocytes contribute to residual glucose production in a mouse model for glycogen storage disease type Ia.

    Science.gov (United States)

    Hijmans, Brenda S; Boss, Andreas; van Dijk, Theo H; Soty, Maud; Wolters, Henk; Mutel, Elodie; Groen, Albert K; Derks, Terry G J; Mithieux, Gilles; Heerschap, Arend; Reijngoud, Dirk-Jan; Rajas, Fabienne; Oosterveer, Maaike H

    2017-12-01

    It is a long-standing enigma how glycogen storage disease (GSD) type I patients retain a limited capacity for endogenous glucose production despite the loss of glucose-6-phosphatase activity. Insight into the source of residual endogenous glucose production is of clinical importance given the risk of sudden death in these patients, but so far contradictory mechanisms have been proposed. We investigated glucose-6-phosphatase-independent endogenous glucose production in hepatocytes isolated from a liver-specific GSD Ia mouse model (L-G6pc -/- mice) and performed real-time analysis of hepatic glucose fluxes and glycogen metabolism in L-G6pc -/- mice using state-of-the-art stable isotope methodologies. Here we show that G6pc-deficient hepatocytes are capable of producing glucose. In vivo analysis of hepatic glucose metabolism revealed that the hepatic glucokinase flux was decreased by 95% in L-G6pc -/- mice. It also showed increased glycogen phosphorylase flux in L-G6pc -/- mice, which is coupled to the release of free glucose through glycogen debranching. Although the ex vivo activities of debranching enzyme and lysosomal acid maltase, two major hepatic α-glucosidases, were unaltered in L-G6pc -/- mice, pharmacological inhibition of α-glucosidase activity almost completely abolished residual glucose production by G6pc-deficient hepatocytes. Our data indicate that hepatocytes contribute to residual glucose production in GSD Ia. We show that α-glucosidase activity, i.e. glycogen debranching and/or lysosomal glycogen breakdown, contributes to residual glucose production by GSD Ia hepatocytes. A strong reduction in hepatic GCK flux in L-G6pc-/- mice furthermore limits the phosphorylation of free glucose synthesized by G6pc-deficient hepatocytes, allowing the release of glucose into the circulation. The almost complete abrogation of GCK flux in G6pc-deficient liver also explains the contradictory reports on residual glucose production in GSD Ia patients. (Hepatology

  1. Prediction of residual valvular lesions in rheumatic heart disease: role of adhesion molecules.

    Science.gov (United States)

    Hafez, Mona; Yahia, Sohier; Eldars, Waleed; Eldegla, Heba; Matter, Mohamed; Attia, Gehan; Hawas, Samia

    2013-03-01

    Rheumatic heart disease (RHD) is a chronic condition characterized by fibrosis and scarring of the cardiac valves and damage to the heart muscle, leading to congestive heart failure and death. This prospective cohort study was conducted to investigate the possible relation between the levels of serum adhesion molecules and acute rheumatic fever (ARF) carditis, valvular insult severity, and residual valvular lesion after improvement of rheumatic activity. Serum levels of intercellular adhesion molecule 1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), and E-selectin were assayed by enzyme-linked immunoassay (ELISA) for 50 children with ARF carditis during activity and after improvement and for 50 healthy children as control subjects. After the acute attack, patients were followed up regularly to detect residual valvular lesion. The serum levels of these adhesion molecules were significantly higher in the patients than in the control group (p valvular lesion (ICAM-1, >1,032.3 μg/ml; VCAM-1, >3,662.3 μg/ml; E-selectin, >104.8 μg/ml). Finally, by combining the three adhesion molecules in a single prediction model, the highest area under the curve (AUC) ± standard error (SE) was obtained (0.869 ± 0.052), and the positive likelihood ratio for having a residual valvular lesion was increased (17.33). Levels of serum adhesion molecules could predict residual valvular lesions in RHD patients. The authors recommend that the serum level of adhesion molecules be measured in all cases of ARF carditis.

  2. Residuation theory

    CERN Document Server

    Blyth, T S; Sneddon, I N; Stark, M

    1972-01-01

    Residuation Theory aims to contribute to literature in the field of ordered algebraic structures, especially on the subject of residual mappings. The book is divided into three chapters. Chapter 1 focuses on ordered sets; directed sets; semilattices; lattices; and complete lattices. Chapter 2 tackles Baer rings; Baer semigroups; Foulis semigroups; residual mappings; the notion of involution; and Boolean algebras. Chapter 3 covers residuated groupoids and semigroups; group homomorphic and isotone homomorphic Boolean images of ordered semigroups; Dubreil-Jacotin and Brouwer semigroups; and loli

  3. Proposal for the standardization of flow cytometry protocols to detect minimal residual disease in acute lymphoblastic leukemia

    Science.gov (United States)

    Ikoma, Maura Rosane Valério; Beltrame, Miriam Perlingeiro; Ferreira, Silvia Inês Alejandra Cordoba Pires; Souto, Elizabeth Xisto; Malvezzi, Mariester; Yamamoto, Mihoko

    2015-01-01

    Minimal residual disease is the most powerful predictor of outcome in acute leukemia and is useful in therapeutic stratification for acute lymphoblastic leukemia protocols. Nowadays, the most reliable methods for studying minimal residual disease in acute lymphoblastic leukemia are multiparametric flow cytometry and polymerase chain reaction. Both provide similar results at a minimal residual disease level of 0.01% of normal cells, that is, detection of one leukemic cell in up to 10,000 normal nucleated cells. Currently, therapeutic protocols establish the minimal residual disease threshold value at the most informative time points according to the appropriate methodology employed. The expertise of the laboratory in a cancer center or a cooperative group could be the most important factor in determining which method should be used. In Brazil, multiparametric flow cytometry laboratories are available in most leukemia treatment centers, but multiparametric flow cytometry processes must be standardized for minimal residual disease investigations in order to offer reliable and reproducible results that ensure quality in the clinical application of the method. The Minimal Residual Disease Working Group of the Brazilian Society of Bone Marrow Transplantation (SBTMO) was created with that aim. This paper presents recommendations for the detection of minimal residual disease in acute lymphoblastic leukemia based on the literature and expertise of the laboratories who participated in this consensus, including pre-analytical and analytical methods. This paper also recommends that both multiparametric flow cytometry and polymerase chain reaction are complementary methods, and so more laboratories with expertise in immunoglobulin/T cell receptor (Ig/TCR) gene assays are necessary in Brazil. PMID:26670404

  4. Validation of the ICF core set for neuromuscular diseases

    NARCIS (Netherlands)

    Bos, Isaac; Stallinga, H. A.; Middel, B.; Kuks, J. B. M.; Wynia, K.

    Background. Understanding of the consequences of a neuromuscular disease (NMD) can improve when a valid sample of disease-specific categories based on the International Classification of Functioning, Disabilities, and Health (ICF) is available. Objective. To examine the content validity of the

  5. Validation of the ICF core set for neuromuscular diseases

    NARCIS (Netherlands)

    K. Wynia; J.B. Kuks; H.A. Stallinga; B. Middel; I. Bos

    2013-01-01

    BACKGROUND: Understanding of the consequences of a neuromuscular disease (NMD) can improve when a valid sample of disease-specific categories based on the International Classification of Functioning, Disabilities, and Health (ICF) is available. OBJECTIVE: To examine the content validity of the

  6. Transfusion transmitted diseases in perioperative and intensive care settings

    Directory of Open Access Journals (Sweden)

    Rekha Das

    2014-01-01

    Full Text Available Patients in the perioperative period and intensive care unit are commonly exposed to blood transfusion (BT. They are at increased risk of transfusion transmitted bacterial, viral and protozoal diseases. The risk of viral transmission has decreased steadily, but the risk of bacterial transmission remains same. Bacterial contamination is more in platelet concentrates than in red cells and least in plasma. The chances of sepsis, morbidity and mortality depend on the number of transfusions and underlying condition of the patient. Challenges to safe BT continue due to new emerging pathogens and various management problems. Strategies to restrict BT, optimal surgical and anaesthetic techniques to reduce blood loss and efforts to develop transfusion alternatives should be made. Literature search was performed using search words/phrases blood transfusion, transfusion, transfusion transmitted diseases, transfusion transmitted bacterial diseases, transfusion transmitted viral diseases, transfusion transmitted protozoal diseases or combinations, on PubMed and Google Scholar from 1990 to 2014.

  7. Precision and prognostic value of clone-specific minimal residual disease in acute myeloid leukemia.

    Science.gov (United States)

    Hirsch, Pierre; Tang, Ruoping; Abermil, Nassera; Flandrin, Pascale; Moatti, Hannah; Favale, Fabrizia; Suner, Ludovic; Lorre, Florence; Marzac, Christophe; Fava, Fanny; Mamez, Anne-Claire; Lapusan, Simona; Isnard, Françoise; Mohty, Mohamad; Legrand, Ollivier; Douay, Luc; Bilhou-Nabera, Chrystele; Delhommeau, François

    2017-07-01

    The genetic landscape of adult acute myeloid leukemias (AML) has been recently unraveled. However, due to their genetic heterogeneity, only a handful of markers are currently used for the evaluation of minimal residual disease (MRD). Recent studies using multi-target strategies indicate that detection of residual mutations in less than 5% of cells in complete remission is associated with a better survival. Here, in a series of 69 AMLs with known clonal architecture, we design a clone-specific strategy based on fluorescent in situ hybridization and high-sensitivity next generation sequencing to detect chromosomal aberrations and mutations, respectively, in follow-up samples. The combination of these techniques allows tracking chromosomal and genomic lesions down to 0.5-0.4% of the cell population in remission samples. By testing all lesions in follow-up samples from 65 of 69 evaluable patients, we find that initiating events often persist and appear to be, on their own, inappropriate markers to predict short-term relapse. In contrast, the persistence of two or more lesions in more than 0.4% of the cells from remission samples is strongly associated with lower leukemia-free and overall survivals in univariate and multivariate analyses. Although larger prospective studies are needed to extend these results, our data show that a personalized, clone-specific, MRD follow up strategy is feasible in the vast majority of AML cases. Copyright© 2017 Ferrata Storti Foundation.

  8. Geographical variation of Crohn's disease residual incidence in the Province of Quebec, Canada

    Directory of Open Access Journals (Sweden)

    Lowe Anne-Marie

    2010-05-01

    Full Text Available Abstract Background Crohn's disease (CD is clinically expressed as a chronic affection of the gastrointestinal tract currently known to have a multifactorial etiology involving a complex pathophysiological host response modulated by genetic susceptibilities, demographic determinants and environmental factors. With more than 20 cases per 100,000 person-years, the province of Quebec, Canada is among regions of the world with highest reported occurrence of CD in relation to other places where comparable estimates are available. This ecological study was designed to provide a medium-scale spatial exploration of CD incidence after accounting for the influence of known population and regional determinants. Health records of consulting patients in southern Quebec were compiled from 1995 to 2000 and used to estimate age and sex standardized rates per health area (n = 156. Various statistical models taking into account the regional effect of Jewish ethnicity, aboriginal ancestry, material deprivation, prescription for oral contraceptives, reportable enteric infection incidence, smoking as well as latitude and longitude locations were fitted. Results The final regression model presented a coefficient of determination of 22.8% and there was evidence of an eastern trend in the residual incidence (p = 0.018. Overall, the smoothed residual incidence presented a heterogeneous spatial pattern with evidence of patches (multiple health areas of high, low and contrasting values. Health areas with most extreme incidence residuals where also distributed over the whole province including one area in the metropolitan area of Montreal and others in surrounding areas. Conclusions These findings suggest that known populational and regional factors derived through census information only explain a limited fraction of the geographical variation of CD incidence and lead to speculate that the effects of these factors may be incompletely captured (imperfect construction of

  9. Screening for Residual Disease in Pediatric Burkitt Lymphoma Using Consensus Primer Pools

    Directory of Open Access Journals (Sweden)

    Melissa Agsalda

    2009-01-01

    Full Text Available Assessing molecular persistent or minimal residual disease (PD/MRD in childhood Burkitt lymphoma (BL is challenging because access to original tumor is usually needed to design patient-specific primers (PSPs. Because BL is characterized by rearranged immunoglobulin heavy chain (IgVH genes, IgVH primer pools from IgVH1–IgVH7 regions were tested to detect PD/MRD, thus eliminating the need for original tumor. The focus of the current study was to assess the feasibility of using IgVH primer pools to detect disease in clinical specimens. Fourteen children diagnosed with B-NHL had follow-up repository specimens available to assess PD/MRD. Of the 14 patients, 12 were PD/MRD negative after 2 months of therapy and remained in remission at the end of therapy; 2/14 patients were PD/MRD positive at 2-3 months and later relapsed. PSP-based assays from these 14 patients showed 100% concordance with the current assay. This feasibility study warrants further investigation to assess PD/MRD using IgVH primer pools, which could have clinical significance as a real-time assessment tool to monitor pediatric BL and possibly other B-cell non-Hodgkin lymphoma therapy.

  10. Statistical tests against systematic errors in data sets based on the equality of residual means and variances from control samples: theory and applications.

    Science.gov (United States)

    Henn, Julian; Meindl, Kathrin

    2015-03-01

    Statistical tests are applied for the detection of systematic errors in data sets from least-squares refinements or other residual-based reconstruction processes. Samples of the residuals of the data are tested against the hypothesis that they belong to the same distribution. For this it is necessary that they show the same mean values and variances within the limits given by statistical fluctuations. When the samples differ significantly from each other, they are not from the same distribution within the limits set by the significance level. Therefore they cannot originate from a single Gaussian function in this case. It is shown that a significance cutoff results in exactly this case. Significance cutoffs are still frequently used in charge-density studies. The tests are applied to artificial data with and without systematic errors and to experimental data from the literature.

  11. Chronic pain in the setting of Parkinson's disease and depression.

    Science.gov (United States)

    Stein, W M; Read, S

    1997-10-01

    A 65-year-old woman with chronic pain was admitted to the hospital for severe recurrent major depression complicating Parkinson's disease (PD). Pain complaints were closely related to the fluctuating motor syndrome of PD. Specifically, pain was experienced in conjunction with hypomobility, and, as a result, she self-medicated with extra carbidopa/levodopa. A regimen of tramadol and cyclobenzaprine, along with sustained-release carbidopa/levodopa for PD and buproprion for her depression resulted in sustained symptomatic and functional improvement. Craving for, and self-medication with, supplemental carbidopa/levodopa ceased. Theoretical support for synergism among dopamine and opioid neurotransmitter systems can be found in recent literature.

  12. Morphological and immunological criteria of minimal residual disease detection in children with B-cell precursors acute lymphoblastic leukemia

    Science.gov (United States)

    Beznos, O. A.; Grivtsova, L. Yu; Popa, A. V.; Shervashidze, M. A.; Serebtyakova, I. N.; Tupitsyn, N. N.; Selchuk, V. U.; Grebennikova, O. P.; Titova, G. V.

    2018-01-01

    One of the key factors of prognosis and risk stratification in patients with B-cell precursor acute lymphoblastic leukemia (BCP-ALL) is minimal residual disease (MRD). Identification of MRD on the day 15th is one of the most significant in prognosis of the disease. We compared data of a morphological and flow cytometry results of assessment of a bone marrow (BM) at the day 15th of induction chemotherapy in children with BCP-ALL.

  13. Active disease and residual damage in treated Wegener's granulomatosis: an observational study using pulmonary high-resolution computed tomography

    International Nuclear Information System (INIS)

    Komocsi, Andras; Reuter, Michael; Heller, Martin; Murakoezi, Henriette; Gross, Wolfgang L.; Schnabel, Armin

    2003-01-01

    The purpose of this study was to determine to what extent high-resolution computed tomography (HRCT) of the lungs can distinguish active inflammatory disease from inactive cicatricial disease in patients treated for Wegener's granulomatosis (WG). Twenty-eight WG patients with active pulmonary disease underwent a first HRCT examination immediately before standard immunosuppressive treatment and a second examination after clinical remission had been achieved. Lesions remaining after treatment were categorized as residual damage and were compared with findings during active disease to see by what features active and cicatricial disease can be distinguished. During active disease 17 patients had nodules/masses, 12 had ground-glass opacities, 6 had septal lines and 6 had non-septal lines. After treatment, ground-glass opacities had resolved completely. Nodules/masses had resolved in 8 patients and had diminished in 7 patients. Residual nodules were distinguished from nodules/masses in active disease by lack of cavitation and a diameter of mostly <15 mm. In one-third of patients lines resolved, but in 8 instances new lines evolved during immunosuppression. During a follow-up period of a median 26.5 months (range 20.0-33.8), patients with residual nodules or lines had no more relapses than patients with completely cleared lungs. Treated pulmonary WG leaves substantial residual damage. High-resolution CT does assist in the distinction between active and inactive lesions. Ground-glass opacities, cavitating nodules/masses and masses measuring more than 3 cm represent active disease ordinarily. Non-cavitary small nodules and septal or non-septal lines can be either active or cicatricial lesions. The nature of these lesions needs to be clarified by longitudinal observation. (orig.)

  14. Prognostic value of multicenter flow cytometry harmonized assessment of minimal residual disease in acute myeloblastic leukemia.

    Science.gov (United States)

    Lacombe, Francis; Campos, Lydia; Allou, Kaoutar; Arnoulet, Christine; Delabarthe, Adrienne; Dumezy, Florent; Feuillard, Jean; Geneviève, Franck; Guérin, Estelle; Guy, Julien; Jouault, Hélène; Lepelley, Pascale; Maynadié, Marc; Solly, Françoise; Ballon, Orianne Wagner; Preudhomme, Claude; Baruchel, André; Dombret, Hervé; Ifrah, Norbert; Béné, Marie C

    2017-12-07

    The assessment of minimal residual disease (MRD) in acute myeloblastic leukemia is of growing interest as a prognostic marker of patients' outcome. Multiparameter flow cytometry (MFC), tracking leukemia-associated immunophenotypic patterns, has been shown in several studies to be a useful tool to investigate MRD. Here, we report a multicenter prospective study which allowed to define a harmonized analysis strategy, as well as the efficacy of MFC MRD to predict outcome. This study included 276 patients, in 10 different MFC centers, of whom 268 had at least 1 MRD check point. The combination of a CD45, CD34, and CD33 backbone, with the addition of CD117, CD13, CD7, and CD15 in 2 five-color tubes allowed to define each patient's multiparameter immunophenotypic characteristics at diagnosis, according to a Boolean combination of gates. The same individual diagnosis gating strategy was then applied at each MRD time point for each patient. MRD levels were stratified according to log by log thresholds, from 5 × 10 -2 (the classical morphological threshold to define remission) down to MRD1) as well as when considering all time points together. Finally, MRD levels were independent of cytogenetics and allowed in fact to further stratify all cytogenetics risk groups. In summary, this multicenter study demonstrates that a simple combination of immunophenotypic markers successfully allows for the detection of MRD in acute myeloblastic leukemia patients, with a strong correlation to outcome. Copyright © 2017 John Wiley & Sons, Ltd.

  15. The prognostic significance of minimal residual disease in adult Egyptian patients with precursor acute lymphoblastic leukemia.

    Science.gov (United States)

    Samra, Mohamed A; Mahmoud, Hossam K; Abdelhamid, Thoraya M; El Sharkawy, Nahla M; Elnahass, Yasser H; Elgammal, Mossaad; Abdelfattah, Rafaat M; Eid, Salem; Ghaleb, Fayek M; Kamel, Azza M

    2013-09-01

    Minimal residual disease (MRD) studies in adult acute lymphoblastic leukemia (ALL) give highly significant prognostic information superior to other standard criteria as age, gender and total leucocytic count (TLC) in distinguishing patients at high and low risk of relapse. We aimed to determine the value of MRD monitoring by flowcytometry (FCM) in predicting outcome in adult Precursor ALL patients. Bone marrow (BM) samples were analyzed by 4-color FCM collected at diagnosis and after induction therapy (MRD1) to correlate MRD positivity with disease free survival (DFS) and overall survival (OS). Study included 57 adult ALL patients (44 males and 13 females) with a median age of 22 years (18-49). DFS showed no significant difference with age, gender and initial TLC (p=0.838, 0.888 and 0.743, respectively). Cumulative DFS at 2 years was 34% for B-lineage ALL (n: 35) and 57% for T-lineage ALL (n: 18) (p = 0.057). Cumulative DFS at 2 years was 7% for MRD1 positive (high risk, HR) versus 57% for MRD1 negative patients (Low risk, LR) (p MRD1, OS at 2 years was 18% for MRD1 HR (n: 17) versus 65% for MRD1 LR (n: 38) (p < 0.001). OS was 35% for high-risk patients (n: 30) and 62% for low-risk patients (n: 27) classified according to GMALL risk stratification (p = 0.017). MRD by FCM is a strong independent predictor of outcome in terms of DFS and OS and is a powerful informative parameter in guiding individual treatment in ALL patients. Copyright © 2013. Production and hosting by Elsevier B.V.

  16. Long-term follow-up of residual mediastinal masses in treated Hodgkin's disease using MR imaging

    International Nuclear Information System (INIS)

    Nyman, R.; Forsgren, G.; Glimelius, B.

    1995-01-01

    Ten patients, with substantial residual mediastinal masses of low signal intensity (SI) in the T2-weighted image (T2WI), were reinvestigated with MR 19-79 months after completing treatment of Hodgkin's disease. All patients were in complete remission. During the follow-up period, the masses had decreased in size by 0-95% (median 67%) as compared to their initial post-therapy size. The SI continued to be low in the T2WI and was unaffected by the degree of size reduction. It is speculated that these mainly fibrotic residual masses undergo slow degradation of the fibrotic part and/or resorption of remaining inflammatory tissue. It is important to understand the natural, long-term MR imaging changes of these residual masses in order more easily to recognize tumour recurrence or other pathologic conditions. (orig.)

  17. Pattern of and reason for postoperative residual disease in patients with advanced ovarian cancer following upfront radical debulking surgery.

    Science.gov (United States)

    Heitz, Florian; Harter, Philipp; Alesina, Piero F; Walz, Martin K; Lorenz, Dietmar; Groeben, Harald; Heikaus, Sebastian; Fisseler-Eckhoff, Anette; Schneider, Stephanie; Ataseven, Beyhan; Kurzeder, Christian; Prader, Sonia; Beutel, Bianca; Traut, Alexander; du Bois, Andreas

    2016-05-01

    Describing the pattern of and reasons for post-operative tumor residuals in patients with advanced epithelial ovarian cancer (AOC) operated in a specialized gynecologic cancer center following a strategy of maximum upfront debulking followed by systemic chemotherapy. All consecutive AOC-patients treated between 2005 and 2015 due to stages FIGO IIIB/IV were included in this single-center analysis. 739 patients were included in this analysis. In 81 (11.0%) patients, chemotherapy had already started before referral. Of the remaining 658 patients, upfront debulking was indicated in 578 patients (87.8%), while 80 patients (12.8%) were classified ineligible for upfront debulking; mostly due to comorbidities. A complete tumor resection was achieved in 66.1% of the 578 patients with upfront surgery, 25.4% had residuals 1-10mm and 8.5% had residuals exceeding 10mm, and 12.5% of patients had multifocal residual disease. Most common localization was small bowel mesentery and serosa (79.8%), porta hepatis/hepatoduodenal ligament (10.1%), liver parenchyma (4.3%), pancreas (8.0%), gastric serosa (3.2%), and tumor surrounding/infiltrating the truncus coeliacus (2.7%); 14.9% of the patients had non-resectable supra diaphragmatic lesions. Size of residual tumor was significantly associated with progression-free and overall survival. Upfront debulking for AOC followed by systemic chemotherapy was our main treatment strategy in almost 90% of all patients. The majority experienced a benefit by this approach; while 11.7% of patients probably did not. Understanding sites and reason for residual disease may help to develop adequate surgical training programs but also to identify patients that would better benefit from alternative treatment strategies. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Influence of different disease control pesticide strategies on multiple pesticide residue levels in apple

    DEFF Research Database (Denmark)

    Poulsen, Mette Erecius; Naef, A.; Gasser, S.

    2009-01-01

    Seven pesticide application strategies were investigated to control apple scab (Venturia inaequalis) and powdery mildew (Podosphaera leucotricha) and, at the same time.. fulfil the new quality standards implemented by some German retailers. These demand that pesticide residues should be below 80......% of European Maximum Residue Levels (EU MRL) and that the number of residues present at levels above 0.01 mg kg(-1) should be limited to a maximum of four. The strategies fulfilled the requirement to use combinations of different active substances in order to prevent the emergence of resistance to pesticides....... The trials were conducted at two sites in Switzerland, in 2007, and all strategies and applications were in accordance with actual practice. Four replicates of apple samples from each strategy were then analysed for pesticide residues. The incidence of infection with apple scab and powdery mildew were...

  19. How many standard area diagram sets are needed for accurate disease severity assessment

    Science.gov (United States)

    Standard area diagram sets (SADs) are widely used in plant pathology: a rater estimates disease severity by comparing an unknown sample to actual severities in the SADs and interpolates an estimate as accurately as possible (although some SADs have been developed for categorizing disease too). Most ...

  20. Minimal Residual Disease Evaluation in Childhood Acute Lymphoblastic Leukemia: An Economic Analysis

    Science.gov (United States)

    Gajic-Veljanoski, O.; Pham, B.; Pechlivanoglou, P.; Krahn, M.; Higgins, Caroline; Bielecki, Joanna

    2016-01-01

    Background Minimal residual disease (MRD) testing by higher performance techniques such as flow cytometry and polymerase chain reaction (PCR) can be used to detect the proportion of remaining leukemic cells in bone marrow or peripheral blood during and after the first phases of chemotherapy in children with acute lymphoblastic leukemia (ALL). The results of MRD testing are used to reclassify these patients and guide changes in treatment according to their future risk of relapse. We conducted a systematic review of the economic literature, cost-effectiveness analysis, and budget-impact analysis to ascertain the cost-effectiveness and economic impact of MRD testing by flow cytometry for management of childhood precursor B-cell ALL in Ontario. Methods A systematic literature search (1998–2014) identified studies that examined the incremental cost-effectiveness of MRD testing by either flow cytometry or PCR. We developed a lifetime state-transition (Markov) microsimulation model to quantify the cost-effectiveness of MRD testing followed by risk-directed therapy to no MRD testing and to estimate its marginal effect on health outcomes and on costs. Model input parameters were based on the literature, expert opinion, and data from the Pediatric Oncology Group of Ontario Networked Information System. Using predictions from our Markov model, we estimated the 1-year cost burden of MRD testing versus no testing and forecasted its economic impact over 3 and 5 years. Results In a base-case cost-effectiveness analysis, compared with no testing, MRD testing by flow cytometry at the end of induction and consolidation was associated with an increased discounted survival of 0.0958 quality-adjusted life-years (QALYs) and increased discounted costs of $4,180, yielding an incremental cost-effectiveness ratio (ICER) of $43,613/QALY gained. After accounting for parameter uncertainty, incremental cost-effectiveness of MRD testing was associated with an ICER of $50,249/QALY gained. In

  1. Influence of different disease control pesticide strategies on multiple pesticide residue levels in apple

    DEFF Research Database (Denmark)

    Poulsen, Mette Erecius; Naef, A.; Gasser, S.

    2009-01-01

    Seven pesticide application strategies were investigated to control apple scab (Venturia inaequalis) and powdery mildew (Podosphaera leucotricha) and, at the same time.. fulfil the new quality standards implemented by some German retailers. These demand that pesticide residues should be below 80...

  2. {sup 18}F-FDG PET/CT for detection and localization of residual or recurrent disease in patients with multiple myeloma after stem cell transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Derlin, Thorsten; Wisotzki, Christian; Klutmann, Susanne [University Medical Center Hamburg-Eppendorf, Department of Nuclear Medicine, Hamburg (Germany); Weber, Christoph; Habermann, Christian R.; Herrmann, Jochen [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Ayuk, Francis; Wolschke, Christine; Kroeger, Nicolaus [University Medical Center Hamburg-Eppendorf, Clinic for Stem Cell Transplantation, Hamburg (Germany)

    2012-03-15

    The aim of the study was to determine the diagnostic performance of {sup 18}F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT for the detection and localization of residual or recurrent disease in patients with multiple myeloma (MM) after stem cell transplantation. A total of 197 whole-body {sup 18}F-FDG PET/CT scans were performed in 99 patients with MM at different time points in the course of disease after autologous or allogeneic stem cell transplantation. Post-transplant PET/CT scans and clinical remission status as determined by the clinical gold standard (Uniform Response Criteria) were analysed and compared. A total of 576 focal osseous and extramedullary lesions were detected in 79 scans. Additional diffuse bone marrow involvement was detected in 17 patients. {sup 18}F-FDG PET/CT had a sensitivity of 54.6%, a specificity of 82.1%, a positive predictive value of 82.3%, a negative predictive value of 54.2% and an overall accuracy of 65.5%. The sensitivity of {sup 18}F-FDG PET/CT was shown to depend on the disease category according to the Uniform Response Criteria for myeloma. In patients with MM in the post-transplant setting, {sup 18}F-FDG PET/CT may (1) contribute to the detection and localization of disease, (2) provide information about the extent of distinct myeloma manifestations and the total disease burden and (3) add information about the metabolic activity of disease, but (4) has substantially lower sensitivity for this purpose compared to the pretreatment setting. (orig.)

  3. Set-membership estimations for the evolution of infectious diseases in heterogeneous populations.

    Science.gov (United States)

    Tsachev, Tsvetomir; Veliov, Vladimir M; Widder, Andreas

    2017-04-01

    The paper presents an approach for set-membership estimation of the state of a heterogeneous population in which an infectious disease is spreading. The population state may consist of susceptible, infected, recovered, etc. groups, where the individuals are heterogeneous with respect to traits, relevant to the particular disease. Set-membership estimations in this context are reasonable, since only vague information about the distribution of the population along the space of heterogeneity is available in practice. The presented approach comprises adapted versions of methods which are known in estimation and control theory, and involve solving parametrized families of optimization problems. Since the models of disease spreading in heterogeneous populations involve distributed systems (with non-local dynamics and endogenous boundary conditions), these problems are non-standard. The paper develops the needed theoretical instruments and a solution scheme. SI and SIR models of epidemic diseases are considered as case studies and the results reveal qualitative properties that may be of interest.

  4. Residual signal auto-correlation to evaluate speech in Parkinson’s disease patients Auto-correlação do sinal residual para avaliação da fala em pacientes com doença de Parkinson

    Directory of Open Access Journals (Sweden)

    José Carlos Pereira

    2006-12-01

    Full Text Available OBJECTIVE: To evaluate the maximum residual signal auto-correlation also known as pitch amplitude (PA values in patients with Parkinson’s disease (PD patients. METHOD: The signals of 21 Parkinson’s patients were compared with 15 healthy individuals, divided according age and gender. RESULTS: Statistical difference was seen between groups for PA, 0.39 for controls and 0.25 for PD. Normal value threshold was set as 0.3; (pOBJETIVO: Avaliar autocorrelação do sinal residual também denominado como amplitude do pitch (PA em pacientes com doença de Parkinson (PD. MÉTODO: Os valores de PA, estratificados de acordo com idade e sexo, em 21 pacientes com doença de Parkinson foram analisados e comparados aos dados obtidos em 15 indivíduos sadios. RESULTADOS: Foi determinada diferença estatística para a PA entre os dois grupos (p0,3. Nos pacientes com PD 80,77% dos pacientes tinham a PA <0,3, enquanto que entre os controles somente 12,28% apresentavam valores abaixo de 0,3. O diagrama de dispersão para idade e sexo para os doentes com PD mostraram um p=0,001 e r=0,54. Não houve diferença em relação a sexo e idade entre os grupos. CONCLUSÃO: A significativa diferença da PA entre pacientes com PD e controles demonstra a especificidade da análise. Os resultados apontam para a necessidade de estudos controlados, prospectivos, para implementar o uso e indicações da determinação da amplitude do pitch na avaliação da fala em pacientes com doença de Parkinson.

  5. Minimal Residual Disease and Childhood Leukemia: Standard of Care Recommendations From the Pediatric Oncology Group of Ontario MRD Working Group.

    Science.gov (United States)

    Athale, Uma H; Gibson, Paul J; Bradley, Nicole M; Malkin, David M; Hitzler, Johann

    2016-06-01

    Minimal residual disease (MRD) is an independent predictor of relapse risk in children with leukemia and is widely used for risk-adapted treatment. This article summarizes current evidence supporting the use of MRD, including clinical significance, current international clinical practice, impact statement, and recommended indications. The proposed MRD recommendations have been endorsed by the MRD Working Group of the Pediatric Oncology Group of Ontario and provide the foundation for a strategy that aims at equitable access to MRD evaluation for children with leukemia. © 2016 Wiley Periodicals, Inc.

  6. Vitamin D deficiency in Crohn's disease: prevalence, risk factors and supplement use in an outpatient setting.

    LENUS (Irish Health Repository)

    Suibhne, Treasa Nic

    2012-03-01

    Vitamin D deficiency impacts on bone health and has potential new roles in inflammation. We aimed to determine the prevalence of and risk factors for vitamin D deficiency and to explore vitamin D supplement usage in patients with Crohn\\'s disease (CD) in an outpatient setting, compared with controls.

  7. How to manage medications in the setting of liver disease with the application of six questions.

    Science.gov (United States)

    Nguyen, H M; Cutie, A J; Pham, D Q

    2010-06-01

    Reviewing the current literature to guide clinicians managing medications in the setting of liver disease. Using the terms liver disease, medication management, and therapeutic monitoring, a literature review was conducted to identify peer-reviewed articles in MEDLINE (1966-April 2009). Reference citations were reviewed as an additional resource. Published English-language literatures, articles and trials were reviewed. Emphasis was placed on prospective, randomised, double-blind, placebo-controlled clinical trials. An informed decision on how to manage medications in the setting of liver disease should account for changes that transpire in a medication's first-pass metabolism, protein binding, volume of distribution, clearance and pharmacodynamic interactions. To incorporate these issues within one's thought process, clinicians can utilise the following six questions to evaluate a medication use: (i) Is the patient experiencing acute or chronic liver failure? (ii) Does the drug have high hepatic first-pass metabolism? (iii) Is the medication highly protein-bound? (iv) Is there a change in the volume of distribution for the medication? (v) Is the clearance of the medication significantly altered? and (vi) Is there a pharmacodynamic interaction with the medication? The introduction and use of six clinically relevant questions in the setting of liver disease can serve as a guide to clinicians who manage patients with liver disease.

  8. Could (Disseminated and Residual Minimal Disease be a useful prognostic marker in non-Hodgkin paediatric Lymphomas?

    Directory of Open Access Journals (Sweden)

    Lara Mussolin

    2014-06-01

    Full Text Available Minimal Disseminated Disease (MDD represents the small number of tumour cells in the patients' bone marrow at the time of diagnosis, whereas Minimal Residual Disease (MRD represents the small number of tumour cells remaining in the bone marrow during treatment. Generally, MDD and MRD are measured by polymerase chain reaction, a highly sensitive technique. For a long time, bone marrow involvement has been considered an uncommon event in solid tumours. However, in recent years, several studies demonstrated that MDD and MRD could be powerful tools in paediatric non-Hodgkin lymphoma for stratifying patients in different prognostic groups. Risk stratification in future clinical trials on non-Hodgkin lymphoma based on these newly identified risk categories should be useful to improve therapies in order to increase survival for high-risk patients and decrease toxicity for low-risk patients.http://dx.doi.org/10.7175/cmi.v8i2.902 

  9. The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Shin, Tae Rim; Oh, Yeon-Mok; Park, Joo Hun; Lee, Keu Sung; Oh, Sunghee; Kang, Dae Ryoung; Sheen, Seungsoo; Seo, Joon Beom; Yoo, Kwang Ha; Lee, Ji-Hyun; Kim, Tae-Hyung; Lim, Seong Yong; Yoon, Ho Il; Rhee, Chin Kook; Choe, Kang-Hyeon; Lee, Jae Seung; Lee, Sang-Do

    2015-10-01

    The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC ≥ 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P pulmonary hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.

  10. Assessing genetic effects in survival data by correlating martingale residuals with an application to age at onset of Huntington disease.

    Science.gov (United States)

    Wintrebert, Claire M A; Zwinderman, Aeilko H; Maat-Kievit, Anneke; Roos, Raymund A; van Houwelingen, Hans C

    2006-09-30

    Genetic models for survival data are hard to formulate and hard to fit. For example, the popular gamma-frailty model for sib-pair data does not generalize easily to extended pedigrees and is not easy to fit. In this paper we show how martingale residuals from a (marginal) Cox model can be employed to estimate the presence of a genetic effect and to estimate genetic correlations depending on the genetic distance (kinship). The methodology is applied to age at onset of Huntington disease (HD) in carriers of the HD gene. The number of CAG repeats in the HD gene is a well-known predictor for age at onset of the disease. However, there is an indication that other genes might be involved as well; leading to unexplained familial clustering. Using our methodology, we found a clearly significant genetic association between the martingale residuals with correlations of about 0.6 for relatives that share 50 per cent of their genes (sib-pairs and parent-child) and about 0.3 for relatives that share 25 per cent of their genes (grandparent-grandchild, uncle/aunt-niece/nephew).

  11. Patient Expectations and Perceptions of Goal-setting Strategies for Disease Management in Rheumatoid Arthritis.

    Science.gov (United States)

    Strand, Vibeke; Wright, Grace C; Bergman, Martin J; Tambiah, Jeyanesh; Taylor, Peter C

    2015-11-01

    To identify how patients perceive the broad effect of active rheumatoid arthritis (RA) on their daily lives and indicate how RA disease management could benefit from the inclusion of individual goal-setting strategies. Two multinational surveys were completed by patients with RA. The "Good Days Fast" survey was conducted to explore the effect of disease on the daily lives and relationships of women with RA. The "Getting to Your Destination Faster" survey examined RA patients' treatment expectations and goal-setting practices. Respondents from all countries agreed that RA had a substantial negative effect on many aspects of their lives (work productivity, daily routines, participation in social and leisure activities) and emotional well-being (loss of self-confidence, feelings of detachment, isolation). Daily pain was a paramount issue, and being pain- and fatigue-free was considered the main indicator of a "good day." Setting personal, social, and treatment goals, as well as monitoring disease progress to achieve these, was considered very beneficial by patients with RA, but discussion of treatment goals seldom appeared to be a part of medical appointments. Many patients with RA feel unable to communicate their disease burden and treatment goals, which are critically important to them, to their healthcare provider (HCP). Insights gained from these 2 surveys should help to guide patients and HCP to better focus upon mutually defined goals for continued improvement of management and achievement of optimal care in RA.

  12. Setting up fuel supply strategies for large-scale bio-energy projects using agricultural and forest residues. A methodology for developing countries

    International Nuclear Information System (INIS)

    Junginger, M.

    2000-08-01

    The objective of this paper is to develop a coherent methodology to set up fuel supply strategies for large-scale biomass-conversion units. This method will explicitly take risks and uncertainties regarding availability and costs in relation to time into account. This paper aims at providing general guidelines, which are not country-specific. These guidelines cannot provide 'perfect fit'-solutions, but aim to give general help to overcome barriers and to set up supply strategies. It will mainly focus on residues from the agricultural and forestry sector. This study focuses on electricity or both electricity and heat production (CHP) with plant scales between 1040 MWe. This range is chosen due to rules of economies of scale. In large-scale plants the benefits of increased efficiency outweigh increased transportation costs, allowing a lower price per kWh which in turn may allow higher biomass costs. However, fuel-supply risks tend to get higher with increasing plant size, which makes it more important to assess them for large(r) conversion plants. Although the methodology does not focus on a specific conversion technology, it should be stressed that the technology must be able to handle a wide variety of biomass fuels with different characteristics because many biomass residues are not available the year round and various fuels are needed for a constant supply. The methodology allows for comparing different technologies (with known investment and operational and maintenance costs from literature) and evaluation for different fuel supply scenarios. In order to demonstrate the methodology, a case study was carried out for the north-eastern part of Thailand (Isaan), an agricultural region. The research was conducted in collaboration with the Regional Wood Energy Development Programme in Asia (RWEDP), a project of the UN Food and Agricultural Organization (FAO) in Bangkok, Thailand. In Section 2 of this paper the methodology will be presented. In Section 3 the economic

  13. Nursing Activities for Patients With Chronic Disease in Primary Care Settings: A Practice Analysis.

    Science.gov (United States)

    Poitras, Marie-Eve; Chouinard, Maud-Christine; Gallagher, Frances; Fortin, Martin

    Nurses in primary care organizations play a central role for patients with chronic disease. Lack of clarity in role description may be associated with underutilization of nurse competencies that could benefit the growing population of patients with chronic disease. The purpose of the research was to describe nursing activities in primary care settings with patients with chronic disease. A Web-based survey was sent to nurses practicing in Family Medicine Groups in the Canadian Province of Québec. Participants rated the frequency with which they carried out nursing activities in five domains: (a) global assessment, (b) care and case management, (c) health promotion, (d) nurse-physician collaboration, and (e) planning services for patients with chronic disease. Findings were summarized with descriptive statistics (means, standard deviations, and ranges). The survey was completed by 266 of the 322 nurses who received the survey (82.6%). Activities in the health promotion and global assessment of the patient domains were carried out most frequently. Planning services for patients with chronic disease were least frequently performed. This study provides a broad description of nursing activities with patients with chronic disease in primary care. The findings provide a baseline for clinicians and researchers to document and improve nursing activities for optimal practice for patients with chronic disease.

  14. The importance of antibiotic residues presence detection in milk

    OpenAIRE

    Dubravka Samaržija; Neven Antunac

    2002-01-01

    Antibiotic residues are the most present inhibitory substances in milkhaving undesirable effect on human health, technological characteristics and the quality of milk and dairy products. In order to protect consumer's health and to ensure high quality milk production, European Union (EU) regulation 2377/90 sets a maximum permitted levels for antibiotic residues in milk. Although the presence of antibiotic residues in milk can be due to animal diseases treatment, and in the case of milking ani...

  15. Residual deposits (residual soil)

    International Nuclear Information System (INIS)

    Khasanov, A.Kh.

    1988-01-01

    Residual soil deposits is accumulation of new formate ore minerals on the earth surface, arise as a result of chemical decomposition of rocks. As is well known, at the hyper genes zone under the influence of different factors (water, carbonic acid, organic acids, oxygen, microorganism activity) passes chemical weathering of rocks. Residual soil deposits forming depends from complex of geologic and climatic factors and also from composition and physical and chemical properties of initial rocks

  16. Cardiovascular disease prevention in low resource settings: lessons from the Heartfile experience in Pakistan.

    Science.gov (United States)

    Nishtar, Sania

    2003-01-01

    This paper outlines activities of the Heartfile Program in Pakistan (http://heartfile.org). The program focuses on cardiovascular disease prevention and health promotion, and includes several initiatives that encompass building policy, reorienting health services, and developing community interventions that utilize the print and electronic media and outreach at the grass-root level to incorporate social marketing approaches. Initiated by the nonprofit private sector, the program now links with major public sector primary healthcare programs, and is currently spearheading formulation of the National Action Plan on Noncommunicable Disease Prevention and Control in Pakistan. In addition, the program is being refined, validated, and packaged as a replicable model for other developing countries and in low resource settings, utilizing appropriate principles of franchising with inbuilt components sensitive to cultural and social adaptations. A review of the planning process, implementation strategy, and fund-raising experience is presented. Strategies unique to low resource settings, such as the development of cost- and time-efficient strategic alliances and partnerships, have also been highlighted. In addition, specific caveats are identified as being helpful to private sector development of chronic disease prevention programs in resource-constrained settings, and a road map to a sustainable public-private sector partnership is provided.

  17. Low Residual CBF Variability in Alzheimer's Disease after Correction for CO(2) Effect

    DEFF Research Database (Denmark)

    Rodell, Anders Bertil; Aanerud, Joel; Braendgaard, Hans

    2012-01-01

    We tested the claim that inter-individual CBF variability in Alzheimer's disease (AD) is substantially reduced after correction for arterial carbon dioxide tension (PaCO(2)). Specifically, we tested whether the variability of CBF in brain of patients with AD differed significantly from brain of age...

  18. DNA Methylation Adds Prognostic Value to Minimal Residual Disease Status in Pediatric T-Cell Acute Lymphoblastic Leukemia

    DEFF Research Database (Denmark)

    Borssén, Magnus; Haider, Zahra; Landfors, Mattias

    2016-01-01

    BACKGROUND: Despite increased knowledge about genetic aberrations in pediatric T-cell acute lymphoblastic leukemia (T-ALL), no clinically feasible treatment-stratifying marker exists at diagnosis. Instead patients are enrolled in intensive induction therapies with substantial side effects....... In modern protocols, therapy response is monitored by minimal residual disease (MRD) analysis and used for postinduction risk group stratification. DNA methylation profiling is a candidate for subtype discrimination at diagnosis and we investigated its role as a prognostic marker in pediatric T......-ALL. PROCEDURE: Sixty-five diagnostic T-ALL samples from Nordic pediatric patients treated according to the Nordic Society of Pediatric Hematology and Oncology ALL 2008 (NOPHO ALL 2008) protocol were analyzed by HumMeth450K genome wide DNA methylation arrays. Methylation status was analyzed in relation...

  19. Interlinkage among cardio-metabolic disease markers in an urban poor setting in Nairobi, Kenya.

    Science.gov (United States)

    Haregu, Tilahun Nigatu; Oti, Samuel; Ngomi, Nicholas; Khayeka-Wandabwa, Christopher; Egondi, Thaddaeus; Kyobutungi, Catherine

    2016-01-01

    The main cardio-metabolic diseases - mostly cardiovascular diseases such as stroke and ischemic heart disease - share common clinical markers such as raised blood pressure and blood glucose. The pathways of development of many of these conditions are also interlinked. In this regard, a higher level of co-occurrence of the main cardio-metabolic disease markers is expected. Evidence about the patterns of occurrence of cardio-metabolic markers and their interlinkage in the sub-Saharan African setting is inadequate. The goal of the study was to describe the interlinkage among common cardio-metabolic disease markers in an African setting. We used data collected in a cross-sectional study from 5,190 study participants as part of cardiovascular disease risk assessment in the urban slums of Nairobi, Kenya. Five commonly used clinical markers of cardio-metabolic conditions were considered in this analysis. These markers were waist circumference, blood pressure, random blood glucose, total blood cholesterol, and triglyceride levels. Patterns of these markers were described using means, standard deviations, and proportions. The associations between the markers were determined using odds ratios. The weighted prevalence of central obesity, hypertension, hyperglycemia, hypercholesterolemia, and hypertriglyceridemia were 12.3%, 7.0%, 2.5%, 10.3%, and 17.3%, respectively. Women had a higher prevalence of central obesity and hypercholesterolemia as compared to men. Blood glucose was strongly associated with central obesity, blood pressure, and triglyceride levels, whereas the association between blood glucose and total blood cholesterol was not statistically significant. This study shows that most of the common cardio-metabolic markers are interlinked, suggesting a higher probability of comorbidity due to cardio-metabolic conditions and thus the need for integrated approaches.

  20. Interlinkage among cardio-metabolic disease markers in an urban poor setting in Nairobi, Kenya

    Directory of Open Access Journals (Sweden)

    Tilahun Nigatu Haregu

    2016-02-01

    Full Text Available Introduction: The main cardio-metabolic diseases – mostly cardiovascular diseases such as stroke and ischemic heart disease – share common clinical markers such as raised blood pressure and blood glucose. The pathways of development of many of these conditions are also interlinked. In this regard, a higher level of co-occurrence of the main cardio-metabolic disease markers is expected. Evidence about the patterns of occurrence of cardio-metabolic markers and their interlinkage in the sub-Saharan African setting is inadequate. Objective: The goal of the study was to describe the interlinkage among common cardio-metabolic disease markers in an African setting. Design: We used data collected in a cross-sectional study from 5,190 study participants as part of cardiovascular disease risk assessment in the urban slums of Nairobi, Kenya. Five commonly used clinical markers of cardio-metabolic conditions were considered in this analysis. These markers were waist circumference, blood pressure, random blood glucose, total blood cholesterol, and triglyceride levels. Patterns of these markers were described using means, standard deviations, and proportions. The associations between the markers were determined using odds ratios. Results: The weighted prevalence of central obesity, hypertension, hyperglycemia, hypercholesterolemia, and hypertriglyceridemia were 12.3%, 7.0%, 2.5%, 10.3%, and 17.3%, respectively. Women had a higher prevalence of central obesity and hypercholesterolemia as compared to men. Blood glucose was strongly associated with central obesity, blood pressure, and triglyceride levels, whereas the association between blood glucose and total blood cholesterol was not statistically significant. Conclusions: This study shows that most of the common cardio-metabolic markers are interlinked, suggesting a higher probability of comorbidity due to cardio-metabolic conditions and thus the need for integrated approaches.

  1. Substitutions of PrP N-terminal histidine residues modulate scrapie disease pathogenesis and incubation time in transgenic mice.

    Directory of Open Access Journals (Sweden)

    Sabina Eigenbrod

    Full Text Available Prion diseases have been linked to impaired copper homeostasis and copper induced-oxidative damage to the brain. Divalent metal ions, such as Cu2+ and Zn2+, bind to cellular prion protein (PrPC at octapeptide repeat (OR and non-OR sites within the N-terminal half of the protein but information on the impact of such binding on conversion to the misfolded isoform often derives from studies using either OR and non-OR peptides or bacterially-expressed recombinant PrP. Here we created new transgenic mouse lines expressing PrP with disrupted copper binding sites within all four histidine-containing OR's (sites 1-4, H60G, H68G, H76G, H84G, "TetraH>G" allele or at site 5 (composed of residues His-95 and His-110; "H95G" allele and monitored the formation of misfolded PrP in vivo. Novel transgenic mice expressing PrP(TetraH>G at levels comparable to wild-type (wt controls were susceptible to mouse-adapted scrapie strain RML but showed significantly prolonged incubation times. In contrast, amino acid replacement at residue 95 accelerated disease progression in corresponding PrP(H95G mice. Neuropathological lesions in terminally ill transgenic mice were similar to scrapie-infected wt controls, but less severe. The pattern of PrPSc deposition, however, was not synaptic as seen in wt animals, but instead dense globular plaque-like accumulations of PrPSc in TgPrP(TetraH>G mice and diffuse PrPSc deposition in (TgPrP(H95G mice, were observed throughout all brain sections. We conclude that OR and site 5 histidine substitutions have divergent phenotypic impacts and that cis interactions between the OR region and the site 5 region modulate pathogenic outcomes by affecting the PrP globular domain.

  2. Substitutions of PrP N-terminal histidine residues modulate scrapie disease pathogenesis and incubation time in transgenic mice.

    Science.gov (United States)

    Eigenbrod, Sabina; Frick, Petra; Bertsch, Uwe; Mitteregger-Kretzschmar, Gerda; Mielke, Janina; Maringer, Marko; Piening, Niklas; Hepp, Alexander; Daude, Nathalie; Windl, Otto; Levin, Johannes; Giese, Armin; Sakthivelu, Vignesh; Tatzelt, Jörg; Kretzschmar, Hans; Westaway, David

    2017-01-01

    Prion diseases have been linked to impaired copper homeostasis and copper induced-oxidative damage to the brain. Divalent metal ions, such as Cu2+ and Zn2+, bind to cellular prion protein (PrPC) at octapeptide repeat (OR) and non-OR sites within the N-terminal half of the protein but information on the impact of such binding on conversion to the misfolded isoform often derives from studies using either OR and non-OR peptides or bacterially-expressed recombinant PrP. Here we created new transgenic mouse lines expressing PrP with disrupted copper binding sites within all four histidine-containing OR's (sites 1-4, H60G, H68G, H76G, H84G, "TetraH>G" allele) or at site 5 (composed of residues His-95 and His-110; "H95G" allele) and monitored the formation of misfolded PrP in vivo. Novel transgenic mice expressing PrP(TetraH>G) at levels comparable to wild-type (wt) controls were susceptible to mouse-adapted scrapie strain RML but showed significantly prolonged incubation times. In contrast, amino acid replacement at residue 95 accelerated disease progression in corresponding PrP(H95G) mice. Neuropathological lesions in terminally ill transgenic mice were similar to scrapie-infected wt controls, but less severe. The pattern of PrPSc deposition, however, was not synaptic as seen in wt animals, but instead dense globular plaque-like accumulations of PrPSc in TgPrP(TetraH>G) mice and diffuse PrPSc deposition in (TgPrP(H95G) mice), were observed throughout all brain sections. We conclude that OR and site 5 histidine substitutions have divergent phenotypic impacts and that cis interactions between the OR region and the site 5 region modulate pathogenic outcomes by affecting the PrP globular domain.

  3. Integration of non-communicable diseases in health care: tackling the double burden of disease in African settings.

    Science.gov (United States)

    Temu, Florence; Leonhardt, Marcus; Carter, Jane; Thiam, Sylla

    2014-01-01

    Sub-Saharan African countries now face the double burden of Non Communicable and Communicable Diseases. This situation represents a major threat to fragile health systems and emphasises the need for innovative integrative approaches to health care delivery. Health services need to be reorganised to address populations' needs holistically and effectively leverage resources in already resource-limited settings. Access and delivery of quality health care should be reinforced and implemented at primary health care level within the framework of health system strengthening. Competencies need to be developed around services provided rather than specific diseases. New models of integration within the health sector and other sectors should be explored and further evidence generated to inform policy and practice to combat the double burden.

  4. Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the perspective of physiotherapists.

    Science.gov (United States)

    Rauch, Alexandra; Kirchberger, Inge; Stucki, Gerold; Cieza, Alarcos

    2009-12-01

    The 'Comprehensive ICF Core Set for obstructive pulmonary diseases' (OPD) is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with OPD. To optimize a multidisciplinary and patient-oriented approach in pulmonary rehabilitation, in which physiotherapy plays an important role, the ICF offers a standardized language and understanding of functioning. For it to be a useful tool for physiotherapists in rehabilitation of patients with OPD, the objective of this study was to validate this Comprehensive ICF Core Set for OPD from the perspective of physiotherapists. A three-round survey based on the Delphi technique of physiotherapists who are experienced in the treatment of OPD asked about the problems, resources and aspects of environment of patients with OPD that physiotherapists treat in clinical practice (physiotherapy intervention categories). Responses were linked to the ICF and compared with the existing Comprehensive ICF Core Set for OPD. Fifty-one physiotherapists from 18 countries named 904 single terms that were linked to 124 ICF categories, 9 personal factors and 16 'not classified' concepts. The identified ICF categories were mainly third-level categories compared with mainly second-level categories of the Comprehensive ICF Core Set for OPD. Seventy of the ICF categories, all personal factors and 15 'not classified' concepts gained more than 75% agreement among the physiotherapists. Of these ICF categories, 55 (78.5%) were covered by the Comprehensive ICF Core Set for OPD. The validity of the Comprehensive ICF Core Set for OPD was largely supported by the physiotherapists. Nevertheless, ICF categories that were not covered, personal factors and not classified terms offer opportunities towards the final ICF Core Set for OPD and further research to strengthen physiotherapists' perspective in pulmonary rehabilitation.

  5. Correlation set analysis: detecting active regulators in disease populations using prior causal knowledge

    Directory of Open Access Journals (Sweden)

    Huang Chia-Ling

    2012-03-01

    Full Text Available Abstract Background Identification of active causal regulators is a crucial problem in understanding mechanism of diseases or finding drug targets. Methods that infer causal regulators directly from primary data have been proposed and successfully validated in some cases. These methods necessarily require very large sample sizes or a mix of different data types. Recent studies have shown that prior biological knowledge can successfully boost a method's ability to find regulators. Results We present a simple data-driven method, Correlation Set Analysis (CSA, for comprehensively detecting active regulators in disease populations by integrating co-expression analysis and a specific type of literature-derived causal relationships. Instead of investigating the co-expression level between regulators and their regulatees, we focus on coherence of regulatees of a regulator. Using simulated datasets we show that our method performs very well at recovering even weak regulatory relationships with a low false discovery rate. Using three separate real biological datasets we were able to recover well known and as yet undescribed, active regulators for each disease population. The results are represented as a rank-ordered list of regulators, and reveals both single and higher-order regulatory relationships. Conclusions CSA is an intuitive data-driven way of selecting directed perturbation experiments that are relevant to a disease population of interest and represent a starting point for further investigation. Our findings demonstrate that combining co-expression analysis on regulatee sets with a literature-derived network can successfully identify causal regulators and help develop possible hypothesis to explain disease progression.

  6. Setting strategy for system change: using concept mapping to prioritise national action for chronic disease prevention.

    Science.gov (United States)

    Wutzke, Sonia; Roberts, Nick; Willis, Cameron; Best, Allan; Wilson, Andrew; Trochim, William

    2017-08-08

    Chronic diseases are a serious and urgent problem, requiring at-scale, multi-component, multi-stakeholder action and cooperation. Despite numerous national frameworks and agenda-setting documents to coordinate prevention efforts, Australia, like many countries internationally, is yet to substantively impact the burden from chronic disease. Improved evidence on effective strategies for the prevention of chronic disease is required. This research sought to articulate a priority set of important and feasible action domains to inform future discussion and debate regarding priority areas for chronic disease prevention policy and strategy. Using concept mapping, a mixed-methods approach to making use of the best available tacit knowledge of recognised, diverse and well-experienced actors, and national actions to improve the prevention of chronic disease in Australia were identified and then mapped. Participants (ranging from 58 to 78 in the various stages of the research) included a national sample of academics, policymakers and practitioners. Data collection involved the generation and sorting of statements by participants. A series of visual representations of the data were then developed. A total of 95 statements were distilled into 12 clusters for action, namely Inter-Sectoral Partnerships; Systems Perspective/Action; Governance; Roles and Responsibilities; Evidence, Feedback and Learning; Funding and Incentive; Creating Demand; Primary Prevention; Social Determinants and Equity; Healthy Environments; Food and Nutrition; and Regulation and Policy. Specific areas for more immediate national action included refocusing the health system to prevention over cure, raising the profile of public health with health decision-makers, funding policy- and practice-relevant research, improving communication about prevention, learning from both global best-practice and domestic successes and failures, increasing the focus on primary prevention, and developing a long-term prevention

  7. Pancreatitis with normal lipase and amylase in setting of end-stage renal disease.

    Science.gov (United States)

    Sharma, Anuj; Masood, Umair; Khan, Babar; Chawla, Kunal; Manocha, Divey

    2017-09-01

    Pancreatitis with normal lipase and amylase level is a rare phenomenon. This is especially true in patient with end-stage renal disease as lipase and amylase are renally excreted. Literature review reveals previous case report of pancreatitis with normal lipase and amylase level, however, none of them occurred in the setting of end-stage renal disease. Our case is the first such reported case of pancreatitis in such setting. Here we report a 30year old male with past medical history of end-stage renal disease who presented in emergency department with acute abdominal pain. Laboratory work up revealed normal lipase and amylase level. However, radiological work up was consistent with pancreatitis. This case report highlight the importance of taking the overall clinical picture rather than laboratory work up to rule in or rule out the diagnosis of pancreatitis. Furthermore, this should also serve an important reminder for clinicians to further investigate where clinical suspicion for pancreatitis is high. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Impact of inter- and intrafraction deviations and residual set-up errors on PTV margins. Different alignment techniques in 3D conformal prostate cancer radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Langsenlehner, T.; Doeller, C.; Winkler, P.; Kapp, K.S. [Graz Medical Univ. (Austria). Dept. of Therapeutic Radiology and Oncology; Galle, G. [Graz Medical Univ. (Austria). Dept. of Urology

    2013-04-15

    The aim of this work was to analyze interfraction and intrafraction deviations and residual set-up errors (RSE) after online repositioning to determine PTV margins for 3 different alignment techniques in prostate cancer radiotherapy. The present prospective study included 44 prostate cancer patients with implanted fiducials treated with three-dimensional (3D) conformal radiotherapy. Daily localization was based on skin marks followed by marker detection using kilovoltage (kV) imaging and subsequent patient repositioning. Additionally, in-treatment megavoltage (MV) images were obtained for each treatment field. In an off-line analysis of 7,273 images, interfraction prostate motion, RSE after marker-based prostate localization, prostate position during each treatment session, and the effect of treatment time on intrafraction deviations were analyzed to evaluate PTV margins. Margins accounting for interfraction deviation, RSE and intrafraction motion were 14.1, 12.9, and 15.1 mm in anterior-posterior (AP), superior-inferior (SI), and left-right (LR) direction for skin mark alignment and 9.6, 8.7, and 2.6 mm for bony structure alignment, respectively. Alignment to implanted markers required margins of 4.6, 2.8, and 2.5 mm. As margins to account for intrafraction motion increased with treatment prolongation PTV margins could be reduced to 3.9, 2.6, and 2.4 mm if treatment time was {<=} 4 min. With daily online correction and repositioning based on implanted fiducials, a significant reduction of PTV margins can be achieved. The use of an optimized workflow with faster treatment techniques such as volumetric modulated arc techniques (VMAT) could allow for a further decrease. (orig.)

  9. Impact of inter- and intrafraction deviations and residual set-up errors on PTV margins. Different alignment techniques in 3D conformal prostate cancer radiotherapy.

    Science.gov (United States)

    Langsenlehner, T; Döller, C; Winkler, P; Gallé, G; Kapp, K S

    2013-04-01

    The aim of this work was to analyze interfraction and intrafraction deviations and residual set-up errors (RSE) after online repositioning to determine PTV margins for 3 different alignment techniques in prostate cancer radiotherapy. The present prospective study included 44 prostate cancer patients with implanted fiducials treated with three-dimensional (3D) conformal radiotherapy. Daily localization was based on skin marks followed by marker detection using kilovoltage (kV) imaging and subsequent patient repositioning. Additionally, in-treatment megavoltage (MV) images were obtained for each treatment field. In an off-line analysis of 7,273 images, interfraction prostate motion, RSE after marker-based prostate localization, prostate position during each treatment session, and the effect of treatment time on intrafraction deviations were analyzed to evaluate PTV margins. Margins accounting for interfraction deviation, RSE and intrafraction motion were 14.1, 12.9, and 15.1 mm in anterior-posterior (AP), superior-inferior (SI), and left-right (LR) direction for skin mark alignment and 9.6, 8.7, and 2.6 mm for bony structure alignment, respectively. Alignment to implanted markers required margins of 4.6, 2.8, and 2.5 mm. As margins to account for intrafraction motion increased with treatment prolongation PTV margins could be reduced to 3.9, 2.6, and 2.4 mm if treatment time was ≤ 4 min. With daily online correction and repositioning based on implanted fiducials, a significant reduction of PTV margins can be achieved. The use of an optimized workflow with faster treatment techniques such as volumetric modulated arc techniques (VMAT) could allow for a further decrease.

  10. Impact of inter- and intrafraction deviations and residual set-up errors on PTV margins. Different alignment techniques in 3D conformal prostate cancer radiotherapy

    International Nuclear Information System (INIS)

    Langsenlehner, T.; Doeller, C.; Winkler, P.; Kapp, K.S.; Galle, G.

    2013-01-01

    The aim of this work was to analyze interfraction and intrafraction deviations and residual set-up errors (RSE) after online repositioning to determine PTV margins for 3 different alignment techniques in prostate cancer radiotherapy. The present prospective study included 44 prostate cancer patients with implanted fiducials treated with three-dimensional (3D) conformal radiotherapy. Daily localization was based on skin marks followed by marker detection using kilovoltage (kV) imaging and subsequent patient repositioning. Additionally, in-treatment megavoltage (MV) images were obtained for each treatment field. In an off-line analysis of 7,273 images, interfraction prostate motion, RSE after marker-based prostate localization, prostate position during each treatment session, and the effect of treatment time on intrafraction deviations were analyzed to evaluate PTV margins. Margins accounting for interfraction deviation, RSE and intrafraction motion were 14.1, 12.9, and 15.1 mm in anterior-posterior (AP), superior-inferior (SI), and left-right (LR) direction for skin mark alignment and 9.6, 8.7, and 2.6 mm for bony structure alignment, respectively. Alignment to implanted markers required margins of 4.6, 2.8, and 2.5 mm. As margins to account for intrafraction motion increased with treatment prolongation PTV margins could be reduced to 3.9, 2.6, and 2.4 mm if treatment time was ≤ 4 min. With daily online correction and repositioning based on implanted fiducials, a significant reduction of PTV margins can be achieved. The use of an optimized workflow with faster treatment techniques such as volumetric modulated arc techniques (VMAT) could allow for a further decrease. (orig.)

  11. Dancing for Parkinson Disease: A Randomized Trial of Irish Set Dancing Compared With Usual Care.

    Science.gov (United States)

    Shanahan, Joanne; Morris, Meg E; Bhriain, Orfhlaith Ni; Volpe, Daniele; Lynch, Tim; Clifford, Amanda M

    2017-09-01

    To examine the feasibility of a randomized controlled study design and to explore the benefits of a set dancing intervention compared with usual care. Randomized controlled design, with participants randomized to Irish set dance classes or a usual care group. Community based. Individuals with idiopathic Parkinson disease (PD) (N=90). The dance group attended a 1.5-hour dancing class each week for 10 weeks and undertook a home dance program for 20 minutes, 3 times per week. The usual care group continued with their usual care and daily activities. The primary outcome was feasibility, determined by recruitment rates, success of randomization and allocation procedures, attrition, adherence, safety, willingness of participants to be randomized, resource availability, and cost. Secondary outcomes were motor function (motor section of the Unified Parkinson's Disease Rating Scale), quality of life (Parkinson's Disease Questionnaire-39), functional endurance (6-min walk test), and balance (mini-BESTest). Ninety participants were randomized (45 per group). There were no adverse effects or resource constraints. Although adherence to the dancing program was 93.5%, there was >40% attrition in each group. Postintervention, the dance group had greater nonsignificant gains in quality of life than the usual care group. There was a meaningful deterioration in endurance in the usual care group. There were no meaningful changes in other outcomes. The exit questionnaire showed participants enjoyed the classes and would like to continue participation. For people with mild to moderately severe PD, set dancing is feasible and enjoyable and may improve quality of life. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  12. A 12-residue epitope displayed on phage T7 reacts strongly with antibodies against foot-and-mouth disease virus.

    Science.gov (United States)

    Wong, Chuan Loo; Yong, Chean Yeah; Muhamad, Azira; Syahir, Amir; Omar, Abdul Rahman; Sieo, Chin Chin; Tan, Wen Siang

    2018-05-01

    Foot-and-mouth disease (FMD) is a major threat to the livestock industry worldwide. Despite constant surveillance and effective vaccination, the perpetual mutations of the foot-and-mouth disease virus (FMDV) pose a huge challenge to FMD diagnosis. The immunodominant region of the FMDV VP1 protein (residues 131-170) displayed on phage T7 has been used to detect anti-FMDV in bovine sera. In the present study, the functional epitope was further delineated using amino acid sequence alignment, homology modelling and phage display. Two highly conserved regions (VP1 145-152 and VP1 159-170 ) were identified among different FMDV serotypes. The coding regions of these two epitopes were fused separately to the T7 genome and displayed on the phage particles. Interestingly, chimeric phage displaying the VP1 159-170 epitope demonstrated a higher antigenicity than that displaying the VP1 131-170 epitope. By contrast, phage T7 displaying the VP1 145-152 epitope did not react significantly with the anti-FMDV antibodies in vaccinated bovine sera. This study has successfully identified a smaller functional epitope, VP1 159-170 , located at the C-terminal end of the structural VP1 protein. The phage T7 displaying this shorter epitope is a promising diagnostic reagent to detect anti-FMDV antibodies in vaccinated animals.

  13. Challenges of malaria diagnosis in clinical settings and disease surveillance under reduced malaria burden in Tanzania

    Directory of Open Access Journals (Sweden)

    Donath Samuel Tarimo

    2017-01-01

    Full Text Available Febrile illnesses that are caused by malaria and other infectious diseases are a major cause of morbidity and mortality in sub-Saharan Africa. In malaria endemic countries, malaria is considered as one of the most serious febrile illnesses. Over the last two decades, major investment in malaria control has witnessed a major achievement in decline of malaria burden, however, other causes of febrile illnesses have remained prevalent. The decline in malaria burden poses challenges for the diagnosis of malaria in clinical settings, research and disease surveillance. This review highlights the challenges facing the diagnosis of malarial and nonmalarial fevers under reduced malaria burden from the perspectives of parasite diagnosis and interpretations of the diagnoses of malarial and non-malarial fevers, and the possible approaches to address the challenges for a better understanding of the dynamics of febrile illnesses under reduced malaria burden.

  14. Molecular biomarkers in extrahepatic bile duct cancer patients undergoing chemoradiotherapy for gross residual disease after surgery

    International Nuclear Information System (INIS)

    Koh, Hyeon Kang; Kim, Kyu Bo; Chie, Eui Kyu; Ha, Sung W.; Park, Hae Jin

    2012-01-01

    To analyze the outcomes of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients who underwent R2 resection or bypass surgery and to identify prognostic factors affecting clinical outcomes, especially in terms of molecular biomarkers. Medical records of 21 patients with EHBD cancer who underwent R2 resection or bypass surgery followed by chemoradiotherapy from May 2001 to June 2010 were retrospectively reviewed. All surgical specimens were re-evaluated by immunohistochemical staining using phosphorylated protein kinase B (pAKT), CD24, matrix metalloproteinase 9 (MMP9), survivin, and β-catenin antibodies. The relationship between clinical outcomes and immunohistochemical results was investigated. At a median follow-up of 20 months, the actuarial 2-year locoregional progression-free, distant metastasis-free and overall survival were 37%, 56%, and 54%, respectively. On univariate analysis using clinicopathologic factors, there was no significant prognostic factor. In the immunohistochemical staining, cytoplasmic staining, and nuclear staining of pAKT was positive in 10 and 6 patients, respectively. There were positive CD24 in 7 patients, MMP9 in 16 patients, survivin in 8 patients, and β-catenin in 3 patients. On univariate analysis, there was no significant value of immunohistochemical results for clinical outcomes. There was no significant association between clinical outcomes of patients with EHBD cancer who received chemoradiotherapy after R2 resection or bypass surgery and pAKT, CD24, MMP9, survivin, and β-catenin. Future research is needed on a larger data set or with other molecular biomarkers.

  15. Molecular biomarkers in extrahepatic bile duct cancer patients undergoing chemoradiotherapy for gross residual disease after surgery

    Energy Technology Data Exchange (ETDEWEB)

    Koh, Hyeon Kang; Kim, Kyu Bo; Chie, Eui Kyu; Ha, Sung W. [Seoul National University College of Medicine, Seoul (Korea, Republic of); Park, Hae Jin [Dept. of Radiation Oncology, Soonchunhyang University Hospital, Seoul (Korea, Republic of)

    2012-12-15

    To analyze the outcomes of chemoradiotherapy for extrahepatic bile duct (EHBD) cancer patients who underwent R2 resection or bypass surgery and to identify prognostic factors affecting clinical outcomes, especially in terms of molecular biomarkers. Medical records of 21 patients with EHBD cancer who underwent R2 resection or bypass surgery followed by chemoradiotherapy from May 2001 to June 2010 were retrospectively reviewed. All surgical specimens were re-evaluated by immunohistochemical staining using phosphorylated protein kinase B (pAKT), CD24, matrix metalloproteinase 9 (MMP9), survivin, and {beta}-catenin antibodies. The relationship between clinical outcomes and immunohistochemical results was investigated. At a median follow-up of 20 months, the actuarial 2-year locoregional progression-free, distant metastasis-free and overall survival were 37%, 56%, and 54%, respectively. On univariate analysis using clinicopathologic factors, there was no significant prognostic factor. In the immunohistochemical staining, cytoplasmic staining, and nuclear staining of pAKT was positive in 10 and 6 patients, respectively. There were positive CD24 in 7 patients, MMP9 in 16 patients, survivin in 8 patients, and {beta}-catenin in 3 patients. On univariate analysis, there was no significant value of immunohistochemical results for clinical outcomes. There was no significant association between clinical outcomes of patients with EHBD cancer who received chemoradiotherapy after R2 resection or bypass surgery and pAKT, CD24, MMP9, survivin, and {beta}-catenin. Future research is needed on a larger data set or with other molecular biomarkers.

  16. An Environmental Data Set for Vector-Borne Disease Modeling and Epidemiology

    Science.gov (United States)

    Chabot-Couture, Guillaume; Nigmatulina, Karima; Eckhoff, Philip

    2014-01-01

    Understanding the environmental conditions of disease transmission is important in the study of vector-borne diseases. Low- and middle-income countries bear a significant portion of the disease burden; but data about weather conditions in those countries can be sparse and difficult to reconstruct. Here, we describe methods to assemble high-resolution gridded time series data sets of air temperature, relative humidity, land temperature, and rainfall for such areas; and we test these methods on the island of Madagascar. Air temperature and relative humidity were constructed using statistical interpolation of weather station measurements; the resulting median 95th percentile absolute errors were 2.75°C and 16.6%. Missing pixels from the MODIS11 remote sensing land temperature product were estimated using Fourier decomposition and time-series analysis; thus providing an alternative to the 8-day and 30-day aggregated products. The RFE 2.0 remote sensing rainfall estimator was characterized by comparing it with multiple interpolated rainfall products, and we observed significant differences in temporal and spatial heterogeneity relevant to vector-borne disease modeling. PMID:24755954

  17. An environmental data set for vector-borne disease modeling and epidemiology.

    Directory of Open Access Journals (Sweden)

    Guillaume Chabot-Couture

    Full Text Available Understanding the environmental conditions of disease transmission is important in the study of vector-borne diseases. Low- and middle-income countries bear a significant portion of the disease burden; but data about weather conditions in those countries can be sparse and difficult to reconstruct. Here, we describe methods to assemble high-resolution gridded time series data sets of air temperature, relative humidity, land temperature, and rainfall for such areas; and we test these methods on the island of Madagascar. Air temperature and relative humidity were constructed using statistical interpolation of weather station measurements; the resulting median 95th percentile absolute errors were 2.75°C and 16.6%. Missing pixels from the MODIS11 remote sensing land temperature product were estimated using Fourier decomposition and time-series analysis; thus providing an alternative to the 8-day and 30-day aggregated products. The RFE 2.0 remote sensing rainfall estimator was characterized by comparing it with multiple interpolated rainfall products, and we observed significant differences in temporal and spatial heterogeneity relevant to vector-borne disease modeling.

  18. An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.

    Science.gov (United States)

    Hack, Nawaz; Fayad, Sarah M; Monari, Erin H; Akbar, Umer; Hardwick, Angela; Rodriguez, Ramon L; Malaty, Irene A; Romrell, Janet; Shukla, Aparna A Wagle; McFarland, Nikolaus; Ward, Herbert E; Okun, Michael S

    2014-01-01

    To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD). The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y) score, and degree of response to clozapine therapy. There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus). The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15), disease duration of 17-240 months (mean 108.14±51.13) and H&Y score of 2 to 4 (mean 2.51±0.51). The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%), nursing home (NH) placement (11%) and leucopenia (8%). Responses to clozapine across the cohort were: complete (33%), partial (33%), absent (16%), and unknown (16%). Age (r = -0.36, p0.05). This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

  19. An eight-year clinic experience with clozapine use in a Parkinson's disease clinic setting.

    Directory of Open Access Journals (Sweden)

    Nawaz Hack

    Full Text Available BACKGROUND: To examine our eight year clinic-based experience in a Parkinson's disease expert clinical care center using clozapine as a treatment for refractory psychosis in Parkinson's disease (PD. METHODS: The study was a retrospective chart review which covered eight years of clozapine registry use. Statistical T-tests, chi-square, correlations and regression analysis were used to analyze treatment response for potential associations of age, disease duration, and Hoehn & Yahr (H&Y score, and degree of response to clozapine therapy. RESULTS: There were 36 participants included in the analysis (32 PD, 4 parkinsonism-plus. The characteristics included 30.6% female, age 45-87 years (mean 68.3±10.15, disease duration of 17-240 months (mean 108.14±51.13 and H&Y score of 2 to 4 (mean 2.51±0.51. The overall retention rate on clozapine was 41% and the most common reasons for discontinuation were frequent blood testing (28%, nursing home (NH placement (11% and leucopenia (8%. Responses to clozapine across the cohort were: complete (33%, partial (33%, absent (16%, and unknown (16%. Age (r = -0.36, p0.05. CONCLUSIONS: This single-center experience highlights the challenges associated with clozapine therapy in PD psychosis. Frequent blood testing remains a significant barrier for clozapine, even in patients with therapeutic benefit. Surprisingly, all patients admitted to a NH discontinued clozapine due to logistical issues of administration and monitoring within that setting. Consideration of the barriers to clozapine therapy will be important to its use and to its continued success in an outpatient setting.

  20. Residual disease and HPV persistence after cryotherapy for cervical intraepithelial neoplasia grade 2/3 in HIV-positive women in Kenya.

    Directory of Open Access Journals (Sweden)

    Hugo De Vuyst

    Full Text Available To assess residual cervical intraepithelial neoplasia (CIN 2/3 disease and clearance of high-risk (hr human papillomavirus (HPV infections at 6 months after cryotherapy among HIV-positive women.Follow-up study.79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy and after cryotherapy (cells.At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI: 66.4-85.9. 18 women (22.8% had residual CIN2/3, and all these women had hrHPV at baseline. CD4 count and duration of combination antiretroviral therapy (cART were not associated with residual CIN2/3. CIN3 instead of CIN2 was the only significant risk factor for residual disease (odds ratio, OR vs CIN2 = 4.3; 95% CI: 1.2-15.0 among hrHPV-positive women after adjustment for age and HPV16 infection. Persistence of hrHPV types previously detected in biopsies was found in 77.5% of women and was associated with residual CIN2/3 (OR = 8.1, 95% CI: 0.9-70. The sensitivity, specificity, and negative predictive value of hrHPV test in detecting residual CIN2/3 were 0.94, 0.36, and 0.96 respectively.Nearly one quarter of HIV-positive women had residual CIN2/3 disease at 6 months after cryotherapy, and the majority had persistent hrHPV. CD4 count and cART use were not associated with residual disease or hrHPV persistence. The value of hrHPV testing in the detection of residual CIN2/3 was hampered by a low specificity.

  1. Residual Disease and HPV Persistence after Cryotherapy for Cervical Intraepithelial Neoplasia Grade 2/3 in HIV-Positive Women in Kenya

    Science.gov (United States)

    De Vuyst, Hugo; Mugo, Nelly R.; Franceschi, Silvia; McKenzie, Kevin; Tenet, Vanessa; Njoroge, Julia; Rana, Farzana S.; Sakr, Samah R.; Snijders, Peter J. F.; Chung, Michael H.

    2014-01-01

    Objective To assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women. Design Follow-up study. Methods 79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells). Results At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI): 66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at baseline. CD4 count and duration of combination antiretroviral therapy (cART) were not associated with residual CIN2/3. CIN3 instead of CIN2 was the only significant risk factor for residual disease (odds ratio, OR vs CIN2 = 4.3; 95% CI: 1.2–15.0) among hrHPV-positive women after adjustment for age and HPV16 infection. Persistence of hrHPV types previously detected in biopsies was found in 77.5% of women and was associated with residual CIN2/3 (OR = 8.1, 95% CI: 0.9–70). The sensitivity, specificity, and negative predictive value of hrHPV test in detecting residual CIN2/3 were 0.94, 0.36, and 0.96 respectively. Conclusions Nearly one quarter of HIV-positive women had residual CIN2/3 disease at 6 months after cryotherapy, and the majority had persistent hrHPV. CD4 count and cART use were not associated with residual disease or hrHPV persistence. The value of hrHPV testing in the detection of residual CIN2/3 was hampered by a low specificity. PMID:25343563

  2. Control of spread of Augusta disease caused by tobacco necrosis virus in tulip by composting residual waste of small bulbs, tunics, roots and soil debris

    NARCIS (Netherlands)

    Asjes, C.J.; Barnhoorn, G.J.

    2002-01-01

    In this study the elimination of the infectious virus/fungus complex of tobacco necrosis virus (TNV; cause of Augusta disease in tulip) and Olpidium brassicae in different soil types and residual waste material of soil debris, small tulip bulbs, roots and tunics by temperature treatments of

  3. Fusion gene transcripts and Ig/TCR gene rearrangements are complementary but infrequent targets for PCR-based detection of minimal residual disease in acute myeloid leukemia

    NARCIS (Netherlands)

    Boeckx, N.; M.J. Willemse; T. Szczepanski (Tomasz); V.H.J. van der Velden (Vincent); A.W. Langerak (Anton); P. Vandekerckhove (Philippe); J.J.M. van Dongen (Jacques)

    2002-01-01

    textabstractPCR-based monitoring of minimal residual disease (MRD) in acute leukemias can be achieved via detection of fusion gene transcripts of chromosome aberrations or detection of immunoglobulin (lg) and T cell receptor (TCR) gene rearrangements. We wished to assess whether both PCR targets are

  4. Immunoglobulin kappa deleting element rearrangements in precursor-B acute lymphoblastic leukemia are stable targets for detection of minimal residual disease by real-time quantitative PCR

    NARCIS (Netherlands)

    van der Velden, V. H. J.; Willemse, M. J.; van der Schoot, C. E.; Hählen, K.; van Wering, E. R.; van Dongen, J. J. M.

    2002-01-01

    Immunoglobulin gene rearrangements are used as PCR targets for detection of minimal residual disease (MRD) in acute lymphoblastic leukemia (ALL). We Investigated the occurrence of monoclonal immunoglobulin kappa-deleting element (IGK-Kde) rearrangements by Southern blotting and PCR/heteroduplex

  5. Successful Therapy Reduction and Intensification for Childhood Acute Lymphoblastic Leukemia Based on Minimal Residual Disease Monitoring : Study ALL10 From the Dutch Childhood Oncology Group

    NARCIS (Netherlands)

    Pieters, Rob; de Groot-Kruseman, Hester; Van der Velden, Vincent; Fiocco, Marta; van den Berg, Henk; Bont, de Evelien; Egeler, R. Maarten; Hoogerbrugge, Peter; Kaspers, Gertjan; Van der Schoot, Ellen; De Haas, Valerie; Van Dongen, Jacques

    2016-01-01

    Purpose Outcome of childhood acute lymphoblastic leukemia (ALL) improved greatly by intensifying chemotherapy for all patients. Minimal residual disease (MRD) levels during the first months predict outcome and may select patients for therapy reduction or intensification. Methods Patients 1 to 18

  6. Prolonged persistence of PCR-detectable minimal residual disease after diagnosis or first relapse predicts poor outcome in childhood B-precursor acute lymphoblastic leukemia

    NARCIS (Netherlands)

    Steenbergen, E. J.; Verhagen, O. J.; van Leeuwen, E. F.; van den Berg, H.; Behrendt, H.; Slater, R. M.; von dem Borne, A. E.; van der Schoot, C. E.

    1995-01-01

    The follow up of minimal residual disease (MRD) in childhood B-precursor ALL by polymerase chain reaction (PCR) may be of help for further stratification of treatment protocols, to improve outcome. However, the clinical relevance of this approach has yet to be defined. We report the retrospective

  7. Burden of Disease Study and Priority Setting in Korea: an Ethical Perspective.

    Science.gov (United States)

    Park, So Youn; Kwon, Ivo; Oh, In Hwan

    2016-11-01

    When thinking about priority setting in access to healthcare resources, decision-making requires that cost-effectiveness is balanced against medical ethics. The burden of disease has emerged as an important approach to the assessment of health needs for political decision-making. However, the disability adjusted life years approach hides conceptual and methodological issues regarding the claims and value of disabled people. In this article, we discuss ethical issues that are raised as a consequence of the introduction of evidence-based health policy, such as economic evidence, in establishing resource allocation priorities. In terms of ethical values in health priority setting in Korea, there is no reliable rationale for the judgment used in decision-making as well as for setting separate and distinct priorities for different government bodies. An important question, therefore, is which ethical values guiding the practice of decision-making should be reconciled with the economic evidence found in Korean healthcare. The health technology assessment core model from the European network for Health Technology Assessment (EUnetHTA) project is a good example of incorporating ethical values into decision-making. We suggest that a fair distribution of scarce healthcare resources in South Korea can be achieved by considering the ethical aspects of healthcare.

  8. Specialized Nursing Practice for Chronic Disease Management in the Primary Care Setting

    Science.gov (United States)

    2013-01-01

    Background In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. Objectives To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. Data Sources and Review Methods A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. Results Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. Limitations There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. Conclusions Specialized nurses with

  9. Active disease and residual damage in treated Wegener's granulomatosis: an observational study using pulmonary high-resolution computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Komocsi, Andras [Poliklinik fuer Rheumatologie, Universitaet Luebeck, Ratzeburger Allee 160, 23538 Luebeck (Germany); Reuter, Michael; Heller, Martin [Klinik fuer Diagnostische Radiologische, Universitaet Kiel, Arnold-Heller-Strasse 7, 24105 Kiel (Germany); Murakoezi, Henriette; Gross, Wolfgang L.; Schnabel, Armin [Poliklinik fuer Rheumatologie, Universitaet Luebeck, Ratzeburger Allee 160, 23538 Luebeck (Germany); Rheumaklinik Bad Bramstedt, Ratzeburger Allee 160, 23538 Luebeck (Germany)

    2003-01-01

    The purpose of this study was to determine to what extent high-resolution computed tomography (HRCT) of the lungs can distinguish active inflammatory disease from inactive cicatricial disease in patients treated for Wegener's granulomatosis (WG). Twenty-eight WG patients with active pulmonary disease underwent a first HRCT examination immediately before standard immunosuppressive treatment and a second examination after clinical remission had been achieved. Lesions remaining after treatment were categorized as residual damage and were compared with findings during active disease to see by what features active and cicatricial disease can be distinguished. During active disease 17 patients had nodules/masses, 12 had ground-glass opacities, 6 had septal lines and 6 had non-septal lines. After treatment, ground-glass opacities had resolved completely. Nodules/masses had resolved in 8 patients and had diminished in 7 patients. Residual nodules were distinguished from nodules/masses in active disease by lack of cavitation and a diameter of mostly <15 mm. In one-third of patients lines resolved, but in 8 instances new lines evolved during immunosuppression. During a follow-up period of a median 26.5 months (range 20.0-33.8), patients with residual nodules or lines had no more relapses than patients with completely cleared lungs. Treated pulmonary WG leaves substantial residual damage. High-resolution CT does assist in the distinction between active and inactive lesions. Ground-glass opacities, cavitating nodules/masses and masses measuring more than 3 cm represent active disease ordinarily. Non-cavitary small nodules and septal or non-septal lines can be either active or cicatricial lesions. The nature of these lesions needs to be clarified by longitudinal observation. (orig.)

  10. CT Findings of Disease with Elevated Serum D-Dimer Levels in an Emergency Room Setting

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Ji Youn; Kwon, Woo Cheol; Kim, Young Ju [Dept. of Radiology, Wonju Christian Hospital, Yensei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2012-01-15

    Pulmonary embolism and deep vein thrombosis are the leading causes of elevated serum D-dimer levels in the emergency room. Although D-dimer is a useful screening test because of its high sensitivity and negative predictive value, it has a low specificity. In addition, D-dimer can be elevated in various diseases. Therefore, information on the various diseases with elevated D-dimer levels and their radiologic findings may allow for accurate diagnosis and proper management. Herein, we report the CT findings of various diseases with elevated D-dimer levels in an emergency room setting, including an intravascular contrast filling defect with associated findings in a venous thromboembolism, fracture with soft tissue swelling and hematoma formation in a trauma patient, enlargement with contrast enhancement in the infected organ of a patient, coronary artery stenosis with a perfusion defect of the myocardium in a patient with acute myocardial infarction, high density of acute thrombus in a cerebral vessel with a low density of affected brain parenchyma in an acute cerebral infarction, intimal flap with two separated lumens in a case of aortic dissection, organ involvement of malignancy in a cancer patient, and atrophy of a liver with a dilated portal vein and associated findings.

  11. Comparison between Three Promising ß-emitting Radionuclides, 67Cu, 47Sc and 161Tb, with Emphasis on Doses Delivered to Minimal Residual Disease

    Science.gov (United States)

    Champion, Christophe; Quinto, Michele A.; Morgat, Clément; Zanotti-Fregonara, Paolo; Hindié, Elif

    2016-01-01

    PURPOSE: Radionuclide therapy is increasingly seen as a promising option to target minimal residual disease. Copper-67, scandium-47 and terbium-161 have a medium-energy β- emission which is similar to that of lutetium-177, but offer the advantage of having diagnostic partner isotopes suitable for pretreatment imaging. The aim of this study was to compare the efficacy of 67Cu, 47Sc and 161Tb to irradiate small tumors. METHODS: The absorbed dose deriving from a homogeneous distribution of 67Cu, 47Sc or 161Tb in water-density spheres was calculated with the Monte Carlo code CELLDOSE. The diameters of the spheres ranged from 5 mm to 10 µm, thus simulating micrometastases or single tumor cells. All electron emissions, including β- spectra, Auger and conversion electrons were taken into account. Because these radionuclides differ in electron energy per decay, the simulations were run assuming that 1 MeV was released per µm3, which would result in a dose of 160 Gy if totally absorbed. RESULTS: The absorbed dose was similar for the three radionuclides in the 5-mm sphere (146-149 Gy), but decreased differently in smaller spheres. In particular, 161Tb delivered higher doses compared to the other radionuclides. For instance, in the 100-µm sphere, the absorbed dose was 24.1 Gy with 67Cu, 14.8 Gy with 47Sc and 44.5 Gy with 161Tb. Auger and conversion electrons accounted for 71% of 161Tb dose. The largest dose differences were found in cell-sized spheres. In the 10-µm sphere, the dose delivered by 161Tb was 4.1 times higher than that from 67Cu and 8.1 times that from 47Sc. CONCLUSION: 161Tb can effectively irradiate small tumors thanks to its decay spectrum that combines medium-energy β- emission and low-energy conversion and Auger electrons. Therefore 161Tb might be a better candidate than 67Cu and 47Sc for treating minimal residual disease in a clinical setting. PMID:27446495

  12. Identify, isolate, inform: Background and considerations for Ebola virus disease preparedness in U.S. ambulatory care settings.

    Science.gov (United States)

    Chea, Nora; Perz, Joseph F; Srinivasan, Arjun; Laufer, Alison S; Pollack, Lori A

    2015-11-01

    Public health activities to identify and monitor persons at risk for Ebola virus disease in the United States include directing persons at risk to assessment facilities that are prepared to safely evaluate for Ebola virus disease. Although it is unlikely that a person with Ebola virus disease will unexpectedly present to a nonemergency ambulatory care facility, the Centers for Disease Control and Prevention have provided guidance for this setting that can be summarized as identify, isolate, and inform. Published by Elsevier Inc.

  13. Intensified external-beam radiation therapy improves the outcome of stage 4 neuroblastoma in children > 1 year with residual local disease

    International Nuclear Information System (INIS)

    Simon, T.; Hero, B.; Berthold, F.; Bongartz, R.; Mueller, R.P.; Schmidt, M.

    2006-01-01

    Background and purpose: in neuroblastoma, the value of radiation therapy in high-intensive first-line treatment protocols is still not exactly known but radiation-associated long-term effects need to be considered. The impact of external-beam radiation therapy (EBRT) on event-free (EFS) and overall survival (OS) of stage 4 neuroblastoma patients of the NB97 trial was analyzed. Patients and methods: the authors retrospectively analyzed data of 110 stage 4 neuroblastoma patients ≥ 1 year who underwent induction therapy and high-dose chemotherapy with stem cell transplantation without relapse. Intensified local EBRT (36 Gy) of the residual tumor volume was reserved for patients with residual viable tumor documented by MRI and corresponding metaiodobenzylguanidine (MIBG) uptake. Results: 13 patients who received EBRT for local residual disease had similar outcome (3-year EFS 85 ± 10%, 3-year OS 92 ± 7%) as 74 patients without any MIBG residual (3-year EFS 61 ± 6%, 3-year OS 75 ± 6%). Outcome was worse in 23 children without EBRT to residual primary (3-year EFS 25 ± 10%, 3-year OS 51 ± 11%). Separate analysis of 14 patients with isolated localized residual disease found far better outcome of eight patients with EBRT (3-year EFS 100%, 3-year OS 100%) compared to six patients without EBRT (3-year EFS 20 ± 18%, 3-year OS 20 ± 18%). Multivariate analysis identified EBRT as influential on EFS (hazard ratio 0.27) and OS (hazard ratio 0.17) in addition to MYCN amplification and presence of primary tumor site MIBG residual. Conclusion: EBRT appeared effective in high-intensive treatment of stage 4 neuroblastoma. It seems to compensate the disadvantage of incomplete response to induction chemotherapy. These retrospective results need confirmation by a prospective randomized trial. (orig.)

  14. Comparison of two accelerometer filter settings in individuals with Parkinson’s disease

    International Nuclear Information System (INIS)

    Wallén, Martin Benka; Nero, Håkan; Franzén, Erika; Hagströmer, Maria

    2014-01-01

    This study compared common free-living physical activity (PA) outcomes, assessed with the Actigraph GT3X+ accelerometer and processed with two different filter settings, in a sample of elderly individuals with Parkinson´s disease (PD). Sixty-six individuals (73.1  ±  5.8 years) with mild to moderate idiopathic PD carried an accelerometer for 7 d. Data were processed with the default filter setting and a low frequency extension filter (LFE). Significantly larger values were obtained with the LFE for mean counts and steps per day, and for minutes per day in low intensity- and lifestyle activities at moderate intensity, but not for moderate-to vigorous intensity ambulatory activities. The largest difference was observed for mean ± SD steps per day (default = 4730  ±  3210; LFE = 11 117  ±  4553). Intraclass correlation confidence intervals and limits of agreement were generally wide, indicating poor agreement. A sub-study, in which 15 individuals with PD performed a self-paced 3 min walk, demonstrated that neither filter setting differed from video-recorded steps (p ≥ 0.05). This suggests that the LFE might overestimate PA-outcomes in free-living conditions. Until new evidence supporting an extension of the lower filter-band is presented, it is recommended that the default filter setting be used when assessing PA in elderly individuals with PD. (paper)

  15. Time point-dependent concordance of flow cytometry and real-time quantitative polymerase chain reaction for minimal residual disease detection in childhood acute lymphoblastic leukemia.

    Science.gov (United States)

    Gaipa, Giuseppe; Cazzaniga, Giovanni; Valsecchi, Maria Grazia; Panzer-Grümayer, Renate; Buldini, Barbara; Silvestri, Daniela; Karawajew, Leonid; Maglia, Oscar; Ratei, Richard; Benetello, Alessandra; Sala, Simona; Schumich, Angela; Schrauder, Andre; Villa, Tiziana; Veltroni, Marinella; Ludwig, Wolf-Dieter; Conter, Valentino; Schrappe, Martin; Biondi, Andrea; Dworzak, Michael N; Basso, Giuseppe

    2012-10-01

    Flow cytometric analysis of leukemia-associated immunophenotypes and polymerase chain reaction-based amplification of antigen-receptor genes rearrangements are reliable methods for monitoring minimal residual disease. The aim of this study was to compare the performances of these two methodologies in the detection of minimal residual disease in childhood acute lymphoblastic leukemia. Polymerase chain reaction and flow cytometry were simultaneously applied for prospective minimal residual disease measurements at days 15, 33 and 78 of induction therapy on 3565 samples from 1547 children with acute lymphoblastic leukemia enrolled into the AIEOP-BFM ALL 2000 trial. The overall concordance was 80%, but different results were observed according to the time point. Most discordances were found at day 33 (concordance rate 70%) in samples that had significantly lower minimal residual disease. However, the discordance was not due to different starting materials (total versus mononucleated cells), but rather to cell input number. At day 33, cases with minimal residual disease below or above the 0.01% cut-off by both methods showed a very good outcome (5-year event-free survival, 91.6%) or a poor one (5-year event-free survival, 50.9%), respectively, whereas discordant cases showed similar event-free survival rates (around 80%). Within the current BFM-based protocols, flow cytometry and polymerase chain reaction cannot simply substitute each other at single time points, and the concordance rates between their results depend largely on the time at which they are used. Our findings suggest a potential complementary role of the two technologies in optimizing risk stratification in future clinical trials.

  16. Is cost-effectiveness analysis preferred to severity of disease as the main guiding principle in priority setting in resource poor settings? The case of Uganda

    Directory of Open Access Journals (Sweden)

    Norheim Ole

    2004-01-01

    Full Text Available Abstract Introduction Several studies carried out to establish the relative preference of cost-effectiveness of interventions and severity of disease as criteria for priority setting in health have shown a strong preference for severity of disease. These preferences may differ in contexts of resource scarcity, as in developing countries, yet information is limited on such preferences in this context. Objective This study was carried out to identify the key players in priority setting in health and explore their relative preference regarding cost-effectiveness of interventions and severity of disease as criteria for setting priorities in Uganda. Design 610 self-administered questionnaires were sent to respondents at national, district, health sub-district and facility levels. Respondents included mainly health workers. We used three different simulations, assuming same patient characteristics and same treatment outcome but with varying either severity of disease or cost-effectiveness of treatment, to explore respondents' preferences regarding cost-effectiveness and severity. Results Actual main actors were identified to be health workers, development partners or donors and politicians. This was different from what respondents perceived as ideal. Above 90% of the respondents recognised the importance of both severity of disease and cost-effectiveness of intervention. In the three scenarios where they were made to choose between the two, a majority of the survey respondents assigned highest weight to treating the most severely ill patient with a less cost-effective intervention compared to the one with a more cost-effective intervention for a less severely ill patient. However, international development partners in in-depth interviews preferred the consideration of cost-effectiveness of intervention. Conclusions In a survey among health workers and other actors in priority setting in Uganda, we found that donors are considered to have more say than

  17. Flow cytometric minimal residual disease monitoring in children with acute lymphoblastic leukemia treated by regimens with reduced intensity

    Directory of Open Access Journals (Sweden)

    A. M. Popov

    2015-01-01

    Full Text Available 191 consecutive unselected children with acute lymphoblastic leukemia aged from 1 to 16 years were enrolled in the study. Bone marrow samples were obtained at the time of initial diagnostics as well as at days 15 (n = 188, 36 (n = 191, and 85 (n = 187 of remission induction. Minimal residual disease (MRD was assessed by 6–10-color flow cytometry. Flow cytometry data at day 15 allowed distinguishing three patients groups with significantly different outcome (p ˂ 0.0001: 35.64 % patients with MRD < 0.1 % represented 5-year event-free survival (EFS of 100 %; 48.40 % cases with 0.1 % ≤ MRD< 10 % had EFS 84.6 ± 4.2 %; 15.96 % patients with very high MRD (≥ 10 % belonged to group with poor outcome (EFS 56.7 ± 9.0 %. At the end of remission induction (day 36 36 children (18.85 % with MRD higher than 0.1 % had significantly worse outcome compared to remaining ones (EFS 49.4 ± 9.0 and 93.5 ± 2.1 % respectively; p ˂ 0.0001. From a clinical standpoint it is relevant to evaluate both low-risk and high-risk criteria. Multivariate analysis showed that day 15 MRD data is better for low-risk patients definition while end-induction MRD is the strongest unfavorable prognostic factor.

  18. Long-Term Outcomes after Imatinib Mesylate Discontinuation in Chronic Myeloid Leukemia Patients with Undetectable Minimal Residual Disease.

    Science.gov (United States)

    Yhim, Ho-Young; Lee, Na-Ri; Song, Eun-Kee; Yim, Chang-Yeol; Jeon, So Yeon; Lee, Bohee; Kim, Jeong-A; Kim, Hee Sun; Cho, Eun Hae; Kwak, Jae-Yong

    2016-01-01

    Imatinib mesylate (IM) discontinuation is under active investigation in chronic myeloid leukemia-chronic phase (CML-CP) patients with undetectable minimal residual disease (UMRD). However, limited data exist on the long-term outcomes following IM discontinuation in patients treated with frontline IM therapy. We consecutively enrolled patients with CML-CP who discontinued IM after achieving UMRD for ≥12 months between June 2009 and January 2013. Nineteen patients (8 male, 11 female) were included. After IM discontinuation, 14 patients (74%) lost UMRD after a median of 4.0 months. Of the 14 patients with molecular relapses, 12 (86%) relapsed within the first 9 months after IM discontinuation and 2 (14%) relapsed at 20.5 and 22.8 months, respectively. No molecular relapse was observed after 2 years of IM discontinuation. With a median follow-up of 58.1 months (range 23.0-66.5), the estimated UMRD persistence rate at 5 years was 23.7%. IM was readministered in all patients with molecular relapse, and 12 patients (86%) reachieved UMRD at a median of 5.3 months. A high-risk Sokal score, delayed UMRD achievement and short-term IM therapy were significantly associated with molecular relapse. These findings suggest that IM discontinuation in patients who achieved UMRD after frontline IM therapy resulted in favorable long-term outcomes in terms of safety and feasibility. © 2015 S. Karger AG, Basel.

  19. Minimal Residual Disease Monitoring of Acute Myeloid Leukemia by Massively Multiplex Digital PCR in Patients with NPM1 Mutations.

    Science.gov (United States)

    Mencia-Trinchant, Nuria; Hu, Yang; Alas, Maria Antonina; Ali, Fatima; Wouters, Bas J; Lee, Sangmin; Ritchie, Ellen K; Desai, Pinkal; Guzman, Monica L; Roboz, Gail J; Hassane, Duane C

    2017-07-01

    The presence of minimal residual disease (MRD) is widely recognized as a powerful predictor of therapeutic outcome in acute myeloid leukemia (AML), but methods of measurement and quantification of MRD in AML are not yet standardized in clinical practice. There is an urgent, unmet need for robust and sensitive assays that can be readily adopted as real-time tools for disease monitoring. NPM1 frameshift mutations are an established MRD marker present in half of patients with cytogenetically normal AML. However, detection is complicated by the existence of hundreds of potential frameshift insertions, clonal heterogeneity, and absence of sequence information when the NPM1 mutation is identified using capillary electrophoresis. Thus, some patients are ineligible for NPM1 MRD monitoring. Furthermore, a subset of patients with NPM1-mutated AML will have false-negative MRD results because of clonal evolution. To simplify and improve MRD testing for NPM1, we present a novel digital PCR technique composed of massively multiplex pools of insertion-specific primers that selectively detect mutated but not wild-type NPM1. By measuring reaction end points using digital PCR technology, the resulting single assay enables sensitive and specific quantification of most NPM1 exon 12 mutations in a manner that is robust to clonal heterogeneity, does not require NPM1 sequence information, and obviates the need for maintenance of hundreds of type-specific assays and associated plasmid standards. Copyright © 2017 American Society for Investigative Pathology and the Association for Molecular Pathology. Published by Elsevier Inc. All rights reserved.

  20. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease.

    Science.gov (United States)

    Barco, Israel; Chabrera, Carolina; García-Fernández, Antonio; Fraile, Manel; Vidal, MCarmen; González, Sonia; Lain, Jose María; Reñé, Assumpta; Canales, Lidia; Vallejo, Elena; Deu, Jordi; Pessarrodona, Antoni; Giménez, Nuria; García-Font, Marc

    2016-10-01

    The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p=0.020) and lobular carcinomas (p=0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional foci diagnosed by MRI as a dependent variable. Preoperative MRI seems to have a role in preoperative tumour staging for breast cancer patients, as it discloses additional disease foci in some patients, including contralateral involvement. However, given the lack of absolute accuracy, core-needle biopsy cannot be neglected in the diagnosis of such additional malignant foci, which could result in a change in surgical treatment. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Residual disease detected by flow cytometry is an independent predictor of survival in childhood acute myeloid leukaemia; results of the NOPHO-AML 2004 study.

    Science.gov (United States)

    Tierens, Anne; Bjørklund, Elizabeth; Siitonen, Sanna; Marquart, Hanne Vibeke; Wulff-Juergensen, Gitte; Pelliniemi, Tarja-Terttu; Forestier, Erik; Hasle, Henrik; Jahnukainen, Kirsi; Lausen, Birgitte; Jonsson, Olafur G; Palle, Josefine; Zeller, Bem; Fogelstrand, Linda; Abrahamsson, Jonas

    2016-08-01

    Early response after induction is a prognostic factor for disease outcome in childhood acute myeloid leukaemia (AML). Residual disease (RD) detection by multiparameter flow cytometry (MFC) was performed at day 15 and before consolidation therapy in 101 patients enrolled in the Nordic Society of Paediatric Haemato-Oncology AML 2004 study. A multicentre laboratory approach to RD analysis was used. Event-free survival (EFS) and overall survival (OS) was significantly different in patients with and without RD at both time points, using a 0·1% RD cut-off level. RD-negative and -positive patients after first induction showed a 5-year EFS of 65 ± 7% and 22 ± 7%, respectively (P < 0·001) and an OS of 77 ± 6% (P = 0·025) and 51 ± 8%. RD-negative and -positive patients at start of consolidation therapy had a 5-year EFS of 57 ± 7% and 11 ± 7%, respectively (P < 0·001) and an OS of 78 ± 6% and 28 ± 11%) (P < 0·001). In multivariate analysis only RD was significantly correlated with survival. RD before consolidation therapy was the strongest independent prognostic factor for EFS [hazard ratio (HR):5·0; 95% confidence interval (CI):1·9-13·3] and OS (HR:7·0; 95%CI:2·0-24·5). In conclusion, RD before consolidation therapy identifies patients at high risk of relapse in need of intensified treatment. In addition, RD detection can be performed in a multicentre setting and can be implemented in future trials. © 2016 John Wiley & Sons Ltd.

  2. Magnetic resonance imaging in the preoperative setting for breast cancer patients with undetected additional disease

    Energy Technology Data Exchange (ETDEWEB)

    Barco, Israel [Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona (Spain); Chabrera, Carolina [Department of Nursing, School of Health Science TecnoCampus Mataró-Maresme (Spain); and others

    2016-10-15

    Highlights: • Preoperative MRI displays additional disease in 10.4% of cases in patients with infiltrating ductal carcinoma. • In cases with a complex intraductal-associated component, MRI is helpful in managing the surgical approach, and can potentially reduce reoperation rates. • Preoperative MRI showed a 91.9% agreement with the final histology, but core-needle biopsy cannot be rejected, so as to limit unnecessary surgery. • When MRI shows additional disease, there is often a change in the initial surgical plan. • Evolving surgery techniques, such as oncoplastic procedures, can be safely performed as an alternative to mastectomy in some patients. - Abstract: Objective: The last few years have witnessed a significant increase in the preoperative use of Magnetic Resonance Imaging (MRI) for staging purposes in breast cancer (BC) patients. Many studies have confirmed the improvement that MRI can provide in terms of diagnostic assessment, especially with regard to additional disease foci. In the present study, we address the advantages and disadvantages of MRI in the preoperative setting for BC patients. Patients and methods: There were 1513 consecutive breast MRI studies performed in patients with either primary or recurrent BC, who were scheduled for surgery. Results: Beyond the primary lesion, 10.4% of our cases had additional disease at the final histological assessment. MRI overall sensitivity, when considering tumour size and additional foci together, was 74.3%, and 80.3% when considering additional foci exclusively. MRI specificity for additional disease was 95.3%, positive predictive value was 77.4%, and negative predictive value was 94.6%. Nevertheless, 5% of cases had additional tumours that were missed by MRI or, conversely, had additional foci on MRI that were not confirmed by histology. Age (p = 0.020) and lobular carcinomas (p = 0.030) showed significance in the multivariate analysis by logistic regression, using the presence of additional

  3. Chronic disease self-management support for persons with dementia, in a clinical setting

    Directory of Open Access Journals (Sweden)

    Ibrahim JE

    2017-01-01

    Full Text Available Joseph Elias Ibrahim,1 Laura J Anderson,1 Aleece MacPhail,2 Janaka Jonathan Lovell,2 Marie-Claire Davis,1 Margaret Winbolt3 1Department of Forensic Medicine, Monash University, Southbank, 2Ballarat Health Services, Ballarat, 3Australian Centre for Evidence Based Aged Care, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia Abstract: The burden of chronic disease is greater in individuals with dementia, a patient group that is growing as the population is aging. The cornerstone of optimal management of chronic disease requires effective patient self-management. However, this is particularly challenging in older persons with a comorbid diagnosis of dementia. The impact of dementia on a person’s ability to self-manage his/her chronic disease (eg, diabetes mellitus or heart failure varies according to the cognitive domain(s affected, severity of impairment and complexity of self-care tasks. A framework is presented that describes how impairment in cognitive domains (attention and information processing, language, visuospatial ability and praxis, learning and memory and executive function impacts on the five key processes of chronic disease self-management. Recognizing the presence of dementia in a patient with chronic disease may lead to better outcomes. Patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management. Management strategies for clinicians to counter poor self-management due to differentially impaired cognitive domains are also detailed in the presented framework. Clinicians should work in collaboration with patients and care givers to assess a patient’s current capabilities, identify potential barriers to successful self-management and make efforts to adjust the provision of information according to the patient’s skill set. The increasing prevalence of

  4. Role of Noncommunicable Diseases (NCDs) in Resource-Limited Settings (RLS).

    Science.gov (United States)

    Mosepele, Mosepele; Botsile, Elizabeth

    2018-04-01

    As access to effective antiretroviral therapy (ART) expands globally, a decline in AIDS-related morbidity and mortality has been complicated by rising rates of noncommunicable diseases (NCDs). This review provides a brief description of NCDs and existing gaps on knowledge about NCDs among HIV-infected adults mostly in Africa. Recent reports show that one in every five persons living with HIV has a chronic illness, predominantly diabetes and/or hypertension, depression, and most of these conditions are either not diagnosed or not being managed. Human papilloma virus-associated anal dysplasia occurs among 70% of HIV-infected women in RLS. Recognizing risk factors for NCDs and providing effective screening and optimal care remains challenging. Research is urgently needed to carefully characterize HIV-associated NCDs in RLS. Such studies should provide a framework for high-priority NCDs that the limited resources can be focused on in these settings.

  5. Racial/Ethnic Disparities in Quality of Care for Cardiovascular Disease in Ambulatory Settings: A Review.

    Science.gov (United States)

    Dong, Liming; Fakeye, Oludolapo A; Graham, Garth; Gaskin, Darrell J

    2017-09-01

    Racial and ethnic disparities in cardiovascular disease (CVD) outcomes are widely reported, but research has largely focused on differences in quality of inpatient and urgent care to explain these disparate outcomes. The objective of this review is to synthesize recent evidence on racial and ethnic disparities in management of CVD in the ambulatory setting. Database searches yielded 550 articles of which 25 studies met the inclusion criteria. Reviewed studies were categorized into non-interventional studies examining the association between race and receipt of ambulatory CVD services with observational designs, and interventional studies evaluating specific clinical courses of action intended to ameliorate disparities. Based on the Donabedian framework, this review demonstrates that significant racial/ethnic disparities persist in process and outcome measures of quality of ambulatory CVD care. Multimodal interventions were most effective in reducing disparities in CVD outcomes.

  6. Data collection challenges in community settings: Insights from two field studies of patients with chronic disease

    Science.gov (United States)

    Holden, Richard J.; McDougald Scott, Amanda M.; Hoonakker, Peter L.T.; Hundt, Ann S.; Carayon, Pascale

    2014-01-01

    Purpose Collecting information about health and disease directly from patients can be fruitfully accomplished using contextual approaches, ones that combine more and less structured methods in home and community settings. This paper's purpose is to describe and illustrate a framework of the challenges of contextual data collection. Methods A framework is presented based on prior work in community-based participatory research and organizational science, comprised of ten types of challenges across four broader categories. Illustrations of challenges and suggestions for addressing them are drawn from two mixed-method, contextual studies of patients with chronic disease in two regions of the US. Results The first major category of challenges was concerned with the researcher-participant partnership, for example, the initial lack of mutual trust and understanding between researchers, patients, and family members. The second category concerned patient characteristics such as cognitive limitations and a busy personal schedule that created barriers to successful data collection. The third concerned research logistics and procedures such as recruitment, travel distances, and compensation. The fourth concerned scientific quality and interpretation, including issues of validity, reliability, and combining data from multiple sources. The two illustrative studies faced both common and diverse research challenges and used many different strategies to address them. Conclusion Collecting less structured data from patients and others in the community is potentially very productive but requires the anticipation, avoidance, or negotiation of various challenges. Future work is necessary to better understand these challenges across different methods and settings, as well as to test and identify strategies to address them. PMID:25154464

  7. Disease management index of potential years of life lost as a tool for setting priorities in national disease control using OECD health data.

    Science.gov (United States)

    Jang, Sung-In; Nam, Jung-Mo; Choi, Jongwon; Park, Eun-Cheol

    2014-03-01

    Limited healthcare resources make it necessary to maximize efficiency in disease management at the country level by priority-setting according to disease burden. To make the best priority settings, it is necessary to measure health status and have standards for its judgment, as well as consider disease management trends among nations. We used 17 International Classification of Diseases (ICD) categories of potential years of life lost (YPLL) from Organization for Economic Co-operation and Development (OECD) health data for 2012, 37 disease diagnoses YPLL from OECD health data for 2009 across 22 countries and disability-adjusted life years (DALY) from the World Health Organization (WHO). We set a range of 1-1 for each YPLL per disease in a nation (position value for relative comparison, PARC). Changes over 5 years were also accounted for in this disease management index (disease management index, DMI). In terms of ICD categories, the DMI indicated specific areas for priority setting for different countries with regard to managing disease treatment and diagnosis. Our study suggests that DMI is a realistic index that reflects trend changes over the past 5 years to the present state, and PARC is an easy index for identifying relative status. Moreover, unlike existing indices, DMI and PARC make it easy to conduct multiple comparisons among countries and diseases. DMI and PARC are therefore useful tools for policy implications and for future studies incorporating them and other existing indexes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  8. Effect of active prenatal management on pregnancy outcome in sickle cell disease in an African setting.

    Science.gov (United States)

    Rahimy, M C; Gangbo, A; Adjou, R; Deguenon, C; Goussanou, S; Alihonou, E

    2000-09-01

    Sickle cell disease (SCD) is associated with an increased risk of medical complications during pregnancy. In sub-Saharan Africa, fetal and maternal mortality rates are particularly high. This study evaluated the effect of an active prenatal management program on pregnancy outcome in patients with SCD in an African setting. Pregnant women with SCD attending the National Teaching Hospital in Cotonou (The Republic of Benin, West Africa) were recruited before the 28th week of gestation. Management was based on providing information and education about SCD and improving nutritional status, malaria prevention, early detection of bacterial infections, and restricted use of blood transfusion. Maternal and fetal mortality rates and SCD-related morbidity were the principal variables assessed. One hundred and eight patients (42 SS and 66 SC) with 111 fetuses were included in the study. Thirteen fetal deaths (from 9 SS and 4 SC mothers) were recorded and 2 deaths of SC mothers. The maternal mortality rate of 1.8% was comparable with the overall maternal mortality rate for this maternity unit (1.2%). Few SCD-related events were recorded. Plasmodium falciparum malaria infection was the major cause of morbidity. Sixty-three patients (19 SS and 44 SC) successfully completed their pregnancy (58.3%) without requiring transfusion. Providing pregnant SCD patients with relevant medical care based on simple cost-effective approaches can have a positive impact on SCD-associated morbidity and mortality in an otherwise difficult setting in Africa. (Blood. 2000;96:1685-1689)

  9. Analysis of Margin Index as a Method for Predicting Residual Disease After Breast-Conserving Surgery in a European Cancer Center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2011-06-03

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) × 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  10. Analysis of margin index as a method for predicting residual disease after breast-conserving surgery in a European cancer center.

    LENUS (Irish Health Repository)

    Bolger, Jarlath C

    2012-02-01

    INTRODUCTION: Breast-conserving surgery (BCS), followed by appropriate adjuvant therapies is established as a standard treatment option for women with early-stage invasive breast cancers. A number of factors have been shown to correlate with local and regional disease recurrence. Although margin status is a strong predictor of disease recurrence, consensus is yet to be established on the optimum margin necessary. Margenthaler et al. recently proposed the use of a "margin index," combining tumor size and margin status as a predictor of residual disease after BCS. We applied this new predictive tool to a population of patients with primary breast cancer who presented to a symptomatic breast unit to determine its suitability in predicting those who require reexcision surgery. METHODS: Retrospective analysis of our breast cancer database from January 1, 2000 to June 30, 2010 was performed, including all patients who underwent BCS. Of 531 patients who underwent BCS, 27.1% (144\\/531) required further reexcision procedures, and 55 were eligible for inclusion in the study. Margin index was calculated as: margin index = closest margin (mm)\\/tumor size (mm) x 100, with index >5 considered optimum. RESULTS: Of the 55 patients included, 31% (17\\/55) had residual disease. Fisher\\'s exact test showed margin index not to be a significant predictor of residual disease on reexcision specimen (P = 0.57). Of note, a significantly higher proportion of our patients presented with T2\\/3 tumors (60% vs. 38%). CONCLUSIONS: Although an apparently elegant tool for predicting residual disease after BCS, we have shown that it is not applicable to a symptomatic breast unit in Ireland.

  11. Health literacy and chronic disease management: drawing from expert knowledge to set an agenda.

    Science.gov (United States)

    Poureslami, Iraj; Nimmon, Laura; Rootman, Irving; Fitzgerald, Mark J

    2017-08-01

    Understanding the nature and impact of health literacy is a priority in health promotion and chronic disease prevention and treatment. Health literacy comprises the application of a broad set of skills to access, comprehend, evaluate, communicate and act on health information for improved health and well-being. A complex concept, it involves multiple participants and is enacted across a wide variety of contexts. Health literacy's complexity has given rise to challenges achieving a standard definition and developing means to measure all its dimensions. In May 2013, a group of health literacy experts, clinicians and policymakers convened at an Expert Roundtable to review the current state of health literacy research and practice, and make recommendations about refining its definition, expanding its measurement and integrating best practices into chronic disease management. The four-day knowledge exchange concluded that the successful integration of health literacy into policy and practice depends on the development of a more substantial evidence base. A review of the successes and gaps in health literacy research, education and interventions culminated in the identification of key priorities to further the health literacy agenda. The workshop was funded by the UBC Peter Wall Institute for Advanced Studies, Vancouver. © The Author 2016. Published by Oxford University Press.

  12. Risk assessment in the prevention of cardiovascular disease in low-resource settings.

    Science.gov (United States)

    Ofori, Sandra N; Odia, Osaretin J

    2016-01-01

    Cardiovascular disease (CVD) prevalence is increasing in low- and middle-income countries. Total risk assessment is key to prevention. Studies and guidelines published between 1990 and 2013 were sought using Medline database, PubMed, and World Health Organization report sheets. Search terms included 'risk assessment' and 'cardiovascular disease prevention'. Observational studies and randomized controlled trials were reviewed. The ideal risk prediction tool is one that is derived from the population in which it is to be applied. Without national population-based cohort studies in sub-Saharan African countries like Nigeria, there is no tool that is used consistently. Regardless of which one is adopted by national guidelines, routine consistent use is advocated by various CVD prevention guidelines. In low-resource settings, the consistent use of simple tools like the WHO charts is recommended, as the benefit of a standard approach to screening outweighs the risk of missing an opportunity to prevent CVD. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  13. Using the Timed Up & Go test in a clinical setting to predict falling in Parkinson's disease.

    Science.gov (United States)

    Nocera, Joe R; Stegemöller, Elizabeth L; Malaty, Irene A; Okun, Michael S; Marsiske, Michael; Hass, Chris J

    2013-07-01

    To investigate the ability of the Timed Up & Go test to identify patients with Parkinson's disease at risk for a fall. Cross-sectional cohort study. Sixteen participating National Parkinson's Foundation Centers of Excellence. A query yielded a total of 2985 records (1828 men and 1157 women). From these, 884 were excluded because of a lack of crucial information (age, diagnosis, presence of deep brain stimulation, disease duration, inability of performing the Timed Up & Go test without assistance) at the time of testing, leaving 2097 patients included in the analysis. Not applicable. The primary outcome measure for this study was falls. The chief independent variable was the Timed Up & Go test. The initial model examined the prediction of falls from the Timed Up & Go test, adjusting for all study covariates. The estimated models in the imputed data sets represented a significant improvement above chance (χ(2) range [df=17], 531.29-542.39, Pfall. The findings suggest that the Timed Up & Go test may be an accurate assessment tool to identify those at risk for falls. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  14. Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting

    Directory of Open Access Journals (Sweden)

    Thomas A Barnes

    2011-01-01

    Full Text Available Thomas A Barnes1, Len Fromer21Department of Cardiopulmonary Sciences, Northeastern University, Boston, MA, USA; 2David Geffen School of Medicine at UCLA, Los Angeles, CA, USAObjective: To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD by the use of office spirometry.Methods: This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most recent published evaluations of office spirometry and the analysis of preliminary data from a recent spirometry mass screening project. A mass screening study by the American Association for Respiratory Care and the COPD Foundation was used to identify the most effective way for general practitioners to implement office spirometry in order to stage COPD.Results: A simple three-step method is described to identify people with a high pre-test probability in an attempt to detect moderate to severe COPD: COPD questionnaire, measurement of peak expiratory flow, and office spirometry. Clinical practice guidelines exist for office spirometry basics for safety, use of electronic peak flow devices, and portable spirometers.Conclusion: Spirometry can be undertaken in primary care offices with acceptable levels of technical expertise. Using office spirometry, primary care physicians can diagnose the presence and severity of COPD. Spirometry can guide therapies for COPD and predict outcomes when used in general practice.Keywords: chronic obstructive pulmonary disease, spirometry, family practice, primary care physician

  15. Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement.

    Science.gov (United States)

    Ferris, Matthew J; Danish, Hasan; Switchenko, Jeffrey M; Deng, Claudia; George, Bradley A; Goldsmith, Kelly C; Wasilewski, Karen J; Cash, W Thomas; Khan, Mohammad K; Eaton, Bree R; Esiashvili, Natia

    2017-03-15

    To report the influence of radiation therapy (RT) dose and surgical pathology variables on disease control and overall survival (OS) in patients treated for high-risk neuroblastoma at a single institution. We conducted a retrospective study of 67 high-risk neuroblastoma patients who received RT as part of definitive management from January 2003 until May 2014. At a median follow-up of 4.5 years, 26 patients (38.8%) failed distantly; 4 of these patients also failed locally. One patient progressed locally without distant failure. Local control was 92.5%, and total disease control was 59.5%. No benefit was demonstrated for RT doses over 21.6 Gy with respect to local relapse-free survival (P=.55), disease-free survival (P=.22), or OS (P=.72). With respect to local relapse-free survival, disease-free survival, and OS, no disadvantage was seen for positive lymph nodes on surgical pathology, positive surgical margins, or gross residual disease. Of the patients with gross residual disease, 75% (6 of 8) went on to have no evidence of disease at time of last follow-up, and the 2 patients who failed did so distantly. Patients with high-risk neuroblastoma in this series maintained excellent local control, with no benefit demonstrated for radiation doses over 21.6 Gy, and no disadvantage demonstrated for gross residual disease after surgery, positive surgical margins, or pathologic lymph node positivity. Though the limitations of a retrospective review for an uncommon disease must be kept in mind, with small numbers in some of the subgroups, it seems that dose escalation should be considered only in exceptional circumstances. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Favorable Local Control From Consolidative Radiation Therapy in High-Risk Neuroblastoma Despite Gross Residual Disease, Positive Margins, or Nodal Involvement

    Energy Technology Data Exchange (ETDEWEB)

    Ferris, Matthew J., E-mail: mjferri@emory.edu [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Danish, Hasan [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Switchenko, Jeffrey M. [Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia (United States); Deng, Claudia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States); George, Bradley A.; Goldsmith, Kelly C.; Wasilewski, Karen J.; Cash, W. Thomas [Aflac Cancer and Blood Disorders Center, Children' s Healthcare of Atlanta, Atlanta, Georgia (United States); Khan, Mohammad K.; Eaton, Bree R.; Esiashvili, Natia [Department of Radiation Oncology, Emory University, Atlanta, Georgia (United States); Winship Cancer Institute, Emory University, Atlanta, Georgia (United States)

    2017-03-15

    Purpose: To report the influence of radiation therapy (RT) dose and surgical pathology variables on disease control and overall survival (OS) in patients treated for high-risk neuroblastoma at a single institution. Methods and Materials: We conducted a retrospective study of 67 high-risk neuroblastoma patients who received RT as part of definitive management from January 2003 until May 2014. Results: At a median follow-up of 4.5 years, 26 patients (38.8%) failed distantly; 4 of these patients also failed locally. One patient progressed locally without distant failure. Local control was 92.5%, and total disease control was 59.5%. No benefit was demonstrated for RT doses over 21.6 Gy with respect to local relapse–free survival (P=.55), disease-free survival (P=.22), or OS (P=.72). With respect to local relapse–free survival, disease-free survival, and OS, no disadvantage was seen for positive lymph nodes on surgical pathology, positive surgical margins, or gross residual disease. Of the patients with gross residual disease, 75% (6 of 8) went on to have no evidence of disease at time of last follow-up, and the 2 patients who failed did so distantly. Conclusions: Patients with high-risk neuroblastoma in this series maintained excellent local control, with no benefit demonstrated for radiation doses over 21.6 Gy, and no disadvantage demonstrated for gross residual disease after surgery, positive surgical margins, or pathologic lymph node positivity. Though the limitations of a retrospective review for an uncommon disease must be kept in mind, with small numbers in some of the subgroups, it seems that dose escalation should be considered only in exceptional circumstances.

  17. Anti Myelin Oligodendrocyte Glycoprotein associated Immunoglobulin G (AntiMOG-IgG)-associated Neuromyelitis Optica Spectrum Disorder with Persistent Disease Activity and Residual Cognitive Impairment.

    Science.gov (United States)

    Pandit, Lekha; Nakashima, Ichiro; Mustafa, Sharik; Takahashi, Toshiyuki; Kaneko, Kimhiko

    2017-01-01

    Antibodies targeting myelin oligodendrocyte glycoprotein (MOG) have been recently reported in association with idiopathic inflammatory central nervous system disorders. Initially believed to be a benign disorder, anti MOG-IgG was noted to cause steroid responsive recurrent optic neuritis and isolated longitudinally extensive myelitis. However, there is growing evidence that the disease may be predominantly relapsing, often producing severe visual loss and involving regions other than the spinal cord and optic nerve. We report an adolescent male with an aggressive disease course previously undescribed in anti MOG-IgG-associated disease that left him with residual cognitive dysfunction.

  18. Behçet disease-associated MHC class I residues implicate antigen binding and regulation of cell-mediated cytotoxicity.

    Science.gov (United States)

    Ombrello, Michael J; Kirino, Yohei; de Bakker, Paul I W; Gül, Ahmet; Kastner, Daniel L; Remmers, Elaine F

    2014-06-17

    The HLA protein, HLA-B*51, encoded by HLA-B in MHC, is the strongest known genetic risk factor for Behçet disease (BD). Associations between BD and other factors within the MHC have been reported also, although strong regional linkage disequilibrium complicates their confident disentanglement from HLA-B*51. In the current study, we examined a combination of directly obtained and imputed MHC-region SNPs, directly obtained HLA-B locus types, and imputed classical HLA types with their corresponding polymorphic amino acid residues for association with BD in 1,190 cases and 1,257 controls. SNP mapping with logistic regression of the MHC identified the HLA-B/MICA region and the region between HLA-F and HLA-A as independently associated with BD (P MHC class I (MHC-I) amino acid residues, including anchor residues that critically define the selection and binding of peptides to MHC-I molecules, residues known to influence MHC-I-killer immunoglobulin-like receptor interactions, and a residue located in the signal peptide of HLA-B. The locations of these variants collectively implicate MHC-I peptide binding in the pathophysiology of BD. Furthermore, several lines of evidence suggest a role for altered regulation of cellular cytotoxicity in BD pathogenesis.

  19. Treatment of minimal residual disease after surgery or chemotherapy in mice carrying HPV16-associated tumours: cytokine and gene therapy with IL-2 and GM-CSF

    Czech Academy of Sciences Publication Activity Database

    Mikyšková, Romana; Indrová, Marie; Šímová, Jana; Jandlová, Táňa; Bieblová, Jana; Jinoch, P.; Bubeník, Jan; Vonka, V.

    2004-01-01

    Roč. 24, č. 1 (2004), s. 161-167 ISSN 1019-6439 R&D Projects: GA MZd NC7148; GA MZd NC7552; GA ČR GA301/01/0985 Institutional research plan: CEZ:AV0Z5052915 Keywords : HPV16 * gene therapy * minimal residual tumour disease Subject RIV: FD - Oncology ; Hematology Impact factor: 3.056, year: 2004

  20. Genetically modified cellular vaccines against human papillomavirus type 16 (HPV16)-associated tumors: adjuvant treatment of minimal residual disease after surgery/chemotherapy

    Czech Academy of Sciences Publication Activity Database

    Bubeník, Jan; Šímová, Jana

    2009-01-01

    Roč. 14, č. 1 (2009), s. 169-173 ISSN 1107-0625 R&D Projects: GA ČR GA301/06/0774; GA ČR GA301/07/1410 EU Projects: European Commission(XE) 18933 - CLINIGENE Institutional research plan: CEZ:AV0Z50520514 Keywords : residual tumour disease * HPV 16 * cellular vaccines Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 0.600, year: 2009

  1. Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting

    Science.gov (United States)

    Barnes, Thomas A; Fromer, Len

    2011-01-01

    Objective: To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD) by the use of office spirometry. Methods: This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most recent published evaluations of office spirometry and the analysis of preliminary data from a recent spirometry mass screening project. A mass screening study by the American Association for Respiratory Care and the COPD Foundation was used to identify the most effective way for general practitioners to implement office spirometry in order to stage COPD. Results: A simple three-step method is described to identify people with a high pre-test probability in an attempt to detect moderate to severe COPD: COPD questionnaire, measurement of peak expiratory flow, and office spirometry. Clinical practice guidelines exist for office spirometry basics for safety, use of electronic peak flow devices, and portable spirometers. Conclusion: Spirometry can be undertaken in primary care offices with acceptable levels of technical expertise. Using office spirometry, primary care physicians can diagnose the presence and severity of COPD. Spirometry can guide therapies for COPD and predict outcomes when used in general practice. PMID:21472091

  2. Metabolic and Kidney Diseases in the Setting of Climate Change, Water Shortage, and Survival Factors.

    Science.gov (United States)

    Johnson, Richard J; Stenvinkel, Peter; Jensen, Thomas; Lanaspa, Miguel A; Roncal, Carlos; Song, Zhilin; Bankir, Lise; Sánchez-Lozada, Laura G

    2016-08-01

    Climate change (global warming) is leading to an increase in heat extremes and coupled with increasing water shortage, provides a perfect storm for a new era of environmental crises and potentially, new diseases. We use a comparative physiologic approach to show that one of the primary mechanisms by which animals protect themselves against water shortage is to increase fat mass as a means for providing metabolic water. Strong evidence suggests that certain hormones (vasopressin), foods (fructose), and metabolic products (uric acid) function as survival signals to help reduce water loss and store fat (which also provides a source of metabolic water). These mechanisms are intricately linked with each other and stimulated by dehydration and hyperosmolarity. Although these mechanisms were protective in the setting of low sugar and low salt intake in our past, today, the combination of diets high in fructose and salty foods, increasing temperatures, and decreasing available water places these survival signals in overdrive and may be accelerating the obesity and diabetes epidemics. The recent discovery of multiple epidemics of CKD occurring in agricultural workers in hot and humid environments may represent harbingers of the detrimental consequences of the combination of climate change and overactivation of survival pathways. Copyright © 2016 by the American Society of Nephrology.

  3. Detección molecular de enfermedad mínima residual en melanoma y otros tumores sólidos Molecular detection of minimal residual disease in melanoma and solid tumors

    Directory of Open Access Journals (Sweden)

    Valeria Vázquez

    2009-02-01

    Full Text Available La disponibilidad de métodos altamente sensibles y específicos para la detección de enfermedad mínima residual en pacientes con tumores sólidos podría tener importantes consecuencias pronósticas y terapéuticas. Uno de los métodos más usados para la detección molecular de células cancerosas es la técnica de RT-PCR, que permite la amplificación de secuencias de ARNm específicas de distintos tejidos. La misma fue aplicada por primera vez en la detección de células tumorales circulantes en sangre periférica de pacientes con melanoma avanzado, poco tiempo después fue adaptada para la búsqueda de enfermedad mínima residual en otros tumores sólidos. El objetivo de la presente revisión es evaluar la información publicada desde el primer estudio sobre este tema en 1991 y analizar el valor clínico de los hallazgos obtenidos. Se discute también la importancia del manejo de la muestra y de la estandarización de los procedimientos de RT-PCR.The availability of highly sensitive and specific methods for the detection of minimal residual disease in patients with solid tumors may have important prognostic and therapeutic implications. One of the most widely used methods for the molecular detection of cancer cells is the RT-PCR technique, which leads to the amplification of tissue-specific mRNA. It was firstly applied in the detection of circulating tumor cells in peripheral blood of patients with advanced melanoma; and soon it was adapted for the detection of minimal residual disease in other solid tumors. The aim of the present review is to evaluate the published data since the first study in 1991 and to analyze the clinical value of the findings obtained. The importance of sample handling and standardization of RT-PCR procedures is also discussed.

  4. Stereotactic Body Radiation Therapy Can Be Used Safely to Boost Residual Disease in Locally Advanced Non-Small Cell Lung Cancer: A Prospective Study

    Energy Technology Data Exchange (ETDEWEB)

    Feddock, Jonathan, E-mail: jmfedd0@uky.edu [Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky (United States); Arnold, Susanne M. [Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky (United States); Department of Medical Oncology, University of Kentucky, Lexington, Kentucky (United States); Shelton, Brent J. [Department of Biostatistics, University of Kentucky, Lexington, Kentucky (United States); Sinha, Partha; Conrad, Gary [Department of Radiology, University of Kentucky, Lexington, Kentucky (United States); Chen, Li [Department of Biostatistics, University of Kentucky, Lexington, Kentucky (United States); Rinehart, John [Department of Medical Oncology, University of Kentucky, Lexington, Kentucky (United States); McGarry, Ronald C. [Department of Radiation Medicine, University of Kentucky, Lexington, Kentucky (United States)

    2013-04-01

    Purpose: To report the results of a prospective, single-institution study evaluating the feasibility of conventional chemoradiation (CRT) followed by stereotactic body radiation therapy (SBRT) as a means of dose escalation for patients with stage II-III non-small cell lung cancer (NSCLC) with residual disease. Methods and Materials: Patients without metastatic disease and with radiologic evidence of limited residual disease (≤5 cm) within the site of the primary tumor and good or complete nodal responses after standard CRT to a target dose of 60 Gy were considered eligible. The SBRT boost was done to achieve a total combined dose biological equivalent dose >100 Gy to the residual primary tumor, consisting of 10 Gy × 2 fractions (20 Gy total) for peripheral tumors, and 6.5 Gy × 3 fractions (19.5 Gy total) for medial tumors using the Radiation Therapy Oncology Group protocol 0813 definitions. The primary endpoint was the development of grade ≥3 radiation pneumonitis (RP). Results: After a median follow-up of 13 months, 4 patients developed acute grade 3 RP, and 1 (2.9%) developed late and persistent grade 3 RP. No patients developed grade 4 or 5 RP. Mean lung dose, V2.5, V5, V10, and V20 values were calculated for the SBRT boost, and none were found to significantly predict for RP. Only advancing age (P=.0147), previous smoking status (P=.0505), and high CRT mean lung dose (P=.0295) were significantly associated with RP development. At the time of analysis, the actuarial local control rate at the primary tumor site was 82.9%, with only 6 patients demonstrating recurrence. Conclusions: Linear accelerator-based SBRT for dose escalation of limited residual NSCLC after definitive CRT was feasible and did not increase the risk for toxicity above that for standard radiation therapy.

  5. SAGES: A Suite of Freely-Available Software Tools for Electronic Disease Surveillance in Resource-Limited Settings

    Science.gov (United States)

    2011-05-10

    3] Recently, the emergence of the novel 2009 influenza A ( H1N1 ) virus and the SARS coronavirus have demonstrated how rapidly pathogens can spread...standards in both minimum data sets for disease surveillance and routine diagnosis and care. Analysis & Visualization. As previously discussed, the...g002 SAGES Electronic Disease Surveillance PLoS ONE | www.plosone.org 3 May 2011 | Volume 6 | Issue 5 | e19750 for pandemic influenza as well as

  6. Assessing genetic effects in survival data by correlating martingale residuals with an application to age at onset of Huntington disease

    NARCIS (Netherlands)

    Wintrebert, Claire M. A.; Zwinderman, Aeilko H.; Maat-Kievit, Anneke; Roos, Raymund A.; van Houwelingen, Hans C.

    2006-01-01

    Genetic models for survival data are hard to formulate and hard to fit. For example, the popular gamma-frailty model for sib-pair data does not generalize easily to extended pedigrees and is not easy to fit. In this paper we show how martingale residuals from a (marginal) Cox model can be employed

  7. Protocol for the development of a Core Outcome Set (COS) for hemorrhoidal disease: an international Delphi study.

    Science.gov (United States)

    van Tol, R R; Melenhorst, J; Dirksen, C D; Stassen, L P S; Breukink, S O

    2017-07-01

    Over the last decade, many studies were performed regarding treatment options for hemorrhoidal disease. Randomised controlled trials (RCTs) should have well-defined primary and secondary outcomes. However, the reported outcome measures are numerous and diverse. The heterogeneity of outcome definition in clinical trials limits transparency and paves the way for bias. The development of a core outcome set (COS) helps minimizing this problem. A COS is an agreed minimum set of outcomes that should be measured and reported in all clinical trials of a specific disease. The aim of this project is to generate a COS regarding the outcome of treatment after hemorrhoidal disease. A Delphi study will be performed by an international steering group healthcare professionals and patients with the intention to create a standard outcome set for future clinical trials for the treatment of hemorrhoidal disease. First, a literature review will be conducted to establish which outcomes are used in clinical trials for hemorrhoidal disease. Secondly, both healthcare professionals and patients will participate in several consecutive rounds of online questionnaires and a face-to-face meeting to refine the content of the COS. Development of a COS for hemorrhoidal disease defines a minimum outcome-reporting standard and will improve the quality of research in the future.

  8. Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Londero, Viviana; Bazzocchi, Massimo; Del Frate, Chiara; Francescutti, Giuliana; Zuiani, Chiara [Institute of Radiology, University of Udine, via Colugna 50, 33100, Udine (Italy); Puglisi, Fabio [Department of Oncology, University of Udine, via Colugna 50, 33100, Udine (Italy); Di Loreto, Carla [Institute of Pathology, University of Udine, via Colugna 50, 33100, Udine (Italy)

    2004-08-01

    The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography. (orig.)

  9. Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy

    International Nuclear Information System (INIS)

    Londero, Viviana; Bazzocchi, Massimo; Del Frate, Chiara; Francescutti, Giuliana; Zuiani, Chiara; Puglisi, Fabio; Di Loreto, Carla

    2004-01-01

    The accuracy of mammography, sonography and magnetic resonance imaging (MRI) in identifying residual disease after neoadjuvant chemotherapy is evaluated and imaging findings are correlated with pathologic findings. Fifteen patients enrolled in an experimental protocol of preoperative neoadjuvant chemotherapy underwent clinical examination, mammography, sonography and dynamic MRI, performed in this order, before and respectively after 2 and 4 cycles of neoadjuvant chemotherapy. Four radiologists, two for mammography, one for sonography and one for MR, examined the images, blinded to the results of the other examinations. All patients underwent radical or conservative surgery, and imaging findings were compared with pathologic findings. MRI identified 2/15 (13.3.%) clinically complete response (CR), 9/15 (60%) partial response (PR), 3/15 (20%) stable disease (SD) and 1/15 (6.7%) progressive disease. Mammography identified 1/15 (6.7%) clinically CR, 8/15 (53.3%) PR and 4/15 (27%) SD, and was not able to evaluate the disease in 2/15 (13%) cases. Sonography presented the same results as MRI. Therefore, MRI and sonography compared to mammography correctly identified residual disease in 100 vs. 86%. MRI resulted in two false-negative results because of the presence of microfoci of in situ ductal carcinoma (DCIS) and invasive lobular carcinoma (LCI). MRI was superior to mammography in cases of multifocal or multicentric disease (83 vs. 33%). Sonography performed after MRI improves the accuracy in evaluation of uncertain foci of multifocal disease seen on MR images with an increase of diagnostic accuracy from 73 to 84.5%. MRI assesses response to neoadjuvant chemotherapy better than traditional methods of physical examination and mammography. (orig.)

  10. Dynamic contrast-enhanced MRI for automatic detection of foci @]@of residual or recurrent disease after prostatectomy

    Energy Technology Data Exchange (ETDEWEB)

    Parra, N.A.; Orman, Amber; Abramowitz, Matthew; Pollack, Alan; Stoyanova, Radka [University of Miami Miller School of Medicine, Department of Radiation Oncology, Miami, FL (United States); Padgett, Kyle [University of Miami Miller School of Medicine, Department of Radiation Oncology, Miami, FL (United States); University of Miami Miller School of Medicine, Department of Radiology, Miami, FL (United States); Casillas, Victor [University of Miami Miller School of Medicine, Department of Radiology, Miami, FL (United States); Punnen, Sanoj [University of Miami Miller School of Medicine, Department of Urology, Miami, FL (United States)

    2017-01-15

    This study aimed to develop an automated procedure for identifying suspicious foci of residual/recurrent disease in the prostate bed using dynamic contrast-enhanced-MRI (DCE-MRI) in prostate cancer patients after prostatectomy. Data of 22 patients presenting for salvage radiotherapy (RT) with an identified gross tumor volume (GTV) in the prostate bed were analyzed retrospectively. An unsupervised pattern recognition method was used to analyze DCE-MRI curves from the prostate bed. Data were represented as a product of a number of signal-vs.-time patterns and their weights. The temporal pattern, characterized by fast wash-in and gradual wash-out, was considered the ''tumor'' pattern. The corresponding weights were thresholded based on the number (1, 1.5, 2, 2.5) of standard deviations away from the mean, denoted as DCE1.0,.., DCE2.5, and displayed on the T2-weighted MRI. The resultant four volumes were compared with the GTV and maximum pre-RT prostate-specific antigen (PSA) level. Pharmacokinetic modeling was also carried out. Principal component analysis determined 2-4 significant patterns in patients' DCE-MRI. Analysis and display of the identified suspicious foci was performed in commercial software (MIM Corporation, Cleveland, OH, USA). In general, DCE1.0/DCE1.5 highlighted larger areas than GTV. DCE2.0 and GTV were significantly correlated (r = 0.60, p < 0.05). DCE2.0/DCA2.5 were also significantly correlated with PSA (r = 0.52, 0.67, p < 0.05). K{sup trans} for DCE2.5 was statistically higher than the GTV's K{sup trans} (p < 0.05), indicating that the automatic volume better captures areas of malignancy. A software tool was developed for identification and visualization of the suspicious foci in DCE-MRI from post-prostatectomy patients and was integrated into the treatment planning system. (orig.) [German] Entwicklung eines automatischen Analyseverfahrens, um nach Prostatektomie mittels dynamischer kontrastmittelverstaerkter

  11. Successful aging theory and the patient with chronic renal disease: application in the clinical setting.

    Science.gov (United States)

    Blevins, Candy; Toutman, Meredith Flood

    2011-01-01

    As life expectancies increase, nurses will care for more individuals with chronic conditions, one of which is chronic renal disease. Increasing diversity and complexity of older adult healthcare needs signals a need to reconceptualize perceptions of successful aging. By emphasizing health promotion and adaptation, successful aging is possible for those with chronic renal disease. This article provides an overview of theory-based strategies for fostering successful aging in the patient with chronic renal disease.

  12. Patterns of clinical presentation of adult coeliac disease in a rural setting

    Directory of Open Access Journals (Sweden)

    D'Souza Charles

    2006-09-01

    Full Text Available Abstract Background In recent years there has been increasing recognition that the pattern of presentation of coeliac disease may be changing. The classic sprue syndrome with diarrhoea and weight loss may be less common than the more subtle presentations of coeliac disease such as an isolated iron deficiency anaemia. As a result, the diagnosis of this treatable condition is often delayed or missed. Recent serologic screening tests allow non-invasive screening to identify most patients with the disease and can be applied in patients with even subtle symptoms indicative of coeliac disease. Both benign and malignant complications of coeliac disease can be avoided by early diagnosis and a strict compliance with a gluten free diet. Aim The aim of this study is to evaluate the trends in clinical presentation of patients diagnosed with adult coeliac disease. In addition, we studied the biochemical and serological features and the prevalence of associated conditions in patients with adult coeliac disease. Methods This is an observational, retrospective, cross-sectional review of the medical notes of 32 adult patients attending the specialist coeliac clinic in a district general hospital. Results Anaemia was the most common mode of presentation accounting for 66% of patients. Less than half of the patients had any of the classical symptoms of coeliac disease and 25% had none of the classical symptoms at presentation. Anti-gliadin antibodies, anti-endomysial antibody and anti-tissue transglutaminase showed 75%, 68% and 90% sensitivity respectively. In combination, serology results were 100% sensitive as screening tests for adult coeliac disease. Fifty nine percent patients had either osteoporosis or osteopenia. There were no malignant complications observed during the follow up of our patients. Conclusion Most adults with coeliac disease have a sub clinical form of the disease and iron deficiency anaemia may be its sole presenting symptom. Only a minority

  13. Connecting Gaucher and Parkinson Disease: Considerations for Clinical and Research Genetic Counseling Settings.

    Science.gov (United States)

    Cook, Lola; Schulze, Jeanine

    2017-12-01

    There are multiple autosomal recessive disorders in which carriers may be at risk for other diseases. This observation calls into question the previous understanding that carriers of autosomal recessive disorders escape clinical consequences. We also know that childhood genetic conditions may have adult disease counterparts (Zimran et al., The Israel Medical Association Journal: IMAJ, 16(11), 723-724, 2014). Individuals who have Gaucher disease and carriers of the disorder are at increased risk for a seemingly unrelated and complex neurological condition, Parkinson disease. Parkinson disease is, in part, caused by the same mutations in the GBA gene that lead to Gaucher disease, and the two conditions are thought to have shared pathophysiology. Briefly reviewed are how these two diseases historically became linked, where their paths cross, potential problems and considerations in disclosure of the link, and current guidelines and research in this area. Genetic counseling experience with a large Parkinson disease cohort is used as a starting point to question the state of clinical and nonclinical practice in disclosing this unusual connection We conclude that more research and discussion are needed to inform practice regarding the crossroads of Gaucher and Parkinson disease.

  14. A methodology for a minimum data set for rare diseases to support national centers of excellence for healthcare and research

    Science.gov (United States)

    Choquet, Rémy; Maaroufi, Meriem; de Carrara, Albane; Messiaen, Claude; Luigi, Emmanuel; Landais, Paul

    2015-01-01

    Background Although rare disease patients make up approximately 6–8% of all patients in Europe, it is often difficult to find the necessary expertise for diagnosis and care and the patient numbers needed for rare disease research. The second French National Plan for Rare Diseases highlighted the necessity for better care coordination and epidemiology for rare diseases. A clinical data standard for normalization and exchange of rare disease patient data was proposed. The original methodology used to build the French national minimum data set (F-MDS-RD) common to the 131 expert rare disease centers is presented. Methods To encourage consensus at a national level for homogeneous data collection at the point of care for rare disease patients, we first identified four national expert groups. We reviewed the scientific literature for rare disease common data elements (CDEs) in order to build the first version of the F-MDS-RD. The French rare disease expert centers validated the data elements (DEs). The resulting F-MDS-RD was reviewed and approved by the National Plan Strategic Committee. It was then represented in an HL7 electronic format to maximize interoperability with electronic health records. Results The F-MDS-RD is composed of 58 DEs in six categories: patient, family history, encounter, condition, medication, and questionnaire. It is HL7 compatible and can use various ontologies for diagnosis or sign encoding. The F-MDS-RD was aligned with other CDE initiatives for rare diseases, thus facilitating potential interconnections between rare disease registries. Conclusions The French F-MDS-RD was defined through national consensus. It can foster better care coordination and facilitate determining rare disease patients’ eligibility for research studies, trials, or cohorts. Since other countries will need to develop their own standards for rare disease data collection, they might benefit from the methods presented here. PMID:25038198

  15. Priority setting of foodborne pathogens: disease burden and costs of selected enteric pathogens

    NARCIS (Netherlands)

    Kemmeren JM; Mangen MJJ; Duynhoven YTHP van; Havelaar AH; MGB

    2006-01-01

    Toxoplasmosis causes the highest disease burden among seven evaluated foodborne pathogens. This is the preliminary conclusion of a major study of the disease burden and related costs of foodborne pathogens. The other micro-organisms that were studied are Campylobacter spp., Salmonella spp.,

  16. Foodborne disease outbreak in a resource-limited setting: a tale of ...

    African Journals Online (AJOL)

    Introduction: Foodborne diseases (FBD) have emerged as a major public health problem worldwide. Though the global burden of FBD is currently unknown, foodborne diarrhoeal diseases kill 1.9 million children globally every year. On 25th September 2014, health authorities in Eastern Region of Ghana were alerted of a ...

  17. Diabetes-related microvascular and macrovascular diseases in the physical therapy setting.

    Science.gov (United States)

    Cade, W Todd

    2008-11-01

    Physical therapists commonly treat people with diabetes for a wide variety of diabetes-associated impairments, including those from diabetes-related vascular disease. Diabetes is associated with both microvascular and macrovascular diseases affecting several organs, including muscle, skin, heart, brain, and kidneys. A common etiology links the different types of diabetes-associated vascular disease. Common risk factors for vascular disease in people with diabetes, specifically type 2 diabetes, include hyperglycemia, insulin resistance, dyslipidemia, hypertension, tobacco use, and obesity. Mechanisms for vascular disease in diabetes include the pathologic effects of advanced glycation end product accumulation, impaired vasodilatory response attributable to nitric oxide inhibition, smooth muscle cell dysfunction, overproduction of endothelial growth factors, chronic inflammation, hemodynamic dysregulation, impaired fibrinolytic ability, and enhanced platelet aggregation. It is becoming increasingly important for physical therapists to be aware of diabetes-related vascular complications as more patients present with insulin resistance and diabetes. The opportunities for effective physical therapy interventions (such as exercise) are significant.

  18. Vaccine preventable disease incidence as a complement to vaccine efficacy for setting vaccine policy

    Science.gov (United States)

    Gessner, Bradford D.; Feikin, Daniel R.

    2015-01-01

    Traditionally, vaccines have been evaluated in clinical trials that establish vaccine efficacy (VE) against etiology-confirmed disease outcomes, a measure important for licensure. Yet, VE does not reflect a vaccine’s public health impact because it does not account for relative disease incidence. An additional measure that more directly establishes a vaccine’s public health value is the vaccine preventable disease incidence (VPDI), which is the incidence of disease preventable by vaccine in a given context. We describe how VE and VPDI can vary, sometimes in inverse directions, across disease outcomes and vaccinated populations. We provide examples of how VPDI can be used to reveal the relative public health impact of vaccines in developing countries, which can be masked by focus on VE alone. We recommend that VPDI be incorporated along with VE into the analytic plans of vaccine trials, as well as decisions by funders, ministries of health, and regulatory authorities. PMID:24731817

  19. Evaluation of minimal residual disease in patients with chronic myeloid leukaemia on IFN-alpha 2b therapy using conventional cytogenetics and fluorescence in situ hybridization.

    Science.gov (United States)

    Talwar, Rashmi; Choudhry, V P; Jobanputra, Vaidehi; Kucheria, Kiran

    2002-01-01

    Chronic myeloid leukaemia (CML) is a haematopoietic malignancy characterized by the presence of the Philadelphia (Ph) chromosome that results from balanced reciprocal translocation between chromosomes 9 and 22 leading to the formation of the bcr/abl fusion gene. Studies have shown that interferon-alpha (IFN-alpha) therapy induces both cytogenetic (reduction in Ph+ cells) and molecular response (reduction in the bcr/abl positive cells) in a large proportion of patients, thereby improving their prognosis and survival. There are no reports available from India on the clinical management of CML patients using IFN-alpha therapy and molecular methods for the evaluation of residual disease. We evaluated the efficacy of IFN-alpha 2b therapy bysequential cytogenetic and molecularanalysis. Karyotypingwas done from G-banded metaphases obtained from 24-hour culture of bone marrow aspirates of 45 patients. Cytogenetic analysis was repeated at intervals of 4-6 months during the course of IFN-alpha therapy. Dual-colour fluorescence in situ hybridization (FISH) analysis using specific probes for bcr and abl genes was done to assess the molecular response. Eight patients achieved complete cytogenetic response with no Ph+ cells. Using FISH analysis, 4 of these patients were negative for the fusion gene implying a complete response, while the remaining 4 patients showed bcr/abl fusion signals that represent residual disease. Our study emphasizes the need for sequential cytogenetic and molecular analysis in the management of patients with CML and for the evaluation of minimal residual disease in patients on IFN-alpha therapy.

  20. Improved Diagnostic Accuracy of Alzheimer's Disease by Combining Regional Cortical Thickness and Default Mode Network Functional Connectivity: Validated in the Alzheimer's Disease Neuroimaging Initiative Set.

    Science.gov (United States)

    Park, Ji Eun; Park, Bumwoo; Kim, Sang Joon; Kim, Ho Sung; Choi, Choong Gon; Jung, Seung Chai; Oh, Joo Young; Lee, Jae-Hong; Roh, Jee Hoon; Shim, Woo Hyun

    2017-01-01

    To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal ( p Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease.

  1. Risk assessment in the prevention of cardiovascular disease in low-resource settings

    Directory of Open Access Journals (Sweden)

    Sandra N. Ofori

    2016-05-01

    Conclusions: In low-resource settings, the consistent use of simple tools like the WHO charts is recommended, as the benefit of a standard approach to screening outweighs the risk of missing an opportunity to prevent CVD.

  2. Systematic review of electronic surveillance of infectious diseases with emphasis on antimicrobial resistance surveillance in resource-limited settings.

    Science.gov (United States)

    Rattanaumpawan, Pinyo; Boonyasiri, Adhiratha; Vong, Sirenda; Thamlikitkul, Visanu

    2018-02-01

    Electronic surveillance of infectious diseases involves rapidly collecting, collating, and analyzing vast amounts of data from interrelated multiple databases. Although many developed countries have invested in electronic surveillance for infectious diseases, the system still presents a challenge for resource-limited health care settings. We conducted a systematic review by performing a comprehensive literature search on MEDLINE (January 2000-December 2015) to identify studies relevant to electronic surveillance of infectious diseases. Study characteristics and results were extracted and systematically reviewed by 3 infectious disease physicians. A total of 110 studies were included. Most surveillance systems were developed and implemented in high-income countries; less than one-quarter were conducted in low-or middle-income countries. Information technologies can be used to facilitate the process of obtaining laboratory, clinical, and pharmacologic data for the surveillance of infectious diseases, including antimicrobial resistance (AMR) infections. These novel systems require greater resources; however, we found that using electronic surveillance systems could result in shorter times to detect targeted infectious diseases and improvement of data collection. This study highlights a lack of resources in areas where an effective, rapid surveillance system is most needed. The availability of information technology for the electronic surveillance of infectious diseases, including AMR infections, will facilitate the prevention and containment of such emerging infectious diseases. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  3. Liver function in Huntington's disease assessed by blood biochemical analyses in a clinical setting

    DEFF Research Database (Denmark)

    Nielsen, Signe Marie Borch; Vinther-Jensen, Tua; Nielsen, Jørgen E.

    2016-01-01

    Huntington's disease (HD) is a dominantly inherited, progressive neurological disorder caused by a CAG repeat elongation in the huntingtin gene. In addition to motor-, psychiatric- A nd cognitive dysfunction, peripheral disease manifestations in the form of metabolic changes and cellular...... indicated by the Unified Huntington's disease rating scale-Total Functional Capacity Score (UHDRS-TFC). For gamma-glutamyl transferase, elevated levels were more frequent in the manifest groups than in both the HD gene-expansion negative controls and premanifest HD gene-expansion carriers. Finally...... dysfunction are seen. Blood levels of a wide range of hormones, metabolites and proteins have been analyzed in HD patients, identifying several changes associated with the disease. However, a comprehensive panel of liver function tests (LFT) has not been performed. We investigated a cohort of manifest...

  4. The PICS Technique: A Novel Approach for Residual Curvature Correction During Penile Prosthesis Implantation in Patients With Severe Peyronie's Disease Using the Collagen Fleece TachoSil.

    Science.gov (United States)

    Hatzichristodoulou, Georgios

    2018-03-01

    Correction of residual curvature during inflatable penile prosthesis (IPP) implantation in patients with Peyronie's disease (PD) by plaque incision and grafting is a common approach. To present a novel technique for residual curvature correction during IPP implantation using collagen fleece (TachoSil, Baxter Healthcare Corp, Deerfield, IL, USA). After the IPP (Titan Touch, Coloplast, Minneapolis, MN, USA) is placed, the implant is inflated maximally. When residual curvature exceeds 40°, the PICS (penile implant in combination with the Sealing technique) technique is performed. The device is deflated, and a circumcising skin incision and penile degloving are performed. After elevation of the neurovascular bundle, the device is reinflated maximally. Plaque incision is performed at the point of maximum curvature using electrocautery. This leads to penile straightening because the tension is removed. In the next step, the defect of the tunica is closed with collagen fleece, which sticks to the tunica and defect without any sutures needed. The neurovascular bundle is reapproximated and the Buck fascia is closed. This is followed by closure of penile skin. Primary outcome measurements were straightening rates, operative times, 5-item International Index of Erectile Function (IIEF-5) scores at follow-up, immediate and late complications, and patient satisfaction. The PICS technique was applied to 15 patients. Mean patient age was 61.7 years (52-79 years). Mean residual curvature after IPP was 66.7° (50-90°). Mean operative time was 117.3 minutes (100-140 minutes). Mean follow-up was 15.1 months (1-29 months). 12 of 15 patients (80%) showed a totally straight penis. 3 patients (20%) had residual curvature of 10° at follow-up, which did not interfere with sexual intercourse. Mean IIEF-5 score at follow-up was 24.2 (22-25). No immediate or late complications occurred. All patients were satisfied with the surgical outcomes. This novel technique prevents puncture or

  5. Cardiovascular Disease and Risk in Primary Care Settings in the United States

    OpenAIRE

    Ndumele, Chima D.; Baer, Heather J.; Shaykevich, Shimon; Lipsitz, Stuart; Hicks, LeRoi S.

    2011-01-01

    Primary care site may play an important role in cardiovascular disease prevalence; however, the distribution of risk factors and outcomes across care sites is not known. We conducted a cross-sectional analysis of 21,778 adult participants from the National Health and Nutrition Examination Survey (99-08) using multivariable logistic regression to assess the relationship between site of usual care and disease prevalence. We examine patients’ self-reported history of several chronic conditions (...

  6. Prognostic Implication of Functional Incomplete Revascularization and Residual Functional SYNTAX Score in Patients With Coronary Artery Disease.

    Science.gov (United States)

    Choi, Ki Hong; Lee, Joo Myung; Koo, Bon-Kwon; Nam, Chang-Wook; Shin, Eun-Seok; Doh, Joon-Hyung; Rhee, Tae-Min; Hwang, Doyeon; Park, Jonghanne; Zhang, Jinlong; Kim, Kyung-Jin; Hu, Xinyang; Wang, Jianan; Ye, Fei; Chen, Shaoliang; Yang, Junqing; Chen, Jiyan; Tanaka, Nobuhiro; Yokoi, Hiroyoshi; Matsuo, Hitoshi; Takashima, Hiroaki; Shiono, Yasutsugu; Akasaka, Takashi

    2018-02-12

    The aim of this study was to investigate the prognostic implication of functional incomplete revascularization (IR) and residual functional SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) score (rFSS) in comparison with 3-vessel fractional flow reserve (FFR) and residual SYNTAX score. IR is associated with poor clinical outcomes in patients who underwent percutaneous coronary intervention. A total of 385 patients who underwent 3-vessel FFR measurement after stent implantation were included in this study. The rFSS was defined as residual SYNTAX score measured only in vessels with FFR ≤0.8. The study population was divided into the functional IR group (rFSS ≥1) and the functional complete revascularization (CR) group (rFSS = 0). The primary outcome was major adverse cardiac events (MACEs; a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization) at 2 years. Functional CR was achieved in 283 patients (73.5%). At 2-year follow-up, the functional IR group showed a significantly higher risk for MACEs (functional IR vs. CR, 14.6% vs. 4.2%; hazard ratio: 4.09; 95% confidence interval: 1.82 to 9.21; p system (rFSS) after stent implantation better discriminated the risk for adverse events than anatomic or physiological assessment alone. (Clinical Implication of 3-Vessel Fractional Flow Reserve [FFR]; NCT01621438). Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  7. Seasonality of water quality and diarrheal disease counts in urban and rural settings in south India

    Science.gov (United States)

    Kulinkina, Alexandra V.; Mohan, Venkat R.; Francis, Mark R.; Kattula, Deepthi; Sarkar, Rajiv; Plummer, Jeanine D.; Ward, Honorine; Kang, Gagandeep; Balraj, Vinohar; Naumova, Elena N.

    2016-02-01

    The study examined relationships among meteorological parameters, water quality and diarrheal disease counts in two urban and three rural sites in Tamil Nadu, India. Disease surveillance was conducted between August 2010 and March 2012; concurrently water samples from street-level taps in piped distribution systems and from household storage containers were tested for pH, nitrate, total dissolved solids, and total and fecal coliforms. Methodological advances in data collection (concurrent prospective disease surveillance and environmental monitoring) and analysis (preserving temporality within the data through time series analysis) were used to quantify independent effects of meteorological conditions and water quality on diarrheal risk. The utility of a local calendar in communicating seasonality is also presented. Piped distribution systems in the study area showed high seasonal fluctuations in water quality. Higher ambient temperature decreased and higher rainfall increased diarrheal risk with temperature being the predominant factor in urban and rainfall in rural sites. Associations with microbial contamination were inconsistent; however, disease risk in the urban sites increased with higher median household total coliform concentrations. Understanding seasonal patterns in health outcomes and their temporal links to environmental exposures may lead to improvements in prospective environmental and disease surveillance tailored to addressing public health problems.

  8. Contact tracing following outbreak of Ebola virus disease in urban settings in Nigeria.

    Science.gov (United States)

    Fawole, Olufunmilayo Ibitola; Dalhat, Mahmood Muazu; Park, Meeyoung; Hall, Casey Daniel; Nguku, Patrick Mboya; Adewuyi, Peter Adebayo

    2017-01-01

    An outbreak of Ebola virus disease occurred in Nigeria between July and September 2014. Contact tracing commenced in Lagos, and extended to Port Harcourt and Enugu as the outbreak continued to spread. A total of 899 contacts were traced. Contact tracing enhanced immediate identification of symptomatic contacts, some of whom eventually became cases. Contact tracing could be challenging in urban cities. However, use of electronic technology, adequate logistics, and highly skilled personnel enhanced the tracing of contacts to facilitate the successful containment of the outbreak. Nigeria was certified to be Ebola free on 21st October 2014. Ebola virus surveillance needs to be maintained to ensure the disease has been contained and to prevent future outbreaks. This case study aims to help trainees to review concepts, apply skills, and address challenges for contact tracing based on the experience of the Nigerian Field Epidemiology Training Network during the 2014 Ebola virus disease outbreak.

  9. Application of biclustering of gene expression data and gene set enrichment analysis methods to identify potentially disease causing nanomaterials

    Directory of Open Access Journals (Sweden)

    Andrew Williams

    2015-12-01

    Full Text Available Background: The presence of diverse types of nanomaterials (NMs in commerce is growing at an exponential pace. As a result, human exposure to these materials in the environment is inevitable, necessitating the need for rapid and reliable toxicity testing methods to accurately assess the potential hazards associated with NMs. In this study, we applied biclustering and gene set enrichment analysis methods to derive essential features of altered lung transcriptome following exposure to NMs that are associated with lung-specific diseases. Several datasets from public microarray repositories describing pulmonary diseases in mouse models following exposure to a variety of substances were examined and functionally related biclusters of genes showing similar expression profiles were identified. The identified biclusters were then used to conduct a gene set enrichment analysis on pulmonary gene expression profiles derived from mice exposed to nano-titanium dioxide (nano-TiO2, carbon black (CB or carbon nanotubes (CNTs to determine the disease significance of these data-driven gene sets.Results: Biclusters representing inflammation (chemokine activity, DNA binding, cell cycle, apoptosis, reactive oxygen species (ROS and fibrosis processes were identified. All of the NM studies were significant with respect to the bicluster related to chemokine activity (DAVID; FDR p-value = 0.032. The bicluster related to pulmonary fibrosis was enriched in studies where toxicity induced by CNT and CB studies was investigated, suggesting the potential for these materials to induce lung fibrosis. The pro-fibrogenic potential of CNTs is well established. Although CB has not been shown to induce fibrosis, it induces stronger inflammatory, oxidative stress and DNA damage responses than nano-TiO2 particles.Conclusion: The results of the analysis correctly identified all NMs to be inflammogenic and only CB and CNTs as potentially fibrogenic. In addition to identifying several

  10. A review of methods for assessment of coronary microvascular disease in both clinical and experimental settings

    DEFF Research Database (Denmark)

    Pries, A.R.; Habazettl, H.; Ambrosio, G.

    2008-01-01

    with abnormalities of the coronary microcirculation and may thus represent a manifestation of coronary microvascular disease (CMD). Elucidation of the role of the microvasculature in the genesis of myocardial ischaemia and cardiac damage-in the presence or absence of obstructive coronary atherosclerosis......-will certainly result in more rational diagnostic and therapeutic interventions for patients with ischaemic heart disease. Specifically targeted research based on improved assessment modalities is needed to improve the diagnosis of CMD and to translate current molecular, cellular, and physiological knowledge...

  11. Residual disease detected by flow cytometry is an independent predictor of survival in childhood acute myeloid leukaemia; results of the NOPHO-AML 2004 study

    DEFF Research Database (Denmark)

    Tierens, Anne; Bjørklund, Elizabeth; Siitonen, Sanna

    2016-01-01

    Early response after induction is a prognostic factor for disease outcome in childhood acute myeloid leukaemia (AML). Residual disease (RD) detection by multiparameter flow cytometry (MFC) was performed at day 15 and before consolidation therapy in 101 patients enrolled in the Nordic Society...... of Paediatric Haemato-Oncology AML 2004 study. A multicentre laboratory approach to RD analysis was used. Event-free survival (EFS) and overall survival (OS) was significantly different in patients with and without RD at both time points, using a 0·1% RD cut-off level. RD-negative and -positive patients after...... first induction showed a 5-year EFS of 65 ± 7% and 22 ± 7%, respectively (P consolidation therapy had a 5-year EFS of 57 ± 7% and 11 ± 7%, respectively (P

  12. Residue processing

    Energy Technology Data Exchange (ETDEWEB)

    Gieg, W.; Rank, V.

    1942-10-15

    In the first stage of coal hydrogenation, the liquid phase, light and heavy oils were produced; the latter containing the nonliquefied parts of the coal, the coal ash, and the catalyst substances. It was the problem of residue processing to extract from these so-called let-down oils that which could be used as pasting oils for the coal. The object was to obtain a maximum oil extraction and a complete removal of the solids, because of the latter were returned to the process they would needlessly burden the reaction space. Separation of solids in residue processing could be accomplished by filtration, centrifugation, extraction, distillation, or low-temperature carbonization (L.T.C.). Filtration or centrifugation was most suitable since a maximum oil yield could be expected from it, since only a small portion of the let-down oil contained in the filtration or centrifugation residue had to be thermally treated. The most satisfactory centrifuge at this time was the Laval, which delivered liquid centrifuge residue and centrifuge oil continuously. By comparison, the semi-continuous centrifuges delivered plastic residues which were difficult to handle. Various apparatus such as the spiral screw kiln and the ball kiln were used for low-temperature carbonization of centrifuge residues. Both were based on the idea of carbonization in thin layers. Efforts were also being made to produce electrode carbon and briquette binder as by-products of the liquid coal phase.

  13. Mass Spectrometry Data Set for Renal Cell Carcinoma and Polycystic Kidney Disease Cell Models

    Energy Technology Data Exchange (ETDEWEB)

    Stewart, B. J. [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2017-01-05

    This data set will be evaluated by collaborators at UC Davis for possible inclusion in a research paper for publication in a scientific journal and to assist in the design of additional experiments. Researchers from UC Davis and LLNL will contribute to the manuscript.

  14. A complementary role of multiparameter flow cytometry and high-throughput sequencing for minimal residual disease detection in chronic lymphocytic leukemia: an European Research Initiative on CLL study.

    LENUS (Irish Health Repository)

    Rawstron, A C

    2016-04-01

    In chronic lymphocytic leukemia (CLL) the level of minimal residual disease (MRD) after therapy is an independent predictor of outcome. Given the increasing number of new agents being explored for CLL therapy, using MRD as a surrogate could greatly reduce the time necessary to assess their efficacy. In this European Research Initiative on CLL (ERIC) project we have identified and validated a flow-cytometric approach to reliably quantitate CLL cells to the level of 0.0010% (10(-5)). The assay comprises a core panel of six markers (i.e. CD19, CD20, CD5, CD43, CD79b and CD81) with a component specification independent of instrument and reagents, which can be locally re-validated using normal peripheral blood. This method is directly comparable to previous ERIC-designed assays and also provides a backbone for investigation of new markers. A parallel analysis of high-throughput sequencing using the ClonoSEQ assay showed good concordance with flow cytometry results at the 0.010% (10(-4)) level, the MRD threshold defined in the 2008 International Workshop on CLL guidelines, but it also provides good linearity to a detection limit of 1 in a million (10(-6)). The combination of both technologies would permit a highly sensitive approach to MRD detection while providing a reproducible and broadly accessible method to quantify residual disease and optimize treatment in CLL.

  15. Influence of contact definitions in assessment of the relative importance of social settings in disease transmission risk.

    Directory of Open Access Journals (Sweden)

    Kirsty J Bolton

    Full Text Available BACKGROUND: Realistic models of disease transmission incorporating complex population heterogeneities require input from quantitative population mixing studies. We use contact diaries to assess the relative importance of social settings in respiratory pathogen spread using three measures of person contact hours (PCH as proxies for transmission risk with an aim to inform bipartite network models of respiratory pathogen transmission. METHODS AND FINDINGS: Our survey examines the contact behaviour for a convenience sample of 65 adults, with each encounter classified as occurring in a work, retail, home, social, travel or "other" setting. The diary design allows for extraction of PCH-interaction (cumulative time in face-face conversational or touch interaction with contacts--analogous to the contact measure used in several existing surveys--as well as PCH-setting (product of time spent in setting and number of people present and PCH-reach (product of time spent in setting and number of people in close proximity. Heterogeneities in day-dependent distribution of risk across settings are analysed using partitioning and cluster analyses and compared between days and contact measures. Although home is typically the highest-risk setting when PCH measures isolate two-way interactions, its relative importance compared to social and work settings may reduce when adopting a more inclusive contact measure that considers the number and duration of potential exposure events. CONCLUSIONS: Heterogeneities in location-dependent contact behaviour as measured by contact diary studies depend on the adopted contact definition. We find that contact measures isolating face-face conversational or touch interactions suggest that contact in the home dominates, whereas more inclusive contact measures indicate that home and work settings may be of higher importance. In the absence of definitive knowledge of the contact required to facilitate transmission of various

  16. Investigation of a cluster of ten cases of Hodgkin's disease in an occupational setting

    NARCIS (Netherlands)

    Swaen, G.M.H.; Slangen, J.J.M.; Ott, M.G.; Kusters, E.; van den Langenbergh, G.; Arends, J.W.; Zober, A.

    1996-01-01

    The objective of this study was to identify occupational exposures that might be etiologically linked to an unusual cluster of ten cases of Hodgkin's disease. The cases were identified within the active workforce of a large chemical manufacturing firm over a 23-year period by the medical director of

  17. Follow-up of patients with rheumatic heart diseases in the outpatient setting

    Directory of Open Access Journals (Sweden)

    B S Belov

    2009-01-01

    Full Text Available The major tasks of a follow-up of patients with rheumatic cardiac defects (RCD are formulated on the basis of the recommendations of international and national scientific associations. At the same time, a clinicianXs experience and judgments play an important role in supervising patients with chronic rheumatic heart disease and RCD.

  18. Characterisation of aggression in Huntington's disease: rates, types and antecedents in an inpatient rehabilitation setting.

    Science.gov (United States)

    Brown, Anahita; Sewell, Katherine; Fisher, Caroline A

    2017-10-01

    To systematically review aggression in an inpatient Huntington's cohort examining rates, types and antecedents. Although the prevalence of aggression in Huntington's disease is high, research into this problematic behaviour has been limited. Few studies have investigated the nature of aggressive behaviour in Huntington's disease or antecedents that contribute to its occurrence. A systematic, double-coded, electronic medical file audit. The electronic hospital medical records of 10 people with Huntington's disease admitted to a brain disorders unit were audited for a 90-day period using the Overt Aggression Scale-Modified for Neurorehabilitation framework, yielding 900 days of clinical data. Nine of 10 clients exhibited aggression during the audit period. Both verbal (37·1%) aggression and physical aggression were common (33·8%), along with episodes of mixed verbal and physical aggression (15·2%), while aggression to objects/furniture was less prevalent (5·5%). The most common antecedent was physical guidance with personal care, far exceeding any other documented antecedents, and acting as the most common trigger for four of the nine clients who exhibited aggression. For the remaining five clients, there was intraindividual heterogeneity in susceptibility to specific antecedents. In Huntington's sufferers at mid- to late stages following disease onset, particular care should be made with personal care assistance due to the propensity for these procedures to elicit an episode of aggression. However, given the degree of intraindividual heterogeneity in susceptibility to specific antecedents observed in the present study, individualised behaviour support plans and sensory modulation interventions may be the most useful in identifying triggers and managing aggressive episodes. Rates of aggression in Huntington's disease inpatients can be high. Knowledge of potential triggers, such as personal care, is important for nursing and care staff, so that attempts can be

  19. Monkeypox disease transmission in an experimental setting: prairie dog animal model.

    Directory of Open Access Journals (Sweden)

    Christina L Hutson

    Full Text Available Monkeypox virus (MPXV is considered the most significant human public health threat in the genus Orthopoxvirus since the eradication of variola virus (the causative agent of smallpox. MPXV is a zoonotic agent endemic to forested areas of Central and Western Africa. In 2003, MPXV caused an outbreak in the United States due to the importation of infected African rodents, and subsequent sequential infection of North American prairie dogs (Cynomys ludovicianus and humans. In previous studies, the prairie dog MPXV model has successfully shown to be very useful for understanding MPXV since the model emulates key characteristics of human monkeypox disease. In humans, percutaneous exposure to animals has been documented but the primary method of human-to-human MPXV transmission is postulated to be by respiratory route. Only a few animal model studies of MPXV transmission have been reported. Herein, we show that MPXV infected prairie dogs are able to transmit the virus to naive animals through multiple transmission routes. All secondarily exposed animals were infected with MPXV during the course of the study. Notably, animals secondarily exposed appeared to manifest more severe disease; however, the disease course was very similar to those of experimentally challenged animals including inappetence leading to weight loss, development of lesions, production of orthopoxvirus antibodies and shedding of similar levels or in some instances higher levels of MPXV from the oral cavity. Disease was transmitted via exposure to contaminated bedding, co-housing, or respiratory secretions/nasal mucous (we could not definitively say that transmission occurred via respiratory route exclusively. Future use of the model will allow us to evaluate infection control measures, vaccines and antiviral strategies to decrease disease transmission.

  20. Cardiovascular disease and risk in primary care settings in the United States.

    Science.gov (United States)

    Ndumele, Chima D; Baer, Heather J; Shaykevich, Shimon; Lipsitz, Stuart R; Hicks, Leroi S

    2012-02-15

    Primary care site may play an important role in cardiovascular disease prevalence; however, the distribution of risk factors and outcomes across care sites is not known. In this study, a cross-sectional analysis of 21,778 adult participants from the National Health and Nutrition Examination Survey (NHANES; 1999 to 2008) using multivariate logistic regression was conducted to assess the relation between site of usual care and disease prevalence. Patients' self-reported histories of several chronic conditions (hypertension, diabetes, and hypercholesterolemia), awareness of chronic conditions, and associated cardiovascular events (angina, coronary heart disease, cardiovascular disease, myocardial infarction, and stroke) were examined. After adjustment for demographic and health care utilization characteristics, there were no significant differences in the prevalence of diabetes or hypercholesterolemia among patients receiving usual care at private doctors' offices, hospital outpatient clinics, community-based clinics, and emergency rooms (ER). However, participants without usual sources of care and those receiving usual care at ERs had significantly lower awareness of their chronic conditions than participants at other sites. The odds of having a history of each of the adverse cardiovascular events ranged from 2.21 to 4.18 times higher for patients receiving usual care at ERs relative to private doctors' offices. In conclusion, participants who report using ERs as their usual sites of care are disproportionately more likely to have histories of poor cardiovascular outcomes and are more likely to be unaware of having hypertension or hypercholesterolemia. As health care reform takes place and millions more begin seeking care, it is imperative to ensure access to longitudinal care sites designed for continuous disease management. Copyright © 2012 Elsevier Inc. All rights reserved.

  1. Recalibrating disease parameters for increasing realism in modeling epidemics in closed settings.

    Science.gov (United States)

    Bioglio, Livio; Génois, Mathieu; Vestergaard, Christian L; Poletto, Chiara; Barrat, Alain; Colizza, Vittoria

    2016-11-14

    The homogeneous mixing assumption is widely adopted in epidemic modelling for its parsimony and represents the building block of more complex approaches, including very detailed agent-based models. The latter assume homogeneous mixing within schools, workplaces and households, mostly for the lack of detailed information on human contact behaviour within these settings. The recent data availability on high-resolution face-to-face interactions makes it now possible to assess the goodness of this simplified scheme in reproducing relevant aspects of the infection dynamics. We consider empirical contact networks gathered in different contexts, as well as synthetic data obtained through realistic models of contacts in structured populations. We perform stochastic spreading simulations on these contact networks and in populations of the same size under a homogeneous mixing hypothesis. We adjust the epidemiological parameters of the latter in order to fit the prevalence curve of the contact epidemic model. We quantify the agreement by comparing epidemic peak times, peak values, and epidemic sizes. Good approximations of the peak times and peak values are obtained with the homogeneous mixing approach, with a median relative difference smaller than 20 % in all cases investigated. Accuracy in reproducing the peak time depends on the setting under study, while for the peak value it is independent of the setting. Recalibration is found to be linear in the epidemic parameters used in the contact data simulations, showing changes across empirical settings but robustness across groups and population sizes. An adequate rescaling of the epidemiological parameters can yield a good agreement between the epidemic curves obtained with a real contact network and a homogeneous mixing approach in a population of the same size. The use of such recalibrated homogeneous mixing approximations would enhance the accuracy and realism of agent-based simulations and limit the intrinsic biases of

  2. Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson’s Disease Dementia and Dementia with Lewy Bodies

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    Tamlyn J. Watermeyer

    2016-01-01

    Full Text Available Alongside the physical symptoms associated with Parkinson’s disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual’s needs and abilities. Fundamental to this therapy is a person’s capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson’s disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants’ goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015.

  3. Goal Setting for Cognitive Rehabilitation in Mild to Moderate Parkinson's Disease Dementia and Dementia with Lewy Bodies.

    Science.gov (United States)

    Watermeyer, Tamlyn J; Hindle, John V; Roberts, Julie; Lawrence, Catherine L; Martyr, Anthony; Lloyd-Williams, Huw; Brand, Andrew; Gutting, Petra; Hoare, Zoe; Edwards, Rhiannon Tudor; Clare, Linda

    2016-01-01

    Alongside the physical symptoms associated with Parkinson's disease dementia and dementia with Lewy bodies, health services must also address the cognitive impairments that accompany these conditions. There is growing interest in the use of nonpharmacological approaches to managing the consequences of cognitive disorder. Cognitive rehabilitation is a goal-orientated behavioural intervention which aims to enhance functional independence through the use of strategies specific to the individual's needs and abilities. Fundamental to this therapy is a person's capacity to set goals for rehabilitation. To date, no studies have assessed goal setting in early-stage Parkinson's disease dementia or dementia with Lewy bodies. Semistructured interviews were carried out with 29 participants from an ongoing trial of cognitive rehabilitation for people with these conditions. Here, we examined the goal statements provided by these participants using qualitative content analysis, exploring the types and nature of the goals set. Participants' goals reflected their motivations to learn new skills or improve performance in areas such as technology-use, self-management and orientation, medication management, and social and leisure activities. These results suggest that goal setting is achievable for these participants, provide insight into the everyday cognitive difficulties that they experience, and highlight possible domains as targets for intervention. The trial is registered with ISRCTN16584442 (DOI 10.1186/ISRCTN16584442 13/04/2015).

  4. Development of an Automated Healthcare Kiosk for the Management of Chronic Disease Patients in the Primary Care Setting.

    Science.gov (United States)

    Ng, Grace; Tan, Nicolette; Bahadin, Juliana; Shum, Eugene; Tan, Sze Wee

    2016-07-01

    An increase in the prevalence of chronic disease has led to a rise in the demand for primary healthcare services in many developed countries. Healthcare technology tools may provide the leverage to alleviate the shortage of primary care providers. Here we describe the development and usage of an automated healthcare kiosk for the management of patients with stable chronic disease in the primary care setting. One-hundred patients with stable chronic disease were recruited from a primary care clinic. They used a kiosk in place of doctors' consultations for two subsequent follow-up visits. Patient and physician satisfaction with kiosk usage were measured on a Likert scale. Kiosk blood pressure measurements and triage decisions were validated and optimized. Patients were assessed if they could use the kiosk independently. Patients and physicians were satisfied with all areas of kiosk usage. Kiosk triage decisions were accurate by the 2nd month of the study. Blood pressure measurements by the kiosk were equivalent to that taken by a nurse (p = 0.30, 0.14). Independent kiosk usage depended on patients' language skills and educational levels. Healthcare kiosks represent an alternative way to manage patients with stable chronic disease. They have the potential to replace physician visits and improve access to primary healthcare. Patients welcome the use of healthcare technology tools, including those with limited literacy and education. Optimization of environmental and patient factors may be required prior to the implementation of kiosk-based technology in the healthcare setting.

  5. SAGES: a suite of freely-available software tools for electronic disease surveillance in resource-limited settings.

    Directory of Open Access Journals (Sweden)

    Sheri L Lewis

    Full Text Available Public health surveillance is undergoing a revolution driven by advances in the field of information technology. Many countries have experienced vast improvements in the collection, ingestion, analysis, visualization, and dissemination of public health data. Resource-limited countries have lagged behind due to challenges in information technology infrastructure, public health resources, and the costs of proprietary software. The Suite for Automated Global Electronic bioSurveillance (SAGES is a collection of modular, flexible, freely-available software tools for electronic disease surveillance in resource-limited settings. One or more SAGES tools may be used in concert with existing surveillance applications or the SAGES tools may be used en masse for an end-to-end biosurveillance capability. This flexibility allows for the development of an inexpensive, customized, and sustainable disease surveillance system. The ability to rapidly assess anomalous disease activity may lead to more efficient use of limited resources and better compliance with World Health Organization International Health Regulations.

  6. Mining tissue specificity, gene connectivity and disease association to reveal a set of genes that modify the action of disease causing genes

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    Reverter Antonio

    2008-09-01

    Full Text Available Abstract Background The tissue specificity of gene expression has been linked to a number of significant outcomes including level of expression, and differential rates of polymorphism, evolution and disease association. Recent studies have also shown the importance of exploring differential gene connectivity and sequence conservation in the identification of disease-associated genes. However, no study relates gene interactions with tissue specificity and disease association. Methods We adopted an a priori approach making as few assumptions as possible to analyse the interplay among gene-gene interactions with tissue specificity and its subsequent likelihood of association with disease. We mined three large datasets comprising expression data drawn from massively parallel signature sequencing across 32 tissues, describing a set of 55,606 true positive interactions for 7,197 genes, and microarray expression results generated during the profiling of systemic inflammation, from which 126,543 interactions among 7,090 genes were reported. Results Amongst the myriad of complex relationships identified between expression, disease, connectivity and tissue specificity, some interesting patterns emerged. These include elevated rates of expression and network connectivity in housekeeping and disease-associated tissue-specific genes. We found that disease-associated genes are more likely to show tissue specific expression and most frequently interact with other disease genes. Using the thresholds defined in these observations, we develop a guilt-by-association algorithm and discover a group of 112 non-disease annotated genes that predominantly interact with disease-associated genes, impacting on disease outcomes. Conclusion We conclude that parameters such as tissue specificity and network connectivity can be used in combination to identify a group of genes, not previously confirmed as disease causing, that are involved in interactions with disease causing

  7. Irradiation in the setting of collagen vascular disease: acute and late toxicity

    International Nuclear Information System (INIS)

    Morris, Monica; Powell, Simon

    1996-01-01

    Purpose: Based upon reports of greater toxicity from radiation therapy, collagen vascular diseases have been considered a contraindication to irradiation. We assessed the acute and late complication rate of radiation therapy in patients with collagen vascular disease. Methods and Materials: A retrospective chart review was undertaken to analyze acute and late toxicity in the 96 patients with documented collagen vascular disease (CVD) who were irradiated between 1960 and 1995. The majority had rheumatoid arthritis (55); 14 had systemic lupus erythematosus; 7 polymyositis or dermatomyositis; 7 ankylosing spondylitis; 4 scleroderma; 2 juvenile rheumatoid arthritis; and the remainder various mixed connective tissue disorders. Mean follow up of survivors was 6.3 years from time of irradiation. Treatment was megavoltage in all but 8 cases. Doses ranged from 6 to 70Gy, with an average of 41.7Gy. Treatment of 32 sites was combined with chemotherapy, 15 concurrent with irradiation. Surgery was involved in the treatment of 46 sites. Toxicity was scored using the RTOG acute and the RTOG/EORTC Late Effects on Normal Tissues radiation morbidity scoring scales. Results: Overall, 127 sites were evaluable in 96 patients. Significant (grade 3 or higher) acute complications were seen in 15 of 127 (11.8%) of irradiated sites. The actuarial incidence of significant late complications at 5 and 10 years was 16% and 24%, respectively. There was a single in-field sarcoma. 2 patients had treatment-related deaths, one from leukencephalopathy and the other from postoperative wound infection. Univariate analysis revealed late effects to be more severe in those receiving combined modality treatment (p=.03), and in those with significant acute reactions (p=.0001). Patients with rheumatoid arthritis had less severe late effects than those with other collagen vascular diseases (6% vs 37% at 5 years, p=.0001). We did not demonstrate a difference in late effects according to radiation dose, timing

  8. Minimum incidence of adult invasive pneumococcal disease in Blantyre, Malawi an urban african setting: a hospital based prospective cohort study.

    Science.gov (United States)

    Bar-Zeev, Naor; Mtunthama, Neema; Gordon, Stephen B; Mwafulirwa, Gershom; French, Neil

    2015-01-01

    Invasive pneumococcal disease causes substantial morbidity and mortality in Africa. Evaluating population level indirect impact on adult disease of pneumococcal conjugate vaccine (PCV) programmes in infants requires baseline population incidence rates but these are often lacking in areas with limited disease surveillance. We used hospital based blood culture and cerebrospinal fluid surveillance to calculate minimal incidence of invasive pneumococcal disease in the adult (≥15 years old) population of Blantyre, a rapidly growing urban centre in southern Malawi, in the period preceding vaccine introduction. Invasive pneumococcal disease incidence in Blantyre district was high, mean 58.1 (95% confidence interval (CI): 53.7, 62.7) per 100,000 person years and peaking among 35 to 40 year olds at 108.8 (95%CI: 89.0, 131.7) mirroring the population age prevalence of HIV infection. For pneumococcal bacteraemia in urban Blantyre, mean incidence was 60.6 (95% CI: 55.2, 66.5) per 100,000 person years, peaking among 35 to 40 year olds at 114.8 (95%CI: 90.3, 143.9). We suspected that our surveillance may under-ascertain the true burden of disease, so we used location data from bacteraemic subjects and projected population estimates to calculate local sub-district incidence, then examined the impact of community level socio-demographic covariates as possible predictors of local sub-district incidence of pneumococcal and non-pneumococcal pathogenic bacteraemia. Geographic heterogeneity in incidence was marked with localised hotspots but ward level covariates apart from prison were not associated with pneumococcal bacteraemia incidence. Modelling suggests that the current sentinel surveillance system under-ascertains the true burden of disease. We outline a number of challenges to surveillance for pneumococcal disease in our low-resource setting. Subsequent surveillance in the vaccine era will have to account for geographic heterogeneity when evaluating population level indirect

  9. Minimum incidence of adult invasive pneumococcal disease in Blantyre, Malawi an urban african setting: a hospital based prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Naor Bar-Zeev

    Full Text Available Invasive pneumococcal disease causes substantial morbidity and mortality in Africa. Evaluating population level indirect impact on adult disease of pneumococcal conjugate vaccine (PCV programmes in infants requires baseline population incidence rates but these are often lacking in areas with limited disease surveillance. We used hospital based blood culture and cerebrospinal fluid surveillance to calculate minimal incidence of invasive pneumococcal disease in the adult (≥15 years old population of Blantyre, a rapidly growing urban centre in southern Malawi, in the period preceding vaccine introduction. Invasive pneumococcal disease incidence in Blantyre district was high, mean 58.1 (95% confidence interval (CI: 53.7, 62.7 per 100,000 person years and peaking among 35 to 40 year olds at 108.8 (95%CI: 89.0, 131.7 mirroring the population age prevalence of HIV infection. For pneumococcal bacteraemia in urban Blantyre, mean incidence was 60.6 (95% CI: 55.2, 66.5 per 100,000 person years, peaking among 35 to 40 year olds at 114.8 (95%CI: 90.3, 143.9. We suspected that our surveillance may under-ascertain the true burden of disease, so we used location data from bacteraemic subjects and projected population estimates to calculate local sub-district incidence, then examined the impact of community level socio-demographic covariates as possible predictors of local sub-district incidence of pneumococcal and non-pneumococcal pathogenic bacteraemia. Geographic heterogeneity in incidence was marked with localised hotspots but ward level covariates apart from prison were not associated with pneumococcal bacteraemia incidence. Modelling suggests that the current sentinel surveillance system under-ascertains the true burden of disease. We outline a number of challenges to surveillance for pneumococcal disease in our low-resource setting. Subsequent surveillance in the vaccine era will have to account for geographic heterogeneity when evaluating population

  10. A guide to the effects of a large portion of the residues of triosephosphate isomerase on catalysis, stability, druggability, and human disease.

    Science.gov (United States)

    Olivares-Illana, Vanesa; Riveros-Rosas, Hector; Cabrera, Nallely; Tuena de Gómez-Puyou, Marietta; Pérez-Montfort, Ruy; Costas, Miguel; Gómez-Puyou, Armando

    2017-07-01

    Triosephosphate isomerase (TIM) is a ubiquitous enzyme, which appeared early in evolution. TIM is responsible for obtaining net ATP from glycolysis and producing an extra pyruvate molecule for each glucose molecule, under aerobic and anaerobic conditions. It is placed in a metabolic crossroad that allows a quick balance of the triose phosphate aldolase produced by glycolysis, and is also linked to lipid metabolism through the alternation of glycerol-3-phosphate and the pentose cycle. TIM is one of the most studied enzymes with more than 199 structures deposited in the PDB. The interest for this enzyme stems from the fact that it is involved in glycolysis, but also in aging, human diseases and metabolism. TIM has been a target in the search for chemical compounds against infectious diseases and is a model to study catalytic features. Until February 2017, 62% of all residues of the protein have been studied by mutagenesis and/or using other approaches. Here, we present a detailed and comprehensive recompilation of the reported effects on TIM catalysis, stability, druggability and human disease produced by each of the amino acids studied, contributing to a better understanding of the properties of this fundamental protein. The information reviewed here shows that the role of the noncatalytic residues depend on their molecular context, the delicate balance between the short and long-range interactions in concerted action determining the properties of the protein. Each protein should be regarded as a unique entity that has evolved to be functional in the organism to which it belongs. Proteins 2017; 85:1190-1211. © 2017 Wiley Periodicals, Inc. © 2017 Wiley Periodicals, Inc.

  11. Changes in serum CA-125 can predict optimal cytoreduction to no gross residual disease in patients with advanced stage ovarian cancer treated with neoadjuvant chemotherapy.

    Science.gov (United States)

    Rodriguez, Noah; Rauh-Hain, J Alejandro; Shoni, Melina; Berkowitz, Ross S; Muto, Michael G; Feltmate, Colleen; Schorge, John O; Del Carmen, Marcela G; Matulonis, Ursula A; Horowitz, Neil S

    2012-05-01

    To evaluate the predictive power of serum CA-125 changes in the management of patients undergoing neoadjuvant chemotherapy followed by interval debulking surgery (NACT-IDS) for a new diagnosis of epithelial ovarian carcinoma (EOC). Using the Cancer Registry databases from our institutions, a retrospective review of patients with FIGO stage IIIC and IV EOC who were treated with platinum-based NACT-IDS between January 2006 and December 2009 was conducted. Demographic data, CA-125 levels, radiographic data, chemotherapy, and surgical-pathologic information were obtained. Continuous variables were evaluated by Student's t test or Wilcoxon-Mann-Whitney test. One hundred-three patients with stage IIIC or IV EOC met study criteria. Median number of neoadjuvant cycles was 3. Ninety-nine patients (96.1%) were optimally cytoreduced. Forty-seven patients (47.5%) had resection to no residual disease (NRD). The median CA-125 at diagnosis and before interval debulking was 1749U/mL and 161U/mL, respectively. Comparing patients with NRD v. optimal macroscopic disease (OMD), there was no statistical difference in the mean CA-125 at diagnosis (1566U/mL v. 2077U/mL, p=0.1). There was a significant difference in the mean CA-125 prior to interval debulking, 92 v. 233U/mL (p=0.001). In the NRD group, 38 patients (80%) had preoperative CA-125≤100U/mL compared to 33 patients (63.4%) in the OMD group (p=0.04). Patients who undergo NACT-IDS achieve a high rate of optimal cytoreduction. In our series, after treatment with taxane and platinum-based chemotherapy, patients with a preoperative CA-125 of ≤100U/mL were highly likely to be cytoreduced to no residual disease. Copyright © 2012. Published by Elsevier Inc.

  12. Hirschprung's disease in different settings - a series of three cases from a tertiary referral center.

    Science.gov (United States)

    Singer, Cristina Elena; Coşoveanu, Carmen Simona; Ciobanu, Mircea Ovidiu; Stoica, George Alin; Puiu, Ileana; Gruia, Corina Lavinia; Streba, Liliana; Constantin, Cristian; Neagoe, Carmen Daniela

    2015-01-01

    Failure of neural crest cells to migrate from neural crests during intrauterine development result in partial or total aganglionosis of the colon in newborn. Hirschprung's disease (HD) represents the clinical manifestation of this pathogenic process, currently accounting for the majority of lower intestinal obstruction in the first period of life. Our aim was to present a series of three cases presenting to our tertiary care center with a range of symptoms, all benefiting from surgery and consequent pathology examination of biopsy or resection pieces. The first case was of a male newborn that presented several years ago with common symptoms for HD (abdominal distension, vomiting and the total lack of intestinal passage for feces). Coming from young healthy parents after normal labor, the newborn displayed signs of Down's disease after physical examination. After abdominal radiography, the patient underwent surgery and consecutive pathology revealed notable signs of Crohn's disease (CD): massive stasis in the serosa and submucosa, chronic inflammatory infiltrate and lack of nervous cells in both plexuses and mucosa. Immunohistochemistry revealed low intensity CD34 membrane staining for fibroblast-like ganglion cells while CD117 staining showed few nervous cells within the mucosa. The second case presented before one year of age with an infectious background, already being operated upon with colostoma. We performed corrective surgery of the colostoma and consecutive pathology showed low CD117 cytoplasmic staining and intensely positive NSE (neuron specific enolase) staining within myenteric plexuses. Finally, the third and most recent case was that of a 4-year-old boy with an early diagnosis of megacolon and no previous surgery, who we evaluated by laparoscopy with five biopsies and consecutive S100 staining revealed a small number of nervous cells within nervous plexuses. In conclusion, an early diagnosis of HD is essential for successful therapeutic measures

  13. Attentional set-shifting deficit in Parkinson's disease is associated with prefrontal dysfunction: an FDG-PET study.

    Directory of Open Access Journals (Sweden)

    Yoichi Sawada

    Full Text Available The attentional set-shifting deficit that has been observed in Parkinson's disease (PD has long been considered neuropsychological evidence of the involvement of meso-prefrontal and prefrontal-striatal circuits in cognitive flexibility. However, recent studies have suggested that non-dopaminergic, posterior cortical pathologies may also contribute to this deficit. Although several neuroimaging studies have addressed this issue, the results of these studies were confounded by the use of tasks that required other cognitive processes in addition to set-shifting, such as rule learning and working memory. In this study, we attempted to identify the neural correlates of the attentional set-shifting deficit in PD using a compound letter task and 18F-fluoro-deoxy-glucose (FDG positron emission tomography during rest. Shift cost, which is a measure of attentional set-shifting ability, was significantly correlated with hypometabolism in the right dorsolateral prefrontal cortex, including the putative human frontal eye field. Our results provide direct evidence that dysfunction in the dorsolateral prefrontal cortex makes a primary contribution to the attentional set-shifting deficit that has been observed in PD patients.

  14. Crohn's disease-associated silent aspiration in the outpatient setting: Anesthesiologists beware.

    Science.gov (United States)

    Snell, Christopher; Coleman, Scott; Van Hal, Michele; Rashidian, Farshad; Okum, Gary; Green, Michael Stuart

    2018-01-01

    Every anesthesia provider fears aspiration of gastric contents during an anesthetic, and it may occur even in the absence of overt signs such as coughing or choking. Whether the aspiration is frank or silent, catastrophic and deleterious consequences may ensue. Therefore, familiarity with risk factors for silent aspiration is essential. Crohn's disease reportedly delays gastric emptying making these patients more susceptible to silent aspiration during surgery. Anesthesia providers must be cognizant of this risk and vigilant in the recognition to formulate a specific treatment plan preoperatively. We present a case of an ambulatory surgical patient with suspected silent aspiration undiagnosed by the anesthesia care team before induction of anesthesia.

  15. Sleep Disordered Breathing in Four Resource-Limited Settings in Peru: Prevalence, Risk Factors, and Association with Chronic Diseases.

    Science.gov (United States)

    Schwartz, Noah G; Rattner, Adi; Schwartz, Alan R; Mokhlesi, Babak; Gilman, Robert H; Bernabe-Ortiz, Antonio; Miranda, J Jaime; Checkley, William

    2015-09-01

    Sleep disordered breathing (SDB) is a highly prevalent condition in high-income countries, with major consequences for cardiopulmonary health, public safety, healthcare utilization, and mortality. However, its prevalence and effect in low- and middle-income countries are less well known. We sought to determine the prevalence, risk factors, and comorbidities of SDB symptoms in four resource-limited settings. Cross-sectional analysis of the CRONICAS Cohort, a population-based age- and sex-stratified sample. Four resource-limited settings in Peru varying in altitude, urbanization, and air pollution. There were 2,682 adults aged 35 to 92 y. Self-reported SDB symptoms (habitual snoring, observed apneas, Epworth Sleepiness Scale), sociodemographics, medical history, anthropometrics, spirometry, blood biomarkers were reported. We found a high prevalence of habitual snoring (30.2%, 95% confidence interval [CI] 28.5-32.0%), observed apneas (20.9%, 95% CI 19.4-22.5%) and excessive daytime sleepiness (18.6%, 95% CI 17.1-20.1%). SDB symptoms varied across sites; prevalence and adjusted odds for habitual snoring were greatest at sea level, whereas those for observed apneas were greatest at high altitude. In multivariable analysis, habitual snoring was associated with older age, male sex, body mass index (BMI), and higher socioeconomic status; observed apneas were associated with BMI; and excessive daytime sleepiness was associated with older age, female sex, and medium socioeconomic status. Adjusted odds of cardiovascular disease, depression, and hypertension and total chronic disease burden increased progressively with the number of SDB symptoms. A threefold increase in the odds of having an additional chronic comorbid disease (adjusted odds ratio 3.57, 95% CI 2.18-5.84) was observed in those with all three versus no SDB symptoms. Sleep disordered breathing symptoms were highly prevalent, varied widely across four resource-limited settings in Peru, and exhibited strong

  16. Revealing the Micro-scale Signature of Endemic Zoonotic Disease Transmission in an African Urban Setting.

    Directory of Open Access Journals (Sweden)

    Hervé Bourhy

    2016-04-01

    Full Text Available The development of novel approaches that combine epidemiological and genomic data provides new opportunities to reveal the spatiotemporal dynamics of infectious diseases and determine the processes responsible for their spread and maintenance. Taking advantage of detailed epidemiological time series and viral sequence data from more than 20 years reported by the National Reference Centre for Rabies of Bangui, the capital city of Central African Republic, we used a combination of mathematical modeling and phylogenetic analysis to determine the spatiotemporal dynamics of rabies in domestic dogs as well as the frequency of extinction and introduction events in an African city. We show that although dog rabies virus (RABV appears to be endemic in Bangui, its epidemiology is in fact shaped by the regular extinction of local chains of transmission coupled with the introduction of new lineages, generating successive waves of spread. Notably, the effective reproduction number during each wave was rarely above the critical value of 1, such that rabies is not self-sustaining in Bangui. In turn, this suggests that rabies at local geographic scales is driven by human-mediated dispersal of RABV among sparsely connected peri-urban and rural areas as opposed to dispersion in a relatively large homogenous urban dog population. This combined epidemiological and genomic approach enables development of a comprehensive framework for understanding disease persistence and informing control measures, indicating that control measures are probably best targeted towards areas neighbouring the city that appear as the source of frequent incursions seeding outbreaks in Bangui.

  17. Focused cardiac ultrasound is feasible in the general practice setting and alters diagnosis and management of cardiac disease

    Directory of Open Access Journals (Sweden)

    James Yates

    2016-08-01

    Full Text Available Background: Ultrasound-assisted examination of the cardiovascular system with focused cardiac ultrasound by the treating physician is non-invasive and changes diagnosis and management of patient’s with suspected cardiac disease. This has not been reported in a general practice setting. Aim: To determine whether focused cardiac ultrasound performed on patients aged over 50 years changes the diagnosis and management of cardiac disease by a general practitioner. Design and setting: A prospective observational study of 80 patients aged over 50 years and who had not received echocardiography or chest CT within 12 months presenting to a general practice. Method: Clinical assessment and management of significant cardiac disorders in patients presenting to general practitioners were recorded before and after focused cardiac ultrasound. Echocardiography was performed by a medical student with sufficient training, which was verified by an expert. Differences in diagnosis and management between conventional and ultrasound-assisted assessment were recorded. Results and conclusion: Echocardiography and interpretation were acceptable in all patients. Significant cardiac disease was detected in 16 (20% patients, including aortic stenosis in 9 (11% and cardiac failure in 7 (9%, which were missed by clinical examination in 10 (62.5% of these patients. Changes in management occurred in 12 patients (15% overall and 75% of those found to have significant cardiac disease including referral for diagnostic echocardiography in 8 (10%, commencement of heart failure treatment in 3 (4% and referral to a cardiologist in 1 patient (1%. Routine focused cardiac ultrasound is feasible and frequently alters the diagnosis and management of cardiac disease in patients aged over 50 years presenting to a general practice.

  18. Use of traditional medicines to cope with climate-sensitive diseases in a resource poor setting in Bangladesh.

    Science.gov (United States)

    Haque, Md Aminul; Louis, Valérie R; Phalkey, Revati; Sauerborn, Rainer

    2014-02-25

    This study aims to explore the use of traditional medicines to cope with climate sensitive diseases in areas vulnerable to climate change. We assessed the extent to which traditional or alternative medicines were used for the treatment of the climate sensitive diseases by villagers as part of their health-coping strategies. The study deployed a mixed-method research design to know the health-coping strategies of the people in a resource-poor setting.A cross sectional study was conducted from September 2010 to March 2011 among 450 households selected randomly in the districts of Rajshahi and Khulna, Bangladesh. The elder males or females of each household were interviewed. For qualitative methods, twelve focus group discussions (six with females and six with males) and fifteen key informant interviews were conducted by the research team, using interview guidelines on the use of traditional medicine. Univariate analysis showed that the use of traditional medicines has increased among community members of all socio-economic and demographic backgrounds. Due to the increased incidence of disease and sickness respondents had to increase the use of their cultural means to cope with adverse health situations. A systematic collection of knowledge on the use of traditional medicines to cope with climate-sensitive diseases can help the adaptation of communities vulnerable to climate change. In addition it can be instrumental in creating a directory of traditional medicine components used for specific diseases and highlight the effectiveness and relevance of traditional medicines as health-coping strategies. This may be useful for policymakers, researchers, and development partners to adapt existing health care policy in resource-limited contexts. It may also encourage WHO, national and international institutions, such as pharmaceutical companies, to carry out research investigating the effectiveness of these traditional medicines and integrate them with modern medicine

  19. Continuity of Care to Optimize Chronic Disease Management in the Community Setting

    Science.gov (United States)

    2013-01-01

    Background This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. Objective The objective of this evidence-based analysis was to determine if continuity of care is associated with decreased health resource utilization, improved patient outcomes, and patient satisfaction. Data Sources MEDLINE, EMBASE, CINAHL, the Cochrane Library, and the Centre for Reviews and Dissemination database were searched for studies on continuity of care and chronic disease published from January 2002 until December 2011. Review Methods Systematic reviews, randomized controlled trials, and observational studies were eligible if they assessed continuity of care in adults and reported health resource utilization, patient outcomes, or patient satisfaction. Results Eight systematic reviews and 13 observational studies were identified. The reviews concluded that there is an association between continuity of care and outcomes; however, the literature base is weak. The observational studies found that higher continuity of care was frequently associated with fewer hospitalizations and emergency department visits. Three systematic reviews reported that higher continuity of care is associated with improved patient satisfaction, especially among patients with chronic conditions. Limitations Most of the studies were retrospective cross-sectional studies of large administrative databases. The databases do not capture information on trust and confidence in the provider, which is a critical component of relational continuity of care. The definitions for the selection of patients from the databases varied across studies. Conclusions There is low quality evidence that: Higher

  20. Developing open source, self-contained disease surveillance software applications for use in resource-limited settings

    Directory of Open Access Journals (Sweden)

    Campbell Timothy C

    2012-09-01

    Full Text Available Abstract Background Emerging public health threats often originate in resource-limited countries. In recognition of this fact, the World Health Organization issued revised International Health Regulations in 2005, which call for significantly increased reporting and response capabilities for all signatory nations. Electronic biosurveillance systems can improve the timeliness of public health data collection, aid in the early detection of and response to disease outbreaks, and enhance situational awareness. Methods As components of its Suite for Automated Global bioSurveillance (SAGES program, The Johns Hopkins University Applied Physics Laboratory developed two open-source, electronic biosurveillance systems for use in resource-limited settings. OpenESSENCE provides web-based data entry, analysis, and reporting. ESSENCE Desktop Edition provides similar capabilities for settings without internet access. Both systems may be configured to collect data using locally available cell phone technologies. Results ESSENCE Desktop Edition has been deployed for two years in the Republic of the Philippines. Local health clinics have rapidly adopted the new technology to provide daily reporting, thus eliminating the two-to-three week data lag of the previous paper-based system. Conclusions OpenESSENCE and ESSENCE Desktop Edition are two open-source software products with the capability of significantly improving disease surveillance in a wide range of resource-limited settings. These products, and other emerging surveillance technologies, can assist resource-limited countries compliance with the revised International Health Regulations.

  1. Laparoscopy-assisted versus transabdominal reoperation in Hirschprung's disease for residual aganglionosis and transition zone pathology after transanal pull-through.

    Science.gov (United States)

    Xia, Xue; Li, Ning; Wei, Jia; Zhang, Wen; Yu, Donghai; Zhu, Tianqi; Feng, Jiexiong

    2016-04-01

    This study aims to describe laparoscopic reoperation (LSR) and compare its outcomes with transabdominal reoperation (TAR) for treating Hirschsprung's disease (HD). Eighteen patients with HD underwent reoperation for recurring constipation due to residual aganglionosis and transition zone pathology after an initial transanal procedure (LSR, n=10; TAR, n=8). Preoperative, operative and postoperative data were collected through patient follow-ups ranging from 13 to 75months to compare operative characteristics and postoperative outcomes between the two groups. Ten patients underwent laparoscopic reoperation in our institution without major complications. On average, blood loss was significantly lower in the LSR group (mean±standard deviation, 83±32.7mL) than in the TAR group (185±69mL) (P=0.001). The LSR group had a shorter hospitalization time (12±2days) than the TAR group (15±2.1days) (P=0.02). There was no statistically significant difference in incidence of postoperative complications between the two groups. LSR is safe and technically feasible in HD for recurring constipation due to residual aganglionosis and transition zone pathology, when initial transanal procedure fails. Although RA and TZP can be cured by reoperation, great efforts should be made to diminish the necessity of reoperation. Copyright © 2015 Elsevier Inc. All rights reserved.

  2. Moving targets: The challenges of studying infectious diseases among pregnant women in resource limited settings.

    Science.gov (United States)

    Divala, Titus H; Mungwira, Randy G; Laufer, Miriam K

    2015-11-25

    Conducting clinical trials to prevent and treat infectious diseases in pregnancy is essential to saving maternal and newborn lives, though it is fraught with challenges. We have been conducting research in malaria treatment and prevention in children and pregnant women in Blantyre, Malawi for over a decade. Here, we review some of the unique challenges that we have faced in leading research studies that with rigor and integrity and maintaining the highest ethical standard. We conclude with concrete strategies to overcome some of the apparent obstacles that frequently focus on building trust through bidirectional communication with local health workers and communities. We also highlight the key role of local and international investigators to advocate for the health of the communities in which they work. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Anxiety and Atopic Disease: Comorbidity in a Youth Mental Health Setting.

    Science.gov (United States)

    Becker-Haimes, Emily M; Diaz, Kathleen I; Haimes, Bryan A; Ehrenreich-May, Jill

    2017-08-01

    Anxiety frequently co-occurs with atopic diseases (e.g., allergies) in community samples, although data are limited to community and pediatric medical samples. Little work has examined atopy rates among mental health treatment seeking youth or whether youth with comorbid anxiety and atopy present similarly to non-comorbid youth. Using initial intake data from a University-based specialty youth clinic for anxiety and depressive disorders (n = 189), rates of atopic comorbidity were benchmarked against lifetime prevalence estimates in epidemiological samples. Anxiety severity and parental stress were compared between youth with and without atopy. Results indicated high rates of atopy in the clinical sample (51.3 %) relative to population atopy estimates (34.5 %). Anxious youth with atopy exhibited more overall and generalized anxiety symptoms relative to non-atopic youth (ps youth. This suggests potentially heightened clinical severity for youth with co-occurring anxiety and atopy.

  4. Dietary counselling for cardiovascular disease prevention in primary care settings: results from a German physician survey.

    Science.gov (United States)

    Görig, Tatiana; Mayer, Manfred; Bock, Christina; Diehl, Katharina; Hilger, Jennifer; Herr, Raphael M; Schneider, Sven

    2014-06-01

    Primary care physicians (PCPs) play an important role in the promotion of healthy dietary behaviour. However, little is known about the practice of and factors associated with the provision of dietary counselling in primary health care in Germany. To explore the attitudes towards and factors associated with the routine provision of dietary counselling in Germany using data from the nationwide, representative sample of the Physician Survey on Cardiovascular Disease Prevention. A total of 4074 randomly selected PCPs (response rate: 33.9%) provided data on dietary counselling for prevention of cardiovascular disease (CVD) based on the 5 A's (Assess, Advise, Agree, Assist, Arrange), attitudes towards dietary counselling and patients' and practice characteristics. While the majority of PCPs (86%) reported having high levels of competence in providing dietary advice, only 49% felt they had been successful in counselling their patients on nutrition. PCPs routinely asked (68%) and advised patients to change their dietary habits more frequently (77%) compared to other counselling techniques based on the 5 A's. Female physicians and those with a higher percentage of privately insured patients and patients at higher risk of CVD were more likely to use the 5 A's to routinely counsel their patients on nutrition. The data showed high levels of involvement by German PCPs in CVD prevention and dietary counselling. The rather low perceived success of dietary intervention and differences with respect to patients' health insurance status indicate a need to address both communication skills in medical training and appropriate reimbursement of preventive services. © The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  5. Residual risk

    African Journals Online (AJOL)

    ing the residual risk of transmission of HIV by blood transfusion. An epidemiological approach assumed that all HIV infections detected serologically in first-time donors were pre-existing or prevalent infections, and that all infections detected in repeat blood donors were new or incident infections. During 1986 - 1987,0,012%.

  6. Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings.

    Science.gov (United States)

    Hamre, Harald J; Witt, Claudia M; Kienle, Gunver S; Meinecke, Christoph; Glockmann, Anja; Willich, Stefan N; Kiene, Helmut

    2009-06-19

    Many children with chronic disease use complementary therapies. Anthroposophic treatment for paediatric chronic disease is provided by physicians and differs from conventional treatment in the use of special therapies (art therapy, eurythmy movement exercises, rhythmical massage therapy) and special medications. We studied clinical outcomes in children with chronic diseases under anthroposophic treatment in routine outpatient settings. In conjunction with a health benefit program, consecutive outpatients starting anthroposophic treatment for any chronic disease participated in a prospective cohort study. Main outcome was disease severity (Disease and Symptom Scores, physicians' and caregivers' assessment on numerical rating scales 0-10). Disease Score was documented after 0, 6, and 12 months, Symptom Score after 0, 3, 6, 12, 18, and 24 months. A total of 435 patients were included. Mean age was 8.2 years (standard deviation 3.3, range 1.0-16.9 years). Most common indications were mental disorders (46.2% of patients; primarily hyperkinetic, emotional, and developmental disorders), respiratory disorders (14.0%), and neurological disorders (5.7%). Median disease duration at baseline was 3.0 years (interquartile range 1.0-5.0 years). The anthroposophic treatment modalities used were medications (69.2% of patients), eurythmy therapy (54.7%), art therapy (11.3%), and rhythmical massage therapy (6.7%). Median number of eurythmy/art/massage therapy sessions was 12 (interquartile range 10-20), median therapy duration was 118 days (interquartile range 78-189 days).From baseline to six-month follow-up, Disease Score improved by average 3.00 points (95% confidence interval 2.76-3.24 points, p therapies within the first six study months. Children under anthroposophic treatment had long-term improvement of chronic disease symptoms. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that

  7. Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings

    Directory of Open Access Journals (Sweden)

    Willich Stefan N

    2009-06-01

    Full Text Available Abstract Background Many children with chronic disease use complementary therapies. Anthroposophic treatment for paediatric chronic disease is provided by physicians and differs from conventional treatment in the use of special therapies (art therapy, eurythmy movement exercises, rhythmical massage therapy and special medications. We studied clinical outcomes in children with chronic diseases under anthroposophic treatment in routine outpatient settings. Methods In conjunction with a health benefit program, consecutive outpatients starting anthroposophic treatment for any chronic disease participated in a prospective cohort study. Main outcome was disease severity (Disease and Symptom Scores, physicians' and caregivers' assessment on numerical rating scales 0–10. Disease Score was documented after 0, 6, and 12 months, Symptom Score after 0, 3, 6, 12, 18, and 24 months. Results A total of 435 patients were included. Mean age was 8.2 years (standard deviation 3.3, range 1.0–16.9 years. Most common indications were mental disorders (46.2% of patients; primarily hyperkinetic, emotional, and developmental disorders, respiratory disorders (14.0%, and neurological disorders (5.7%. Median disease duration at baseline was 3.0 years (interquartile range 1.0–5.0 years. The anthroposophic treatment modalities used were medications (69.2% of patients, eurythmy therapy (54.7%, art therapy (11.3%, and rhythmical massage therapy (6.7%. Median number of eurythmy/art/massage therapy sessions was 12 (interquartile range 10–20, median therapy duration was 118 days (interquartile range 78–189 days. From baseline to six-month follow-up, Disease Score improved by average 3.00 points (95% confidence interval 2.76–3.24 points, p Conclusion Children under anthroposophic treatment had long-term improvement of chronic disease symptoms. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study

  8. Management of chronic kidney disease: primary health-care setting, self-care and multidisciplinary approach.

    Science.gov (United States)

    Cueto-Manzano, A M; Martínez-Ramírez, H R; Cortés-Sanabria, L

    2010-11-01

    End-stage renal disease (ESRD) is a growing problem, particularly in developing countries. Factors closely related with lifestyle and dietary habits that negatively affect kidney function are rarely modified by isolated medical intervention. Therefore, the present study was designed to determine the effect of an educational program with a multidisciplinary health-care approach supported by self-help groups on the lifestyle and dietary habits of patients at high risk of developing chronic kidney disease (CKD). 51 patients with overweight/obesity, 45 with hypertension and 88 with Type 2 diabetes mellitus (DM2) from a Family Medicine Unit, who had failed to meet clinical practice recommendations, were studied over 6 months. Patients received educational intervention guided by a multidisciplinary health team for 4 weeks (including topics such as emotional management, nutritional patterns, exercise and health-related problems). Reinforcement of goals and group dynamics were performed every 3 months. Additionally, self-help groups were constituted during the first month, and functioned with free activities, selected by patients and supported by the health team, for the duration of the study. A lifestyle questionnaire was administered at baseline and the end of the study; clinical and biochemical evaluations were performed every 3 months. Baseline lifestyle and dietary habits were unhealthy in all groups, particularly with regard to diet and exercise, and clinical and biochemical variables were concordant with inadequate achievement of clinical practice recommendations. After 6 months experience within this program, many of the negative lifestyle characteristics significantly improved. All groups reported a notable improvement in nutritional and exercise habits, as well as in management of the emotions. Only diabetic and hypertensive patients significantly improved the knowledge of their disease and adherence to treatment. None of the groups managed to reduce smoking or

  9. Assessing diabetes practices in clinical settings: precursor to building community partnerships around disease management.

    Science.gov (United States)

    Prochaska, John D; Mier, Nelda; Bolin, Jane N; Hora, Kerrie L; Clark, Heather R; Ory, Marcia G

    2009-12-01

    Many recommended best practices exist for clinical and community diabetes management and prevention. However, in many cases, these recommendations are not being fully utilized. It is useful to gain a sense of currently utilized and needed practices when beginning a partnership building effort to ameliorate such practice problems. The purpose of this study was to assess current practices in clinical settings within the Brazos Valley in preparation for beginning a community-based participatory research project on improving diabetes prevention and management in this region. Fifty-seven physicians with admission privileges to a regional health system were faxed a survey related to current diabetes patient loads, knowledge and implementation of diabetes-related best practices, and related topics. Both qualitative and quantitative examination of the data was conducted. Fifteen percent of responding providers indicated they implemented diabetes prevention best practices, with significant differences between primary-care physicians and specialists. Respondents indicated a need for educational and counseling resources, as well as an increased health-care workforce in the region. The utilization of a faxed-based survey proved an effective means for assessing baseline data as well as serving as a catalyst for further discussion around coalition development. Results indicated a strong need for both clinical and community-based services regarding diabetes prevention and management, and provided information and insight to begin focused community dialogue around diabetes prevention and management needs across the region. Other sites seeking to begin similar projects may benefit from a similar process.

  10. Person-Centered Care in the Home Setting for Parkinson's Disease: Operation House Call Quality of Care Pilot Study.

    Science.gov (United States)

    Hack, Nawaz; Akbar, Umer; Monari, Erin H; Eilers, Amanda; Thompson-Avila, Amanda; Hwynn, Nelson H; Sriram, Ashok; Haq, Ihtsham; Hardwick, Angela; Malaty, Irene A; Okun, Michael S

    2015-01-01

    Objective. (1) To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson's disease (PD) in a rural setting. (2) To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s) of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson's disease was confirmed using standardized criteria, and the Unified Parkinson's Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work). One Operation House Call patient has successfully received deep brain stimulation (DBS). Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

  11. Content Validity of the Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases: An International Delphi Survey.

    Science.gov (United States)

    Jobst, Andrea; Kirchberger, Inge; Cieza, Alarcos; Stucki, Gerold; Stucki, Armin

    2013-01-01

    The "Comprehensive ICF Core Set for Chronic Obstructive Pulmonary Diseases (COPD)" is an application of the International Classification of Functioning, Disability and Health (ICF) and represents the typical spectrum of problems in functioning of patients with COPD. The objective of this study was to validate this ICF Core Set from the perspective of physicians. Physicians experienced in COPD treatment were asked about the patients' problems treated by physicians in patients with COPD in a three-round electronic mail survey using the Delphi technique. Responses were linked to the ICF. Seventy-six physicians in 44 countries gave a total of 1330 responses that were linked to 148 different ICF categories. Nine ICF categories were not represented in the Comprehensive ICF Core Set for COPD although at least 75% of the participants have rated them as important. Nineteen concepts were linked to the not yet developed ICF component personal factors and seventeen concepts were not covered by the ICF. The high percentage of ICF categories represented in the ICF Core Set for COPD indicates satisfactory content validity from the perspective of the physicians. However, some issues were raised that were not covered and need to be investigated further.

  12. Tracking Restoration of Park and Urban Street Settings in Coronary Artery Disease Patients

    Directory of Open Access Journals (Sweden)

    Regina Grazuleviciene

    2016-05-01

    Full Text Available The physiological effects of natural and urban environments on the cardiovascular system of coronary artery disease (CAD patients are not fully understood. This controlled field study examines the effects of restorative walking in a park vs. in an urban street environment on CAD patients’ stress parameters and cardiac function. Methods: Twenty stable CAD patients were randomly allocated to 7 days controlled walking in a city park or in an urban street environment group. The relationship between different environmental exposures and health effects was analyzed using Wilcoxon signed-rank test and exact Mann-Whitney U test. Results: The mean reduction in cortisol levels and negative effects after the walk on the first day was greater in the city park than in the urban street exposed group, while a reduction in negative effects in the urban group were greater after seven days. The reduction in diastolic blood pressure (DBP in the park group was evident on the seventh day before the walk (−4 mm Hg, p = 0.031 and 60 min after the walk (−6.00 mm Hg, p = 0.002. The cortisol slope was negatively associated with the DBP changes (r = −0.514, p < 0.05. Conclusions: Physical activity in a green environment with noise and air pollution levels lower than in an urban environment has a greater positive effect on CAD patients’ stress level and hemodynamic parameters. Mitigating green environmental influences may allow urban residents to maintain health and reduce disability.

  13. Timing for Pacing after Acquired Conduction Disease in the Setting of Endocarditis

    Directory of Open Access Journals (Sweden)

    Daniel Brancheau

    2015-01-01

    Full Text Available A 53-year-old gentleman with a history of a mechanical aortic valve presented to the emergency department complaining of a sudden right-sided abdominal pain. He was found to have atrioventricular dissociation on his initial electrocardiogram and his blood cultures grew Streptococcus viridans. The suspicion for endocarditis with periaortic abscess was high so a transthoracic echocardiogram was performed and showed a mass in the left ventricular outflow tract. For better visualization, a transesophageal echocardiogram was recommended and revealed a bileaflet mechanical aortic valve with perivalvular abscess and valvular vegetation as well as severe eccentric paravalvular aortic regurgitation. After sterilization, the patient underwent a successful surgery. Postoperatively, he remained in complete heart block and a permanent pacemaker placement was performed after complete sterilization. He tolerated the procedure well and was discharged home in a stable condition. Perivalvular abscess is one of the most common cardiac complications of infective endocarditis and is associated with an increased risk of mortality. It is imperative to have appropriate treatment guidelines established. However, because of the relative nature of the disease process and the acuity at which intervention needs to be done, a true assessment of the duration of antibiotic therapy prior to surgical intervention, timing of pacemaker placement, and the type of pacemaker is controversial.

  14. Construction and analysis of the NCI-EDRN breast cancer reference set for circulating markers of disease.

    Science.gov (United States)

    Marks, Jeffrey R; Anderson, Karen S; Engstrom, Paul; Godwin, Andrew K; Esserman, Laura J; Longton, Gary; Iversen, Edwin S; Mathew, Anu; Patriotis, Christos; Pepe, Margaret S

    2015-02-01

    Many circulating biomarkers have been reported for the diagnosis of breast cancer, but few, if any, have undergone rigorous credentialing using prospective cohorts and blinded evaluation. The NCI Early Detection Research Network (EDRN) has created a prospective, multicenter collection of plasma and serum samples from 832 subjects designed to evaluate circulating biomarkers for the detection and diagnosis of breast cancer. These samples are available to investigators who wish to evaluate their biomarkers using a set of blinded samples. The breast cancer reference set is composed of blood samples collected using a standard operating procedure at four U.S. medical centers from 2008 to 2010 from women undergoing either tissue diagnosis for breast cancer or routine screening mammography. The reference set contains samples from women with incident invasive cancer (n = 190), carcinoma in situ (n = 55), benign pathology with atypia (n = 63), benign disease with no atypia (n = 231), and women with no evidence of breast disease by screening mammography (BI-RADS 1 or 2, n = 276). Using a subset of plasma samples (n = 505) from the reference set, we analyzed 90 proteins by multiplexed immunoassays for their potential utility as diagnostic markers. We found that none of these markers is useful for distinguishing cancer from benign controls. However, elevated CA-125 does appear to be a candidate marker for estrogen receptor-negative cancers. Markers that can distinguish benign breast conditions from invasive cancer have not yet been found. Availability of prospectively collected samples should improve future validation efforts. ©2014 American Association for Cancer Research.

  15. Use of Wilms Tumor 1 Gene Expression as a Reliable Marker for Prognosis and Minimal Residual Disease Monitoring in Acute Myeloid Leukemia With Normal Karyotype Patients.

    Science.gov (United States)

    Marjanovic, Irena; Karan-Djurasevic, Teodora; Ugrin, Milena; Virijevic, Marijana; Vidovic, Ana; Tomin, Dragica; Suvajdzic Vukovic, Nada; Pavlovic, Sonja; Tosic, Natasa

    2017-05-01

    Acute myeloid leukemia with normal karyotype (AML-NK) represents the largest group of AML patients classified with an intermediate prognosis. A constant need exists to introduce new molecular markers for more precise risk stratification and for minimal residual disease (MRD) monitoring. Quantitative assessment of Wilms tumor 1 (WT1) gene transcripts was performed using real-time polymerase chain reaction. The bone marrow samples were collected at the diagnosis from 104 AML-NK patients and from 34 of these patients during follow-up or disease relapse. We found that overexpression of the WT1 gene (WT1 high status), present in 25.5% of patients, was an independent unfavorable factor for achieving complete remission. WT1 high status was also associated with resistance to therapy and shorter disease-free survival and overall survival. Assessment of the log reduction value of WT1 expression, measured in paired diagnosis/complete remission samples, revealed that patients with a log reduction of < 2 had a tendency toward shorter disease-free survival and overall survival and a greater incidence of disease relapse. Combining WT1 gene expression status with NPM1 and FLT3-ITD mutational status, we found that the tumor behavior of intermediate patients (FLT3-ITD - /NPM1 - double negative) with WT1 high status is almost the same as the tumor behavior of the adverse risk group. WT1 expression status represents a good molecular marker of prognosis, response to treatment, and MRD monitoring. Above all, the usage of the WT1 expression level as an additional marker for more precise risk stratification of AML-NK patients could lead to more adapted, personalized treatment protocols. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. The importance of antibiotic residues presence detection in milk

    Directory of Open Access Journals (Sweden)

    Dubravka Samaržija

    2002-01-01

    Full Text Available Antibiotic residues are the most present inhibitory substances in milkhaving undesirable effect on human health, technological characteristics and the quality of milk and dairy products. In order to protect consumer's health and to ensure high quality milk production, European Union (EU regulation 2377/90 sets a maximum permitted levels for antibiotic residues in milk. Although the presence of antibiotic residues in milk can be due to animal diseases treatment, and in the case of milking animals, they are mostly present after mastitis treatment. The aim of this work is to stress the importance of the continuous control on antibiotic residues presence in milk, due to the role that milk and dairy products have in human nutrition. In this paper, different groups of antibiotics, mechanisms of theirs action, mistakes occurring in dairy products manufacture as well as the methods for theirs detection are described.

  17. The use of Phyllanthus niruri L. as an immunomodulator for the treatment of infectious diseases in clinical settings

    Directory of Open Access Journals (Sweden)

    Raymond Rubianto Tjandrawinata

    2017-03-01

    Full Text Available Phyllanthus niruri L. (Euphorbiaceae (P. niruri has traditionally been used in many tropical countries to treat various ailments, such as kidney stones, chronic liver diseases, diabetes and viral infections. The versatile ethnomedicinal usage of the herb is tightly associated with its multiple pharmacological properties such as immunomodulator, anti-viral, antibacterial, diuretic, anti-hyperglycemia and hepatoprotector. The scope of this review is limited only to the clinical evidences demonstrating benefits of the plant P. niruri with its immunomodulatory properties, for the treatment of various infectious diseases. These evidences are expected to provide the plant a more significant place in the current clinical settings, particularly in the management of infectious diseases. P. niruri as an immunomodulator has scientifically been studied and evaluated in various clinical trials for the treatment of chronic hepatitis B, pulmonary tuberculosis, vaginitis, as well as varicella-zoster infection. In such diseases, the effective immune system is crucial to the treatment success and eradication of the pathogens. In those clinical studies, P. niruri has been proven for its capacity to modulate and activate the immune system. In fact, there are numerous in vitro and animal studies reporting potential benefits of the immunomodulatory properties of P. niruri, and numbers of randomized controlled clinical studies have been published to date. In the light of the scarcity of research to discover new, more effective and safe anti-infection chemical entities, that is also complicated with the growing threat from the new generations of drug resistant-pathogens, the utilization of nature-derived immunomodulatory agents, either alone or combined with the currently available antibiotics or antivirals, is undoubtedly promising and of clinical importance. Most of the studies on P. niruri warrant its potential benefits in various infectious diseases, and are

  18. HIV-Associated Cryptococcal Disease in Resource-Limited Settings: A Case for “Prevention Is Better Than Cure”?

    Directory of Open Access Journals (Sweden)

    Rita O. Oladele

    2017-12-01

    Full Text Available Cryptococcal disease remains a significant source of global morbidity and mortality for people living with HIV, especially in resource-limited settings. The recently updated estimate of cryptococcal disease revealed a global incidence of 223,100 cases annually with 73% of these cases being diagnosed in sub-Saharan Africa. Furthermore, 75% of the estimated 181,100 deaths associated with cryptococcal disease occur in sub-Saharan Africa. Point-of-care diagnostic assays have revolutionised the diagnosis of this deadly opportunistic infection. The theory of asymptomatic cryptococcal antigenaemia as a forerunner to symptomatic meningitis and death has been conclusively proven. Thus, cryptococcal antigenaemia screening coupled with pre-emptive antifungal therapy has been demonstrated as a cost-effective strategy with survival benefits and has been incorporated into HIV national guidelines in several countries. However, this is yet to be implemented in a number of other high HIV burden countries. Flucytosine-based combination therapy during the induction phase is associated with improved survival, faster cerebrospinal fluid sterilisation and fewer relapses. Flucytosine, however, is unavailable in many parts of the world. Studies are ongoing on the efficacy of shorter regimens of amphotericin B. Early diagnosis, proactive antifungal therapy with concurrent management of raised intracranial pressure creates the potential to markedly reduce mortality associated with this disease.

  19. Integration of family planning services into a sexually transmitted disease clinic setting.

    Science.gov (United States)

    Shlay, Judith C; McEwen, Dean; Bell, Deborah; Maravi, Moises; Rinehart, Deborah; Fang, Hai; Devine, Sharon; Mickiewicz, Theresa; Dreisbach, Susan

    2013-08-01

    Sexually transmitted diseases (STDs) and unintended pregnancy are significant and costly public health concerns. Integrating family planning services (FPS) into STD visits provides an opportunity to address both concerns simultaneously. Our objectives were to create an electronic eligibility reminder to identify male and female patients eligible for FPS during an STD clinic visit and measure FPS use, additional cost of integrated services, and patient/provider satisfaction and to explore the impact on incident pregnancy and STDs. Quasi-experimental design compared enrollment and patient/provider satisfaction before (2008) and after implementation (2010). Incident pregnancy and STD 12 months after the initial visit before and after were explored. Time and cost were calculated. Quantitative and qualitative analyses were performed. A total of 9695 clients (male, 5842; female, 3853) in 2008 and 10,021 clients (male, 5852; female, 4169) in 2010 were eligible for FPS. Enrollment in FPS increased (2008: 51.6%, 2010: 95.3%; P < 0.01). Total additional cost was US$29.25/visit, and additional staff time was 4.01 minutes for integrated visits. Staff satisfaction increased and client satisfaction remained high. Among women returning within 12 months (39.6% in 2008, 37.1% in 2010), pregnancies were lower among enrolled versus nonenrolled women for 2008 (7.7% vs. 19.5%, P < 0.01) and 2010 (13.1% vs. 25.9%, P = 0.05). Incident STDs did not differ. An electronic eligibility reminder of FPS increased FPS use. Integration of FPS with STD services is feasible, is well accepted, and increases costs minimally. Integration may reduce pregnancy rates without increasing STD rates.

  20. Perspectives on healthcare, chronic non-communicable disease, and healthworlds in an urban and rural setting.

    Science.gov (United States)

    Lopes Ibanez-Gonzalez, Daniel

    2014-01-01

    Amidst diverging discourses describing chronic non-communicable disease (NCD) and healthcare access, the hermeneutical tradition within sociology, particularly as exemplified in the work of Jurgen Habermas, provides a starting point for exploring and interpreting the experiences of chronic illness and healthcare access. In this study, we aimed to understand how women living with NCDs experience their illness and access healthcare in an urban and rural context. This study was a mixed-methods comparative case study of the healthcare access experiences of women with NCDs in an urban and rural area in South Africa. The core of the study methodology was a comparative qualitative case study, with quantitative methods serving to contextualise the findings. The cross-sectional survey describes a low resource population with a high prevalence of NCDs. Slightly over half the respondents in urban Soweto (50.7%) reported having at least one NCD. Only around a third (33.3%) of these participants reported accessing formal healthcare services in the past 6 months. Similar trends were found in the review of research carried out in rural Agincourt. The qualitative case study in Soweto is characterised by a preoccupation with how medicine from the clinic interacts with the body. The Agincourt qualitative case study highlights the importance of church membership, particularly of African Christian Churches, as the strongest factor motivating against the open use of traditional medicine. A consideration of the findings suggests five broad themes for further research: 1) processes of constructing body narratives; 2) encounters with purposive-rational systems; 3) encounters with traditional medicine; 4) encounters with contemporary informal medicine; and 5) religion and healthcare. These five themes constitute the beginning of a comprehensive schema of the lifeworld/healthworld.

  1. Ability of procalcitonin to discriminate infection from non-infective inflammation using two pleural disease settings.

    Directory of Open Access Journals (Sweden)

    Fiona J McCann

    -infective inflammation. Procalcitonin is superior to CRP in distinguishing infection from non-infective pleural diseases, even when controlled for the level of systemic inflammation.

  2. Surgical treatment of residual osgood-schlatter disease in young adults: role of the mobile osseous fragment.

    Science.gov (United States)

    Nierenberg, Gabriel; Falah, Mazen; Keren, Yaniv; Eidelman, Mark

    2011-03-11

    Osgood-Schlatter disease is a well-known condition in late childhood characterized by pain over the tibial tubercle. This condition usually resolves spontaneously at skeletal maturity. Few patients develop pain over the tibial tubercle. Radiological examination demonstrates a round regular ossification over the tubercle. Treatment is usually symptomatic, but occasionally surgical treatment is necessary, usually due to the development of a painful ossicle. This article reports our experience with refractory Osgood-Schlatter disease in 22 patients. Most patients were operated under local anesthesia. A midline longitudinal skin incision was used, followed by subperiosteal dissection of the osseous fragment. The knee was put in soft dressing. Patients were encouraged to resume daily activity immediately postoperatively. No wound complications were noted. All patients returned to their previous level of physical activity within 12 weeks postoperatively. All but 1 were free of pain on kneeling or direct pressure over the knee joint. Based on our experience, we devised a treatment algorithm. We believe that the key factors for successful surgical treatment are clear visualization of separation on lateral knee radiographic view and a clinical mobility positive test (firm grasping of the prominent part of the tubercle and its sliding movement). Our results are uniformly good; the only failure related to mistaken inclusion criteria where the lateral radiograph did not show a distinctly separated fragment. Copyright 2011, SLACK Incorporated.

  3. Residual basins

    International Nuclear Information System (INIS)

    D'Elboux, C.V.; Paiva, I.B.

    1980-01-01

    Exploration for uranium carried out over a major portion of the Rio Grande do Sul Shield has revealed a number of small residual basins developed along glacially eroded channels of pre-Permian age. Mineralization of uranium occurs in two distinct sedimentary units. The lower unit consists of rhythmites overlain by a sequence of black shales, siltstones and coal seams, while the upper one is dominated by sandstones of probable fluvial origin. (Author) [pt

  4. Molecular sources of residual cardiovascular risk, clinical signals, and innovative solutions: relationship with subclinical disease, undertreatment, and poor adherence: implications of new evidence upon optimizing cardiovascular patient outcomes

    Directory of Open Access Journals (Sweden)

    Kones R

    2013-10-01

    Full Text Available Richard KonesCardiometabolic Research Institute, Houston, TX, USAAbstract: Residual risk, the ongoing appreciable risk of major cardiovascular events (MCVE in statin-treated patients who have achieved evidence-based lipid goals, remains a concern among cardiologists. Factors that contribute to this continuing risk are atherogenic non-low-density lipoprotein (LDL particles and atherogenic processes unrelated to LDL cholesterol, including other risk factors, the inherent properties of statin drugs, and patient characteristics, ie, genetics and behaviors. In addition, providers, health care systems, the community, public policies, and the environment play a role. Major statin studies suggest an average 28% reduction in LDL cholesterol and a 31% reduction in relative risk, leaving a residual risk of about 69%. Incomplete reductions in risk, and failure to improve conditions that create risk, may result in ongoing progression of atherosclerosis, with new and recurring lesions in original and distant culprit sites, remodeling, arrhythmias, rehospitalizations, invasive procedures, and terminal disability. As a result, identification of additional agents to reduce residual risk, particularly administered together with statin drugs, has been an ongoing quest. The current model of atherosclerosis involves many steps during which disease may progress independently of guideline-defined elevations in LDL cholesterol. Differences in genetic responsiveness to statin therapy, differences in ability of the endothelium to regenerate and repair, and differences in susceptibility to nonlipid risk factors, such as tobacco smoking, hypertension, and molecular changes associated with obesity and diabetes, may all create residual risk. A large number of inflammatory and metabolic processes may also provide eventual therapeutic targets to lower residual risk. Classically, epidemiologic and other evidence suggested that raising high-density lipoprotein (HDL cholesterol

  5. Alzheimer's disease detection via automatic 3D caudate nucleus segmentation using coupled dictionary learning with level set formulation.

    Science.gov (United States)

    Al-Shaikhli, Saif Dawood Salman; Yang, Michael Ying; Rosenhahn, Bodo

    2016-12-01

    This paper presents a novel method for Alzheimer's disease classification via an automatic 3D caudate nucleus segmentation. The proposed method consists of segmentation and classification steps. In the segmentation step, we propose a novel level set cost function. The proposed cost function is constrained by a sparse representation of local image features using a dictionary learning method. We present coupled dictionaries: a feature dictionary of a grayscale brain image and a label dictionary of a caudate nucleus label image. Using online dictionary learning, the coupled dictionaries are learned from the training data. The learned coupled dictionaries are embedded into a level set function. In the classification step, a region-based feature dictionary is built. The region-based feature dictionary is learned from shape features of the caudate nucleus in the training data. The classification is based on the measure of the similarity between the sparse representation of region-based shape features of the segmented caudate in the test image and the region-based feature dictionary. The experimental results demonstrate the superiority of our method over the state-of-the-art methods by achieving a high segmentation (91.5%) and classification (92.5%) accuracy. In this paper, we find that the study of the caudate nucleus atrophy gives an advantage over the study of whole brain structure atrophy to detect Alzheimer's disease. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  6. Identification, summary and comparison of tools used to measure organizational attributes associated with chronic disease management within primary care settings.

    Science.gov (United States)

    Lukewich, Julia; Corbin, Renée; VanDenKerkhof, Elizabeth G; Edge, Dana S; Williamson, Tyler; Tranmer, Joan E

    2014-12-01

    Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice-Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice-Based Surveys collected the most information on organizational attributes. There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country. The data collection tools identified in this review can be used to establish data collection strategies to collect this important information. © 2014 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  7. Health-Related Quality of Life in Patients with Alzheimer's Disease in Different German Health Care Settings.

    Science.gov (United States)

    Heßmann, Philipp; Seeberg, Greta; Reese, Jens Peter; Dams, Judith; Baum, Erika; Müller, Matthias J; Dodel, Richard; Balzer-Geldsetzer, Monika

    2016-01-01

    The purpose of this study is to evaluate the health-related quality of life (HrQoL) of patients with Alzheimer's disease (AD) in different care settings (institutionalized versus community-dwelling) across all severity stages of dementia. Patients were consecutively recruited with their primary caregivers (123 inpatients and 272 outpatients), and the impact of patient-related parameters such as behavioral and psychological symptoms of dementia (BPSD) (Geriatric Depression Scale [GDS] and Neuropsychiatric Inventory [NPI]) and functional capacity (Alzheimer's Disease Cooperative Study-Activities of Daily Living [ADCS-ADL]) on HrQoL was analyzed. Patients' HrQoL was assessed using self-reported and caregiver-rated generic (EuroQoL Instrument) and dementia-specific (Quality of Life-Alzheimer's Disease [Qol-AD]) scales. Patients reported a considerably higher HrQoL than their caregivers on the QoL-AD, EQ-5D, and EQ VAS (p patients with lower MMSE scores. The mean self-reported QoL-AD decreased from 32.3±5.7 in the group with the highest MMSE scores to 27.1±5.5 in patients with the lowest MMSE scores (p patients versus participants in outpatient settings (proxy-rated QoL-AD 19.7±4.6 versus 26.0±7.1, p patients' HrQoL. Multivariate models explained between 22% and 54% of the variance in patients' HrQoL. To analyze the causative direction of the reported associations, further longitudinal studies should be conducted.

  8. Specialized nursing practice for chronic disease management in the primary care setting: an evidence-based analysis.

    Science.gov (United States)

    2013-01-01

    In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model

  9. Effects of intensive induction and consolidation chemotherapy with idarubicin and high dose cytarabine on minimal residual disease levels in newly diagnosed adult precursor-B acute lymphoblastic leukemia

    Directory of Open Access Journals (Sweden)

    Kenneth F. Bradstock

    2016-12-01

    Full Text Available An intensive induction regimen, consisting of idarubicin and high dose cytarabine, was assessed in 19 adult patients, median age 44 years, with newly diagnosed precursor-B acute lymphoblastic leukemia (ALL. Patients achieving a complete response (CR were given an attenuated consolidation course. The primary endpoints were induction death rate and incidence of serious non-hematological toxicity. Grades 3–4 diarrhoea occurred in 47% of patients during induction. Two patients (11% died during induction therapy, and 2 were withdrawn due to resistant disease or prolonged marrow hypoplasia. Fifteen patients achieved CR (79%, but levels of minimal residual disease (MRD after induction were comparable with those previously observed using a modified pediatric protocol. Overall survival at 5 years was 36.8% while leukemia-free survival was 44.1%. An intensive AML protocol used in adults with ALL resulted in substantial toxicity and provided similar levels of cytoreduction to conventional ALL protocols, without improving long-term outcomes.

  10. Predictive role of minimal residual disease and log clearance in acute myeloid leukemia: a comparison between multiparameter flow cytometry and Wilm's tumor 1 levels.

    Science.gov (United States)

    Rossi, Giovanni; Minervini, Maria Marta; Melillo, Lorella; di Nardo, Francesco; de Waure, Chiara; Scalzulli, Potito Rosario; Perla, Gianni; Valente, Daniela; Sinisi, Nicola; Cascavilla, Nicola

    2014-07-01

    In acute myeloid leukemia (AML), the detection of minimal residual disease (MRD) as well as the degree of log clearance similarly identifies patients with poor prognosis. No comparison was provided between the two approaches in order to identify the best one to monitor follow-up patients. In this study, MRD and clearance were assessed by both multiparameter flow cytometry (MFC) and WT1 expression at different time points on 45 AML patients achieving complete remission. Our results by WT1 expression showed that log clearance lower than 1.96 after induction predicted the recurrence better than MRD higher than 77.0 copies WT1/10(4) ABL. Conversely, on MFC, MRD higher than 0.2 % after consolidation was more predictive than log clearance below 2.64. At univariate and multivariate analysis, positive MRD values and log clearance below the optimal cutoffs were associated with a shorter disease-free survival (DFS). At the univariate analysis, positive MRD values were also associated with overall survival (OS). Therefore, post-induction log clearance by WT1 and post-consolidation MRD by MFC represented the most informative approaches to identify the relapse. At the optimal timing of assessment, positive MRD and log-clearance values lower than calculated thresholds similarly predicted an adverse prognosis in AML.

  11. Early recovery of circulating immature B cells in B-lymphoblastic leukemia patients after CD19 targeted CAR T cell therapy: A pitfall for minimal residual disease detection.

    Science.gov (United States)

    Xiao, Wenbin; Salem, Dalia; McCoy, Catharine S; Lee, Daniel; Shah, Nirali N; Stetler-Stevenson, Maryalice; Yuan, Constance M

    2017-09-09

    CD19-targeted chimeric-antigen receptor-modified T-cells (CAR-T) are promising in the treatment of refractory B-lymphoblastic leukemia (B-ALL). Minimal residual disease (MRD) detection by multicolor flow cytometry (FCM) is critical to distinguish B-ALL MRD from regenerating, non-neoplastic B-cell populations. FCM was performed on samples from 9 patients with B-ALL treated with CAR-T. All 9 patients showed response to CAR-T. Additionally, FCM revealed circulating CD10 + B cells, potentially mimicking MRD. Circulating CD10+ B-cells were detected in blood from 3 days to 3 months after CAR-T, comprising 73% (median) of B-cells (52-83%, 95%CI). They expressed CD19, CD10, CD20, bright CD9, CD22, CD24, moderate CD38 and dim CD58, but were CD34 (-), with bright CD45 and polyclonal surface light chain immunoglobulin (sIg) expression. A similar CD10 + B-cell subpopulation was detected by marrow FCM, amidst abundant B-cell precursors. These circulating CD10 + B-cells are compatible with immature B-cells, and are a reflection of B-cell recovery within the marrow. They are immunophenotypically distinguishable from residual B-ALL. Expression of light chain sIg and key surface antigens characterizing regenerating B-cell precursors can distinguish immature B-cells from B-ALL MRD and prevent misdiagnosis. © 2017 International Clinical Cytometry Society. © 2017 International Clinical Cytometry Society.

  12. A multicenter assessment of the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease at primary debulking for advanced epithelial ovarian cancer.

    Science.gov (United States)

    Suidan, Rudy S; Ramirez, Pedro T; Sarasohn, Debra M; Teitcher, Jerrold B; Iyer, Revathy B; Zhou, Qin; Iasonos, Alexia; Denesopolis, John; Zivanovic, Oliver; Long Roche, Kara C; Sonoda, Yukio; Coleman, Robert L; Abu-Rustum, Nadeem R; Hricak, Hedvig; Chi, Dennis S

    2017-04-01

    To assess the ability of preoperative computed tomography scan and CA-125 to predict gross residual disease (RD) at primary cytoreduction in advanced ovarian cancer. A prospective, non-randomized, multicenter trial of patients who underwent primary debulking for stage III-IV epithelial ovarian cancer previously identified 9 criteria associated with suboptimal (>1cm residual) cytoreduction. This is a secondary post-hoc analysis looking at the ability to predict any RD. Four clinical and 18 radiologic criteria were assessed, and a multivariate model predictive of RD was developed. From 7/2001-12/2012, 350 patients met eligibility criteria. The complete gross resection rate was 33%. On multivariate analysis, 3 clinical and 8 radiologic criteria were significantly associated with the presence of any RD: age≥60years (OR=1.5); CA-125≥600U/mL (OR=1.3); ASA 3-4 (OR=1.6); lesions in the root of the superior mesenteric artery (OR=4.1), splenic hilum/ligaments (OR=1.4), lesser sac >1cm (OR=2.2), gastrohepatic ligament/porta hepatis (OR=1.4), gallbladder fossa/intersegmental fissure (OR=2); suprarenal retroperitoneal lymph nodes (OR=1.3); small bowel adhesions/thickening (OR=1.1); and moderate-severe ascites (OR=2.2). All ORs were significant with p<0.01. A 'predictive score' was assigned to each criterion based on its multivariate OR, and the rate of having any RD for patients who had a total score of 0-2, 3-5, 6-8, and ≥9 was 45%, 68%, 87%, and 96%, respectively. We identified 11 criteria associated with RD, and developed a predictive model in which the rate of having any RD was directly proportional to a predictive score. This model may be helpful in treatment planning. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Simulation modelling of population dynamics of mosquito vectors for rift valley Fever virus in a disease epidemic setting.

    Directory of Open Access Journals (Sweden)

    Clement N Mweya

    Full Text Available Rift Valley Fever (RVF is weather dependent arboviral infection of livestock and humans. Population dynamics of mosquito vectors is associated with disease epidemics. In our study, we use daily temperature and rainfall as model inputs to simulate dynamics of mosquito vectors population in relation to disease epidemics.Time-varying distributed delays (TVDD and multi-way functional response equations were implemented to simulate mosquito vectors and hosts developmental stages and to establish interactions between stages and phases of mosquito vectors in relation to vertebrate hosts for infection introduction in compartmental phases. An open-source modelling platforms, Universal Simulator and Qt integrated development environment were used to develop models in C++ programming language. Developed models include source codes for mosquito fecundity, host fecundity, water level, mosquito infection, host infection, interactions, and egg time. Extensible Markup Language (XML files were used as recipes to integrate source codes in Qt creator with Universal Simulator plug-in. We observed that Floodwater Aedines and Culicine population continued to fluctuate with temperature and water level over simulation period while controlled by availability of host for blood feeding. Infection in the system was introduced by floodwater Aedines. Culicines pick infection from infected host once to amplify disease epidemic. Simulated mosquito population show sudden unusual increase between December 1997 and January 1998 a similar period when RVF outbreak occurred in Ngorongoro district.Findings presented here provide new opportunities for weather-driven RVF epidemic simulation modelling. This is an ideal approach for understanding disease transmission dynamics towards epidemics prediction, prevention and control. This approach can be used as an alternative source for generation of calibrated RVF epidemics data in different settings.

  14. Simulation modelling of population dynamics of mosquito vectors for rift valley Fever virus in a disease epidemic setting.

    Science.gov (United States)

    Mweya, Clement N; Holst, Niels; Mboera, Leonard E G; Kimera, Sharadhuli I

    2014-01-01

    Rift Valley Fever (RVF) is weather dependent arboviral infection of livestock and humans. Population dynamics of mosquito vectors is associated with disease epidemics. In our study, we use daily temperature and rainfall as model inputs to simulate dynamics of mosquito vectors population in relation to disease epidemics. Time-varying distributed delays (TVDD) and multi-way functional response equations were implemented to simulate mosquito vectors and hosts developmental stages and to establish interactions between stages and phases of mosquito vectors in relation to vertebrate hosts for infection introduction in compartmental phases. An open-source modelling platforms, Universal Simulator and Qt integrated development environment were used to develop models in C++ programming language. Developed models include source codes for mosquito fecundity, host fecundity, water level, mosquito infection, host infection, interactions, and egg time. Extensible Markup Language (XML) files were used as recipes to integrate source codes in Qt creator with Universal Simulator plug-in. We observed that Floodwater Aedines and Culicine population continued to fluctuate with temperature and water level over simulation period while controlled by availability of host for blood feeding. Infection in the system was introduced by floodwater Aedines. Culicines pick infection from infected host once to amplify disease epidemic. Simulated mosquito population show sudden unusual increase between December 1997 and January 1998 a similar period when RVF outbreak occurred in Ngorongoro district. Findings presented here provide new opportunities for weather-driven RVF epidemic simulation modelling. This is an ideal approach for understanding disease transmission dynamics towards epidemics prediction, prevention and control. This approach can be used as an alternative source for generation of calibrated RVF epidemics data in different settings.

  15. [Variability of diarrheal diseases in children under 5 living in an urban setting: observations in Rufisque, Senegal].

    Science.gov (United States)

    Sy, I; Handschumacher, P; Wyss, K; Cisse, G; Lo, B; Piermay, J L; Tanner, M

    2010-02-01

    Rapid urbanization has created numerous health risks in developing countries, but the exact impact on many diseases in function of living conditions is unclear. For insight into this complex relationship, a study on diarrheal diseases was carried out to obtain knowledge about the distribution of health risks in an urban setting. An epidemiological survey with a combined longitudinal and transverse design was conducted in Rufisque, Senegal, from April 2002 to March 2003 in a sample including households with children less than 5-years-old living in four areas presenting different levels of hygiene. Results showed a high overall incidence of diarrhea (6.5 episodes/child/year) but there were major discrepancies between the four study areas in direct relation with level of hygiene. The annual incidence per child was lower in the low-cost housing project (fair hygiene, 3.4 episodes) than in the Castors area (poor hygiene, 6.8 episodes), Diokoul Wague area (very poor hygiene, 7.3 episodes) and Goufe Aldiana area (no hygiene, 8.4 episodes). The study showed only a slight seasonal effect on diarrheal disease in the different areas. However, the differences observed between areas during the cold and hot dry seasons were considerably attenuated in the rainy season. This variability in the incidence rate that underlines the diversity of urban living conditions depends on a variety of risk factors (such as age and number of children) that may interact, although hygiene level remains critical. For issues usually given priority at the national level, multiplying studies aimed at fine analysis of factors underlying disease transmission is useful since this approach can improve understanding of public health policy in city environments characterized by the complex conditions (density and diversity) created by urbanization.

  16. Circulating lipocalin 2 is neither related to liver steatosis in patients with non-alcoholic fatty liver disease nor to residual liver function in cirrhosis.

    Science.gov (United States)

    Meier, Elisabeth M; Pohl, Rebekka; Rein-Fischboeck, Lisa; Schacherer, Doris; Eisinger, Kristina; Wiest, Reiner; Krautbauer, Sabrina; Buechler, Christa

    2016-09-01

    Lipocalin 2 (LCN2) is induced in the injured liver and associated with inflammation. Aim of the present study was to evaluate whether serum LCN2 is a non-invasive marker to assess hepatic steatosis in patients with non-alcoholic fatty liver disease (NAFLD) or residual liver function in patients with liver cirrhosis. Therefore, LCN2 was measured by ELISA in serum of 32 randomly selected patients without fatty liver (controls), 24 patients with ultrasound diagnosed NAFLD and 42 patients with liver cirrhosis mainly due to alcohol. Systemic LCN2 was comparable in patients with liver steatosis, those with liver cirrhosis and controls. LCN2 negatively correlated with bilirubin in both cohorts. In cirrhosis, LCN2 was not associated with more advanced liver injury defined by the CHILD-PUGH score and model for end-stage liver disease score. Resistin but not C-reactive protein or chemerin positively correlated with LCN2. LCN2 levels were not increased in patients with ascites or patients with esophageal varices. Consequently, reduction of portal pressure by transjugular intrahepatic portosystemic shunt did not affect LCN2 levels. Hepatic venous blood (HVS), portal venous blood and systemic venous blood levels of LCN2 were similar. HVS LCN2 was unchanged in patients with end-stage liver cirrhosis compared to those with well-compensated disease arguing against increased hepatic release. Current data exclude that serum LCN2 is of any value as steatosis marker in patients with NAFLD and indicator of liver function in patients with alcoholic liver cirrhosis. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Conformation-Specific IR and UV Spectroscopy of the Amino Acid Glutamine: Amide-Stacking and Hydrogen Bonding in AN Important Residue in Neurodegenerative Diseases

    Science.gov (United States)

    Walsh, Patrick S.; Dean, Jacob C.; Zwier, Timothy S.

    2014-06-01

    Glutamine plays an important role in several neurodegenerative diseases including Huntington's disease (HD) and Alzheimer's disease (AD). An intriguing aspect of the structure of glutamine is its incorporation of an amide group in its side chain, thereby opening up the possibility of forming amide-amide H-bonds between the peptide backbone and side chain. In this study the conformational preferences of two capped gluatamines Z(carboxybenzyl)-Glutamine-X (X=OH, NHMe) are studied under jet-cooled conditions in the gas phase in order to unlock the intrinsic structural motifs that are favored by this flexible sidechain. Conformational assignments are made by comparing the hydride stretch ( 3100-3700 cm-1) and amide I and II ( 1400-1800 cm-1) resonant ion-dip infrared spectra with predictions from harmonic frequency calculations. Assigned structures will be compared to previously published results on both natural and unnatural residues. Particular emphasis will be placed on the comparison between glutamine and unconstrained γ-peptides due to the similar three-carbon spacing between backbone and side chain in glutamine to the backbone spacing in γ-peptides. The ability of the glutamine side-chain to form amide stacked conformations will be a main focus, along with the prevalence of extended backbone type structures. W. H. James, III, C W. Müller, E. G. Buchanan, M. G. D. Nix, L. Guo, L. Roskop, M. S. Gordon, L. V. Slipchenko, S. H. Gellman, and T. S. Zwier, J. Am. Chem. Soc., 2009, 131(40), 14243-14245.

  18. Potential demal exposure of florists to fungicide residues on flowers and risk assessment

    OpenAIRE

    Toumi, Khaoula; Joly, L.; Vleminckx, C.; Schiffers, Bruno

    2017-01-01

    Flowers are susceptible to many pests and diseases. Therefore, they can be sprayed several times during their growth considering that no MRL are set for flow-ers. High levels of pesticide residues potentially expose daily the florists who han-dle cut flowers and possibly could endanger their health. A study was carried out to evaluate the risk for florists exposed to fungicide residues during normal profes-sional tasks. Cotton gloves were distributed to 20 florists (two pairs to each florist)...

  19. Analysis of failures and clinical outcome of advanced epithelial ovarian cancer in patients with microscopic residual disease at second-look reassessment following primary cytoreductive surgery and first-line platinum-based chemotherapy.

    Science.gov (United States)

    Gadducci, A; Tana, R; Landoni, F; Ferrari, F; Peiretti, M; Perrone, F; Sartori, E

    2013-01-01

    To assess the pattern of failure and survival of advanced ovarian cancer patients with microscopic residual disease at second-look following cytoreductive surgery and platinum-based chemotherapy. Nine-five women were retrospectively analyzed. Residual disease after initial surgery was > one cm in 58 (61.1%) patients, first-line chemotherapy was paclitaxel/platinum-based in 70 (73.7%) patients, second-look findings showed no macroscopic residuum but positive random peritoneal biopsies and/or positive washing ("true" microscopic residual disease) in 79 (83.2%) patients, and a macroscopic residuum which was completely resected (converted complete response) in 16(16.8%) patients. Eight-one (85.2%) patients developed recurrent disease after a median time of 14 months (range four to 51). The abdomen (29.6%) and the pelvis (28.4%) were the most common sites of failure. Two- and five-year survival after second-look were 78.1% and 31.0%, respectively. The clinical and pathological features with prognostic relevance at presentation (age, histotype, and tumor grade), as well as type of first-line chemotherapy and treatment after second-look were not related to the clinical outcome. There was a trend for a better survival in patients with optimal primary cytoreduction compared with those with suboptimal primary cytoreduction (five-year survival = 42.7% vs 23.4%). There was no significant difference in survival between the converted complete responders and the patients with "true" microscopic residual disease. These data confirm the unsatisfactory clinical outcome of patients with microscopic residual disease after first-line chemotherapy and the limited benefit of second-look reassessment.

  20. Touch-down reverse transcriptase-PCR detection of IgV(H) rearrangement and Sybr-Green-based real-time RT-PCR quantitation of minimal residual disease in patients with chronic lymphocytic leukemia

    Czech Academy of Sciences Publication Activity Database

    Peková, Soňa; Marková, J.; Pajer, Petr; Dvořák, Michal; Cetkovský, P.; Schwarz, J.

    2005-01-01

    Roč. 9, č. 1 (2005), s. 23-34 ISSN 1084-8592 Institutional research plan: CEZ:AV0Z50520514 Keywords : minimal residual disease * chronic lymphocytic leukaemia * IgV(H) rearrangement Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 2.562, year: 2003

  1. The TEL-AML1 real-time quantitative polymerase chain reaction (PCR) might replace the antigen receptor-based genomic PCR in clinical minimal residual disease studies in children with acute lymphoblastic leukaemia

    NARCIS (Netherlands)

    de Haas, V.; Breunis, W. B.; dee, R.; Verhagen, O. J. H. M.; Kroes, W.; van Wering, E. R.; van Dongen, J. J. M.; van den Berg, H.; van der Schoot, C. E.

    2002-01-01

    Prospective studies in children with B-precursor acute lymphoblastic leukaemia (ALL) have shown that polymerase chain reaction (PCR)-based detection of minimal residual disease (MRD) using immunoglobin (Ig) and T-cell receptor (TCR) gene rearrangements as targets can be used to identify patients

  2. Molecular detection of minimal residual disease is a strong predictive factor of relapse in childhood B-lineage acute lymphoblastic leukemia with medium risk features. A case control study of the International BFM study group

    NARCIS (Netherlands)

    Biondi, A; Valsecchi, MG; Seriu, T; D'Aniello, E; Willemse, MJ; Fasching, K; Pannunzio, A; Gadner, H; Schrappe, M; Kamps, WA; Bartram, CR; van Dongen, JJM; Panzer-Grumayer, ER

    2000-01-01

    The medium-risk B cell precursor acute lymphoblastic leukemia (ALL) accounts for 50-60% of total childhood ALL and comprises the largest number of relapses still unpredictable with diagnostic criteria. To evaluate the prognostic impact of minimal residual disease (MRD) in this specific group, a case

  3. Evaluation of a train-the-trainer program for stable coronary artery disease management in community settings: A pilot study.

    Science.gov (United States)

    Shen, Zhiyun; Jiang, Changying; Chen, Liqun

    2018-02-01

    To evaluate the feasibility and effectiveness of conducting a train-the-trainer (TTT) program for stable coronary artery disease (SCAD) management in community settings. The study involved two steps: (1) tutors trained community nurses as trainers and (2) the community nurses trained patients. 51 community nurses attended a 2-day TTT program and completed questionnaires assessing knowledge, self-efficacy, and satisfaction. By a feasibility and non-randomized control study, 120 SCAD patients were assigned either to intervention group (which received interventions from trained nurses) or control group (which received routine management). Pre- and post-intervention, patients' self-management behaviors and satisfaction were assessed to determine the program's overall impact. Community nurses' knowledge and self-efficacy improved (PSCAD management in community settings in China was generally feasible and effective, but many obstacles remain including patients' noncompliance, nurses' busy work schedules, and lack of policy supports. Finding ways to enhance the motivation of community nurses and patients with SCAD are important in implementing community-based TTT programs for SCAD management; further multicenter and randomized control trials are needed. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. Validity and predictive ability of the juvenile arthritis disease activity score based on CRP versus ESR in a Nordic population-based setting

    DEFF Research Database (Denmark)

    Nordal, E B; Zak, M; Aalto, K

    2012-01-01

    To compare the juvenile arthritis disease activity score (JADAS) based on C reactive protein (CRP) (JADAS-CRP) with JADAS based on erythrocyte sedimentation rate (ESR) (JADAS-ESR) and to validate JADAS in a population-based setting.......To compare the juvenile arthritis disease activity score (JADAS) based on C reactive protein (CRP) (JADAS-CRP) with JADAS based on erythrocyte sedimentation rate (ESR) (JADAS-ESR) and to validate JADAS in a population-based setting....

  5. RESIDUAL RISK ASSESSMENTS - RESIDUAL RISK ...

    Science.gov (United States)

    This source category previously subjected to a technology-based standard will be examined to determine if health or ecological risks are significant enough to warrant further regulation for Coke Ovens. These assesments utilize existing models and data bases to examine the multi-media and multi-pollutant impacts of air toxics emissions on human health and the environment. Details on the assessment process and methodologies can be found in EPA's Residual Risk Report to Congress issued in March of 1999 (see web site). To assess the health risks imposed by air toxics emissions from Coke Ovens to determine if control technology standards previously established are adequately protecting public health.

  6. Model Selection and Evaluation Based on Emerging Infectious Disease Data Sets including A/H1N1 and Ebola

    Directory of Open Access Journals (Sweden)

    Wendi Liu

    2015-01-01

    Full Text Available The aim of the present study is to apply simple ODE models in the area of modeling the spread of emerging infectious diseases and show the importance of model selection in estimating parameters, the basic reproduction number, turning point, and final size. To quantify the plausibility of each model, given the data and the set of four models including Logistic, Gompertz, Rosenzweg, and Richards models, the Bayes factors are calculated and the precise estimates of the best fitted model parameters and key epidemic characteristics have been obtained. In particular, for Ebola the basic reproduction numbers are 1.3522 (95% CI (1.3506, 1.3537, 1.2101 (95% CI (1.2084, 1.2119, 3.0234 (95% CI (2.6063, 3.4881, and 1.9018 (95% CI (1.8565, 1.9478, the turning points are November 7,November 17, October 2, and November 3, 2014, and the final sizes until December 2015 are 25794 (95% CI (25630, 25958, 3916 (95% CI (3865, 3967, 9886 (95% CI (9740, 10031, and 12633 (95% CI (12515, 12750 for West Africa, Guinea, Liberia, and Sierra Leone, respectively. The main results confirm that model selection is crucial in evaluating and predicting the important quantities describing the emerging infectious diseases, and arbitrarily picking a model without any consideration of alternatives is problematic.

  7. Identification of a set of endogenous reference genes for miRNA expression studies in Parkinson's disease blood samples.

    Science.gov (United States)

    Serafin, Alice; Foco, Luisa; Blankenburg, Hagen; Picard, Anne; Zanigni, Stefano; Zanon, Alessandra; Pramstaller, Peter P; Hicks, Andrew A; Schwienbacher, Christine

    2014-10-10

    Research on microRNAs (miRNAs) is becoming an increasingly attractive field, as these small RNA molecules are involved in several physiological functions and diseases. To date, only few studies have assessed the expression of blood miRNAs related to Parkinson's disease (PD) using microarray and quantitative real-time PCR (qRT-PCR). Measuring miRNA expression involves normalization of qRT-PCR data using endogenous reference genes for calibration, but their choice remains a delicate problem with serious impact on the resulting expression levels. The aim of the present study was to evaluate the suitability of a set of commonly used small RNAs as normalizers and to identify which of these miRNAs might be considered reliable reference genes in qRT-PCR expression analyses on PD blood samples. Commonly used reference genes snoRNA RNU24, snRNA RNU6B, snoRNA Z30 and miR-103a-3p were selected from the literature. We then analyzed the effect of using these genes as reference, alone or in any possible combination, on the measured expression levels of the target genes miR-30b-5p and miR-29a-3p, which have been previously reported to be deregulated in PD blood samples. We identified RNU24 and Z30 as a reliable and stable pair of reference genes in PD blood samples.

  8. Ethnic disparities in educational and occupational gradients of estimated cardiovascular disease risk: The Healthy Life in an Urban Setting study.

    Science.gov (United States)

    Perini, Wilco; Agyemang, Charles; Snijder, Marieke B; Peters, Ron J G; Kunst, Anton E

    2018-03-01

    European societies are becoming increasingly ethnically diverse. This may have important implications for socio-economic inequalities in health due to the often disadvantaged position of ethnic minority groups in both socio-economic status (SES) and disease, especially cardiovascular disease (CVD). The aim of this study was to determine whether the socio-economic gradient of estimated CVD risk differs between ethnic groups. Using the Healthy Life in an Urban Setting study, we obtained data on SES and CVD risk factors among participants from six ethnic backgrounds residing in Amsterdam. SES was measured using educational level and occupational level. CVD risk was estimated based on the occurrence of CVD risk factors using the Dutch version of the systematic coronary risk evaluation algorithm. Ethnic disparities in socio-economic gradients for estimated CVD risk were determined using the relative index of inequality (RII). Among Dutch-origin men, the RII for estimated CVD risk according to educational level was 6.15% (95% confidence interval [CI] 4.35-7.96%), indicating that those at the bottom of the educational hierarchy had a 6.15% higher estimated CVD risk relative than those at the top. Among Dutch-origin women, the RII was 4.49% (CI 2.45-6.52%). The RII was lower among ethnic minority groups, ranging from 0.83% to 3.13% among men and -0.29% to 5.12% among women, indicating weaker associations among these groups. Results were similar based on occupational level. Ethnic background needs to be considered in associations between SES and disease. The predictive value of SES varies between ethnic groups and may be quite poor for some groups.

  9. Engineering a mobile health tool for resource-poor settings to assess and manage cardiovascular disease risk: SMARThealth study.

    Science.gov (United States)

    Raghu, Arvind; Praveen, Devarsetty; Peiris, David; Tarassenko, Lionel; Clifford, Gari

    2015-04-29

    The incidence of chronic diseases in low- and middle-income countries is rapidly increasing both in urban and rural regions. A major challenge for health systems globally is to develop innovative solutions for the prevention and control of these diseases. This paper discusses the development and pilot testing of SMARTHealth, a mobile-based, point-of-care Clinical Decision Support (CDS) tool to assess and manage cardiovascular disease (CVD) risk in resource-constrained settings. Through pilot testing, the preliminary acceptability, utility, and efficiency of the CDS tool was obtained. The CDS tool was part of an mHealth system comprising a mobile application that consisted of an evidence-based risk prediction and management algorithm, and a server-side electronic medical record system. Through an agile development process and user-centred design approach, key features of the mobile application that fitted the requirements of the end users and environment were obtained. A comprehensive analytics framework facilitated a data-driven approach to investigate four areas, namely, system efficiency, end-user variability, manual data entry errors, and usefulness of point-of-care management recommendations to the healthcare worker. A four-point Likert scale was used at the end of every risk assessment to gauge ease-of-use of the system. The system was field-tested with eleven village healthcare workers and three Primary Health Centre doctors, who screened a total of 292 adults aged 40 years and above. 34% of participants screened by health workers were identified by the CDS tool to be high CVD risk and referred to a doctor. In-depth analysis of user interactions found the CDS tool feasible for use and easily integrable into the workflow of healthcare workers. Following completion of the pilot, further technical enhancements were implemented to improve uptake of the mHealth platform. It will then be evaluated for effectiveness and cost-effectiveness in a cluster randomized

  10. Analysis of SAT type foot-and-mouth disease virus capsid proteins and the identification of putative amino acid residues affecting virus stability.

    Directory of Open Access Journals (Sweden)

    Francois F Maree

    Full Text Available Foot-and-mouth disease virus (FMDV initiates infection by adhering to integrin receptors on target cells, followed by cell entry and disassembly of the virion through acidification within endosomes. Mild heating of the virions also leads to irreversible dissociation into pentamers, a characteristic linked to reduced vaccine efficacy. In this study, the structural stability of intra- and inter-serotype chimeric SAT2 and SAT3 virus particles to various conditions including low pH, mild temperatures or high ionic strength, was compared. Our results demonstrated that while both the SAT2 and SAT3 infectious capsids displayed different sensitivities in a series of low pH buffers, their stability profiles were comparable at high temperatures or high ionic strength conditions. Recombinant vSAT2 and intra-serotype chimeric viruses were used to map the amino acid differences in the capsid proteins of viruses with disparate low pH stabilities. Four His residues at the inter-pentamer interface were identified that change protonation states at pH 6.0. Of these, the H145 of VP3 appears to be involved in interactions with A141 in VP3 and K63 in VP2, and may be involved in orientating H142 of VP3 for interaction at the inter-pentamer interfaces.

  11. Major impact of an early bone marrow checkpoint (day 21) for minimal residual disease in flow cytometry in childhood acute lymphoblastic leukemia.

    Science.gov (United States)

    Eveillard, Marion; Robillard, Nelly; Arnoux, Isabelle; Garand, Richard; Rialland, Fanny; Thomas, Caroline; Strullu, Marion; Michel, Gérard; Béné, Marie C; Fossat, Chantal; Loosveld, Marie

    2017-06-01

    The early persistence of minimal residual disease (MRD) is considered a poor prognostic factor indicative of chemoresistance in acute lymphoblastic leukemia. In French children, chemosensitivity is assessed at day 21 post-induction by cytomorphology. Here, it was investigated whether a more precise evaluation could be obtained at this time point with multiparameter flow cytometry (MFC). This study enrolled 123 children with de novo acute lymphoblastic leukemia. MRD0 was investigated at day 21 in MFC with a combination of antibodies based on the immunophenotype of diagnosis. It was also evaluated at day 35 by immunoglobulin/T-cell receptor quantitative real-time polymerase chain reaction (MRD1). Three risk groups could be delineated based on MRD0. Patients with MFC/MRD0 levels >10 -2 (n = 25) were considered high risk, those with levels between 10 -2 and 10 -4 (n = 46) intermediate risk, and those MRD1 levels, compared with 112 patients, were consistent (-/- or +/+) in 57.2% of the cases. Both MRD0+/MRD1+ and MRD0+/MRD1- patients had a significantly worse EFS (p = 0.0001) than those with undetectable MRD at both MRD0 and MRD1. This study confirms the usefulness and superiority of an early point of MRD detection by MFC. In addition, MRD0 in MFC identifies a subgroup of patients with poorer prognosis (MRD0+/MRD1-). Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  12. Design and analytic validation of BCR-ABL1 quantitative reverse transcription polymerase chain reaction assay for monitoring minimal residual disease.

    Science.gov (United States)

    Jennings, Lawrence J; Smith, Frederick A; Halling, Kevin C; Persons, Diane L; Kamel-Reid, Suzanne

    2012-01-01

    Monitoring minimal residual disease by quantitative reverse transcription polymerase chain reaction has proven clinically useful, but as yet there are no Food and Drug Administration-approved tests. Guidelines have been published that provide important information on validation of such tests; however, no practical examples have previously been published. To provide an example of the design and validation of a quantitative reverse transcription polymerase chain reaction test. To describe the approach used by an individual laboratory for development and validation of a laboratory-developed quantitative reverse transcription polymerase chain reaction test for BCR-ABL1 fusion transcripts. Elements of design and analytic validation of a laboratory-developed quantitative molecular test are discussed using quantitative detection of BCR-ABL1 fusion transcripts as an example. Validation of laboratory-developed quantitative molecular tests requires careful planning and execution to adequately address all required analytic performance parameters. How these are addressed depends on the potential for technical errors and confidence required for a given test result. We demonstrate how one laboratory validated and clinically implemented a quantitative BCR-ABL1 assay that can be used for the management of patients with chronic myelogenous leukemia.

  13. Clinical relevance of minimal residual disease monitoring in mature B-cell disorders: role of qualitative and quantitative PCR-based strategies Monitorização e relevância clínica da doença residual mínima nas síndromes linfoproliferativas de células B-maduras

    Directory of Open Access Journals (Sweden)

    Selina Sametti

    2001-04-01

    Full Text Available Although current treatments can induce clinically complete remissions in a high proportion of patients with mature B-cell disorders (MBCD, most of them actually relapse, because of the persistence of residual tumour cells which are undetectable using conventional diagnostic procedures. Qualitative polymerase-chain-reaction (PCR based methods are increasingly used for minimal residual disease (MRD detection, and provide useful prognostic information. In recent years these assays have been integrated by reliable quantitative PCR-approaches that are likely to further increase the prognostic impact of MRD analysis in MBCD. In this review current approaches for qualitative and quantitative detection of MRD in MBCD are summarised. In addition, the prognostic aspects of molecular monitoring in the autologous and allogeneic transplantation setting are summarised. The experience accumulated over the past decade shows that PCR analysis has a prognostic impact in most MBCD especially when treated with high-dose regimens. Major advantages coming from the introduction of molecular monitoring in clinical programs have been: i a rapid evaluation of the anti-tumour activity of innovative treatments; and ii an early identification of patients with a high-risk of disease recurrence.Os tratamentos atuais induzem remissão clínica completa em uma alta percentagem de pacientes portadores de Síndromes linfoproliferativas de células B maduras (SLBM. No entanto, muitos destes pacientes recaem devido a persistência de células tumorais residuais que são indetectáveis pelos métodos de diagnóstico convencionais. Os métodos baseados na reação em cadeia da polimerase (PCR qualitativos cada vez mais têm sido utilizados para a detecção da doença residual mínima (DRM e propiciam informações úteis em relação ao prognóstico dos pacientes. Neste relato as condutas atuais em relação a DRM e o emprego dos métodos de PCR qualitativos e quantitativos s

  14. The vexed relationship between Clostridium difficile and inflammatory bowel disease: an assessment of carriage in an outpatient setting among patients in remission.

    LENUS (Irish Health Repository)

    Clayton, Evelyn M

    2009-05-01

    Comorbidity with Clostridium difficile may cause diagnostic delay in newly presenting inflammatory bowel disease (IBD) patients, trigger relapse in established disease, confound therapies, and serve as an indicator of an underlying defect in innate immunity. Retrospective analyses have suggested community acquisition; to address this we conducted a prospective analysis of C. difficile carriage in IBD patients using molecular methods specifically in an outpatient setting.

  15. A comparison of Irish set dancing and exercises for people with Parkinson's disease: a phase II feasibility study.

    Science.gov (United States)

    Volpe, Daniele; Signorini, Matteo; Marchetto, Anna; Lynch, Timothy; Morris, Meg E

    2013-06-04

    People with idiopathic Parkinson's disease (PD) frequently have low activity levels, poor mobility and reduced quality of life. Although increased physical activity may improve mobility, balance and wellbeing, adherence to exercises and activity programs over the longer term can be challenging, particularly for older people with progressive neurological conditions such as PD. Physical activities that are engaging and enjoyable, such as dancing, might enhance adherence over the long term. The objective of this study was to evaluate the feasibility of a randomized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD. Twenty-four people with idiopathic PD referred for movement rehabilitation were randomized to receive standard physiotherapy exercises or Irish set dancing classes once per week plus a weekly home program for 6 months (12 in each group). The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation. The primary outcome was motor disability measured by the motor component of the UPDRS, which was assessed prior to and after therapy by trained assessors blinded to group assignment. The Timed Up and Go, the Berg Balance Scale and the modified Freezing of Gait Questionnaire were secondary measures. Quality of life of the people with PD was evaluated using the PDQ-39. Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe. There were no differences between groups in the rate of adverse events such as falls, serious injuries, death or rates of admission to hospital. The physiotherapists who provided usual care remained blind to group allocation, with no change in their standard clinical practice. Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy. Although improvements were made in both groups, the dance group showed superior results to

  16. Residual nilpotence and residual solubility of groups

    International Nuclear Information System (INIS)

    Mikhailov, R V

    2005-01-01

    The properties of the residual nilpotence and the residual solubility of groups are studied. The main objects under investigation are the class of residually nilpotent groups such that each central extension of these groups is also residually nilpotent and the class of residually soluble groups such that each Abelian extension of these groups is residually soluble. Various examples of groups not belonging to these classes are constructed by homological methods and methods of the theory of modules over group rings. Several applications of the theory under consideration are presented and problems concerning the residual nilpotence of one-relator groups are considered.

  17. Impacts of constrained culling and vaccination on control of foot and mouth disease in near-endemic settings: A pair approximation model

    OpenAIRE

    Ringa, N.; Bauch, C.T.

    2014-01-01

    Many countries have eliminated foot and mouth disease (FMD), but outbreaks remain common in other countries. Rapid development of international trade in animals and animal products has increased the risk of disease introduction to FMD-free countries. Most mathematical models of FMD are tailored to settings that are normally disease-free, and few models have explored the impact of constrained control measures in a ‘near-endemic’ spatially distributed host population subject to frequent FMD re-...

  18. Expression of the C- KIT Molecule in Acute Myeloid Leukemias: Implications of the Immuno phenotypes CD117 and CD15 in the Detection of Minimal Residual Disease

    International Nuclear Information System (INIS)

    Omar, S.

    2001-01-01

    Study of the c-kit proto-oncogene (CD117) may be of help for the identification of phenotypic profiles that are absent or present at very low frequencies on normal human blast cells and therefore might be of great value for the detection of leukemic cells displaying such immuno phenotypes in patients in complete remission. Design and methods: Ninety patients with acute myeloid leukemias, diagnosed according to FAB criteria and immunological marker studies, were studied for the dual expression on blast cells of the CD117/CD15 immuno phenotype co expression by direct immunofluorescence assay using dual staining combination flow cytometry. Results: In 69/90 acute myeloid leukemia patients analyzed (77%), blast cells expressed the CD117 antigen. Moreover, in 38 of them (42% of acute myeloid leukemia cases), leukemic blasts co expressed the CD117 and CD15 antigens. There was no significant correlation between the FAB classification and the CD117 and CD15 expression in acute myeloid leukemia cases. Conclusions: These results suggest that immunological methods for the detection of MRD based on the existence of aberrant phenotypes could be used in the majority of AML patients. This phenotype CD117/CD15, present in acute myeloid leukemia cases at a relatively high frequency (42%), represents an aberrant phenotype, because it was not detected on normal human blast cells, suggesting that the use of these combinations of monoclonal antibodies could be of help in detecting residual leukemic blasts among normal blast cells. The use of the CD117 antigen in different monoclonal antibodies combinations may be of great help for the detection of minimal residual disease in a high proportion of acute myeloid leukemia cases, especially in those patients displaying the CD117+/CD15+ immuno phenotype, because cells co expressing both antigens in normal blasts, if present, are at very low frequencies. The simultaneous assessment of two or more markers in single cells has facilitated the

  19. Positively charged residues at the five-fold symmetry axis of cell culture-adapted foot-and-mouth disease virus permit novel receptor interactions.

    Science.gov (United States)

    Berryman, Stephen; Clark, Stuart; Kakker, Naresh K; Silk, Rhiannon; Seago, Julian; Wadsworth, Jemma; Chamberlain, Kyle; Knowles, Nick J; Jackson, Terry

    2013-08-01

    Field isolates of foot-and-mouth disease virus (FMDV) have a restricted cell tropism which is limited by the need for certain RGD-dependent integrin receptors. In contrast, cell culture-adapted viruses use heparan sulfate (HS) or other unidentified molecules as receptors to initiate infection. Here, we report several novel findings resulting from cell culture adaptation of FMDV. In cell culture, a virus with the capsid of the A/Turkey/2/2006 field isolate gained the ability to infect CHO and HS-deficient CHO cells as a result of a single glutamine (Q)-to-lysine (K) substitution at VP1-110 (VP1-(Q)110(K)). Using site-directed mutagenesis, the introduction of lysine at this same site also resulted in an acquired ability to infect CHO cells by type O and Asia-1 FMDV. However, this ability appeared to require a second positively charged residue at VP1-109. CHO cells express two RGD-binding integrins (α5β1 and αvβ5) that, although not used by FMDV, have the potential to be used as receptors; however, viruses with the VP1-(Q)110(K) substitution did not use these integrins. In contrast, the VP1-(Q)110(K) substitution appeared to result in enhanced interactions with αvβ6, which allowed a virus with KGE in place of the normal RGD integrin-binding motif to use αvβ6 as a receptor. Thus, our results confirmed the existence of nonintegrin, non-HS receptors for FMDV on CHO cells and revealed a novel, non-RGD-dependent use of αvβ6 as a receptor. The introduction of lysine at VP1-110 may allow for cell culture adaptation of FMDV by design, which may prove useful for vaccine manufacture when cell culture adaptation proves intractable.

  20. Minimal residual disease (MRD detection with translocations and T-cell receptor and immunoglobulin gene rearrangements in adult acute lymphoblastic leukemia patients: a pilot study

    Directory of Open Access Journals (Sweden)

    Muge Sayitoglu

    2008-09-01

    Full Text Available Objective: Monitoring minimal residual disease has become increasingly important in clinical practice of ALL management. Break-point fusion regions of leukaemia related chromosomal aberrations and rearranged immunoglobulin (Ig and T cell-receptor (TCR genes are used as leukaemia specific markers in genetic studies of MRD.Material and Methods: A total of 31 consecutive patients with newly diagnosed ALL were screened for eligibility criteria. Of those 26 were included in the study. One patient with partial response following induction therapy and four patients who were lost to follow-up after induction were excluded from the study; thus 21 patients were evaluated for MRD by using polymerase chain reaction (PCR, heteroduplex analysis, sequencing and quantitative real time PCR techniques. Results: Chromosomal aberrations were detected in 5 (24% of the patients and were used for MRD monitoring. Three patients had t(9;22 translocation, the other 2 had t(4;11 and t(1;19. MRD-based risk stratification of the16 patients analysed for Ig/TCR rearrangements revealed 3 low-risk, 11 intermediate-risk and 2 high-risk patients.Conclusion: MRD monitoring is progressively getting to be a more important predictive factor in adult ALL patients. As reported by others confirmed by our limited data there is a good correlation between MRD status and clinical outcome in patients receiving chemotherapy. The pilot-study presented here is the first that systematically and consecutively performs a molecular MRD monitoring of ALL patients in Turkey.

  1. Minimal residual disease-based risk stratification in Chinese childhood acute lymphoblastic leukemia by flow cytometry and plasma DNA quantitative polymerase chain reaction.

    Directory of Open Access Journals (Sweden)

    Suk Hang Cheng

    Full Text Available Minimal residual disease, or MRD, is an important prognostic indicator in childhood acute lymphoblastic leukemia. In ALL-IC-BFM 2002 study, we employed a standardized method of flow cytometry MRD monitoring for multiple centers internationally using uniformed gating, and determined the relevant MRD-based risk stratification strategies in our local patient cohort. We also evaluated a novel method of PCR MRD quantitation using peripheral blood plasma. For the bone marrow flow MRD study, patients could be stratified into 3 risk groups according to MRD level using a single time-point at day-15 (Model I (I-A: 10%, or using two time-points at day-15 and day-33 (Model II (II-A: day-15<10% and day-33<0.01%, II-B: day-15 ≥ 10% or day-33 ≥ 0.01% but not both, II-C: day-15 ≥ 10% and day-33 ≥ 0.01%, which showed significantly superior prediction of relapse (p = .00047 and <0.0001 respectively. Importantly, patients with good outcome (frequency: 56.0%, event-free survival: 90.1% could be more accurately predicted by Model II. In peripheral blood plasma PCR MRD investigation, patients with day-15-MRD ≥ 10(-4 were at a significantly higher risk of relapse (p = 0.0117. By multivariate analysis, MRD results from both methods could independently predict patients' prognosis, with 20-35-fold increase in risk of relapse for flow MRD I-C and II-C respectively, and 5.8-fold for patients having plasma MRD of ≥ 10(-4. We confirmed that MRD detection by flow cytometry is useful for prognostic evaluation in our Chinese cohort of childhood ALL after treatment. Moreover, peripheral blood plasma DNA MRD can be an alternative where bone marrow specimen is unavailable and as a less invasive method, which allows close monitoring.

  2. Minimal residual disease-based risk stratification in Chinese childhood acute lymphoblastic leukemia by flow cytometry and plasma DNA quantitative polymerase chain reaction.

    Science.gov (United States)

    Cheng, Suk Hang; Lau, Kin Mang; Li, Chi Kong; Chan, Natalie P H; Ip, Rosalina K L; Cheng, Chi Keung; Lee, Vincent; Shing, Matthew M K; Leung, Alex W K; Ha, Shau Yin; Cheuk, Daniel K L; Lee, Anselm C W; Li, Chak Ho; Luk, Chung Wing; Ling, Siu Cheung; Hrusak, Ondrej; Mejstrikova, Ester; Leung, Yonna; Ng, Margaret H L

    2013-01-01

    Minimal residual disease, or MRD, is an important prognostic indicator in childhood acute lymphoblastic leukemia. In ALL-IC-BFM 2002 study, we employed a standardized method of flow cytometry MRD monitoring for multiple centers internationally using uniformed gating, and determined the relevant MRD-based risk stratification strategies in our local patient cohort. We also evaluated a novel method of PCR MRD quantitation using peripheral blood plasma. For the bone marrow flow MRD study, patients could be stratified into 3 risk groups according to MRD level using a single time-point at day-15 (Model I) (I-A: 10%), or using two time-points at day-15 and day-33 (Model II) (II-A: day-15<10% and day-33<0.01%, II-B: day-15 ≥ 10% or day-33 ≥ 0.01% but not both, II-C: day-15 ≥ 10% and day-33 ≥ 0.01%), which showed significantly superior prediction of relapse (p = .00047 and <0.0001 respectively). Importantly, patients with good outcome (frequency: 56.0%, event-free survival: 90.1%) could be more accurately predicted by Model II. In peripheral blood plasma PCR MRD investigation, patients with day-15-MRD ≥ 10(-4) were at a significantly higher risk of relapse (p = 0.0117). By multivariate analysis, MRD results from both methods could independently predict patients' prognosis, with 20-35-fold increase in risk of relapse for flow MRD I-C and II-C respectively, and 5.8-fold for patients having plasma MRD of ≥ 10(-4). We confirmed that MRD detection by flow cytometry is useful for prognostic evaluation in our Chinese cohort of childhood ALL after treatment. Moreover, peripheral blood plasma DNA MRD can be an alternative where bone marrow specimen is unavailable and as a less invasive method, which allows close monitoring.

  3. RT-qPCR and RT-Digital PCR: A Comparison of Different Platforms for the Evaluation of Residual Disease in Chronic Myeloid Leukemia.

    Science.gov (United States)

    Alikian, Mary; Whale, Alexandra S; Akiki, Susanna; Piechocki, Kim; Torrado, Celia; Myint, Thet; Cowen, Simon; Griffiths, Michael; Reid, Alistair G; Apperley, Jane; White, Helen; Huggett, Jim F; Foroni, Letizia

    2017-02-01

    Tyrosine kinase inhibitors (TKIs) are the cornerstone of successful clinical management of patients with chronic myeloid leukemia (CML). Quantitative monitoring of the percentage of the fusion transcript BCR-ABL1 (breakpoint cluster region-c-abl oncogene 1, non-receptor tyrosine kinase) BCR-ABL1 IS (%BCR-ABL1 IS ) by reverse transcription-quantitative PCR (RT-qPCR) is the gold standard strategy for evaluating patient response to TKIs and classification into prognostic subgroups. However, this approach can be challenging to perform in a reproducible manner. Reverse-transcription digital PCR (RT-dPCR) is an adaptation of this method that could provide the robust and standardized workflow needed for truly standardized patient stratification. BCR-ABL1 and ABL1 transcript copy numbers were quantified in a total of 102 samples; 70 CML patients undergoing TKI therapy and 32 non-CML individuals. 3 commercially available digital PCR platforms (QS3D, QX200 and Raindrop) were compared with the platform routinely used in the clinic for RT-qPCR using the EAC (Europe Against Cancer) assay. Measurements on all instruments correlated well when the %BCR-ABL1 IS was ≥0.1%. In patients with residual disease below this level, greater variations were measured both within and between instruments limiting comparable performance to a 4 log dynamic range. RT-dPCR was able to quantify low-level BCR-ABL1 transcript copies but was unable to improve sensitivity below the level of detection achieved by RT-qPCR. However, RT-dPCR was able to perform these sensitive measurements without use of a calibration curve. Adaptions to the protocol to increase the amount of RNA measured are likely to be necessary to improve the analytical sensitivity of BCR-ABL testing on a dPCR platform. © 2016 American Association for Clinical Chemistry.

  4. Association of germline genetic variants in RFC, IL15 and VDR genes with minimal residual disease in pediatric B-cell precursor ALL.

    Science.gov (United States)

    Dawidowska, Małgorzata; Kosmalska, Maria; Sędek, Łukasz; Szczepankiewicz, Aleksandra; Twardoch, Magdalena; Sonsala, Alicja; Szarzyńska-Zawadzka, Bronisława; Derwich, Katarzyna; Lejman, Monika; Pawelec, Katarzyna; Obitko-Płudowska, Agnieszka; Pawińska-Wąsikowska, Katarzyna; Kwiecińska, Kinga; Kołtan, Andrzej; Dyla, Agnieszka; Grzeszczak, Władysław; Kowalczyk, Jerzy R; Szczepański, Tomasz; Ziętkiewicz, Ewa; Witt, Michał

    2016-07-18

    Minimal residual disease (MRD) enables reliable assessment of risk in acute lymphoblastic leukemia (ALL). However, little is known on association between MRD status and germline genetic variation. We examined 159 Caucasian (Slavic) patients with pediatric ALL, treated according to ALL-IC-BFM 2002/2009 protocols, in search for association between 23 germline polymorphisms and MRD status at day 15, day 33 and week 12, with adjustment for MRD-associated clinical covariates. Three variants were significantly associated with MRD: rs1544410 in VDR (MRD-day15); rs1051266 in RFC (MRD-day33, MRD-week12), independently and in an additive effect with rs10519613 in IL15 (MRD-day33). The risk alleles for MRD-positivity were: A allele of VDR (OR = 2.37, 95%CI = 1.07-5.21, P = 0.03, MRD-day15); A of RFC (OR = 1.93, 95%CI = 1.05-3.52, P = 0.03, MRD-day33 and MRD-week12, P RFC and IL15 loci than in patients with risk alleles in one locus or no risk alleles: 2 vs. 1 (OR = 3.94, 95% CI = 1.28-12.11, P = 0.024), 2 vs. 0 (OR = 6.75, 95% CI = 1.61-28.39, P = 0.012). Germline variation in genes related to pharmacokinetics/pharmacodynamics of anti-leukemic drugs and to anti-tumor immunity of the host is associated with MRD status and might help improve risk assessment in ALL.

  5. History of consolidation is prognostic in acute myeloid leukemia patients undergoing allogeneic hematopoietic cell transplantation in minimal residual disease-negative first complete remission.

    Science.gov (United States)

    Rashidi, Armin; Linden, Michael A; DeFor, Todd E; Warlick, Erica; Bejanyan, Nelli; Yohe, Sophia; Weisdorf, Daniel J; Ustun, Celalettin

    2017-10-01

    Prognostic factors among acute myeloid leukemia (AML) patients undergoing allogeneic hematopoietic cell transplantation (allo-HCT) in minimal residual disease (MRD)-negative first complete remission (CR1) are unknown. We retrospectively attempted to answer the following question: In AML patients undergoing allo-HCT in MRD-negative CR1, does a history of prior consolidation provide additional prognostic information? The inclusion criteria were: (i) Age > 18 years, (ii) AML in CR1 after 1-2 cycles of intensive induction chemotherapy, with or without consolidation, (iii) Allo-HCT between 1/2003 and 4/2016 at our institution, (iv) Available standard-sensitivity 4-color flow cytometry results from a bone marrow aspiration at diagnosis and after completion of all previous chemotherapy within one month prior to HCT, (v) Flow cytometry-based MRD-negative status at the time of HCT. A history of prior consolidation was associated with favorable overall survival (Hazard Ratio [95% Confidence Interval]: 0.59 [0.35-0.99], P = .046), relapse-free survival (0.60 [0.37-0.96], P = .036), and relapse (0.50 [0.27-0.92], P = .025). Analysis of potential sources of bias was unrevealing. In AML patients undergoing allo-HCT in MRD-negative CR1, a history of prior consolidation was associated with favorable outcomes. If the path to pre-HCT MRD negativity includes consolidation, it may identify patients with improved prognosis following HCT in MRD-negative state. These results warrant validation in larger cohorts. © 2017 Wiley Periodicals, Inc.

  6. Pilot Testing and Implementation of a mHealth tool for Non-communicable Diseases in a Humanitarian Setting.

    Science.gov (United States)

    Doocy, Shannon; Paik, Kenneth; Lyles, Emily; Tam, Hok Hei; Fahed, Zeina; Winkler, Eric; Kontunen, Kaisa; Mkanna, Abdalla; Burnham, Gilbert

    2017-06-05

    Given the protracted nature of the crisis in Syria, national and international assistance agencies face immense challenges in providing for the needs of refugees and the host Lebanese due to the high burden of noncommunicable diseases (NCDs) among both populations. These are complex conditions to manage, and the resources for refugee care limited, having dramatic implications for Lebanon's health system. A longitudinal cohort study was implemented from January 2015 through August 2016 to evaluate the effectiveness of treatment guidelines and an mHealth application on quality of care and health outcomes for patients in primary health care facilities in Lebanon serving Syrian refugees and host communities. Overall, reporting in clinic medical records remained low, however, during the mHealth phase recording of BMI and blood pressure were significantly greater in the mHealth application as compared to clinic medical records. Patient exit interviews reported a much more frequent measurement of weight, height, blood pressure, and blood glucose, suggesting these may be assessed more often than they are recorded. Satisfaction with the clinic visit improved significantly during implementation of the mHealth application as compared to both baseline and guidelines implementation in all measures. Despite positive changes, provider uptake of the application was low; patients indicated that the mHealth application was used in a minority (21.7%) of consultations. Provider perspectives on how the application changed patient interactions were mixed. Similar to previous evidence, this study further demonstrates the need to incorporate new interventions with existing practices and reporting requirements to minimize duplication of efforts and, consequently, strengthen provider usage. Additional research is needed to identify organizational and provider-side factors associated with uptake of similar applications, particularly in complex settings, to optimize the benefit of such tools.

  7. Vaccine Induced Herd Immunity for Control of Respiratory Syncytial Virus Disease in a Low-Income Country Setting.

    Science.gov (United States)

    Kinyanjui, Timothy M; House, Thomas A; Kiti, Moses C; Cane, Patricia A; Nokes, David J; Medley, Graham F

    2015-01-01

    Respiratory syncytial virus (RSV) is globally ubiquitous, and infection during the first six months of life is a major risk for severe disease and hospital admission; consequently RSV is the most important viral cause of respiratory morbidity and mortality in young children. Development of vaccines for young infants is complicated by the presence of maternal antibodies and immunological immaturity, but vaccines targeted at older children avoid these problems. Vaccine development for young infants has been unsuccessful, but this is not the case for older children (> 6 m). Would vaccinating older children have a significant public health impact? We developed a mathematical model to explore the benefits of a vaccine against RSV. We have used a deterministic age structured model capturing the key epidemiological characteristics of RSV and performed a statistical maximum-likelihood fit to age-specific hospitalization data from a developing country setting. To explore the effects of vaccination under different mixing assumptions, we included two versions of contact matrices: one from a social contact diary study, and the second a synthesised construction based on demographic data. Vaccination is assumed to elicit an immune response equivalent to primary infection. Our results show that immunisation of young children (5-10 m) is likely to be a highly effective method of protection of infants (herd immunity). A full sensitivity and uncertainty analysis using Latin Hypercube Sampling of the parameter space shows that our results are robust to model structure and model parameters. This result suggests that vaccinating older infants and children against RSV can have a major public health benefit.

  8. Vaccine Induced Herd Immunity for Control of Respiratory Syncytial Virus Disease in a Low-Income Country Setting.

    Directory of Open Access Journals (Sweden)

    Timothy M Kinyanjui

    Full Text Available Respiratory syncytial virus (RSV is globally ubiquitous, and infection during the first six months of life is a major risk for severe disease and hospital admission; consequently RSV is the most important viral cause of respiratory morbidity and mortality in young children. Development of vaccines for young infants is complicated by the presence of maternal antibodies and immunological immaturity, but vaccines targeted at older children avoid these problems. Vaccine development for young infants has been unsuccessful, but this is not the case for older children (> 6 m. Would vaccinating older children have a significant public health impact? We developed a mathematical model to explore the benefits of a vaccine against RSV.We have used a deterministic age structured model capturing the key epidemiological characteristics of RSV and performed a statistical maximum-likelihood fit to age-specific hospitalization data from a developing country setting. To explore the effects of vaccination under different mixing assumptions, we included two versions of contact matrices: one from a social contact diary study, and the second a synthesised construction based on demographic data. Vaccination is assumed to elicit an immune response equivalent to primary infection. Our results show that immunisation of young children (5-10 m is likely to be a highly effective method of protection of infants (<6 m against hospitalisation. The majority benefit is derived from indirect protection (herd immunity. A full sensitivity and uncertainty analysis using Latin Hypercube Sampling of the parameter space shows that our results are robust to model structure and model parameters.This result suggests that vaccinating older infants and children against RSV can have a major public health benefit.

  9. Effect of two commercial herbicides on life history traits of a human disease vector, Aedes aegypti, in the laboratory setting.

    Science.gov (United States)

    Morris, Alexandra; Murrell, Ebony G; Klein, Talan; Noden, Bruce H

    2016-07-01

    Some mosquito species utilize the small niches of water that are abundant in farmland habitats. These niches are susceptible to effects from agricultural pesticides, many of which are applied aerially over large tracts of land. One principal form of weed control in agricultural systems involves the development of herbicide-tolerant crops. The impact of sub-agricultural levels of these herbicides on mosquito survival and life-history traits of resulting adults have not been determined. The aim of this study was to test the effect of two commercial herbicides (Beyond and Roundup) on the survivorship, eclosion time, and body mass of Aedes aegypti. First instar A. aegypti larvae were exposed to varying concentrations (270, 550 and 820 μg/m(2) of glyphosate and 0.74, 1.49, 2.24 μL imazamox/m(2)), all treatments being below recommended application rates, of commercial herbicides in a controlled environment and resulting adult mosquitoes were collected and weighed. Exposure to Roundup had a significant negative effect on A. aegypti survivorship at medium and high sub-agricultural application concentrations, and negatively affected adult eclosion time at the highest concentration. However, exposure to low concentrations of Beyond significantly increased A. aegypti survivorship, although adult female mass was decreased at medium sub-agricultural concentrations. These results demonstrate that low concentrations of two different herbicides, which can occur in rural larval habitats as a result of spray drift, can affect the same species of mosquito in both positive and negative ways depending on the herbicide applied. The effects of commercial herbicides on mosquito populations could have an important effect on disease transmission within agricultural settings, where these and other herbicides are extensively applied to reduce weed growth.

  10. IKZF1plusDefines a New Minimal Residual Disease-Dependent Very-Poor Prognostic Profile in Pediatric B-Cell Precursor Acute Lymphoblastic Leukemia.

    Science.gov (United States)

    Stanulla, Martin; Dagdan, Elif; Zaliova, Marketa; Möricke, Anja; Palmi, Chiara; Cazzaniga, Giovanni; Eckert, Cornelia; Te Kronnie, Geertruy; Bourquin, Jean-Pierre; Bornhauser, Beat; Koehler, Rolf; Bartram, Claus R; Ludwig, Wolf-Dieter; Bleckmann, Kirsten; Groeneveld-Krentz, Stefanie; Schewe, Denis; Junk, Stefanie V; Hinze, Laura; Klein, Norman; Kratz, Christian P; Biondi, Andrea; Borkhardt, Arndt; Kulozik, Andreas; Muckenthaler, Martina U; Basso, Giuseppe; Valsecchi, Maria Grazia; Izraeli, Shai; Petersen, Britt-Sabina; Franke, Andre; Dörge, Petra; Steinemann, Doris; Haas, Oskar A; Panzer-Grümayer, Renate; Cavé, Hélène; Houlston, Richard S; Cario, Gunnar; Schrappe, Martin; Zimmermann, Martin

    2018-03-02

    Purpose Somatic deletions that affect the lymphoid transcription factor-coding gene IKZF1 have previously been reported as independently associated with a poor prognosis in pediatric B-cell precursor (BCP) acute lymphoblastic leukemia (ALL). We have now refined the prognostic strength of IKZF1 deletions by analyzing the effect of co-occurring deletions. Patients and Methods The analysis involved 991 patients with BCP ALL treated in the Associazione Italiana Ematologia ed Oncologia Pediatrica-Berlin-Frankfurt-Muenster (AIEOP-BFM) ALL 2000 trial with complete information for copy number alterations of IKZF1, PAX5, ETV6, RB1, BTG1, EBF1, CDKN2A, CDKN2B, Xp22.33/Yp11.31 (PAR1 region; CRLF2, CSF2RA, and IL3RA), and ERG; replication of findings involved 417 patients from the same trial. Results IKZF1 deletions that co-occurred with deletions in CDKN2A, CDKN2B, PAX5, or PAR1 in the absence of ERG deletion conferred the worst outcome and, consequently, were grouped as IKZF1 plus . The IKZF1 plus group comprised 6% of patients with BCP ALL, with a 5-year event-free survival of 53 ± 6% compared with 79 ± 5% in patients with IKZF1 deletion who did not fulfill the IKZF1 plus definition and 87 ± 1% in patients who lacked an IKZF1 deletion ( P ≤ .001). Respective 5-year cumulative relapse incidence rates were 44 ± 6%, 11 ± 4%, and 10 ± 1% ( P ≤ .001). Results were confirmed in the replication cohort, and multivariable analyses demonstrated independence of IKZF1 plus . The IKZF1 plus prognostic effect differed dramatically in analyses stratified by minimal residual disease (MRD) levels after induction treatment: 5-year event-free survival for MRD standard-risk IKZF1 plus patients was 94 ± 5% versus 40 ± 10% in MRD intermediate- and 30 ± 14% in high-risk IKZF1 plus patients ( P ≤ .001). Corresponding 5-year cumulative incidence of relapse rates were 6 ± 6%, 60 ± 10%, and 60 ± 17% ( P ≤ .001). Conclusion IKZF1 plus describes a new MRD-dependent very

  11. Standardised Outcomes in Nephrology-Polycystic Kidney Disease (SONG-PKD) : Study protocol for establishing a core outcome set in polycystic kidney disease

    NARCIS (Netherlands)

    Cho, Yeoungjee; Sautenet, Benedicte; Rangan, Gopala; Craig, Jonathan C.; Ong, Albert C. M.; Chapman, Arlene; Ahn, Curie; Chen, Dongping; Coolican, Helen; Kao, Juliana Tze-Wah; Gansevoort, Ron; Perrone, Ronald; Harris, Tess; Torres, Vicente; Pei, York; Kerr, Peter G.; Ryan, Jessica; Gutman, Talia; Howell, Martin; Ju, Angela; Manera, Karine E.; Teixeira-Pinto, Armando; Hamiwka, Lorraine A.; Tong, Allison

    2017-01-01

    Background: Autosomal dominant polycystic kidney disease (ADPKD) is the most common potentially life threatening inherited kidney disease and is responsible for 5-10% of cases of end-stage kidney disease (ESKD). Cystic kidneys may enlarge up to 20 times the weight of a normal kidney due to the

  12. A predominance of hypertensive heart disease among patients with cardiac disease in buea, a semi-urban setting, South west region of cameroon

    NARCIS (Netherlands)

    Nkoke, Clovis; Makoge, Christelle; Dzudie, Anastase; Mfeukeu, Liliane Kuate; Luchuo, Engelbert Bain; Menanga, Alain; Kingue, Samuel

    2017-01-01

    Objective: The pattern of heart disease is diverse within and among world regions. The little data on the spectrum of heart disease in Cameroon has been so far limited to major cities. We sought to describe the pattern of heart disease in Buea, the South West Region of Cameroon, a semi-urban

  13. Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings

    OpenAIRE

    Diez-Canseco, Francisco; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. Psicólogo, magíster en Salud Pública.; Ipince, Alessandra; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. antropóloga.; Toyama, Mauricio; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. Facultad de Letras y Ciencias Humanas, Pontificia Universidad Católica del Perú, Lima, Perú. estudiante de Psicología.; Benate-Galvez, Ysabel; Gerencia de Prestaciones Primarias de Salud, Gerencia Central de Prestaciones de Salud, Seguro Social del Perú. médico geriatra.; Galán-Rodas, Edén; Gerencia de Prestaciones Primarias de Salud, Gerencia Central de Prestaciones de Salud, Seguro Social del Perú, EsSalud. Lima, Perú. médico cirujano.; Medina-Verástegui, Julio César; Gerencia de Prestaciones Primarias de Salud, Gerencia Central de Prestaciones de Salud, Seguro Social del Perú, EsSalud. Lima, Perú. médico pediatra.; Sánchez-Moreno, David; Centro de Salud “El Progreso”, Microrred de Salud Carabayllo, Red de Salud Túpac Amaru, DISA V Lima Ciudad, Ministerio de Salud, Lima, Perú. psicólogo.; Araya, Ricardo; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine. Londres, Reino Unido. médico psiquiatra, doctor en Epidemiología Psiquiátrica.; Miranda, J. Jaime; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. médico, magíster y doctor en Epidemiología.

    2014-01-01

    In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Addition...

  14. A case report of symptomatic gallbladder disease in the setting of peritoneal carcinomatosis originating from invasive lobular carcinoma of the breast

    Directory of Open Access Journals (Sweden)

    David Brinkman

    2016-01-01

    Conclusion: Symptomatic gallbladder disease in the setting of peritoneal carcinomatosis secondary to invasive lobular carcinoma is an uncommon presentation to surgeons. A diagnostic laparoscopy is the preferred initial evaluation. If deemed feasible, and if the surgeon has the required experience, a laparoscopic cholecystectomy can be undertaken selectively.

  15. Time perception of cancer patients without evidence of disease and advanced cancer patients in a palliative, end-of-life-care setting

    NARCIS (Netherlands)

    van Laarhoven, Hanneke W. M.; Schilderman, Johannes; Verhagen, Constans A. H. H. V. M.; Prins, Judith B.

    2011-01-01

    Time perception may be an important factor influencing distress of cancer patients. However, no comparative studies have been performed for cancer patients without evidence of disease and advanced cancer patients in the palliative, end-of-life-care setting. The objectives of the study were to assess

  16. Membranoproliferative glomerulonephritis in the setting of multicentric angiofollicular lymph node hyperplasia (Castleman's disease) complicated by Evan's syndrome.

    Science.gov (United States)

    Gakiopoulou, Hariklia; Korkolopoulou, Penelope; Paraskevakou, Helen; Marinaki, Smaragdi; Voulgarelis, Michael; Stofas, Anastasios; Lelouda, Maria; Lazaris, Andreas C; Boletis, John; Patsouris, Efstratios

    2010-06-01

    Systemic Castleman's disease is a lymphoproliferative disorder with various clinical presentations and incompletely understood aetiology. The authors report on a rare case of the plasma cell variant of Castleman's disease associated with autoimmune haemolytic anaemia and autoimmune thrombocytopenia (Evan's syndrome) and complicated by mixed nephrotic-nephritic syndrome and acute renal failure due to an underlying glomerulopathy with microscopic and immunofluorescence findings suggestive of membranoproliferative glomerulonephritis (MPGN) type I. Immunocomplexed glomerulonephritis is rare in Castleman's disease, while, to the best of our knowledge, constellation of all these autoimmune phenomena is reported for the first time suggesting that apart from the putative role of VEGF and IL-6 in the pathogenesis of the disease, a more generalised immunological disturbance occurs, probably through autoantibodies induced by active polyclonal B cells raised from Castleman's disease tumour.

  17. Computational characterization of residue couplings and micropolymorphism-induced changes in the dynamics of two differentially disease-associated human MHC class-I alleles.

    Science.gov (United States)

    Serçinoğlu, Onur; Ozbek, Pemra

    2018-02-01

    Human major histocompatibility complex class I (MHC I) - or human leukocyte antigen (HLA) - proteins present intracellularly processed peptides to cytotoxic T lymphocytes in the adaptive immune response to pathogens. A high level of polymorphism in human MHC I proteins defines the peptide-binding specificity of thousands of different MHC alleles. However, polymorphism as well as the peptide ligand can also affect the global dynamics of the complex. In this study, we conducted classical molecular dynamics simulations of two HLA alleles, the ankylosing spondylitis (AS) associated/tapasin-dependent HLA-B*27:05 and nondisease-associated/tapasin-independent HLA-B*27:09, both in peptide-free forms as well as complex with four different peptides ligands. Our results indicate that in peptide-free form, the single amino acid substitution distinguishing the two alleles (D116H), leads to a weaker dynamic coupling of residues in the tapasin-dependent HLA-B*27:05. In peptide-bound form, several residues of the binding-groove, mostly in A and B pockets, show hinge-like behavior in the global motion of the MHC. Moreover, allele-dependent changes are shown in residue interactions, affecting the B-pocket as well as the beta-2-microglobulin (β2m)-facing residues of the HLA chain.

  18. [Real-time quantitative detection of E2A-PBX1 fusion gene in children with acute lymphoblastic leukemia and its clinical application in minimal residual disease monitoring].

    Science.gov (United States)

    Zhang, Rong; Liao, Jing; Li, Ge; Sun, Huai-Qiang; Shi, Yu-Jun; Yang, Ji-Yun

    2013-06-01

    To establish a real-time reverse transcription-polymerase chain reaction (RT-PCR) for quantitative detection of E2A-PBX1 fusion gene mRNA in acute lymphoblastic leukemia (ALL) children and to explore its clinical significance in minimal residual disease monitoring and prognosis evaluation. Real-time RT-PCR was used to quantitatively detect the mRNA expression of E2A-PBX1 gene in 11 newly diagnosed ALL patients at diagnosis (11 cases), complete remission (11 cases) and periods of relapse (3 cases). Ten children with normal bone marrow cell morphology and without hematopathy or tumor diseases were used as the control group. The median expression levels of E2A-PBX1 fusion gene in the ALL group at diagnosis and the relapse group were significantly higher than in the control and complete remission groups (PE2A-PBX1 negative patients on day 33 during induction of remission, the recurrence rate increased and disease free survival rate at 3 year decreased significantly in E2A-PBX1 positive patients decreased (PE2A-PBX1 levels by real-time RT-PCR is useful for monitoing minimal residual disease, prediction of relapse and individual treatment. The expression level of E2A-PBX1 gene on day 33 during induction of remission can be used for prognosis evaluation.

  19. A survey of residual analysis and a new test of residual trend.

    Science.gov (United States)

    McDowell, J J; Calvin, Olivia L; Klapes, Bryan

    2016-05-01

    A survey of residual analysis in behavior-analytic research reveals that existing methods are problematic in one way or another. A new test for residual trends is proposed that avoids the problematic features of the existing methods. It entails fitting cubic polynomials to sets of residuals and comparing their effect sizes to those that would be expected if the sets of residuals were random. To this end, sampling distributions of effect sizes for fits of a cubic polynomial to random data were obtained by generating sets of random standardized residuals of various sizes, n. A cubic polynomial was then fitted to each set of residuals and its effect size was calculated. This yielded a sampling distribution of effect sizes for each n. To test for a residual trend in experimental data, the median effect size of cubic-polynomial fits to sets of experimental residuals can be compared to the median of the corresponding sampling distribution of effect sizes for random residuals using a sign test. An example from the literature, which entailed comparing mathematical and computational models of continuous choice, is used to illustrate the utility of the test. © 2016 Society for the Experimental Analysis of Behavior.

  20. Improving outcomes of patients with Alzheimer's disease : long-term disease course and nutritional status in a 'real-life' setting

    NARCIS (Netherlands)

    Droogsma, Hinderika

    2015-01-01

    Alzheimer’s Disease (AD) is the most frequent cause of dementia and characterized by cognitive impairment (such as memory impairment), functional decline and neuropsychiatric symptoms (such as anxiety and depression). Since Alzheimer’s disease is one of the most disabling and burdensome health

  1. Toxoplasmosis--a global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries.

    Directory of Open Access Journals (Sweden)

    Jaroslav Flegr

    Full Text Available BACKGROUND: Toxoplasmosis is becoming a global health hazard as it infects 30-50% of the world human population. Clinically, the life-long presence of the parasite in tissues of a majority of infected individuals is usually considered asymptomatic. However, a number of studies show that this 'asymptomatic infection' may also lead to development of other human pathologies. AIMS OF THE STUDY: The purpose of the study was to collect available geoepidemiological data on seroprevalence of toxoplasmosis and search for its relationship with mortality and disability rates in different countries. METHODS AND FINDINGS: Prevalence data published between 1995-2008 for women in child-bearing age were collected for 88 countries (29 European. The association between prevalence of toxoplasmosis and specific disease burden estimated with age-standardized Disability Adjusted Life Year (DALY or with mortality, was calculated using General Linear Method with Gross Domestic Product per capita (GDP, geolatitude and humidity as covariates, and also using nonparametric partial Kendall correlation test with GDP as a covariate. The prevalence of toxoplasmosis correlated with specific disease burden in particular countries explaining 23% of variability in disease burden in Europe. The analyses revealed that for example, DALY of 23 of 128 analyzed diseases and disease categories on the WHO list showed correlations (18 positive, 5 negative with prevalence of toxoplasmosis and another 12 diseases showed positive trends (p<0.1. For several obtained significant correlations between the seroprevalence of toxoplasmosis and specific diseases/clinical entities, possible pathophysiological, biochemical and molecular explanations are presented. CONCLUSIONS: The seroprevalence of toxoplasmosis correlated with various disease burden. Statistical associations does not necessarily mean causality. The precautionary principle suggests however that possible role of toxoplasmosis as a

  2. Toxoplasmosis--a global threat. Correlation of latent toxoplasmosis with specific disease burden in a set of 88 countries.

    Science.gov (United States)

    Flegr, Jaroslav; Prandota, Joseph; Sovičková, Michaela; Israili, Zafar H

    2014-01-01

    Toxoplasmosis is becoming a global health hazard as it infects 30-50% of the world human population. Clinically, the life-long presence of the parasite in tissues of a majority of infected individuals is usually considered asymptomatic. However, a number of studies show that this 'asymptomatic infection' may also lead to development of other human pathologies. The purpose of the study was to collect available geoepidemiological data on seroprevalence of toxoplasmosis and search for its relationship with mortality and disability rates in different countries. Prevalence data published between 1995-2008 for women in child-bearing age were collected for 88 countries (29 European). The association between prevalence of toxoplasmosis and specific disease burden estimated with age-standardized Disability Adjusted Life Year (DALY) or with mortality, was calculated using General Linear Method with Gross Domestic Product per capita (GDP), geolatitude and humidity as covariates, and also using nonparametric partial Kendall correlation test with GDP as a covariate. The prevalence of toxoplasmosis correlated with specific disease burden in particular countries explaining 23% of variability in disease burden in Europe. The analyses revealed that for example, DALY of 23 of 128 analyzed diseases and disease categories on the WHO list showed correlations (18 positive, 5 negative) with prevalence of toxoplasmosis and another 12 diseases showed positive trends (ptoxoplasmosis and specific diseases/clinical entities, possible pathophysiological, biochemical and molecular explanations are presented. The seroprevalence of toxoplasmosis correlated with various disease burden. Statistical associations does not necessarily mean causality. The precautionary principle suggests however that possible role of toxoplasmosis as a triggering factor responsible for development of several clinical entities deserves much more attention and financial support both in everyday medical practice and

  3. Toxoplasmosis – A Global Threat. Correlation of Latent Toxoplasmosis with Specific Disease Burden in a Set of 88 Countries

    Science.gov (United States)

    Flegr, Jaroslav; Prandota, Joseph; Sovičková, Michaela; Israili, Zafar H.

    2014-01-01

    Background Toxoplasmosis is becoming a global health hazard as it infects 30–50% of the world human population. Clinically, the life-long presence of the parasite in tissues of a majority of infected individuals is usually considered asymptomatic. However, a number of studies show that this ‘asymptomatic infection’ may also lead to development of other human pathologies. Aims of the Study The purpose of the study was to collect available geoepidemiological data on seroprevalence of toxoplasmosis and search for its relationship with mortality and disability rates in different countries. Methods and Findings Prevalence data published between 1995–2008 for women in child-bearing age were collected for 88 countries (29 European). The association between prevalence of toxoplasmosis and specific disease burden estimated with age-standardized Disability Adjusted Life Year (DALY) or with mortality, was calculated using General Linear Method with Gross Domestic Product per capita (GDP), geolatitude and humidity as covariates, and also using nonparametric partial Kendall correlation test with GDP as a covariate. The prevalence of toxoplasmosis correlated with specific disease burden in particular countries explaining 23% of variability in disease burden in Europe. The analyses revealed that for example, DALY of 23 of 128 analyzed diseases and disease categories on the WHO list showed correlations (18 positive, 5 negative) with prevalence of toxoplasmosis and another 12 diseases showed positive trends (ptoxoplasmosis and specific diseases/clinical entities, possible pathophysiological, biochemical and molecular explanations are presented. Conclusions The seroprevalence of toxoplasmosis correlated with various disease burden. Statistical associations does not necessarily mean causality. The precautionary principle suggests however that possible role of toxoplasmosis as a triggering factor responsible for development of several clinical entities deserves much more

  4. Bioenergy from sisal residues

    Energy Technology Data Exchange (ETDEWEB)

    Jungersen, G. [Dansk Teknologisk Inst. (Denmark); Kivaisi, A.; Rubindamayugi, M. [Univ. of Dar es Salaam (Tanzania, United Republic of)

    1998-05-01

    The main objectives of this report are: To analyse the bioenergy potential of the Tanzanian agro-industries, with special emphasis on the Sisal industry, the largest producer of agro-industrial residues in Tanzania; and to upgrade the human capacity and research potential of the Applied Microbiology Unit at the University of Dar es Salaam, in order to ensure a scientific and technological support for future operation and implementation of biogas facilities and anaerobic water treatment systems. The experimental work on sisal residues contains the following issues: Optimal reactor set-up and performance; Pre-treatment methods for treatment of fibre fraction in order to increase the methane yield; Evaluation of the requirement for nutrient addition; Evaluation of the potential for bioethanol production from sisal bulbs. The processing of sisal leaves into dry fibres (decortication) has traditionally been done by the wet processing method, which consumes considerable quantities of water and produces large quantities of waste water. The Tanzania Sisal Authority (TSA) is now developing a dry decortication method, which consumes less water and produces a waste product with 12-15% TS, which is feasible for treatment in CSTR systems (Continously Stirred Tank Reactors). (EG)

  5. Treatment reduction for children and young adults with low-risk acute lymphoblastic leukaemia defined by minimal residual disease (UKALL 2003): a randomised controlled trial.

    Science.gov (United States)

    Vora, Ajay; Goulden, Nick; Wade, Rachel; Mitchell, Chris; Hancock, Jeremy; Hough, Rachael; Rowntree, Clare; Richards, Sue

    2013-03-01

    Minimal residual disease (MRD) is the most sensitive and specific predictor of relapse risk in children with acute lymphoblastic leukaemia (ALL) during remission. We assessed whether treatment intensity could be adjusted for children and young adults according to MRD risk stratification. Between Oct 1, 2003 and June 30, 2011, consecutive children and young adults (aged 1-25 years) with ALL from the UK and Ireland were recruited. Eligible patients were categorised into clinical standard, intermediate, and high risk groups on the basis of a combination of National Cancer Institute (NCI) criteria, cytogenetics, and early response to induction therapy, which was assessed by bone marrow blast counts taken at days 8 (NCI high-risk patients) and 15 (NCI standard-risk patients) after induction began. Clinical standard-risk and intermediate-risk patients were assessed for MRD. Those classified as MRD low risk (undetectable MRD at the end of induction [day 29] or detectable MRD at day 29 that became undetectable by week 11) were randomly assigned to receive one or two delayed intensification courses. Patients had received induction, consolidation, and interim maintenance therapy before they began delayed intensification. Delayed intensification consisted of pegylated asparaginase on day 4; vincristine, dexamethasone (alternate weeks), and doxorubicin for 3 weeks; and 4 weeks of cyclophosphamide and cytarabine. Computer randomisation was done with stratification by MRD result and balancing for sex, age, and white blood cell count at diagnosis by method of minimisation. Patients, clinicians, and data analysts were not masked to treatment allocation. The primary outcome was event-free survival (EFS), which was defined as time to relapse, secondary tumour, or death. Our aim was to rule out a 7% reduction in EFS in the group given one delayed intensification course relative to that given two delayed intensification courses. Analyses were by intention to treat. This trial is

  6. Cardiac autonomic neuropathy: The hidden cardiovascular comorbidity in elderly patients with chronic obstructive pulmonary disease attending primary care settings.

    Science.gov (United States)

    Rasheedy, Doha; Taha, Hend M

    2016-03-01

    To quantify the prevalence of chronic comorbidities including cardiac autonomic neuropathy among elderly patients with chronic obstructive pulmonary disease (COPD). A cross-sectional study was carried out on 175 elderly male patients with COPD attending Ain Shams University Hospital, Cairo, Egypt. The comorbidities that might alter cardiac autonomic function in patients with COPD were identified. The patients without reported comorbidities underwent arterial blood gas analysis, pulmonary function tests and autonomic function assessment using cardiovascular reflexes. A total of 69.14% of the participants presented with comorbidities (group 1), whereas 30.85% of the participants reported no comorbidity (group 2). Among the participants, the most prevalent comorbid diseases were hypertension (34.20%), cor pulmonale (31.42%), ischemic heart disease (20.00%), diabetes (18.28%) and congestive heart failure (13.70%). In group 2, 29.60% and 22.20% of the patients had early and definite cardiac autonomic neuropathy (CAN) respectively. CAN occurred early in the course of the disease with 40.90% of mild COPD cases being affected. The patients with definite CAN had the highest resting heart rate. The presence of CAN was related to hypercapnia, but not hypoxemia or COPD severity. COPD has a complex spectrum of comorbidities. Cardiac autonomic neuropathy in elderly male patients with COPD correlated with hypercapnia, but not hypoxemia or the disease severity. © 2015 Japan Geriatrics Society.

  7. Time perception of cancer patients without evidence of disease and advanced cancer patients in a palliative, end-of-life-care setting.

    Science.gov (United States)

    van Laarhoven, Hanneke W M; Schilderman, Johannes; Verhagen, Constans A H H V M; Prins, Judith B

    2011-01-01

    Time perception may be an important factor influencing distress of cancer patients. However, no comparative studies have been performed for cancer patients without evidence of disease and advanced cancer patients in the palliative, end-of-life-care setting. The objectives of the study were to assess time perception in disease-free and advanced cancer patients and examine the relation of time perception with patients' distress. A descriptive research design was used. Ninety-six disease-free and 63 advanced cancer patients filled out Cottle's Circle Test to assess time coherence and time dominance, Cottle's Line Test to assess temporal extension and Bayes' question on speed of time, the European Organisation for Research-and-Treatment of Cancer QOL-Questionnaire version 2.0, Beck's Depression Inventory for primary care, and Beck's Hopelessness-Scale. In patients without evidence of disease, future dominance was most often observed, whereas in advanced cancer patients, the present was the dominant time segment. In both groups, a focus on the past was associated with distress. In contrast with patients without evidence of disease, advanced cancer patients perceived time as moving slowly, and this was correlated with distress. The time perception of cancer patients without evidence of disease and advanced cancer patients is significantly different and is related to distress. The observed relation between a focus on the past and distress gives room for interventions of nurses and other healthcare professionals. Specific attention is needed for differences between cancer patients without evidence of disease and advanced cancer patients.

  8. A Head-to-Head Comparison of UK SF-6D and Thai and UK EQ-5D-5L Value Sets in Thai Patients with Chronic Diseases.

    Science.gov (United States)

    Sakthong, Phantipa; Munpan, Wipaporn

    2017-10-01

    Little was known about the head-to-head comparison of psychometric properties between SF-6D and EQ-5D-5L or the different value sets of EQ-5D-5L. Therefore, this study set out to compare the psychometric properties including agreement, convergent, and known-group validity between the SF-6D and the EQ-5D-5L using the real value sets from Thailand and the UK in patients with chronic diseases. 356 adults taking a medication for at least 3 months were identified from a university hospital in Bangkok, Thailand, between July 2014 and March 2015. Agreement was assessed by intraclass correlation coefficients (ICCs) and Bland-Altman plots. Convergent validity was evaluated using Spearman's rank correlation coefficients between SF-6D and EQ-5D-5L and EQ-VAS and SF-12v2. For known-groups validity, the Mann-Whitney U test and Kruskal-Wallis test were used to examine the associations between SF-6D and EQ-5D-5L and patient characteristics. Agreements between the SF-6D and the EQ-5D-5L using Thai and UK value sets were fair, with ICCs of 0.45 and 0.49, respectively. Bland-Altman plots showed that the majority of the SF-6D index scores were lower than the EQ-5D-5L index scores. Both the EQ-5D-5L value sets were more related to the EQ-VAS and physical health, while the SF-6D was more associated with mental health. Both EQ-5D-5L value sets were more sensitive than the SF-6D in discriminating patients with different levels of more known groups except for adverse drug reactions. The SF-6D and both EQ-5D-5L value sets appeared to be valid but sensitive to different outcomes in Thai patients with chronic diseases.

  9. Complex multi-block analysis identifies new immunologic and genetic disease progression patterns associated with the residual β-cell function 1 year after diagnosis of type 1 diabetes

    DEFF Research Database (Denmark)

    Andersen, Marie Louise Max; Rasmussen, Morten Arendt; Pörksen, Sven

    2013-01-01

    The purpose of the present study is to explore the progression of type 1 diabetes (T1D) in Danish children 12 months after diagnosis using Latent Factor Modelling. We include three data blocks of dynamic paraclinical biomarkers, baseline clinical characteristics and genetic profiles of diabetes...... related SNPs in the analyses. This method identified a model explaining 21.6% of the total variation in the data set. The model consists of two components: (1) A pattern of declining residual β-cell function positively associated with young age, presence of diabetic ketoacidosis and long duration...

  10. Comparison of cardiovascular disease patterns in two data sets of patients admitted at a tertiary care public hospital in Karachi five years apart

    International Nuclear Information System (INIS)

    Kazim, S.F.; Itrat, A.; Butt, N.W.; Ishaq, M.

    2009-01-01

    To compare the disease patterns in two data sets of patients, five years apart, at the National Institute of Cardiovascular Diseases (NICVD), a tertiary care cardiac hospital in Karachi. The underlying objective was to determine any changes in cardiovascular disease patterns at an acute cardiac unit over a period of five years. A retrospective descriptive study was conducted on patients admitted in West Ward, National Institute of Cardiovascular Diseases (NICVD), Karachi in September, 2000 and September, 2005. Patient's record files were reviewed and the relevant information was recorded on a proforma designed for the purpose. In September, 2000, a total of 414 patients were admitted. Of these 71.25% were males. Majority of patients (72.92%) were in the fifth decade of life or beyond. Acute coronary syndrome (ACS) was the commonest presentation, present in 39.8% of the patients. 27.3% had myocardial infarction (MI) while 10.34% were diagnosed with heart muscle diseases. The overall mortality was 3.4%. In September, 2005, a total of 446 patients were admitted. Of these, 63% were males. 71.29% were in the fifth, sixth, and seventh decades of life. 43.04% patients were admitted with acute coronary syndromes (ACS), 26% with myocardial infarction (MI) and 13.45% with heart muscle diseases. The overall mortality was 1.34%. The almost similar results in two data sets of patients five years apart suggests that the cardiovascular disease burden and pattern has not changed significantly at this center. There is a preponderance of cardiovascular illnesses in males and older age groups. ACS and MI account for majority of admissions. (author)

  11. Illness experiences of diabetes in the context of malaria in settings experiencing double burden of disease in southeastern Tanzania

    NARCIS (Netherlands)

    Metta, Emmy; Bailey, Ajay; Kessy, Flora; Geubbels, Eveline; Haisma, Hinke

    2017-01-01

    BACKGROUND: Tanzania is doubly burdened with both non-communicable and infectious diseases, but information on how Tanzanians experience the co-existence of these conditions is limited. Using Kleinman's eight prompting questions the study synthesizes explanatory models from patients to describe

  12. Routine HIV screening of sexually transmitted disease clinic attenders has favourable cost-effectiveness ratio in low HIV prevalence settings

    NARCIS (Netherlands)

    Bos, JM; van der Meijden, WI; Swart, W; Postma, MJ

    2002-01-01

    HIV screening for attenders of clinics for sexually transmitted disease (STD) may identify individuals with high-risk sexual behaviour and avert HIV infections in partners. Extending our previous analysis in AIDS, we performed an economic evaluation of HIV screening of STD-clinic attenders in

  13. Data set of interactomes and metabolic pathways of proteins differentially expressed in brains with Alzheimer׳s disease

    Directory of Open Access Journals (Sweden)

    Benito Minjarez

    2016-06-01

    Full Text Available Alzheimer׳s disease is one of the main causes of dementia in the elderly and its frequency is on the rise worldwide. It is considered the result of complex interactions between genetic and environmental factors, being many of them unknown. Therefore, there is a dire necessity for the identification of novel molecular players for the understanding of this disease. In this data article we determined the protein expression profiles of whole protein extracts from cortex regions of brains from patients with Alzheimer׳s disease in comparison to a normal brain. We identified 721 iTRAQ-labeled polypeptides with more than 95% in confidence. We analyzed all proteins that changed in their expression level and located them in the KEGG metabolic pathways, as well as in the mitochondrial complexes of the electron transport chain and ATP synthase. In addition, we analyzed the over- and sub-expressed polypeptides through IPA software, specifically Core I and Biomarkers I modules. Data in this article is related to the research article “Identification of proteins that are differentially expressed in brains with Alzheimer’s disease using iTRAQ labeling and tandem mass spectrometry” (Minjarez et al., 2016 [1].

  14. Recurrent Iliofemoral Venous Thrombosis in the Setting of May-Thurner Syndrome as the Presenting Symptom of Behcet's Disease.

    Science.gov (United States)

    Lakha, Sameer; Png, Chien Yi Maximilian; Chun, Kevin; Ting, Windsor

    2018-02-23

    Vascular manifestations including pulmonary artery aneurysms and venous thrombosis are seen in up to 14% of patients with Behcet's disease. We report a patient who had recurrent deep vein thrombosis (DVT) as the presenting symptom of Behcet's Disease. A 19-year-old male who presented with acute iliofemoral DVT, confirmed by intravascular ultrasound (IVUS) and venogram. May-Thurner syndrome was also observed. Repeated catheter-based pharmacomechanical thrombolysis, thrombectomy, and subsequent iliac vein stenting were performed. The patient was then discharged on rivaroxaban and aspirin. Five months later, the patient experienced left calf pain. In the interim, he had been diagnosed with Behcet's disease by a rheumatologist who was consulted due to oral ulcers and skin lesions and accordingly started on prednisone, colchicine, and azathioprine. At this time, IVUS and venogram revealed thrombotic occlusion of the previously placed stent. Tissue plasminogen activator was infused into the stent, and pharmacomechanical thrombectomy restored flow through the left iliac veins. Follow-up laboratory workup revealed that subtherapeutic azathioprine dosing, and after appropriate adjustment, the patient has been asymptomatic for 12 months. Acute refractory DVT is a possible presenting symptom of Behcet's disease, which may be complicated by May-Thurner syndrome. Such patients should receive therapeutic immunosuppression in addition to anticoagulation. Copyright © 2018 Elsevier Inc. All rights reserved.

  15. Grief Reactions and Depression in Caregivers of Individuals with Alzheimer's Disease: Results from a Pilot Study in an Urban Setting

    Science.gov (United States)

    Sanders, Sara; Adams, Kathryn Betts

    2005-01-01

    The relationship between grief and depression in caregivers of individuals with Alzheimer's disease has not been clearly defined through empirical research. This pilot study examined the relationship between these two variables and determined the strength of their relationship. A racially diverse sample of caregivers was drawn from an urban…

  16. Can osteoprotegerin be used to identify the presence and severity of coronary artery disease in different clinical settings?

    DEFF Research Database (Denmark)

    Hosbond, Susanne Elisabeth; Diederichsen, Axel Cosmus Pyndt; Saaby, Lotte

    2014-01-01

    PURPOSE: The biomarker Osteoprotegerin (OPG) is associated with coronary artery disease (CAD). The main purpose of this study was to evaluate the diagnostic value of OPG in healthy subjects and in patients with suspected angina pectoris (AP). METHODS: A total of 1805 persons were enrolled: 1152...

  17. Brown fat necrosis in the setting of congenital heart disease and prostaglandin E1 use: a case report

    International Nuclear Information System (INIS)

    Raboi, C.A.; Smith, W.

    1999-01-01

    We report a case of a child with D-transposition of the great arteries treated with prostaglandin E1 (PGE1) who subsequently developed extensive brown fat necrosis. To the best of our knowledge, no previous association among congenital heart disease, PGE1, and brown fat necrosis has been reported

  18. Applying the WHO ICF Framework to Communication Assessment and Goal Setting in Huntington's Disease: A Case Discussion

    Science.gov (United States)

    Power, Emma; Anderson, Alison; Togher, Leanne

    2011-01-01

    Purpose: Huntington's Disease (HD) is a fatal, hereditary neurodegenerative disorder that is characterized by a triad of motor, cognitive and psychiatric symptoms that impact on both communicative effectiveness and the treatment techniques used to maximize communicative participation. The purpose of this article is to describe the application of…

  19. Renal function in children suffering from sickle cell disease: challenge of early detection in highly resource-scarce settings.

    Science.gov (United States)

    Aloni, Michel Ntetani; Ngiyulu, René Makwala; Gini-Ehungu, Jean-Lambert; Nsibu, Célestin Ndosimao; Ekila, Mathilde Bothale; Lepira, François Bompeka; Nseka, Nazaire Mangani

    2014-01-01

    The prevalence of Sickle cell disease is extremely high in Democratic Republic of Congo. Despite this high prevalence of the disease, data on renal abnormalities in children are rare. The study proposed to assess blood pressure, glomerular function, urea and uric acid levels in 65 steady state Congolese children with homozygous sickle cell disease and 67 normal controls. In Hb-SS group, blood pressure level tended to be lower than Hb-AA groups but there was no statistically significant difference (p>0.05) between the two groups. The absolute values for GFR corrected for BSA were significantly higher in Hb-SS group compared to Hb-AA group (130.5±34.1 ml/min/1.73 m2 vs 113.7±24.5 ml/min/1.73 m2; p = 0.004). Children with Hb-SS were more likely to hyperfiltrate (30.8% of subjects) than children with Hb-AA (6.1% of subjects). Proteinuria was found in 4 (6.2%) children with Hb-SS. Uric acid level was significantly increased in children with Hb-SS compared to corresponding values in control group (4.4±1.3 mg/dl vs 3.5±1.1 mg/dl; pchildren with sickle cell disease than in normal controls.

  20. CpG oligodeoxynucleotides are effective in therapy of minimal residual tumour disease after chemotherapy or surgery in a murine model of MHC class I-deficient, HPV16-associated tumours

    Czech Academy of Sciences Publication Activity Database

    Reiniš, Milan; Šímová, Jana; Indrová, Marie; Bieblová, Jana; Bubeník, Jan

    2007-01-01

    Roč. 30, č. 5 (2007), s. 1247-1251 ISSN 1019-6439 R&D Projects: GA ČR GA301/04/0492; GA ČR GA301/06/0774 EU Projects: European Commission(XE) 18933 - CLINIGENE Grant - others:Liga proti rakovině, Praha(CZ) XX Institutional research plan: CEZ:AV0Z50520514 Keywords : HPV16 * minimal residual tumour disease * CpG oligonucleotides Subject RIV: EB - Genetics ; Molecular Biology Impact factor: 2.295, year: 2007

  1. Effects of a Pedometer-Based Telephone Coaching Intervention on Physical Activity Among People with Cardiac Disease in Urban, Rural and Semi-Rural Settings: A Replication Study.

    Science.gov (United States)

    Sangster, Janice; Furber, Susan; Phongsavan, Philayrath; Redfern, Julie; Mark, Andrew; Bauman, Adrian

    2017-04-01

    This study aimed to determine the replicability of a pedometer-based telephone coaching intervention by comparing the outcomes of a study conducted in rural and urban settings to a study that previously found the same intervention effective in a semi-rural setting. Replication studies are conducted to assess whether an efficacious intervention is effective in multiple different settings. This study compared the outcomes of a pedometer-based coaching intervention implemented in urban and rural settings (replication study) with the same intervention implemented in a semi-rural setting (reference study) on physical activity levels. Improvements in total weekly physical activity time in the replication study were significant from baseline to six weeks (pcoaching intervention increases physical activity levels of people with cardiac disease referred to a CR program in diverse settings. This replication study indicates the suitability of this minimal contact, low-cost intervention for further scaling-up to address unmet need in community-dwelling cardiac patients. Copyright © 2016 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.

  2. A case report of symptomatic gallbladder disease in the setting of peritoneal carcinomatosis originating from invasive lobular carcinoma of the breast.

    Science.gov (United States)

    Brinkman, David; Misra, Subhasis; Aydin, Nail

    2016-01-01

    Invasive lobular carcinoma is the second most common type of breast cancer, responsible for 5-15 percent of all cases. Peritoneal carcinomatosis secondary to breast cancer is a rare event, frequently resulting in morbidity and mortality. Symptomatic gallbladder disease in the setting of peritoneal carcinomatosis originating from invasive lobular carcinoma of the breast is a very rare event and is not well covered in literature. A 44year old female patient previously diagnosed with stage IV invasive lobular carcinoma of the left breast with widespread systemic metastases and peritoneal carcinomatosis presented with a three week history of right upper quadrant pain trigged by food intake only, greatly diminishing her quality of life. She had spent almost a year in a progression free disease status but was now suffering from debilitating symptomatic gallbladder disease. Despite the extent of her peritoneal carcinomatosis, she elected to undergo a laparoscopic cholecystectomy. We are presenting a rare case of symptomatic gallbladder disease in the setting of peritoneal carcinomatosis secondary to invasive lobular carcinoma. A major concern is tumor load within nearby portal structures. Even though laparoscopic cholecystectomy could be a viable option to treat the condition, it needs to be applied selectively and very cautiously in the respective patient population. Symptomatic gallbladder disease in the setting of peritoneal carcinomatosis secondary to invasive lobular carcinoma is an uncommon presentation to surgeons. A diagnostic laparoscopy is the preferred initial evaluation. If deemed feasible, and if the surgeon has the required experience, a laparoscopic cholecystectomy can be undertaken selectively. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  3. Improved diagnostic accuracy of Alzheimer's disease by combining regional cortical thickness and default mode network functional connectivity: Validated in the Alzheimer's disease neuroimaging initiative set

    International Nuclear Information System (INIS)

    Park, Ji Eun; Park, Bum Woo; Kim, Sang Joon; Kim, Ho Sung; Choi, Choong Gon; Jung, Seung Jung; Oh, Joo Young; Shim, Woo Hyun; Lee, Jae Hong; Roh, Jee Hoon

    2017-01-01

    To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal (p < 0.001) and supramarginal gyrus (p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease

  4. Improved diagnostic accuracy of Alzheimer's disease by combining regional cortical thickness and default mode network functional connectivity: Validated in the Alzheimer's disease neuroimaging initiative set

    Energy Technology Data Exchange (ETDEWEB)

    Park, Ji Eun; Park, Bum Woo; Kim, Sang Joon; Kim, Ho Sung; Choi, Choong Gon; Jung, Seung Jung; Oh, Joo Young; Shim, Woo Hyun [Dept. of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of); Lee, Jae Hong; Roh, Jee Hoon [University of Ulsan College of Medicine, Asan Medical Center, Seoul (Korea, Republic of)

    2017-11-15

    To identify potential imaging biomarkers of Alzheimer's disease by combining brain cortical thickness (CThk) and functional connectivity and to validate this model's diagnostic accuracy in a validation set. Data from 98 subjects was retrospectively reviewed, including a study set (n = 63) and a validation set from the Alzheimer's Disease Neuroimaging Initiative (n = 35). From each subject, data for CThk and functional connectivity of the default mode network was extracted from structural T1-weighted and resting-state functional magnetic resonance imaging. Cortical regions with significant differences between patients and healthy controls in the correlation of CThk and functional connectivity were identified in the study set. The diagnostic accuracy of functional connectivity measures combined with CThk in the identified regions was evaluated against that in the medial temporal lobes using the validation set and application of a support vector machine. Group-wise differences in the correlation of CThk and default mode network functional connectivity were identified in the superior temporal (p < 0.001) and supramarginal gyrus (p = 0.007) of the left cerebral hemisphere. Default mode network functional connectivity combined with the CThk of those two regions were more accurate than that combined with the CThk of both medial temporal lobes (91.7% vs. 75%). Combining functional information with CThk of the superior temporal and supramarginal gyri in the left cerebral hemisphere improves diagnostic accuracy, making it a potential imaging biomarker for Alzheimer's disease.

  5. Setting priorities for the health care sector in Zimbabwe using cost-effectiveness analysis and estimates of the burden of disease

    DEFF Research Database (Denmark)

    Hansen, Kristian Schultz; Chapman, Glyn

    2008-01-01

    Background: This study aimed at providing information for priority setting in the health care sector of Zimbabwe as well as assessing the efficiency of resource use. A general approach proposed by the World Bank involving the estimation of the burden of disease measured in Disability-Adjusted Life...... a combination of step-down and micro-costing was applied. Effectiveness of health interventions was estimated based on published information on the efficacy adjusted for factors such as coverage and compliance. Results: Very cost-effective interventions were available for the major health problems. Using...... estimates of the burden of disease, the present paper developed packages of health interventions using the estimated cost-effectiveness ratios. These packages could avert a quarter of the burden of disease at total costs corresponding to one tenth of the public health budget in the financial year 1997...

  6. A comparison of Irish set dancing and exercises for people with Parkinson?s disease: A phase II feasibility study

    OpenAIRE

    Volpe, Daniele; Signorini, Matteo; Marchetto, Anna; Lynch, Timothy; Morris, Meg E

    2013-01-01

    Background People with idiopathic Parkinson?s disease (PD) frequently have low activity levels, poor mobility and reduced quality of life. Although increased physical activity may improve mobility, balance and wellbeing, adherence to exercises and activity programs over the longer term can be challenging, particularly for older people with progressive neurological conditions such as PD. Physical activities that are engaging and enjoyable, such as dancing, might enhance adherence over the long...

  7. The Budget Impact of Oral Nutritional Supplements for Disease Related Malnutrition in Elderly in the Community Setting

    OpenAIRE

    Freijer, Karen; Nuijten, Mark J. C.; Schols, Jos M. G. A.

    2012-01-01

    A health economic analysis was performed to assess the economic impact on the national health care budget of using Oral Nutritional Supplements (ONS), being a food for special medical purposes (FSMP) also known as medical nutrition, for the treatment of disease-related malnutrition (DRM) in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (> 65 years) with DRM in the Netherlands. The model reflects t...

  8. Burden of disease from inadequate water, sanitation and hygiene in low- and middle-income settings: a retrospective analysis of data from 145 countries.

    Science.gov (United States)

    Prüss-Ustün, Annette; Bartram, Jamie; Clasen, Thomas; Colford, John M; Cumming, Oliver; Curtis, Valerie; Bonjour, Sophie; Dangour, Alan D; De France, Jennifer; Fewtrell, Lorna; Freeman, Matthew C; Gordon, Bruce; Hunter, Paul R; Johnston, Richard B; Mathers, Colin; Mäusezahl, Daniel; Medlicott, Kate; Neira, Maria; Stocks, Meredith; Wolf, Jennyfer; Cairncross, Sandy

    2014-08-01

    To estimate the burden of diarrhoeal diseases from exposure to inadequate water, sanitation and hand hygiene in low- and middle-income settings and provide an overview of the impact on other diseases. For estimating the impact of water, sanitation and hygiene on diarrhoea, we selected exposure levels with both sufficient global exposure data and a matching exposure-risk relationship. Global exposure data were estimated for the year 2012, and risk estimates were taken from the most recent systematic analyses. We estimated attributable deaths and disability-adjusted life years (DALYs) by country, age and sex for inadequate water, sanitation and hand hygiene separately, and as a cluster of risk factors. Uncertainty estimates were computed on the basis of uncertainty surrounding exposure estimates and relative risks. In 2012, 502,000 diarrhoea deaths were estimated to be caused by inadequate drinking water and 280,000 deaths by inadequate sanitation. The most likely estimate of disease burden from inadequate hand hygiene amounts to 297,000 deaths. In total, 842,000 diarrhoea deaths are estimated to be caused by this cluster of risk factors, which amounts to 1.5% of the total disease burden and 58% of diarrhoeal diseases. In children under 5 years old, 361,000 deaths could be prevented, representing 5.5% of deaths in that age group. This estimate confirms the importance of improving water and sanitation in low- and middle-income settings for the prevention of diarrhoeal disease burden. It also underscores the need for better data on exposure and risk reductions that can be achieved with provision of reliable piped water, community sewage with treatment and hand hygiene. © 2014 The Authors. Tropical Medicine and International Health published by John Wiley & Sons Ltd.

  9. Application of bi-clustering of gene expression data and gene set enrichment analysis methods to identify potentially disease causing nanomaterials

    Directory of Open Access Journals (Sweden)

    Andrew Williams

    2017-12-01

    Full Text Available This article contains data related to the research article ‘Application of bi-clustering of gene expression data and gene set enrichment analysis methods to identify potentially disease causing nanomaterials’ (Williams and Halappanavar, 2015 [1]. The presence of diverse types of nanomaterials (NMs in commerce has grown significantly in the past decade and as a result, human exposure to these materials in the environment is inevitable. The traditional toxicity testing approaches that are reliant on animals are both time- and cost- intensive; employing which, it is not possible to complete the challenging task of safety assessment of NMs currently on the market in a timely manner. Thus, there is an urgent need for comprehensive understanding of the biological behavior of NMs, and efficient toxicity screening tools that will enable the development of predictive toxicology paradigms suited to rapidly assessing the human health impacts of exposure to NMs. In an effort to predict the long term health impacts of acute exposure to NMs, in Williams and Halappanavar (2015 [1], we applied bi-clustering and gene set enrichment analysis methods to derive essential features of altered lung transcriptome following exposure to NMs that are associated with lung-specific diseases. Several datasets from public microarray repositories describing pulmonary diseases in mouse models following exposure to a variety of substances were examined and functionally related bi-clusters showing similar gene expression profiles were identified. The identified bi-clusters were then used to conduct a gene set enrichment analysis on lung gene expression profiles derived from mice exposed to nano-titanium dioxide, carbon black or carbon nanotubes (nano-TiO2, CB and CNTs to determine the disease significance of these data-driven gene sets. The results of the analysis correctly identified all NMs to be inflammogenic, and only CB and CNTs as potentially fibrogenic. Here, we

  10. Disease progression and health care resource consumption in patients affected by hepatitis C virus in real practice setting

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    Perrone V

    2016-10-01

    Full Text Available Valentina Perrone, Diego Sangiorgi, Stefano Buda, Luca Degli Esposti CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy Introduction: Hepatitis C virus (HCV infection represents serious health problems worldwide and is a major contributor to end-stage liver disease including cirrhosis and hepatocellular carcinoma (HCC. In Italy, ~2% of subjects are infected with HCV. The objective of this study was to describe treatment patterns, disease progression, and resource use in HCV.Methods: An observational retrospective cohort analysis based on four Local Health Units administrative and laboratory databases was conducted. HCV-positive patients between January 1, 2009 and December 31, 2010 were included and followed-up for 1 year. To explore which covariates were associated to disease progression (cirrhosis, HCC, death for any cause, Cox proportional hazards models were performed.Results: A total of 9,514 patients were analyzed of which 55.6% were male, aged 58.1±16.1, and prevalence 0.4%; 5.8% were positive to human immunodeficiency virus (HIV infection, 3.0% to hepatitis B virus (HBV, and 1.6% to HCV+HBV+HIV; 26.1% had cirrhosis and 4.3% HCC. The majority of patients (76% did not receive an antiviral treatment; the main factors affecting this decision were age, 44.1% of untreated patients being aged >65 years; 31% were affected by cirrhosis, 6.6% had ongoing substance or alcohol abuse, and 5.5% were affected by HCC. Disease progression in the observed timeframe was less frequent among treated patients (incidence rate per 100 patients/year: cirrhosis 2.1±0.7 vs 13.0±1.0, HCC 0.5±0.3 vs 3.6±0.5, death 0.5±0.3 vs 6.4±0.7. The annual expenditure for HCV management (drugs, hospitalizations, outpatient services was €4,700 per patient.Conclusion: This observational, real-life study shows that only a small proportion of patients received antiviral therapy in the territorial services investigated; among patients who were not treated

  11. Avaliação laboratorial da doença residual mínima na leucemia mielóide crônica por Real-Time PCR Evaluation diagnosis of minimal residual disease in chronic myeloid leukemia by Real-Time PCR

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    Allyne Cristina Grando

    2008-12-01

    Full Text Available A leucemia mielóide crônica (LMC representa 15% das leucemias e apresenta três fases: crônica, acelerada e crise blástica. A partir da análise citogenética, pode ser identificado o cromossomo Philadelphia, característico da LMC. O transplante de células-tronco é o único tratamento curativo, mas é acompanhado de altas taxas de morbimortalidade, dificultando sua aplicação. A doença residual mínima é de grande importância para avaliar a resposta ao tratamento, tanto na verificação de doença residual, quanto na identificação de pacientes com alto risco de recaída. Muitas técnicas específicas têm sido introduzidas para detectar as translocações ou os produtos do cromossomo Philadelphia. A mais sensível é a Real-Time PCR, que detecta uma célula leucêmica em 10(5 células normais. O objetivo deste trabalho foi realizar uma revisão bibliográfica sobre a LMC, dando ênfase à utilização da técnica por Real-Time PCR.Chronic myeloid leukemia (CML represents about 15% of all leukemias and has three phases: the chronic phase, accelerated phase and blast crisis. After cytogenetic analysis, the Philadelphia chromosome, characteristic of CML, can be identificated. Stem cell transplantation is the only curative treatment for CML, but it is accompanied by high levels of morbimortality, difficulting its application. The minimal residual disease is very important for the evaluation of the response to treatment, to verify the residual disease and also to identify patients with a high risk of relapse. Many specific techniques have been introduced for the detection of translocations or products of the Philadelphia chromosome; the most sensitive being Real-Time PCR which detects 1 leukemia cell in 10(5 normal cells. The aim of this study was to perform a bibliographic review of CML, with emphasis on the utilization of the Real-Time PCR technique.

  12. Development of a core outcome set for studies involving patients undergoing major lower limb amputation for peripheral arterial disease: study protocol for a systematic review and identification of a core outcome set using a Delphi survey.

    Science.gov (United States)

    Ambler, Graeme K; Bosanquet, David C; Brookes-Howell, Lucy; Thomas-Jones, Emma; Waldron, Cherry-Ann; Edwards, Adrian G K; Twine, Christopher P

    2017-12-28

    The development of a standardised reporting set is important to ensure that research is directed towards the most important outcomes and that data is comparable. To ensure validity, the set must be agreed by a consensus of stakeholders including patients, healthcare professionals and lay representatives. There is currently no agreed core outcome set for patients undergoing major lower limb amputation for peripheral arterial disease (PAD) for either short- or medium-term research outcomes. By developing these sets we aim to rationalise future trial outcomes, facilitate meta-analysis and improve the quality and applicability of amputation research. We will undertake a comprehensive systematic review of studies of patients undergoing major lower limb amputation for PAD. Data regarding all primary and secondary outcomes reported in relevant studies will be extracted and summarised as outcome domains. We will then undertake focus groups with key stakeholders (patients, carers, health and social care workers) to collect qualitative data to identify the main short- and medium-term research outcomes for patients undergoing major lower limb amputation. Results of the systematic review and focus groups will be combined to create a comprehensive list of potential key outcomes. Stakeholders (patients, researchers and health and social care workers) will then be polled to determine which of the outcomes are considered to be important in a general context using a three-phase Delphi process. After preliminary analysis, results will be presented at a face-to-face meeting of key stakeholders for discussion and voting on the final set of core outcomes. This project is being run in parallel with a feasibility trial assessing perineural catheters in patients undergoing lower limb amputation (the PLACEMENT trial). Full ethical approval has been granted for the study (Wales REC 3 reference number 16/WA/0353). Core outcome sets will be developed for short- and medium-term outcomes of

  13. Comment on the treatment of residual water content in “A consistent set of parametric models for the two-phase flow of immiscible fluids in the subsurface” by L. Luckner et al.

    Science.gov (United States)

    Nimmo, John R.

    1991-01-01

    Luckner et al. [1989] (hereinafter LVN) present a clear summary and generalization of popular formulations used for convenient representation of porous media fluid flow characteristics, including water content (θ) related to suction (h) and hydraulic conductivity (K) related to θ or h. One essential but problematic element in the LVN models is the concept of residual water content (θr; in LVN, θw,r). Most studies using θr determine its value as a fitted parameter and make the assumption that liquid flow processes are negligible at θ values less than θr. While the LVN paper contributes a valuable discussion of the nature of θr, it leaves several problems unresolved, including fundamental difficulties in associating a definite physical condition with θr, practical inadequacies of the models at low θ values, and difficulties in designating a main wetting curve.

  14. Continuity of care to optimize chronic disease management in the community setting: an evidence-based analysis.

    Science.gov (United States)

    2013-01-01

    This evidence-based analysis reviews relational and management continuity of care. Relational continuity refers to the duration and quality of the relationship between the care provider and the patient. Management continuity ensures that patients receive coherent, complementary, and timely care. There are 4 components of continuity of care: duration, density, dispersion, and sequence. The objective of this evidence-based analysis was to determine if continuity of care is associated with decreased health resource utilization, improved patient outcomes, and patient satisfaction. MEDLINE, EMBASE, CINAHL, the Cochrane Library, and the Centre for Reviews and Dissemination database were searched for studies on continuity of care and chronic disease published from January 2002 until December 2011. Systematic reviews, randomized controlled trials, and observational studies were eligible if they assessed continuity of care in adults and reported health resource utilization, patient outcomes, or patient satisfaction. Eight systematic reviews and 13 observational studies were identified. The reviews concluded that there is an association between continuity of care and outcomes; however, the literature base is weak. The observational studies found that higher continuity of care was frequently associated with fewer hospitalizations and emergency department visits. Three systematic reviews reported that higher continuity of care is associated with improved patient satisfaction, especially among patients with chronic conditions. Most of the studies were retrospective cross-sectional studies of large administrative databases. The databases do not capture information on trust and confidence in the provider, which is a critical component of relational continuity of care. The definitions for the selection of patients from the databases varied across studies. There is low quality evidence that: Higher continuity of care is associated with decreased health service utilization.There is

  15. Minimal Rectal Toxicity in the Setting of Comorbid Crohn's Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer.

    Science.gov (United States)

    Singh, Raj; Jackson, Philip S; Blake, Mollie; Cutlip, James; Sharma, Sanjeev

    2017-08-01

    We present one of the first cases of a prostate cancer (PCa) patient with inflammatory bowel disease (IBD) treated with intensity-modulated radiotherapy (IMRT) and a hydrogel rectal spacer. A 73-year-old male with a past medical history significant for Crohn's disease (CD) and the recent diagnosis of T1cN0M0 high-risk PCa was referred for definitive radiotherapy. Given the patient's history of CD and the possible increased risk of gastrointestinal (GI) toxicity and disease exacerbation, prior to IMRT, a hydrogel spacer was placed between the prostate and the anterior rectal wall to further minimize irradiation to the rectum. The patient then received IMRT (78 Gy/2 Gy fractions at a 100 percent isodose line). Over the course of treatment, Radiation Therapy Oncology Group (RTOG) Grade 1 GI toxicities of mild diarrhea were noted during the fifth and sixth weeks of treatment as well as an RTOG Grade 1 genitourinary (GU) toxicity of a decrease in the urinary stream that resolved with tamsulosin. At the 3, 6, 9, and 12-month follow-ups, bowel movements and urinary stream were reported to be at baseline with prostate-specific antigen (PSA) levels of 0.18 ng/mL and 0.03 ng/mL at the three and nine-month follow-ups, respectively. As such, this case report suggests that IBD patients with localized PCa may be viable candidates for radiotherapy given the promising results of hydrogel spacers in combination with IMRT in limiting rectal toxicity.

  16. The "expert patient" approach for non-communicable disease management in low and middle income settings: When the reality confronts the rhetoric.

    Science.gov (United States)

    Xiao, Yue

    2015-09-01

    This paper seeks to explore the relevance between the Western "expert patient" rhetoric and the reality of non-communicable diseases (NCDs) control and management in low and middle income settings from the health sociological perspective. It firstly sets up a conceptual framework of the "expert patient" or the patient self-management approach, showing the rhetoric of the initiative in the developed countries. Then by examining the situation of NCDs control and management in low income settings, the paper tries to evaluate the possibilities of implementing the "expert patient" approach in these countries. Kober and Van Damme's study on the relevance of the "expert patient" for an HIV/AIDS program in low income settings is critically studied to show the relevance of the developed countries' rhetoric of the "expert patient" approach for the reality of developing countries. In addition, the MoPoTsyo diabetes peer educator program is analyzed to show the challenges faced by the low income countries in implementing patient self-management programs. Finally, applications of the expert patient approach in China are discussed as well, to remind us of the possible difficulties in introducing it into rural settings.

  17. Dynamic Simulation, Docking and DFT Studies Applied to a Set of Anti-Acetylcholinesterase Inhibitors in the enzyme β-Secretase (BACE-1): An Important Therapeutic Target in Alzheimer`s disease.

    Science.gov (United States)

    Silva-Junior, Edeildo F; Barcellos Franca, Paulo H; Quintans-Junior, Lucindo J; Mendonca-Junior, Francisco J B; Scotti, Luciana; Scotti, Marcus T; de Aquino, Thiago M; de Araujo-Junior, Joao X

    2017-11-10

    Alzheimer`s disease (AD) affects mainly elderly people over 60 years of age. Currently, there are more than 35 million people with this disease worldwide. The enzyme β-secretase is involved in the processing of the amyloid precursor protein and plays a key role in the physiopathology of AD. The action of some acetylcholinesterase inhibitors (AChEI) as β-secretase inhibitors has been reported. The aim of this study was to highlight the modes of the binding of acetylcholinesterase ligands onto the active site of the β-secretase enzyme. Molecular dynamics and docking were used in order to identify pivotal interactions that favor the inhibitory activity and provide a rational basis for planning novel β-secretase inhibitors. Additionally, density functional theory (DFT) was used to provide accurate energy values for the complexes. A mechanistic study of the amide hydrolysis was also performed at the M06/6-31G(d) basis set. Of the 100 AChE inhibitors, 10 were able to interact with Asp32 and/or Asp228 residues from the enzyme BACE-1, suggesting that these could act as multi-target compounds. These inhibitors were selected for DFT studies in order to provide more accurate energy values. Interestingly, the range of energy values (-27.01 to -8.64 kJ mol-1) obtained was in agreement with the anti-AChE activity. The results obtained in the mechanistic study of compound 93 using DFT are in agreement with theoretical studies described in the literature. The results reported in this study will advance our understanding of the influence of the distinct chemical structures of inhibitors at the active site and aid the development of new virtual screening protocols to design novel AChE multi-target inhibitors. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  18. Overcoming obstacles to establish a multidisciplinary team approach to hepatobiliary diseases: a working model in a Caribbean setting.

    Science.gov (United States)

    Cawich, Shamir O; Johnson, Peter B; Shah, Sundeep; Roberts, Patrick; Arthurs, Milton; Murphy, Trevor; Bonadie, Kimon O; Crandon, Ivor W; Harding, Hyacinth E; Abu Hilal, Mohammed; Pearce, Neil W

    2014-01-01

    By providing a structured forum to exchange information and ideas, multidisciplinary team meetings improve working relationships, expedite investigations, promote evidence-based treatment, and ultimately improve clinical outcomes. This discursive paper reports the introduction of a multidisciplinary team approach to manage hepatobiliary diseases in Jamaica, focusing on the challenges encountered and the methods used to overcome these obstacles. Despite multiple challenges in resource-limited environments, a multidisciplinary team approach can be incorporated into clinical practice in developing nations. Policy makers should make it a priority to support clinical, operational, and governance aspects of the multidisciplinary teams.

  19. Framing, agenda setting, and disease phobia of AIDS-related coverage in the South Korean mass media.

    Science.gov (United States)

    Jung, Minsoo

    2013-01-01

    There has been little research on the concrete role of the press in discourses on AIDS. This study investigated the AIDS discourses created by the major media. In particular, from the perspective of the agenda-setting theory, it examines differences in the framing of AIDS-related news depending on the political orientation and news sources of the press. This study analyzed the thematic frames and news sources implied by AIDS-related coverage. The 2 major media representing conservatism and progressivism were selected as the objects of analysis. As for the search engine for content analysis, the Korean Integrated Newspaper Database System was used, and 151 articles containing "AIDS" or "HIV" over 5 years from January 2005 to December 2010 were analyzed. According to the results of the analysis, there were the 6 following frames: aid/support, accident, human rights, risk, prevention, and biomedicine. Whereas the conservative press in South Korea continued to frame AIDS in the traditional way, the progressive press tended relatively more often to attempt new agenda setting, from the perspective of human rights and inequality. However, both newspaper companies tended mostly to select experts as the sources of AIDS news, thus continuing to exclude infectees and civil and society organizations.

  20. Treating pediatric obesity in the primary care setting to prevent chronic disease: perceptions and knowledge of providers and staff.

    Science.gov (United States)

    Silberberg, Mina; Carter-Edwards, Lori; Murphy, Gwen; Mayhew, Meghan; Kolasa, Kathryn; Perrin, Eliana M; Armstrong, Sarah; Graham, Cameron; Menon, Nidu

    2012-01-01

    The national and international epidemic of chronic disease, including among children, is largely fueled by increasing obesity. It is recommended that primary care play a key role in the treatment of pediatric obesity. A written survey was administered to providers and staff at 13 primary care practices across North Carolina, assessing perceptions on multiple dimensions of pediatric obesity treatment and knowledge of dietitian services. The response rate for the survey was 66.9% (n = 273). Although providers reported feeling comfortable and confident in many areas of childhood obesity, perceived effectiveness was low. Moreover, comfort and confidence were lower for non-primary care providers (PCPs) involved in obesity treatment than for PCPs, and PCP comfort and confidence levels were low for the ability to conduct motivational interviewing and for knowledge of billing for obesity as a diagnosis. Personnel perceived that there were benefits to having a registered dietitian (RD) in their practice and generally understood RD capacity. Survey results provided no evidence that integration of an RD into the practice changed perceptions or knowledge over the course of 1 year. The present study included only 13 practices, mostly rural and all of at least moderate size. Significant change is required if primary care practices are to play the role envisioned for them in stemming childhood obesity and chronic disease. Change will require identifying and addressing specific knowledge and skill gaps, such as those identified in this study. Respondents' positive perceptions of the benefits of RD integration suggest the importance of exploring this clinical model.

  1. Impact of rivastigmine on caregiver burden associated with Alzheimer's disease in both informal care and nursing home settings.

    Science.gov (United States)

    Grossberg, George T

    2008-01-01

    Progressive deterioration in cognitive function and the ability to perform activities of daily living are the hallmarks of Alzheimer's disease (AD). As the disease progresses and behavioural/neuropsychiatric symptoms become more predominant, carers of AD patients themselves encounter a raft of physical, emotional, social and financial problems. Appropriate therapeutic management of AD patients, particularly their behavioural symptoms, may reduce the burden placed on family and professional caregivers. Preservation of cholinergic neurotransmission by cholinesterase inhibitors is the mainstay of pharmacological therapy for AD. Rivastigmine, a dual inhibitor of acetylcholinesterase and butyrylcholinesterase, has pharmacological properties that appear particularly favourable regarding the behavioural symptoms of AD. In addition to its beneficial effects on cognitive and global function, rivastigmine treatment in mild-to-moderate AD is associated with improvements in behavioural symptoms, a decreased requirement for antipsychotic drugs and delays in nursing home placement; reductions in caregiver burden, caregiver time and costs have also been reported. Rivastigmine treatment has also demonstrated improvements in behavioural symptoms and reductions in psychotropic medication usage in nursing home residents with moderate-to-severe AD, and may be associated with a reduction in professional caregiver burden. In summary, the positive effects of rivastigmine on functional and behavioural symptoms of AD help to reduce the time, stress and overall burden associated with caregiving, both in the informal home care and nursing home environments.

  2. Minimizing the Risk of Disease Transmission in Emergency Settings: Novel In Situ Physico-Chemical Disinfection of Pathogen-Laden Hospital Wastewaters

    Science.gov (United States)

    Sozzi, Emanuele; Fabre, Kerline; Fesselet, Jean-François; Ebdon, James E.; Taylor, Huw

    2015-01-01

    The operation of a health care facility, such as a cholera or Ebola treatment center in an emergency setting, results in the production of pathogen-laden wastewaters that may potentially lead to onward transmission of the disease. The research presented here evaluated the design and operation of a novel treatment system, successfully used by Médecins Sans Frontières in Haiti to disinfect CTC wastewaters in situ, eliminating the need for road haulage and disposal of the waste to a poorly-managed hazardous waste facility, thereby providing an effective barrier to disease transmission through a novel but simple sanitary intervention. The physico-chemical protocols eventually successfully treated over 600 m3 of wastewater, achieving coagulation/flocculation and disinfection by exposure to high pH (Protocol A) and low pH (Protocol B) environments, using thermotolerant coliforms as a disinfection efficacy index. In Protocol A, the addition of hydrated lime resulted in wastewater disinfection and coagulation/flocculation of suspended solids. In Protocol B, disinfection was achieved by the addition of hydrochloric acid, followed by pH neutralization and coagulation/flocculation of suspended solids using aluminum sulfate. Removal rates achieved were: COD >99%; suspended solids >90%; turbidity >90% and thermotolerant coliforms >99.9%. The proposed approach is the first known successful attempt to disinfect wastewater in a disease outbreak setting without resorting to the alternative, untested, approach of ‘super chlorination’ which, it has been suggested, may not consistently achieve adequate disinfection. A basic analysis of costs demonstrated a significant saving in reagent costs compared with the less reliable approach of super-chlorination. The proposed approach to in situ sanitation in cholera treatment centers and other disease outbreak settings represents a timely response to a UN call for onsite disinfection of wastewaters generated in such emergencies, and the

  3. Minimizing the Risk of Disease Transmission in Emergency Settings: Novel In Situ Physico-Chemical Disinfection of Pathogen-Laden Hospital Wastewaters.

    Directory of Open Access Journals (Sweden)

    Emanuele Sozzi

    Full Text Available The operation of a health care facility, such as a cholera or Ebola treatment center in an emergency setting, results in the production of pathogen-laden wastewaters that may potentially lead to onward transmission of the disease. The research presented here evaluated the design and operation of a novel treatment system, successfully used by Médecins Sans Frontières in Haiti to disinfect CTC wastewaters in situ, eliminating the need for road haulage and disposal of the waste to a poorly-managed hazardous waste facility, thereby providing an effective barrier to disease transmission through a novel but simple sanitary intervention. The physico-chemical protocols eventually successfully treated over 600 m3 of wastewater, achieving coagulation/flocculation and disinfection by exposure to high pH (Protocol A and low pH (Protocol B environments, using thermotolerant coliforms as a disinfection efficacy index. In Protocol A, the addition of hydrated lime resulted in wastewater disinfection and coagulation/flocculation of suspended solids. In Protocol B, disinfection was achieved by the addition of hydrochloric acid, followed by pH neutralization and coagulation/flocculation of suspended solids using aluminum sulfate. Removal rates achieved were: COD >99%; suspended solids >90%; turbidity >90% and thermotolerant coliforms >99.9%. The proposed approach is the first known successful attempt to disinfect wastewater in a disease outbreak setting without resorting to the alternative, untested, approach of 'super chlorination' which, it has been suggested, may not consistently achieve adequate disinfection. A basic analysis of costs demonstrated a significant saving in reagent costs compared with the less reliable approach of super-chlorination. The proposed approach to in situ sanitation in cholera treatment centers and other disease outbreak settings represents a timely response to a UN call for onsite disinfection of wastewaters generated in such

  4. Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases

    Science.gov (United States)

    Engel, Nora; Ganesh, Gayatri; Patil, Mamata; Yellappa, Vijayashree; Pant Pai, Nitika; Vadnais, Caroline; Pai, Madhukar

    2015-01-01

    Background Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems. Methods In this exploratory qualitative study, we conducted 78 semi-structured interviews and 13 focus group discussions in an urban and rural area of Karnataka, India, with healthcare providers (doctors, nurses, specialists, traditional healers, and informal providers), patients, community health workers, test manufacturers, laboratory technicians, program managers and policy-makers. Participants were purposively sampled to represent settings of hospitals, peripheral labs, clinics, communities and homes, in both the public and private sectors. Results In the Indian context, the onus is on the patient to ensure successful point-of-care testing across homes, clinics, labs and hospitals, amidst uncoordinated providers with divergent and often competing practices, in settings lacking material, money and human resources. We identified three overarching themes affecting point-of-care testing: the main theme is ‘relationships’ among providers and between providers and patients, influenced by the cross-cutting theme of ‘infrastructure’. Challenges with both result in ‘modified practices’ often favouring empirical (symptomatic) treatment over treatment guided by testing. Conclusions Even if tests can be conducted on the spot and infrastructure challenges have been resolved, relationships among providers and between patients and providers are crucial for successful point-of-care testing. Furthermore, these barriers do not act in isolation, but are interlinked and need to be examined

  5. Barriers to Point-of-Care Testing in India: Results from Qualitative Research across Different Settings, Users and Major Diseases.

    Science.gov (United States)

    Engel, Nora; Ganesh, Gayatri; Patil, Mamata; Yellappa, Vijayashree; Pant Pai, Nitika; Vadnais, Caroline; Pai, Madhukar

    2015-01-01

    Successful point-of-care testing, namely ensuring the completion of the test and treat cycle in the same encounter, has immense potential to reduce diagnostic and treatment delays, and impact patient outcomes. However, having rapid tests is not enough, as many barriers may prevent their successful implementation in point-of-care testing programs. Qualitative research on diagnostic practices may help identify such barriers across different points of care in health systems. In this exploratory qualitative study, we conducted 78 semi-structured interviews and 13 focus group discussions in an urban and rural area of Karnataka, India, with healthcare providers (doctors, nurses, specialists, traditional healers, and informal providers), patients, community health workers, test manufacturers, laboratory technicians, program managers and policy-makers. Participants were purposively sampled to represent settings of hospitals, peripheral labs, clinics, communities and homes, in both the public and private sectors. In the Indian context, the onus is on the patient to ensure successful point-of-care testing across homes, clinics, labs and hospitals, amidst uncoordinated providers with divergent and often competing practices, in settings lacking material, money and human resources. We identified three overarching themes affecting point-of-care testing: the main theme is 'relationships' among providers and between providers and patients, influenced by the cross-cutting theme of 'infrastructure'. Challenges with both result in 'modified practices' often favouring empirical (symptomatic) treatment over treatment guided by testing. Even if tests can be conducted on the spot and infrastructure challenges have been resolved, relationships among providers and between patients and providers are crucial for successful point-of-care testing. Furthermore, these barriers do not act in isolation, but are interlinked and need to be examined as such. Also, a test alone has only limited power

  6. Oxytetracycline and penicillin-G residues in cattle slaughtered in south-western Nigeria: Implications for livestock disease management and public health

    Directory of Open Access Journals (Sweden)

    Hezekiah K. Adesokan

    2013-02-01

    Full Text Available After the discovery of indiscriminate antibiotic use in ready-for-slaughter cattle in south-western Nigeria, 90 tissue samples from randomly selected slaughtered cattle were evaluated for oxytetracycline and penicillin-G residues using high performance liquid chromatography and the data analysed by one-way Analysis of variance (ANOVA. The findings revealed residues of oxytetracycline (kidney: 9.47 µ/kg ± 3.24 µ/kg; liver: 12.73 µ/kg ± 4.39 µ/kg; muscle: 16.17 µ/kg ± 5.52 µ/kg and penicillin-G (kidney: 6.27 µ/kg ± 2.46 µ/kg; liver: 8.5 µ/kg ± 2.80 µ/kg; muscle: 11.67 µ/kg ± 2.94 µ/kg in all tissues screened. Significantly high levels (oxytetracycline: F = 16.77; penicillin-G: F = 29.38 were, however, found in muscles, followed by liver and then kidney – findings confirming recent antibiotic administration to the animals before slaughter. The dietary intakes through the tissues screened were 0.024% (oxytetracycline and 0.017% (penicillin-G of the acceptable daily intake (ADI. Although the concentrations in the tissues screened were below the maximum residue limits despite recent administration of these antibiotics before slaughter, the lower concentrations are suggestive of the probable low dosages often administered by those involved in indiscriminate use of antibiotics. This therefore raises serious concerns for the livestock industry as well as human health, given the resultant emergence and spread of resistant strains of bacterial pathogens that could ensue from prolonged use of low dosages of antibiotics. Additionally, the lower concentrations of the daily intakes notwithstanding, the plausible exposure to these antibiotics from other food sources is a cause for concern. Since antimicrobial misuse and its consequent effects are not just a problem limited to Nigeria but also a concern in sub-Saharan Africa, the need for national and international stakeholder intervention is emphasised.

  7. Oxytetracycline and penicillin-G residues in cattle slaughtered in south-western Nigeria: Implications for livestock disease management and public health

    Directory of Open Access Journals (Sweden)

    Hezekiah K. Adesokan

    2013-07-01

    Full Text Available After the discovery of indiscriminate antibiotic use in ready-for-slaughter cattle in south-western Nigeria, 90 tissue samples from randomly selected slaughtered cattle were evaluated for oxytetracycline and penicillin-G residues using high performance liquid chromatography and the data analysed by one-way Analysis of variance (ANOVA. The findings revealed residues of oxytetracycline (kidney: 9.47 µ/kg ± 3.24 µ/kg; liver: 12.73 µ/kg ± 4.39 µ/kg; muscle: 16.17 µ/kg ± 5.52 µ/kg and penicillin-G (kidney: 6.27 µ/kg ± 2.46 µ/kg; liver: 8.5 µ/kg ± 2.80 µ/kg; muscle: 11.67 µ/kg ± 2.94 µ/kg in all tissues screened. Significantly high levels (oxytetracycline: F = 16.77; penicillin-G: F = 29.38 were, however, found in muscles, followed by liver and then kidney – findings confirming recent antibiotic administration to the animals before slaughter. The dietary intakes through the tissues screened were 0.024% (oxytetracycline and 0.017% (penicillin-G of the acceptable daily intake (ADI. Although the concentrations in the tissues screened were below the maximum residue limits despite recent administration of these antibiotics before slaughter, the lower concentrations are suggestive of the probable low dosages often administered by those involved in indiscriminate use of antibiotics. This therefore raises serious concerns for the livestock industry as well as human health, given the resultant emergence and spread of resistant strains of bacterial pathogens that could ensue from prolonged use of low dosages of antibiotics. Additionally, the lower concentrations of the daily intakes notwithstanding, the plausible exposure to these antibiotics from other food sources is a cause for concern. Since antimicrobial misuse and its consequent effects are not just a problem limited to Nigeria but also a concern in sub-Saharan Africa, the need for national and international stakeholder intervention is emphasised.

  8. Novel feature for catalytic protein residues reflecting interactions with other residues.

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    Yizhou Li

    Full Text Available Owing to their potential for systematic analysis, complex networks have been widely used in proteomics. Representing a protein structure as a topology network provides novel insight into understanding protein folding mechanisms, stability and function. Here, we develop a new feature to reveal correlations between residues using a protein structure network. In an original attempt to quantify the effects of several key residues on catalytic residues, a power function was used to model interactions between residues. The results indicate that focusing on a few residues is a feasible approach to identifying catalytic residues. The spatial environment surrounding a catalytic residue was analyzed in a layered manner. We present evidence that correlation between residues is related to their distance apart most environmental parameters of the outer layer make a smaller contribution to prediction and ii catalytic residues tend to be located near key positions in enzyme folds. Feature analysis revealed satisfactory performance for our features, which were combined with several conventional features in a prediction model for catalytic residues using a comprehensive data set from the Catalytic Site Atlas. Values of 88.6 for sensitivity and 88.4 for specificity were obtained by 10-fold cross-validation. These results suggest that these features reveal the mutual dependence of residues and are promising for further study of structure-function relationship.

  9. Nutritional treatment of genome instability: a paradigm shift in disease prevention and in the setting of recommended dietary allowances.

    Science.gov (United States)

    Fenech, Michael

    2003-06-01

    The link between genome instability and adverse health outcomes during the various stages of life, such as infertility, fetal development and cancer, is briefly reviewed against a background of evidence indicating that genome instability, in the absence of overt exposure to genotoxins, is itself a sensitive marker of nutritional deficiency. The latter is illustrated with cross-sectional and dietary intervention data obtained using the micronucleus assay, an efficient biomarker for diagnosing genome instability and nutritional deficiency. The concept of recommended dietary allowances for genome stability and how this could be achieved is discussed together with the emerging field of nutritional genomics for genome stability. The review concludes with a vision for a disease-prevention strategy based on the diagnosis and nutritional treatment of genome instability, i.e. 'Genome Health Clinics'.

  10. Detection and genetic characterization of foot‐and‐mouth disease viruses in samples from clinically healthy animals in endemic settings

    DEFF Research Database (Denmark)

    Jamal, Syed Muhammad; Ferrari, G.; Hussain, M.

    2012-01-01

    in Pakistan (n = 245), one (of three) live animal market in Afghanistan (n = 61) and both the live animal markets in Tajikistan (n = 120) all tested negative. However, 2 of 129 (∼2%) samples from Gondal and 11 of 123 (9%) from Chichawatni markets in Pakistan were positive for FMDV RNA. Similarly, 12 of 81 (15......A total of 1501 oral swab samples from Pakistan, Afghanistan and Tajikistan were collected from clinically healthy animals between July 2008 and August 2009 and assayed for the presence of foot‐and‐mouth disease virus (FMDV) RNA. The oral swab samples from two (of four) live animal markets......%) samples from Kabul and 10 of 20 (50%) from Badakhshan in Afghanistan were found to be positive. Serotypes A and O of FMDV were identified within these samples. Oral swab samples were also collected from dairy colonies in Harbanspura, Lahore (n = 232) and Nagori, Karachi (n = 136), but all tested negative...

  11. Environmental scan of infection prevention and control practices for containment of hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada.

    Science.gov (United States)

    Ocampo, Wrechelle; Geransar, Rose; Clayden, Nancy; Jones, Jessica; de Grood, Jill; Joffe, Mark; Taylor, Geoffrey; Missaghi, Bayan; Pearce, Craig; Ghali, William; Conly, John

    2017-10-01

    Ward closure is a method of controlling hospital-acquired infectious diseases outbreaks and is often coupled with other practices. However, the value and efficacy of ward closures remains uncertain. To understand the current practices and perceptions with respect to ward closure for hospital-acquired infectious disease outbreaks in acute care hospital settings across Canada. A Web-based environmental scan survey was developed by a team of infection prevention and control (IPC) experts and distributed to 235 IPC professionals at acute care sites across Canada. Data were analyzed using a mixed-methods approach of descriptive statistics and thematic analysis. A total of 110 completed responses showed that 70% of sites reported at least 1 outbreak during 2013, 44% of these sites reported the use of ward closure. Ward closure was considered an "appropriate," "sometimes appropriate," or "not appropriate" strategy to control outbreaks by 50%, 45%, and 5% of participants, respectively. System capacity issues and overall risk assessment were main factors influencing the decision to close hospital wards following an outbreak. Results suggest the use of ward closure for containment of hospital-acquired infectious disease outbreaks in Canadian acute care health settings is mixed, with outbreak control methods varying. The successful implementation of ward closure was dependent on overall support for the IPC team within hospital administration. Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  12. Long-term effect of galantamine on cognitive function in patients with Alzheimer’s disease versus a simulated disease trajectory: an observational study in the clinical setting

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    Nakagawa R

    2017-04-01

    Full Text Available Ryoko Nakagawa,1 Takashi Ohnishi,1 Hisanori Kobayashi,1 Toshio Yamaoka,2 Tsutomu Yajima,3 Ai Tanimura,4 Toshiya Kato,4 Kazutake Yoshizawa1 1Evidence Generation Department, Medical Affairs Division, 2Clinical Data Management Department, R&D Division, 3Biostatistics Department, Quantitative Science Division, 4Drug Surveillance Department, R&D Division, Janssen Pharmaceutical K.K., Tokyo, Japan Background: Long-term maintenance of cognitive function is an important goal of treatment for Alzheimer’s disease (AD, but evidence about the long-term efficacy of cholinesterase inhibitors is sparse. To evaluate the long-term efficacy and safety of galantamine for AD in routine clinical practice, we conducted a 72-week post-marketing surveillance study. The effect of galantamine on cognitive function was estimated in comparison with a simulated disease trajectory. Patients and methods: Patients with mild-to-moderate AD received flexible dosing of galantamine (16–24 mg/day during this study. Cognitive function was assessed by the mini mental state examination (MMSE and the clinical status was determined by the Clinical Global Impression-Improvement (CGI-I. Changes of the MMSE score without treatment were estimated in each patient using Mendiondo’s model. Generalized linear mixed model analysis was performed to compare the simulated MMSE scores with the actual scores. Results: Of the 661 patients who were enrolled, 642 were evaluable for safety and 554 were assessed for efficacy. The discontinuation rate was 46.73%. Cognitive decline indicated by the mean change of actual MMSE scores was significantly smaller than the simulated decline. Individual analysis demonstrated that >70% of patients had better actual MMSE scores than their simulated scores. Significant improvement of CGI-I was also observed during the observation period. Adverse events occurred in 28.5% of patients and were serious in 8.41%. The reported events generally corresponded with the

  13. Disease-causing mutations affecting surface residues of mitochondrial glutaryl-CoA dehydrogenase impair stability, heteromeric complex formation and mitochondria architecture.

    Science.gov (United States)

    Schmiesing, Jessica; Lohmöller, Benjamin; Schweizer, Michaela; Tidow, Henning; Gersting, Søren W; Muntau, Ania C; Braulke, Thomas; Mühlhausen, Chris

    2017-02-01

    The neurometabolic disorder glutaric aciduria type 1 (GA1) is caused by mutations in the GCDH gene encoding the mitochondrial matrix protein glutaryl-CoA dehydrogenase (GCDH), which forms homo- and heteromeric complexes. Twenty percent of all pathogenic mutations affect single amino acid residues on the surface of GCDH resulting in a severe clinical phenotype. We report here on heterologous expression studies of 18 missense mutations identified in GA1 patients affecting surface amino acids. Western blot and pulse chase experiments revealed that the stability of half of the GCDH mutants was significantly reduced. In silico analyses showed that none of the mutations impaired the 3D structure of GCDH. Immunofluorescence co-localisation studies in HeLa cells demonstrated that all GCDH mutants were correctly translocated into mitochondria. Surprisingly, the expression of p.Arg88Cys GCDH as well as further substitutions by alanine, lysine, or methionine but not histidine or leucine resulted in the disruption of mitochondrial architecture forming longitudinal structures composed of stacks of cristae and partial loss of the outer mitochondrial membrane. The expression of mitochondrial fusion or fission proteins was not affected in these cells. Bioluminescence resonance energy transfer analyses revealed that all GCDH mutants exhibit an increased binding affinity to electron transfer flavoprotein beta, whereas only p.Tyr155His GCDH showed a reduced interaction with dihydrolipoamide succinyl transferase. Our data underscore the impact of GCDH protein interactions mediated by amino acid residues on the surface of GCDH required for proper enzymatic activity. © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  14. Predictive and Prognostic Role of Tumor-Infiltrating Lymphocytes for Early Breast Cancer According to Disease Subtypes: Sensitivity Analysis of Randomized Trials in Adjuvant and Neoadjuvant Setting.

    Science.gov (United States)

    Carbognin, Luisa; Pilotto, Sara; Nortilli, Rolando; Brunelli, Matteo; Nottegar, Alessia; Sperduti, Isabella; Giannarelli, Diana; Bria, Emilio; Tortora, Giampaolo

    2016-03-01

    The role of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) is still an issue for clinical research. Toward this end, a sensitivity analysis of neoadjuvant and adjuvant randomized clinical trials was performed according to disease subtypes. Pathological complete responses (pCRs) after neoadjuvant treatment according to the presence or absence of lymphocyte-predominant BC (LPBC) were extracted and cumulated as odds ratios (ORs) by adopting a random-effects model by subtype. Overall survival hazard ratios as a function of 10% incremental values of stromal TILs (sTILs) in adjuvant trials were extracted. The interaction test was adopted to determine the differential effect according to the subtype. Eight trials (5,514 patients) were identified. With regard to neoadjuvant setting (4 studies), a significant interaction (p < .0001) according to LPBC was found. The presence of LPBC was associated with a 29.5% increase in pCR rate compared with non-LPBC (p < .0001). The pCR rate was significantly higher in patients with LPBC in triple-negative BC (TNBC) and HER2-positive BC settings, with an absolute difference of 15.7% (95% confidence interval [CI], 4.9%-26.2%) and 33.3% (95% CI, 23.6%-42.7%), respectively. With respect to the adjuvant setting (4 studies), a significant interaction (p < .0001) according to sTILs was found. A survival benefit was more likely to be determined for HER2-positive BC (p = .025) and TNBC (p < .0001), with no statistically significant difference for estrogen receptor-positive/HER2-negative disease. Despite the retrospective nature of this analysis, the presence of TILs may represent a robust predictive and prognostic marker for BC, particularly for TNBC and HER2-positive disease. ©AlphaMed Press.

  15. Person-Centered Care in the Home Setting for Parkinson’s Disease: Operation House Call Quality of Care Pilot Study

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    Nawaz Hack

    2015-01-01

    Full Text Available Objective. (1 To evaluate the feasibility of implementing and evaluating a home visit program for persons with Parkinson’s disease (PD in a rural setting. (2 To have movement disorders fellows coordinate and manage health care delivery. Background. The University of Florida, Center for Movement Disorders and Neurorestoration established Operation House Call to serve patients with PD who could not otherwise afford to travel to an expert center or to pay for medical care. PD is known to lead to significant disability, frequent hospitalization, early nursing home placement, and morbidity. Methods. This was designed as a quality improvement project. Movement disorders fellows travelled to the home(s of underserved PD patients and coordinated their clinical care. The diagnosis of Parkinson’s disease was confirmed using standardized criteria, and the Unified Parkinson’s Disease Rating Scale was performed and best treatment practices were delivered. Results. All seven patients have been followed up longitudinally every 3 to 6 months in the home setting, and they remain functional and independent. None of the patients have been hospitalized for PD related complications. Each patient has a new updatable electronic medical record. All Operation House Call cases are presented during video rounds for the interdisciplinary PD team to make recommendations for care (neurology, neurosurgery, neuropsychology, psychiatry, physical therapy, occupational therapy, speech therapy, and social work. One Operation House Call patient has successfully received deep brain stimulation (DBS. Conclusion. This program is a pilot program that has demonstrated that it is possible to provide person-centered care in the home setting for PD patients. This program could provide a proof of concept for the construction of a larger visiting physician or nurse program.

  16. Febrile illness in healthcare workers caring for Ebola virus disease patients in a high-resource setting.

    Science.gov (United States)

    Fink, Douglas; Cropley, Ian; Jacobs, Michael; Mepham, Stephen

    2017-01-26

    Ebola virus disease (EVD) patients treated in high-resource facilities are cared for by large numbers of healthcare staff. Monitoring these healthcare workers (HCWs) for any illness that may represent transmission of Ebola virus is important both for the individuals and to minimise the community risk. International policies for monitoring HCWs vary considerably and their effectiveness is unknown. Here we describe the United Kingdom (UK) experience of illness in HCWs who cared for three patients who acquired EVD in West Africa. Five of these 93 high-level isolation unit (HLIU) HCWs presented with fever within 21 days of working on the unit; one of these five presented outside of the UK. This article discusses different approaches to monitoring of HCW symptom reporting. The potential impact of these approaches on HLIU staff recruitment, including travel restrictions, is also considered. An international surveillance system enhancing collaboration between national public health authorities may assist HLIU HCW monitoring in case they travel. This article is copyright of The Authors, 2017.

  17. The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting.

    Science.gov (United States)

    Freijer, Karen; Nuijten, Mark J C; Schols, Jos M G A

    2012-01-01

    A health economic analysis was performed to assess the economic impact on the national health care budget of using oral nutritional supplements (ONS), being a food for special medical purposes also known as medical nutrition, for the treatment of disease related malnutrition (DRM) in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (>5 years) with DRM in the Netherlands. The model reflects the costs of DRM and the cost reductions resulting from improvement in DRM due to treatment with ONS. Using ONS for the treatment of DRM in community dwelling elderly, leads to a total annual cost savings of € 13 million (18.9% savings), when all eligible patients are treated. The additional costs of ONS (€ 57 million) are more than balanced by a reduction of other health care costs, e.g., re-/hospitalization (€ 70 million). Sensitivity analyses were performed on all parameters, including duration of treatment with ONS and the prevalence of DRM. This budget impact analysis shows that the use of ONS for treatment of DRM in elderly patients in the community may lead to cost savings in the Netherlands.

  18. The Budget Impact of Oral Nutritional Supplements for Disease Related Malnutrition in Elderly in the Community Setting

    Science.gov (United States)

    Freijer, Karen; Nuijten, Mark J. C.; Schols, Jos M. G. A.

    2012-01-01

    A health economic analysis was performed to assess the economic impact on the national health care budget of using oral nutritional supplements (ONS), being a food for special medical purposes also known as medical nutrition, for the treatment of disease related malnutrition (DRM) in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (>5 years) with DRM in the Netherlands. The model reflects the costs of DRM and the cost reductions resulting from improvement in DRM due to treatment with ONS. Using ONS for the treatment of DRM in community dwelling elderly, leads to a total annual cost savings of € 13 million (18.9% savings), when all eligible patients are treated. The additional costs of ONS (€ 57 million) are more than balanced by a reduction of other health care costs, e.g., re-/hospitalization (€ 70 million). Sensitivity analyses were performed on all parameters, including duration of treatment with ONS and the prevalence of DRM. This budget impact analysis shows that the use of ONS for treatment of DRM in elderly patients in the community may lead to cost savings in the Netherlands. PMID:22629244

  19. The budget impact of oral nutritional supplements for disease related malnutrition in elderly in the community setting

    Directory of Open Access Journals (Sweden)

    Karen eFreyer

    2012-05-01

    Full Text Available A health economic analysis was performed to assess the economic impact on the national health care budget of using Oral Nutritional Supplements (ONS, being a food for special medical purposes (FSMP also known as medical nutrition, for the treatment of disease-related malnutrition (DRM in the community in the Netherlands. An economic model was developed to calculate the budget impact of using ONS in community dwelling elderly (> 65 years with DRM in the Netherlands. The model reflects the costs of DRM and the cost reductions resulting from improvement in DRM due to treatment with ONS. Using ONS for the treatment of DRM in community dwelling elderly, leads to a total annual cost savings of € 13 million (18.9% savings, when all eligible patients are treated. The additional costs of ONS (€ 57 million are more than balanced by a reduction of other health care costs, e.g. re-/hospitalization (€ 70 million. Sensitivity analyses were performed on all parameters, including duration of treatment with ONS and the prevalence of DRM. This budget impact analysis shows that the use of ONS for treatment of DRM in elderly patients in the community may lead to cost savings in the Netherlands.

  20. Environmental factors associated with disease progression after the first demyelinating event: results from the multi-center SET study.

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    Dana Horakova

    Full Text Available OBJECTIVES: To investigate the associations of environmental MS risk factors with clinical and MRI measures of progression in high-risk clinically isolated syndromes (CIS after the first demyelinating event. METHODS: We analyzed 211 CIS patients (age: 28.9±7.8 years enrolled in the SET study, a multi-center study of high-risk CIS patients. Pre-treatment samples were analyzed for IgG antibodies against cytomegalovirus (anti-CMV, Epstein Barr virus (EBV early nuclear antigen-1 (EBNA-1, viral capsid antigen (VCA, early antigen-diffuse (EA-D, 25 hydroxy-vitamin D3 and cotinine levels and HLA DRB1*1501 status. The inclusion criteria required evaluation within 4 months of the initial demyelinating event, 2 or more brain MRI lesions and the presence of two or more oligoclonal bands in cerebrospinal fluid. All patients were treated with interferon-beta. Clinical and MRI assessments were obtained at baseline, 6, 12, and 24 months. RESULTS: The time to first relapse decreased and the number of relapses increased with anti-CMV IgG positivity. Smoking was associated with increased number and volume of contrast-enhancing lesions (CEL during the 2-year period. The cumulative number of CEL and T2 lesions during the 2-year period was greater for individuals in the highest quartile of anti-EBV VCA IgG antibodies. The percent loss of brain volume was increased for those in the highest quartile of with anti-EBV VCA IgG antibodies. CONCLUSIONS: Relapses in CIS patients were associated with CMV positivity whereas anti-EBV VCA positivity was associated with progression on MRI measures, including accumulation of CEL and T2 lesions and development of brain atrophy.

  1. A Household Level Analysis of Water Sanitation Associated with Gastrointestinal Disease in an Urban Slum Setting of South Okkalapa Township, Myanmar

    Directory of Open Access Journals (Sweden)

    Zar Ni Hlaing

    2016-07-01

    Full Text Available This research analyzed the prevalence of water sanitation at the household level against gastrointestinal disease occurrence in the urban slum setting of South Okkalapa Township, Myanmar, using cross-sectional study design techniques. A total of 364 household respondents were interviewed face to face by well-trained research assistants using structured questionnaires. Chi-square tests and multiple logistic regression analyses were used to determine the association between independent and dependent variables. Results showed that the source of household water (OR: 13.58, 95% CI: 6.90-26.74, and the types of drinking water (OR: 1.85, 95% CI: 0.92-3.71, were significantly associated with gastrointestinal diseases (p-value<0.05. After adjustment for confounding factors, this study found that occupation (AOR: 2.63, 95% CI: 1.25-5.54, employment status (AOR: 2.25, 95% CI: 1.01-5.01, type of household toilet (AOR: 8.66, 95% CI: 4.03-18.60, sources of household water (AOR: 6.56, 95% CI: 2.86-15.08, and the method of vector control (AOR: 3.12, 95% CI: 1.37-7.30 were all significantly associated with gastrointestinal diseases (p-value<0.05. Health education and appropriate technology for household water, sanitary latrines, environmental sanitation and waste disposal, and the implementation of policies focusing on systematic water management are therefore urgently required to control the spread of waterborne diseases.

  2. Impacts of constrained culling and vaccination on control of foot and mouth disease in near-endemic settings: A pair approximation model

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    N. Ringa

    2014-12-01

    Full Text Available Many countries have eliminated foot and mouth disease (FMD, but outbreaks remain common in other countries. Rapid development of international trade in animals and animal products has increased the risk of disease introduction to FMD-free countries. Most mathematical models of FMD are tailored to settings that are normally disease-free, and few models have explored the impact of constrained control measures in a ‘near-endemic’ spatially distributed host population subject to frequent FMD re-introductions from nearby endemic wild populations, as characterizes many low-income, resource-limited countries. Here we construct a pair approximation model of FMD and investigate the impact of constraints on total vaccine supply for prophylactic and ring vaccination, and constraints on culling rates and cumulative culls. We incorporate natural immunity waning and vaccine waning, which are important factors for near-endemic populations. We find that, when vaccine supply is sufficiently limited, the optimal approach for minimizing cumulative infections combines rapid deployment of ring vaccination during outbreaks with a contrasting approach of careful rationing of prophylactic vaccination over the year, such that supplies last as long as possible (and with the bulk of vaccines dedicated toward prophylactic vaccination. Thus, for optimal long-term control of the disease by vaccination in near-endemic settings when vaccine supply is limited, it is best to spread out prophylactic vaccination as much as possible. Regardless of culling constraints, the optimal culling strategy is rapid identification of infected premises and their immediate contacts at the initial stages of an outbreak, and rapid culling of infected premises and farms deemed to be at high risk of infection (as opposed to culling only the infected farms. Optimal culling strategies are similar when social impact is the outcome of interest. We conclude that more FMD transmission models should

  3. Efficiency of the kidney disease outcomes quality initiative guidelines for preemptive vascular access in an academic setting.

    Science.gov (United States)

    Kimball, Traci A; Barz, Ken; Dimond, Kelly R; Edwards, James M; Nehler, Mark R

    2011-09-01

    The National Kidney Foundation-Kidney Diseases Outcomes Quality Initiative (KDOQI) for vascular access guidelines state that patients with late-stage chronic kidney disease (CKD) should undergo native arteriovenous fistula (AVF) creation at least 6 months before anticipated start of hemodialysis (HD) treatments to obviate the need for other vascular access types, such as grafts or central catheters. The objective of this study was to determine the incidence of HD, the functional patency, and associated morbidity of AVFs in patients with late-stage CKD placed according to KDOQI. Consecutive patients with late-stage CKD who underwent AVF creation using KDOQI guidelines for anatomy between January 2003 and December 2007 at two tertiary academic centers were retrospectively evaluated. Baseline demographics, AVF type, and clinical comorbidities were recorded. Patients were stratified into one of four groups (groups A-D) over the follow-up course based on two end points: patency of their AVF and whether or not they began HD. The ideal primary outcome was AVF maturation and use for HD (group A; cumulative functional patency). Other outcomes included AVF patency but no HD (group B), HD with AVF failure (group C), or no HD and AVF abandonment (ie, death, refused hemodialysis, kidney transplant, or fistula failure; group D). Secondary outcomes were time to first cannulation, complications, and secondary interventions. AVFs were created (46% forearm and 54% upper arm) in 150 patients with CKD (85% men, median age 63 years old). At a median follow-up of 10 months, 74 patients (49%) were receiving HD and of these, 48 patients (65%) were using their AVF (group A), whereas 26 patients (35%) were not due to fistula failure (group C). Thirty-four patients (23%) never initiated HD treatments, but had a viable AVF (group B), and 42 patients (28%) never initiated HD and abandoned their AVF (group D). Overall, AVF abandonment was 51%. Mean maturation time of all AVFs successfully

  4. Risk of ischaemic heart disease and acute myocardial infarction in a Spanish population: observational prospective study in a primary-care setting

    Directory of Open Access Journals (Sweden)

    Cucalón José M

    2006-02-01

    Full Text Available Abstract Background Ischaemic heart disease is a global priority of health-care policy, because of its social repercussions and its impact on the health-care system. Yet there is little information on coronary morbidity in Spain and on the effect of the principal risk factors on risk of coronary heart disease. The objective of this study is to describe the epidemiology of coronary disease (incidence, mortality and its association with cardiovascular risk factors using the information gathered by primary care practitioners on cardiovascular health of their population. Methods A prospective study was designed. Eight primary-care centres participated, each contributing to the constitution of the cohort with the entire population covered by the centre. A total of 6124 men and women aged over 25 years and free of cardiovascular disease agreed to participate and were thus enrolled and followed-up, with all fatal and non-fatal coronary disease episodes being registered during a 5-year period. Repeated measurements were collected on smoking, blood pressure, weight and height, serum total cholesterol, high-density and low-density lipoproteins and fasting glucose. Rates were calculated for acute myocardial infarction and ischaemic heart disease. Associations between cardiovascular risk factors and coronary disease-free survival were evaluated using Kaplan-Meier and Cox regression analyses. Results Mean age at recruitment was 51.6 ± 15, with 24% of patients being over 65. At baseline, 74% of patients were overweight, serum cholesterol over 240 was present in 35% of patients, arterial hypertension in 37%, and basal glucose over 126 in 11%. Thirty-four percent of men and 13% of women were current smokers. During follow-up, 155 first episodes of coronary disease were detected, which yielded age-adjusted rates of 362 and 191 per 100,000 person-years in men and women respectively. Disease-free survival was associated with all risk factors in univariate

  5. A model for a chikungunya outbreak in a rural Cambodian setting: implications for disease control in uninfected areas.

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    Marguerite Robinson

    2014-09-01

    Full Text Available Following almost 30 years of relative silence, chikungunya fever reemerged in Kenya in 2004. It subsequently spread to the islands of the Indian Ocean, reaching Southeast Asia in 2006. The virus was first detected in Cambodia in 2011 and a large outbreak occurred in the village of Trapeang Roka Kampong Speu Province in March 2012, in which 44% of the villagers had a recent infection biologically confirmed. The epidemic curve was constructed from the number of biologically-confirmed CHIKV cases per day determined from the date of fever onset, which was self-reported during a data collection campaign conducted in the village after the outbreak. All individuals participating in the campaign had infections confirmed by laboratory analysis, allowing for the identification of asymptomatic cases and those with an unreported date of fever onset. We develop a stochastic model explicitly including such cases, all of whom do not appear on the epidemic curve. We estimate the basic reproduction number of the outbreak to be 6.46 (95% C.I. [6.24, 6.78]. We show that this estimate is particularly sensitive to changes in the biting rate and mosquito longevity. Our model also indicates that the infection was more widespread within the population on the reported epidemic start date. We show that the exclusion of asymptomatic cases and cases with undocumented onset dates can lead to an underestimation of the reproduction number which, in turn, could negatively impact control strategies implemented by public health authorities. We highlight the need for properly documenting newly emerging pathogens in immunologically naive populations and the importance of identifying the route of disease introduction.

  6. A Model for a Chikungunya Outbreak in a Rural Cambodian Setting: Implications for Disease Control in Uninfected Areas

    Science.gov (United States)

    Duong, Veasna; Ly, Sowath; Ngan, Chantha; Buchy, Philippe; Tarantola, Arnaud; Rodó, Xavier

    2014-01-01

    Following almost 30 years of relative silence, chikungunya fever reemerged in Kenya in 2004. It subsequently spread to the islands of the Indian Ocean, reaching Southeast Asia in 2006. The virus was first detected in Cambodia in 2011 and a large outbreak occurred in the village of Trapeang Roka Kampong Speu Province in March 2012, in which 44% of the villagers had a recent infection biologically confirmed. The epidemic curve was constructed from the number of biologically-confirmed CHIKV cases per day determined from the date of fever onset, which was self-reported during a data collection campaign conducted in the village after the outbreak. All individuals participating in the campaign had infections confirmed by laboratory analysis, allowing for the identification of asymptomatic cases and those with an unreported date of fever onset. We develop a stochastic model explicitly including such cases, all of whom do not appear on the epidemic curve. We estimate the basic reproduction number of the outbreak to be 6.46 (95% C.I. [6.24, 6.78]). We show that this estimate is particularly sensitive to changes in the biting rate and mosquito longevity. Our model also indicates that the infection was more widespread within the population on the reported epidemic start date. We show that the exclusion of asymptomatic cases and cases with undocumented onset dates can lead to an underestimation of the reproduction number which, in turn, could negatively impact control strategies implemented by public health authorities. We highlight the need for properly documenting newly emerging pathogens in immunologically naive populations and the importance of identifying the route of disease introduction. PMID:25210729

  7. Residual gas analysis

    International Nuclear Information System (INIS)

    Berecz, I.

    1982-01-01

    Determination of the residual gas composition in vacuum systems by a special mass spectrometric method was presented. The quadrupole mass spectrometer (QMS) and its application in thin film technology was discussed. Results, partial pressure versus time curves as well as the line spectra of the residual gases in case of the vaporization of a Ti-Pd-Au alloy were demonstrated together with the possible construction schemes of QMS residual gas analysers. (Sz.J.)

  8. Monitoring of residual disease and guided donor leucocyte infusion after allogeneic bone marrow transplantation by chimaerism analysis with short tandem repeats

    NARCIS (Netherlands)

    de Weger, RA; Tilanus, MGJ; Scheidel, KC; van den Tweel, JG; Verdonck, LF

    In this study, we analysed the chimaeric status of peripheral blood leucocytes (PBLs) in recipients of allogeneic bone marrow transplantation (BMT) with the use of short tandem repeat (STR) microsatellite markers for monitoring the efficacy of BMT and donor leucocyte infusions (DLIs). A set of four

  9. Role of pH in determining the cell-type-specific residual activity of glucocerebrosidase in type 1 Gaucher disease

    NARCIS (Netherlands)

    van Weely, S.; van den Berg, M.; Barranger, J. A.; Sa Miranda, M. C.; Tager, J. M.; Aerts, J. M.

    1993-01-01

    The properties of control and 370Asn-->Ser glucocerebrosidase, the frequently encountered mutated form of the enzyme in type 1 Gaucher disease, were studied in vitro as well as in situ. The catalytic properties of purified 370Asn-->Ser glucocerebrosidase were highly dependent on the assay

  10. Mumps epidemiology in the mid-west of Ireland 2004-2008: increasing disease burden in the university/college setting.

    LENUS (Irish Health Repository)

    Whyte, D

    2009-01-01

    Mumps is a contagious vaccine-preventable viral disease that is experiencing a revival in students attending second and third level colleges. Large mumps outbreaks have been reported in several countries despite the presence of childhood immunisation programmes over many years, including measles, mumps, and rubella (MMR) vaccination. In 2008, 1,377 cases of mumps were notified in Ireland and 1,734 in the first three months of 2009 (provisional data). This paper reviews the recent epidemiology of mumps in the Mid-West region of Ireland and highlights preventive measures. A substantial proportion of cases were not laboratory-confirmed and it is important that doctors continue to notify suspected cases. In the Irish Mid-West, data from enhanced surveillance shows a high proportion of mumps in the age group 15-24 years. Complications were uncommon and rarely severe. Where data were available, over half of the cases did not recall having received two doses of MMR, but most recalled one dose. Parents should continue to ensure children receive both MMR vaccinations so that uptake is optimal for protection. Steps were taken to increase awareness of the disease in the school, college and university settings. Preventive measures implemented to limit mumps transmission in the school\\/college setting over recent years included vaccination of close contacts, isolation for five days and hand hygiene.

  11. Development of a core outcome set for clinical trials in inflammatory bowel disease: study protocol for a systematic review of the literature and identification of a core outcome set using a Delphi survey.

    Science.gov (United States)

    Ma, Christopher; Panaccione, Remo; Fedorak, Richard N; Parker, Claire E; Khanna, Reena; Levesque, Barrett G; Sandborn, William J; Feagan, Brian G; Jairath, Vipul

    2017-06-09

    Crohn's disease (CD) and ulcerative colitis (UC), the main forms of inflammatory bowel disease (IBD), are chronic, progressive and disabling disorders of the gastrointestinal tract. Although data from randomised controlled trials (RCTs) provide the foundation of evidence that validates medical therapy for IBD, considerable heterogeneity exists in the measured outcomes used in these studies. Furthermore, in recent years, there has been a paradigm shift in IBD treatment targets, moving from symptom-based scoring to improvement or normalisation of objective measures of inflammation such as endoscopic appearance, inflammatory biomarkers and histological and radiographic end points. The abundance of new treatment options and evolving end points poses opportunities and challenges for all stakeholders involved in drug development. Accordingly, there exists a need to harmonise measures used in clinical trials through the development of a core outcome set (COS). The development of an IBD-specific COS includes four steps. First, a systematic literature review is performed to identify outcomes previously used in IBD RCTs. Second, semistructured qualitative interviews are conducted with key stakeholders, including patients, clinicians, researchers, pharmaceutical industry representatives, healthcare payers and regulators to identify additional outcomes of importance. Using the outcomes generated from literature review and stakeholder interviews, an international two-round Delphi survey is conducted to prioritise outcomes for inclusion in the COS. Finally, a consensus meeting is held to ratify the COS and disseminate findings for application in future IBD trials. Given that over 30 novel therapeutic compounds are in development for IBD treatment, the design of robust clinical trials measuring relevant and standardised outcomes is crucial. Standardising outcomes through a COS will reduce heterogeneity in trial reporting, facilitate valid comparisons of new therapies and improve

  12. The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings.

    Science.gov (United States)

    Gebreyes, Wondwossen A; Dupouy-Camet, Jean; Newport, Melanie J; Oliveira, Celso J B; Schlesinger, Larry S; Saif, Yehia M; Kariuki, Samuel; Saif, Linda J; Saville, William; Wittum, Thomas; Hoet, Armando; Quessy, Sylvain; Kazwala, Rudovick; Tekola, Berhe; Shryock, Thomas; Bisesi, Michael; Patchanee, Prapas; Boonmar, Sumalee; King, Lonnie J

    2014-01-01

    Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs) are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec) Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI) in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011) and the second congress (Porto de Galinhas, Brazil, 2013) were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1) development of adequate science-based risk management policies, (2) skilled-personnel capacity building, (3) accredited veterinary and public health diagnostic laboratories with a shared database, and (4) improved use of existing natural resources and implementation. The aim of this review is to highlight

  13. The global one health paradigm: challenges and opportunities for tackling infectious diseases at the human, animal, and environment interface in low-resource settings.

    Directory of Open Access Journals (Sweden)

    Wondwossen A Gebreyes

    Full Text Available Zoonotic infectious diseases have been an important concern to humankind for more than 10,000 years. Today, approximately 75% of newly emerging infectious diseases (EIDs are zoonoses that result from various anthropogenic, genetic, ecologic, socioeconomic, and climatic factors. These interrelated driving forces make it difficult to predict and to prevent zoonotic EIDs. Although significant improvements in environmental and medical surveillance, clinical diagnostic methods, and medical practices have been achieved in the recent years, zoonotic EIDs remain a major global concern, and such threats are expanding, especially in less developed regions. The current Ebola epidemic in West Africa is an extreme stark reminder of the role animal reservoirs play in public health and reinforces the urgent need for globally operationalizing a One Health approach. The complex nature of zoonotic diseases and the limited resources in developing countries are a reminder that the need for implementation of Global One Health in low-resource settings is crucial. The Veterinary Public Health and Biotechnology (VPH-Biotec Global Consortium launched the International Congress on Pathogens at the Human-Animal Interface (ICOPHAI in order to address important challenges and needs for capacity building. The inaugural ICOPHAI (Addis Ababa, Ethiopia, 2011 and the second congress (Porto de Galinhas, Brazil, 2013 were unique opportunities to share and discuss issues related to zoonotic infectious diseases worldwide. In addition to strong scientific reports in eight thematic areas that necessitate One Health implementation, the congress identified four key capacity-building needs: (1 development of adequate science-based risk management policies, (2 skilled-personnel capacity building, (3 accredited veterinary and public health diagnostic laboratories with a shared database, and (4 improved use of existing natural resources and implementation. The aim of this review is to

  14. Development of quality indicators for care of chronic kidney disease in the primary care setting using electronic health data: a RAND-modified Delphi method.

    Science.gov (United States)

    Fukuma, Shingo; Shimizu, Sayaka; Niihata, Kakuya; Sada, Ken-Ei; Yanagita, Motoko; Hatta, Tsuguru; Nangaku, Masaomi; Katafuchi, Ritsuko; Fujita, Yoshiro; Koizumi, Junji; Koizumi, Shunzo; Kimura, Kenjiro; Fukuhara, Shunichi; Shibagaki, Yugo

    2017-04-01

    The prevalence of chronic kidney disease (CKD) has recently increased, and maintaining high quality of CKD care is a major factor in preventing end-stage renal disease. Here, we developed novel quality indicators for CKD care based on existing electronic health data. We used a modified RAND appropriateness method to develop quality indicators for the care of non-dialysis CKD patients, by combining expert opinion and scientific evidence. A multidisciplinary expert panel comprising six nephrologists, two primary care physicians, one diabetes specialist, and one rheumatologist assessed the appropriateness of potential indicators extracted from evidence-based clinical guidelines, in accordance with predetermined criteria. We developed novel quality indicators through a four-step process: selection of potential indicators, first questionnaire round, face-to-face meeting, and second questionnaire round. Ten expert panel members evaluated 19 potential indicators in the first questionnaire round, of which 7 were modified, 12 deleted, and 4 newly added during subsequent face-to-face meetings, giving a final total of 11 indicators. Median rate of these 11 indicators in the final set was at least 7, and percentages of agreement exceeded 80 % for all but one indicator. All indicators in the final set can be measured using only existing electronic health data, without medical record review, and 9 of 11 are process indicators. We developed 11 quality indicators to assess quality of care for non-dialysis CKD patients. Strengths of the developed indicators are their applicability in a primary care setting, availability in daily practice, and emphasis on modifiable processes.

  15. Prescription Patterns and Disease Control in Type 2 Diabetes Mellitus Patients in Nursing Home and Home Care Settings: A Retrospective Analysis in Germany.

    Science.gov (United States)

    Kostev, Karel; Rockel, Timo; Jacob, Louis

    2018-01-01

    The aim of this study was to analyze prescription patterns and disease control in patients with type 2 diabetes mellitus (T2DM) in nursing home and home care settings in Germany. The present study is based on data from the Disease Analyzer database (QuintilesIMS). Patients with an initial diagnosis of T2DM and documented HbA1c values between January 2011 and December 2015 were included in the analysis. The index date corresponded to the last documented HbA1c value. Patients in nursing homes were matched (1:1) with patients living at home based on age, gender, and dementia diagnosis. The first outcome of the study was the share of use of several antidiabetic drugs in the two different settings. The second outcome was the mean HbA1c value and the proportion of patients with HbA1c values lower than 7% in the two different groups. In this study, 4925 individuals lived in nursing homes and 4925 individuals lived at home. The mean age was 80.7 years (SD = 7.7). Prescription patterns differed significantly between nursing home and home care settings: insulin (57.9% vs 41.1%), metformin (46.6% vs 60.5%), sulfonylurea (24.9% vs 34.2%), DPP4 inhibitors (13.4% vs 19.8%), and other antihyperglycemic drugs (7.8% vs 12.1%). In contrast, mean HbA1c values (nursing home: 7.2%; home: 7.2%) and the share of patients with Hb1Ac values lower than 7% (nursing home: 49.1%; home: 50.9%) did not differ significantly between the two groups. Overall, the differences in prescription patterns between nursing homes and home care were not associated with significant differences in the management of T2DM.

  16. Characteristics of multiple-diseased elderly in Swedish hospital care and clinical guidelines: Do they make evidence-based priority setting a “mission impossible”?

    Directory of Open Access Journals (Sweden)

    Carlsson, Per

    2009-02-01

    Full Text Available In Sweden, an expected growing gap between available resources and greater potential for medical treatment has brought evidence-based guidelines and priority setting into focus. There are problems, however, in areas where the evidence base is weak and underlying ethical values are controversial. Based on a specified definition of multiple-diseased elderly patients, the aims of this study are: (i to describe and quantify inpatient care utilisation and patient characteristics, particularly regarding cardiovascular disease and co-morbidity; and (ii to question the applicability of evidence-based guidelines for these patients with regard to the reported characteristics (i.e. age and co-morbidity, and to suggest some possible strategies in order to tackle the described problem and the probable presence of ageism. We used data from three sources: (a a literature review, (b a register study, based on a unique population-based register of inpatient care in Sweden, and (c a national cost per patient database. The results show that elderly patients with multiple co-morbidities constitute a large and growing population in Swedish inpatient hospital care. They have multiple and complex needs and a large majority have a cardiovascular disease. There is a relationship between reported characteristics, i.e. age and co-morbidity, and limited applicability of evidence-based guidelines, and this can cause an under-use as well as an over-use of medical interventions. As future clinical studies will be rare due to methodological and financial factors, we consider it necessary to condense existing practical-clinical experiences of individual experts into consensus-based guidelines concerning elderly with multi-morbidity. In such priority setting, it will be important to consider co-morbidity and different degrees of frailty.

  17. Qualitative evaluation of a physical activity-based chronic disease prevention program in a low-income, rural South African setting.

    Science.gov (United States)

    Draper, Catherine E; Nemutandani, Simon M; Grimsrud, Anna T; Rudolph, Michael; Kolbe-Alexander, Tracy L; de Kock, Lauren; Lambert, Estelle V

    2010-01-01

    Chronic diseases, an increasing global concern, are prevalent in the low-income communities of South Africa, where rural health systems bear the double burden of infectious and chronic diseases. The Discovery Healthy Lifestyle Programme (DHLP) is a physical activity-based chronic disease prevention program that has been implemented in a low-income, rural setting in South Africa. The DHLP consists of both school- and primary healthcare clinic-based interventions for learners (Healthnutz) and adults (Live it Up), facilitated by teachers, nurses and community volunteers. The aim of this evaluation was to qualitatively assess the process by which the DHLP was implemented, identifying enabling factors and barriers. Data were collected in target communities at schools and clinics from semi-structured focus groups of program leaders and members, teachers and community members (n = 45), situational analyses of the school physical activity environment, informal community observations and informal interviews with program coordinators. The target communities faced socioeconomic and health inequalities and remained under-resourced and under-served. In spite of these and other challenges, the DHLP was well received by community members and stakeholders. It was valued by respondents for its health and psychosocial outcomes, evidenced by increased knowledge and awareness of the importance of physical activity and healthy lifestyles, and positively altered perceptions of physical activity. Program implementers believed the Live it Up component was growing, and this suggested the sustainability of the program. There were, however, some concerns about the fidelity of the Healthnutz intervention, due to timetabling difficulties. Despite this, teachers were positive about the program and its value for their learners, staff and school. The community characteristics of being under-resourced and under-served appeared to positively influence DHLP implementation. Local government

  18. Agricultural pesticide residues

    International Nuclear Information System (INIS)

    Fuehr, F.

    1984-01-01

    The utilization of tracer techniques in the study of agricultural pesticide residues is reviewed under the following headings: lysimeter experiments, micro-ecosystems, translocation in soil, degradation of pesticides in soil, biological availability of soil-applied substances, bound residues in the soil, use of macro- and microautography, double and triple labelling, use of tracer labelling in animal experiments. (U.K.)

  19. Role of Hot Water System Design on Factors Influential to Pathogen Regrowth: Temperature, Chlorine Residual, Hydrogen Evolution, and Sediment.

    Science.gov (United States)

    Brazeau, Randi H; Edwards, Marc A

    2013-10-01

    Residential water heating is linked to growth of pathogens in premise plumbing, which is the primary source of waterborne disease in the United States. Temperature and disinfectant residual are critical factors controlling increased concentration of pathogens, but understanding of how each factor varies in different water heater configurations is lacking. A direct comparative study of electric water heater systems was conducted to evaluate temporal variations in temperature and water quality parameters including dissolved oxygen levels, hydrogen evolution, total and soluble metal concentrations, and disinfectant decay. Recirculation tanks had much greater volumes of water at temperature ranges with potential for increased pathogen growth when set at 49°C compared with standard tank systems without recirculation. In contrast, when set at the higher end of acceptable ranges (i.e., 60°C), this relationship was reversed and recirculation systems had less volume of water at risk for pathogen growth compared with conventional systems. Recirculation tanks also tended to have much lower levels of disinfectant residual (standard systems had 40-600% higher residual), 4-6 times as much hydrogen, and 3-20 times more sediment compared with standard tanks without recirculation. On demand tankless systems had very small volumes of water at risk and relatively high levels of disinfectant residual. Recirculation systems may have distinct advantages in controlling pathogens via thermal disinfection if set at 60°C, but these systems have lower levels of disinfectant residual and greater volumes at risk if set at lower temperatures.

  20. Association between Household Air Pollution Exposure and Chronic Obstructive Pulmonary Disease Outcomes in 13 Low- and Middle-Income Country Settings.

    Science.gov (United States)

    Siddharthan, Trishul; Grigsby, Matthew R; Goodman, Dina; Chowdhury, Muhammad; Rubinstein, Adolfo; Irazola, Vilma; Gutierrez, Laura; Miranda, J Jaime; Bernabe-Ortiz, Antonio; Alam, Dewan; Kirenga, Bruce; Jones, Rupert; van Gemert, Frederick; Wise, Robert A; Checkley, William

    2018-03-01

    Forty percent of households worldwide burn biomass fuels for energy, which may be the most important contributor to household air pollution. To examine the association between household air pollution exposure and chronic obstructive pulmonary disease (COPD) outcomes in 13 resource-poor settings. We analyzed data from 12,396 adult participants living in 13 resource-poor, population-based settings. Household air pollution exposure was defined as using biomass materials as the primary fuel source in the home. We used multivariable regressions to assess the relationship between household air pollution exposure and COPD outcomes, evaluated for interactions, and conducted sensitivity analyses to test the robustness of our findings. Average age was 54.9 years (44.2-59.6 yr across settings), 48.5% were women (38.3-54.5%), prevalence of household air pollution exposure was 38% (0.5-99.6%), and 8.8% (1.7-15.5%) had COPD. Participants with household air pollution exposure were 41% more likely to have COPD (adjusted odds ratio, 1.41; 95% confidence interval, 1.18-1.68) than those without the exposure, and 13.5% (6.4-20.6%) of COPD prevalence may be caused by household air pollution exposure, compared with 12.4% caused by cigarette smoking. The association between household air pollution exposure and COPD was stronger in women (1.70; 1.24-2.32) than in men (1.21; 0.92-1.58). Household air pollution exposure was associated with a higher prevalence of COPD, particularly among women, and it is likely a leading population-attributable risk factor for COPD in resource-poor settings.

  1. Prevalence of chronic obstructive pulmonary disease and variation in risk factors across four geographically diverse resource-limited settings in Peru.

    Science.gov (United States)

    Jaganath, Devan; Miranda, J Jaime; Gilman, Robert H; Wise, Robert A; Diette, Gregory B; Miele, Catherine H; Bernabe-Ortiz, Antonio; Checkley, William

    2015-03-18

    It is unclear how geographic and social diversity affects the prevalence of chronic obstructive pulmonary disease (COPD). We sought to characterize the prevalence of COPD and identify risk factors across four settings in Peru with varying degrees of urbanization, altitude, and biomass fuel use. We collected sociodemographics, clinical history, and post-bronchodilator spirometry in a randomly selected, age-, sex- and site-stratified, population-based sample of 2,957 adults aged ≥35 years (median age was 54.8 years and 49.3% were men) from four resource-poor settings: Lima, Tumbes, urban and rural Puno. We defined COPD as a post-bronchodilator FEV1/FVC urban Tumbes, 6.1% in urban Puno, 6.2% in Lima, and 9.9% in rural Puno (p < 0.001). Population attributable risks (PARs) of COPD due to smoking ≥10 pack-years were less than 10% for all sites, consistent with a low prevalence of daily smoking (3.3%). Rather, we found that PARs of COPD varied by setting. In Lima, for example, the highest PARs were attributed to post-treatment tuberculosis (16% and 22% for men and women, respectively). In rural Puno, daily biomass fuel for cooking among women was associated with COPD (prevalence ratio 2.22, 95% CI 1.02-4.81) and the PAR of COPD due to daily exposure to biomass fuel smoke was 55%. The burden of COPD in Peru was not uniform and, unlike other settings, was not predominantly explained by tobacco smoking. This study emphasizes the role of biomass fuel use, and highlights pulmonary tuberculosis as an often neglected risk factor in endemic areas.

  2. Double bag or Y-set versus standard transfer systems for continuous ambulatory peritoneal dialysis in end-stage kidney disease.

    Science.gov (United States)

    Daly, Conal; Cody, June D; Khan, Izhar; Rabindranath, Kannaiyan S; Vale, Luke; Wallace, Sheila A

    2014-08-13

    Peritonitis is the most frequent serious complication of continuous ambulatory peritoneal dialysis (CAPD). It has a major influence on the number of patients switching from CAPD to haemodialysis and has probably restricted the wider acceptance and uptake of CAPD as an alternative mode of dialysis.This is an update of a review first published in 2000. This systematic review sought to determine if modifications of the transfer set (Y-set or double bag systems) used in CAPD exchanges are associated with a reduction in peritonitis and an improvement in other relevant outcomes. We searched the Cochrane Renal Group's Specialised Register through contact with the Trials Search Co-ordinator. Studies contained in the Specialised Register are identified through search strategies specifically designed for CENTRAL, MEDLINE and EMBASE. Date of last search: 22 October 2013. Randomised controlled trials (RCTs) or quasi-RCTs comparing double bag, Y-set and standard peritoneal dialysis (PD) exchange systems in patients with end-stage kidney disease. Data were abstracted by a single investigator onto a standard form and analysed by Review Manager. Analysis was by a random effects model and results were expressed as risk ratio (RR) or mean difference (MD) with 95% confidence intervals (CI). Twelve eligible trials with a total of 991 randomised patients were identified. Despite the large total number of patients, few trials covered the same interventions, small numbers of patients were enrolled in each trial and the methodological quality was suboptimal. Y-set and twin-bag systems were superior to conventional spike systems (7 trials, 485 patients, RR 0.64, 95% CI 0.53 to 0.77) in preventing peritonitis in PD. Disconnect systems should be the preferred exchange systems in CAPD.

  3. Impacts of constrained culling and vaccination on control of foot and mouth disease in near-endemic settings: a pair approximation model.

    Science.gov (United States)

    Ringa, N; Bauch, C T

    2014-12-01

    Many countries have eliminated foot and mouth disease (FMD), but outbreaks remain common in other countries. Rapid development of international trade in animals and animal products has increased the risk of disease introduction to FMD-free countries. Most mathematical models of FMD are tailored to settings that are normally disease-free, and few models have explored the impact of constrained control measures in a 'near-endemic' spatially distributed host population subject to frequent FMD re-introductions from nearby endemic wild populations, as characterizes many low-income, resource-limited countries. Here we construct a pair approximation model of FMD and investigate the impact of constraints on total vaccine supply for prophylactic and ring vaccination, and constraints on culling rates and cumulative culls. We incorporate natural immunity waning and vaccine waning, which are important factors for near-endemic populations. We find that, when vaccine supply is sufficiently limited, the optimal approach for minimizing cumulative infections combines rapid deployment of ring vaccination during outbreaks with a contrasting approach of careful rationing of prophylactic vaccination over the year, such that supplies last as long as possible (and with the bulk of vaccines dedicated toward prophylactic vaccination). Thus, for optimal long-term control of the disease by vaccination in near-endemic settings when vaccine supply is limited, it is best to spread out prophylactic vaccination as much as possible. Regardless of culling constraints, the optimal culling strategy is rapid identification of infected premises and their immediate contacts at the initial stages of an outbreak, and rapid culling of infected premises and farms deemed to be at high risk of infection (as opposed to culling only the infected farms). Optimal culling strategies are similar when social impact is the outcome of interest. We conclude that more FMD transmission models should be developed that are

  4. Handling of Solid Residues

    International Nuclear Information System (INIS)

    Medina Bermudez, Clara Ines

    1999-01-01

    The topic of solid residues is specifically of great interest and concern for the authorities, institutions and community that identify in them a true threat against the human health and the atmosphere in the related with the aesthetic deterioration of the urban centers and of the natural landscape; in the proliferation of vectorial transmitters of illnesses and the effect on the biodiversity. Inside the wide spectrum of topics that they keep relationship with the environmental protection, the inadequate handling of solid residues and residues dangerous squatter an important line in the definition of political and practical environmentally sustainable. The industrial development and the population's growth have originated a continuous increase in the production of solid residues; of equal it forms, their composition day after day is more heterogeneous. The base for the good handling includes the appropriate intervention of the different stages of an integral administration of residues, which include the separation in the source, the gathering, the handling, the use, treatment, final disposition and the institutional organization of the administration. The topic of the dangerous residues generates more expectation. These residues understand from those of pathogen type that are generated in the establishments of health that of hospital attention, until those of combustible, inflammable type, explosive, radio-active, volatile, corrosive, reagent or toxic, associated to numerous industrial processes, common in our countries in development

  5. Auto-brewery Syndrome in the Setting of Long-standing Crohn's Disease: A Case Report and Review of the Literature.

    Science.gov (United States)

    Welch, B T; Coelho Prabhu, N; Walkoff, L; Trenkner, S W

    2016-12-01

    A 71-year-old male with 50-year history of Crohn's disease was evaluated for acute onset of dizziness and slurred speech. Blood ethanol levels were elevated despite abstinence from alcohol for over 30 years. CT enterography demonstrated massive dilation of the small bowel with anastomotic stricture. Auto-brewery syndrome may be considered in a patient with chronic obstruction or hypomotility presenting with elevated serum ethanol levels in the setting of high carbohydrate intake. Although treatment algorithms lack validation, judicious use of antibiotic therapy, carbohydrate control, and short courses of antifungal therapy have all been reported in the literature. Importantly, clinical consideration of 'auto-brewery' should be undertaken with substantial caution, given the lack of validated mechanisms linking endogenous ethanol production to peripheral blood ethanol. Copyright © 2016 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.

  6. Assessing the impact of drinking water and sanitation on diarrhoeal disease in low- and middle-income settings: systematic review and meta-regression.

    Science.gov (United States)

    Wolf, Jennyfer; Prüss-Ustün, Annette; Cumming, Oliver; Bartram, Jamie; Bonjour, Sophie; Cairncross, Sandy; Clasen, Thomas; Colford, John M; Curtis, Valerie; De France, Jennifer; Fewtrell, Lorna; Freeman, Matthew C; Gordon, Bruce; Hunter, Paul R; Jeandron, Aurelie; Johnston, Richard B; Mäusezahl, Daniel; Mathers, Colin; Neira, Maria; Higgins, Julian P T

    2014-08-01

    To assess the impact of inadequate water and sanitation on diarrhoeal disease in low- and middle-income settings. The search strategy used Cochrane Library, MEDLINE & PubMed, Global Health, Embase and BIOSIS supplemented by screening of reference lists from previously published systematic reviews, to identify studies reporting on interventions examining the effect of drinking water and sanitation improvements in low- and middle-income settings published between 1970 and May 2013. Studies including randomised controlled trials, quasi-randomised trials with control group, observational studies using matching techniques and observational studies with a control group where the intervention was well defined were eligible. Risk of bias was assessed using a modified Ottawa-Newcastle scale. Study results were combined using meta-analysis and meta-regression to derive overall and intervention-specific risk estimates. Of 6819 records identified for drinking water, 61 studies met the inclusion criteria, and of 12,515 records identified for sanitation, 11 studies were included. Overall, improvements in drinking water and sanitation were associated with decreased risks of diarrhoea. Specific improvements, such as the use of water filters, provision of high-quality piped water and sewer connections, were associated with greater reductions in diarrhoea compared with other interventions. The results show that inadequate water and sanitation are associated with considerable risks of diarrhoeal disease and that there are notable differences in illness reduction according to the type of improved water and sanitation implemented. © 2014 John Wiley & Sons Ltd The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  7. Responsiveness and discriminative capacity of the assessments in ankylosing spondylitis disease-controlling antirheumatic therapy core set and other outcome measures in a trial of etanercept in ankylosing spondylitis

    NARCIS (Netherlands)

    Wanders, Astrid J. B.; Gorman, Jennifer D.; Davis, John C.; Landewe, Robert B. M.; van der Heijde, Désirée M. F. M.

    2004-01-01

    To investigate the responsiveness and discriminative capacity, and the relationship between both, of instruments selected for the disease-controlling antirheumatic therapy (DC-ART) core set by the Assessments in Ankylosing Spondylitis Working Group (ASAS). Responsiveness and discriminative capacity

  8. Clinical Documentation and Data Transfer from Ebola and Marburg Virus Disease Wards in Outbreak Settings: Health Care Workers’ Experiences and Preferences

    Directory of Open Access Journals (Sweden)

    Silja Bühler

    2014-02-01

    Full Text Available Understanding human filovirus hemorrhagic fever (FHF clinical manifestations and evaluating treatment strategies require the collection of clinical data in outbreak settings, where clinical documentation has been limited. Currently, no consensus among filovirus outbreak-response organisations guides best practice for clinical documentation and data transfer. Semi-structured interviews were conducted with health care workers (HCWs involved in FHF outbreaks in sub-Saharan Africa, and with HCWs experienced in documenting and transferring data from high-risk areas (isolation wards or biosafety level 4 laboratories. Methods for data documentation and transfer were identified, described in detail and categorised by requirement for electricity and ranked by interviewee preference. Some methods involve removing paperwork and other objects from the filovirus disease ward without disinfection. We believe that if done properly, these methods are reasonably safe for certain settings. However, alternative methods avoiding the removal of objects, or involving the removal of paperwork or objects after non-damaging disinfection, are available. These methods are not only safer, they are also perceived as safer and likely more acceptable to health workers and members of the community. The use of standardised clinical forms is overdue. Experiments with by sunlight disinfection should continue, and non-damaging disinfection of impregnated paper, suitable tablet computers and underwater cameras should be evaluated under field conditions.

  9. Adaptation and validation of the Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) in a low-literacy setting in sub-Saharan Africa.

    Science.gov (United States)

    Paddick, Stella-Maria; Kisoli, Aloyce; Mkenda, Sarah; Mbowe, Godfrey; Gray, William Keith; Dotchin, Catherine; Ogunniyi, Adesola; Kisima, John; Olakehinde, Olaide; Mushi, Declare; Walker, Richard William

    2017-08-01

    This study aimed to assess the feasibility of a low-literacy adaptation of the Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) for use in rural sub-Saharan Africa (SSA) for interventional studies in dementia. No such adaptations currently exist. Tanzanian and Nigerian health professionals adapted the ADAS-Cog by consensus. Validation took place in a cross-sectional sample of 34 rural-dwelling older adults with mild/moderate dementia alongside 32 non-demented controls in Tanzania. Participants were oversampled for lower educational level. Inter-rater reliability was conducted by two trained raters in 22 older adults (13 with dementia) from the same population. Assessors were blind to diagnostic group. Median ADAS-Cog scores were 28.75 (interquartile range (IQR), 22.96-35.54) in mild/moderate dementia and 12.75 (IQR 9.08-16.16) in controls. The area under the receiver operating characteristic curve (AUC) was 0.973 (95% confidence interval (CI) 0.936-1.00) for dementia. Internal consistency was high (Cronbach's α 0.884) and inter-rater reliability was excellent (intra-class correlation coefficient 0.905, 95% CI 0.804-0.964). The low-literacy adaptation of the ADAS-Cog had good psychometric properties in this setting. Further evaluation in similar settings is required.

  10. Postinduction Minimal Residual Disease Predicts Outcome and Benefit From Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia With NPM1 Mutation: A Study by the Acute Leukemia French Association Group.

    Science.gov (United States)

    Balsat, Marie; Renneville, Aline; Thomas, Xavier; de Botton, Stéphane; Caillot, Denis; Marceau, Alice; Lemasle, Emilie; Marolleau, Jean-Pierre; Nibourel, Olivier; Berthon, Céline; Raffoux, Emmanuel; Pigneux, Arnaud; Rodriguez, Céline; Vey, Norbert; Cayuela, Jean-Michel; Hayette, Sandrine; Braun, Thorsten; Coudé, Marie Magdeleine; Terre, Christine; Celli-Lebras, Karine; Dombret, Hervé; Preudhomme, Claude; Boissel, Nicolas

    2017-01-10

    Purpose This study assessed the prognostic impact of postinduction NPM1-mutated ( NPM1m) minimal residual disease (MRD) in young adult patients (age, 18 to 60 years) with acute myeloid leukemia, and addressed the question of whether NPM1m MRD may be used as a predictive factor of allogeneic stem cell transplantation (ASCT) benefit. Patients and Methods Among 229 patients with NPM1m who were treated in the Acute Leukemia French Association 0702 (ALFA-0702) trial, MRD evaluation was available in 152 patients in first remission. Patients with nonfavorable AML according to the European LeukemiaNet (ELN) classification were eligible for ASCT in first remission. Results After induction therapy, patients who did not achieve a 4-log reduction in NPM1m peripheral blood-MRD (PB-MRD) had a higher cumulative incidence of relapse (subhazard ratio [SHR], 5.83; P benefit was not observed in those with a > 4-log reduction in PB-MRD, with a significant interaction between ASCT effect and PB-MRD response ( P = .024 and .027 for disease-free survival and OS, respectively). Conclusion Our study supports the strong prognostic significance of early NPM1m PB-MRD, independent of the cytogenetic and molecular context. Moreover, NPM1m PB-MRD may be used as a predictive factor for ASCT indication.

  11. [Residual neuromuscular blockade].

    Science.gov (United States)

    Fuchs-Buder, T; Schmartz, D

    2017-06-01

    Even small degrees of residual neuromuscular blockade, i. e. a train-of-four (TOF) ratio >0.6, may lead to clinically relevant consequences for the patient. Especially upper airway integrity and the ability to swallow may still be markedly impaired. Moreover, increasing evidence suggests that residual neuromuscular blockade may affect postoperative outcome of patients. The incidence of these small degrees of residual blockade is relatively high and may persist for more than 90 min after a single intubating dose of an intermediately acting neuromuscular blocking agent, such as rocuronium and atracurium. Both neuromuscular monitoring and pharmacological reversal are key elements for the prevention of postoperative residual blockade.

  12. TENORM: Wastewater Treatment Residuals

    Science.gov (United States)

    Water and wastes which have been discharged into municipal sewers are treated at wastewater treatment plants. These may contain trace amounts of both man-made and naturally occurring radionuclides which can accumulate in the treatment plant and residuals.

  13. Residuation in orthomodular lattices

    Directory of Open Access Journals (Sweden)

    Chajda Ivan

    2017-04-01

    Full Text Available We show that every idempotent weakly divisible residuated lattice satisfying the double negation law can be transformed into an orthomodular lattice. The converse holds if adjointness is replaced by conditional adjointness. Moreover, we show that every positive right residuated lattice satisfying the double negation law and two further simple identities can be converted into an orthomodular lattice. In this case, also the converse statement is true and the corresponence is nearly one-to-one.

  14. Protein structure based prediction of catalytic residues

    Science.gov (United States)

    2013-01-01

    Background Worldwide structural genomics projects continue to release new protein structures at an unprecedented pace, so far nearly 6000, but only about 60% of these proteins have any sort of functional annotation. Results We explored a range of features that can be used for the prediction of functional residues given a known three-dimensional structure. These features include various centrality measures of nodes in graphs of interacting residues: closeness, betweenness and page-rank centrality. We also analyzed the distance of functional amino acids to the general center of mass (GCM) of the structure, relative solvent accessibility (RSA), and the use of relative entropy as a measure of sequence conservation. From the selected features, neural networks were trained to identify catalytic residues. We found that using distance to the GCM together with amino acid type provide a good discriminant function, when combined independently with sequence conservation. Using an independent test set of 29 annotated protein structures, the method returned 411 of the initial 9262 residues as the most likely to be involved in function. The output 411 residues contain 70 of the annotated 111 catalytic residues. This represents an approximately 14-fold enrichment of catalytic residues on the entire input set (corresponding to a sensitivity of 63% and a precision of 17%), a performance competitive with that of other state-of-the-art methods. Conclusions We found that several of the graph based measures utilize the same underlying feature of protein structures, which can be simply and more effectively captured with the distance to GCM definition. This also has the added the advantage of simplicity and easy implementation. Meanwhile sequence conservation remains by far the most influential feature in identifying functional residues. We also found that due the rapid changes in size and composition of sequence databases, conservation calculations must be recalibrated for specific

  15. Characterization of Hospital Residuals

    International Nuclear Information System (INIS)

    Blanco Meza, A.; Bonilla Jimenez, S.

    1997-01-01

    The main objective of this investigation is the characterization of the solid residuals. A description of the handling of the liquid and gassy waste generated in hospitals is also given, identifying the source where they originate. To achieve the proposed objective the work was divided in three stages: The first one was the planning and the coordination with each hospital center, in this way, to determine the schedule of gathering of the waste can be possible. In the second stage a fieldwork was made; it consisted in gathering the quantitative and qualitative information of the general state of the handling of residuals. In the third and last stage, the information previously obtained was organized to express the results as the production rate per day by bed, generation of solid residuals for sampled services, type of solid residuals and density of the same ones. With the obtained results, approaches are settled down to either determine design parameters for final disposition whether for incineration, trituration, sanitary filler or recycling of some materials, and storage politics of the solid residuals that allow to determine the gathering frequency. The study concludes that it is necessary to improve the conditions of the residuals handling in some aspects, to provide the cleaning personnel of the equipment for gathering disposition and of security, minimum to carry out this work efficiently, and to maintain a control of all the dangerous waste, like sharp or polluted materials. In this way, an appreciable reduction is guaranteed in the impact on the atmosphere. (Author) [es

  16. Utilization of traditional, complementary and alternative medicine and mental health among patients with chronic diseases in primary health care settings in Cambodia.

    Science.gov (United States)

    Yi, Siyan; Ngin, Chanrith; Tuot, Sovannary; Chhoun, Pheak; Fleming, Tyler; Brody, Carinne

    2017-01-01

    Coping with chronic illnesses often involves major lifestyle changes that may lead to poor mental health. Furthermore, in order to treat the chronic conditions, many sufferers in Asia turn to traditional, complementary and alternative medicines (TCAM). This study explores prevalence of TCAM use and factors associated with anxiety and depressive symptoms among patients with chronic diseases in Cambodia. In 2015, this cross-sectional study was conducted with outpatients receiving treatment and care for chronic diseases in two urban and two rural primary health centers. Every eligible patient was randomly selected at the health centers using a systematic sampling procedure. Symptoms of anxiety and depression were assessed by using the Hospital Anxiety and Depression Scale (HADS). Multivariate logistic regression models were constructed to explore factors associated with anxiety and depressive symptoms. The study participants included 1528 patients, of whom 77.2% were female, with a mean age of 46.5 years (SD = 15.3). After adjustment, patients with depressive symptoms remained significantly more likely to be in the age groups between 41 and 60 years old and to be married, separated/divorced or widowed compared to those without depressive symptoms. Regarding the use of TCAM, patients with depressive symptoms remained significantly more likely to report using an herbalist, practicing visualization and praying for own health, but less likely to report using vitamins or supplements in the past 12 months. For quality of life, patients with depressive symptoms remained significantly less likely to agree that they had enough energy for their everyday life and had enough money to meet their daily needs. Similar risk factors were also found to be significantly associated with anxiety symptoms. Cambodian patients with chronic diseases who experienced symptoms of anxiety or depression were more likely to report reduced quality of life, greater chronic disease-related stigma

  17. Genetic Analysis with the Immunochip Platform in Behçet Disease. Identification of Residues Associated in the HLA Class I Region and New Susceptibility Loci

    Science.gov (United States)

    Montes-Cano, Marco-Antonio; García-Lozano, José-Raúl; Conde-Jaldón, Marta; Ortego-Centeno, Norberto; Castillo, María Jesús; Sánchez-Bursón, Juan; Juliá, María Rosa; Solans, Roser; Blanco, Ricardo; Barnosi-Marín, Ana-Celia; Gómez de la Torre, Ricardo; Fanlo, Patricia; Rodríguez-Carballeira, Mónica; Camps, Teresa; Castañeda, Santos; Alegre-Sancho, Juan-Jose; Martín, Javier; González-Escribano, María Francisca

    2016-01-01

    Behcet's disease (BD) is an immuno-mediated vasculitis in which knowledge of its etiology and genetic basis is limited. To improve the current knowledge, a genetic analysis performed with the Immunochip platform was carried out in a population from Spain. A discovery cohort comprising 278 BD cases and 1,517 unaffected controls were genotyped using the Immunochip platform. The validation step was performed on an independent replication cohort composed of 130 BD cases and 600 additional controls. The strongest association signals were observed in the HLA class I region, being HLA-B*51 the highest peak (overall P = 6.82E-32, OR = 3.82). A step-wise conditional logistic regression with classical alleles identified HLA-B*57 and HLA-A*03 as additional independent markers. The amino acid model that best explained the association, includes the position 97 of the HLA-B molecule and the position 66 of the HLA-A. Among the non-HLA loci, the most significant in the discovery analysis were: IL23R (rs10889664: P = 3.81E-12, OR = 2.00), the JRKL/CNTN5 region (rs2848479: P = 5.00E-08, OR = 1.68) and IL12A (rs1874886: P = 6.67E-08, OR = 1.72), which were confirmed in the validation phase (JRKL/CNTN5 rs2848479: P = 3.29E-10, OR = 1.66; IL12A rs1874886: P = 1.62E-08, OR = 1.61). Our results confirm HLA-B*51 as a primary-association marker in predisposition to BD and suggest additional independent signals within the class I region, specifically in the genes HLA-A and HLA-B. Regarding the non-HLA genes, in addition to IL-23R, previously reported in our population; IL12A, described in other populations, was found to be a BD susceptibility factor also in Spaniards; finally, a new associated locus was found in the JRKL/CNTN5 region. PMID:27548383

  18. Pesticide residues in locally available cereals and vegetables

    International Nuclear Information System (INIS)

    Cunanan, S.A.; Santos, F.L.; Bonoan, L.S.

    1976-03-01

    Vegetable samples (pechay, cabbage, lettuce, green beans and tomatoes) bought from public markets in the Metro Manila area were analyzed for pesticide residues using gas chromatography. The samples analyzed in 1968-69 contained high levels of chlorinated pesticides such as DDT, Aldrin, Endrin, and Thiodan, while in the samples analyzed in January 1976, no chlorinated and organophosphate pesticides were detected. Cereal samples (rice, corn and sorghum) were obtained from the National Grains Authority and analyzed for pesticide residues and bromine residues. Total bromine residues was determined by neutron activation analysis. In most of the samples analyzed, the concentrations of pesticide residues were below the tolerance levels set by the FAO/WHO Committee on Pesticide Residues in Foods. An exception was one rice sample from Thailand, the bromine residue content (110ppm) of which exceeds the tolerance level of 50ppm

  19. O valor da imunofenotipagem para o diagnóstico do Mieloma Múltiplo e na avaliação da doença residual mínima The value of immunofenotyping for the diagnosis of Multiple Myeloma and for the evaluation of minimal residual disease

    Directory of Open Access Journals (Sweden)

    Roberto P. Falcão

    2007-03-01

    Full Text Available Os plasmócitos normais podem ser diferenciados dos presentes no mieloma múltiplo por imunofenotipagem. Os normais são CD45+, CD19+, CD20+, CD38++, CD56-/fraco, CD138+, mIg-, cIg policlonal. Por outro lado, os plasmócitos do mieloma múltiplo são monoclonais (cIg e aproximadamente 80% são CD19-CD56+ e 20% CD19-CD56-. O perfil na leucemia plasmocitária primária é semelhante ao do mieloma, embora a positividade para o CD56 ocorra em 45% dos casos. Na gamopatia monoclonal de causa indeterminada existe uma mistura de plasmócitos normais e neoplásicos, que têm perfil semelhante ao do mieloma múltiplo. A doença residual na medula é importante para estimar a resposta terapêutica e pode ser avaliada por citometria de fluxo e pela reação da polimerase em cadeia para o rearranjo da cadeia pesada da Ig. A citometria apresenta sensibilidade de 10-4 a 10-5, é realizada em aproximadamente duas horas e a sua aplicabilidade chega a 90%. O PCR qualitativo tem sensibilidade de 10-6 enquanto o quantitativo, 10-5. Em ambos, o tempo para a realização é maior (2-3 dias, com aplicabilidade de 75%.Normal plasma cells can be differentiated from multiple myeloma by their immunophenotype. Normal cells are CD45+, CD19+, CD20+, CD38++, CD56-/dim, CD138+, mIg- and polyclonal cIg. On the other hand, with multiple myeloma, plasma cells are monoclonal (cIg and approximately 80% are CD19- CD56+ and 20% CD19- CD56-. The profile in plasma cell leukemia is similar to myeloma, but the CD56 is positive in 45% of cases. In the monoclonal gammopathy of undetermined significance there is a mixture of normal and neoplastic plasma cells. Residual disease in bone marrow is important to determine the efficacy of treatment and can be evaluated by flow cytometry or polymerase chain reaction of rearranged heavy chains of Ig. Flow cytometry has a sensitivity of 10-4 to 10-5, is performed in 2-3 hours and is applicable in 90% of cases. Qualitative PCR has a sensitivity of 10

  20. Covert dose reduction is a distinct type of medication non-adherence observed across all care settings in inflammatory bowel disease.

    Science.gov (United States)

    Mountifield, Réme; Andrews, Jane M; Mikocka-Walus, Antonina; Bampton, Peter

    2014-12-01

    Non-adherence by dose omission is common and deleterious to outcomes in Inflammatory Bowel Disease (IBD), but covert dose reduction (CDR) remains unexplored. To determine frequency and attitudinal predictors of overall medication non-adherence and of covert dose reduction as separate entities. A cross sectional questionnaire was undertaken involving IBD patients in three different geographical regions and care settings. Demographics, medication adherence by dose omission, and rate of patient initiated dose reduction of conventional meds without practitioner knowledge (CDR) were assessed, along with attitudes toward IBD medication. Of 473 respondents (mean age 50.3 years, 60.2% female) frequency of non-adherence was 21.9%, and CDR 26.9% (p<0.001). By logistic regression, significant independent predictors of non-adherence were dissatisfaction with the patient-doctor relationship (p<0.001), depression (p=0.001), anxiety (p=0.047), and negative views regarding medication efficacy (p<0.001) or safety (p=0.017). Independent predictors of covert dose reduction included regular complementary medicine (CAM) use (p<0.001), experiencing more informative (p<0.001) and comfortable (p=0.006) consultations with alternative practitioners, disbelieving doctor delivered information (p=0.021) and safety concerns regarding conventional medication (p<0.001). Neither the frequency of non-adherence (p=0.569) nor CDR (p=0.914) differed between cohorts by different treatment settings. Covert dose reduction of IBD medication is more common than omission of medication doses, predicted by different factors to usual non-adherence, and has not been previously reported in IBD. The strongest predictor of CDR is regular CAM use. Copyright © 2014 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.

  1. Setting Single or Multiple Goals for Diet and Physical Activity Behaviors Improves Cardiovascular Disease Risk Factors in Adults With Type 2 Diabetes: A Pragmatic Pilot Randomized Trial.

    Science.gov (United States)

    Swoboda, Christine M; Miller, Carla K; Wills, Celia E

    2016-08-01

    The purpose of this study was to evaluate a 4-month telephone-based goal-setting and decision support intervention among adults with type 2 diabetes mellitus (T2DM) and multiple risk factors for cardiovascular disease (CVD). A randomized pretest-posttest control group design was employed. Overweight or obese adults aged 40 to 75 years with T2DM and ≥1 additional CVD risk factor were provided with individualized CVD risk information. At baseline and each biweekly telephone call, the multiple-goal group self-selected both diet- and physical activity-related goals, the single goal group set a single goal, and the control group received information about community health resources. Dietary intake was assessed via a food frequency questionnaire, physical activity via questionnaire, and A1C and blood lipids via fasting fingerstick sample. Between-group differences for clinical (ie, A1C, blood pressure, and blood lipids), physical activity, and dietary variables were evaluated using Kruskal-Wallis, Mann-Whitney U, analysis of variance, and t tests. From pre- to postintervention, the single-goal group demonstrated significant improvement in systolic blood pressure and intake of servings of fruits, vegetables, and refined grains (all P < .05). The multiple-goal group reported significant reduction in percent energy from total, saturated, monounsaturated, and trans fat intake and significant increase in leisure time walking (all P < .05). A multiple-goal approach over 4 months can improve dietary and physical activity outcomes, while a single-goal approach may facilitate improvement in one behavioral domain. Additional research is needed to evaluate maintenance of the achieved changes. © 2016 The Author(s).

  2. Management of NORM Residues

    International Nuclear Information System (INIS)

    2013-06-01

    The IAEA attaches great importance to the dissemination of information that can assist Member States in the development, implementation, maintenance and continuous improvement of systems, programmes and activities that support the nuclear fuel cycle and nuclear applications, and that address the legacy of past practices and accidents. However, radioactive residues are found not only in nuclear fuel cycle activities, but also in a range of other industrial activities, including: - Mining and milling of metalliferous and non-metallic ores; - Production of non-nuclear fuels, including coal, oil and gas; - Extraction and purification of water (e.g. in the generation of geothermal energy, as drinking and industrial process water; in paper and pulp manufacturing processes); - Production of industrial minerals, including phosphate, clay and building materials; - Use of radionuclides, such as thorium, for properties other than their radioactivity. Naturally occurring radioactive material (NORM) may lead to exposures at some stage of these processes and in the use or reuse of products, residues or wastes. Several IAEA publications address NORM issues with a special focus on some of the more relevant industrial operations. This publication attempts to provide guidance on managing residues arising from different NORM type industries, and on pertinent residue management strategies and technologies, to help Member States gain perspectives on the management of NORM residues

  3. Prevalence and Determinants of Pre-Hypertension among Omani Adults Attending Non-Communicable Disease Screening Program in Primary Care Setting in Sohar City

    Directory of Open Access Journals (Sweden)

    Ali Abdullah Al-Maqbali

    2013-09-01

    Full Text Available Objectives: To estimate the prevalence of pre-hypertension and its association with some selected cardiovascular risk factors among the Omani adult population in the primary healthcare setting.Method: A cross-sectional study involving a sample taken from a National Screening Program of chronic non-communicable diseases in primary healthcare institutions, Sohar city, Sultanate of Oman (July 2006 - December 2007. Inclusion criteria included Omanis aged 40 years or above residents of Sohar city attending primary healthcare institutions not previously diagnosed with diabetes mellitus, hypertension, or chronic kidney diseases. Descriptive statistics were used to describe the demographic, physical and metabolic characteristics. Univariate analysis was used to identify the significant association between the characteristics and normal blood pressure, pre-hypertension and hypertension. Chi-squared test was used for categorical variables analysis and independent t-test was used for continuous variables analysis. In order to examine the strength of significant associations, the multinomial logistic regression analysis was used.Results: There were 1498 participants, 41% were males and 59% were females. Overall, pre-hypertension was observed in 45% of the total study population (95% CI: 0.422 - 0.473. There were more males affected than females (46% versus 44%. About 34% of the total study population was hypertensive. The multinomial logistic regression analysis revealed that an increase of one unit of age, body mass index, fasting blood glucose and total blood cholesterol, were significantly associated with higher risk in both pre-hypertension and hypertension. High odds ratio of pre-hypertension and hypertension was found with the total blood cholesterol.Conclusion: The prevalence of pre-hypertension was high among the Omani adult population. The determinants of pre-hypertension in this research age, body mass index, fasting blood glucose and total blood

  4. Weight loss in nonalcoholic Fatty liver disease patients in an ambulatory care setting is largely unsuccessful but correlates with frequency of clinic visits.

    Directory of Open Access Journals (Sweden)

    Anwar Dudekula

    Full Text Available Nonalcoholic fatty liver disease (NALFD is a leading cause of liver disease. Weight loss improves clinical features of NAFLD; however, maintenance of weight loss outside of investigational protocols is poor. The goals of this study were to characterize patterns and clinical predictors of long-term weight loss in ambulatory patients with NAFLD.We retrospectively reviewed 924 non-cirrhotic patients with NAFLD presenting to a liver clinic from May 1st 2007 to April 30th 2013. Overweight and obese patients were counseled on lifestyle modifications for weight loss as per USPSTF guidelines. The primary outcome was percent weight change between the first and last recorded visits: % weight change  =  (weightinitial - weightfinal/(weightinitial. Baseline BMI and percent BMI change were secondary measures. Predictors of weight loss were determined using logistic regression.The mean baseline BMI was 33.3±6.6 kg/m2, and the mean follow-up duration was 17.3±17.6 months. Most patients with NAFLD were in either overweight (26.1% or class I obesity (30.5% categories at baseline, while the prevalence of underweight and class III obesity was lower (0.2% and 15.4%, respectively. Overall, there was no change in mean weight or BMI during the follow-up period, and only 183 patients (19.8% lost at least 5% body weight during the follow up period. Independent predictors of weight loss included number of clinic visits and baseline BMI, and patients with higher baseline BMI required more clinic visits to lose weight.Weight loss is largely unsuccessful in NAFLD patients in the ambulatory care setting. Frequent clinical encounters are associated with weight reduction, especially among individuals with high baseline BMI. Future studies are required to define effective weight loss strategies in NAFLD patients.

  5. Using rough sets, neural networks, and logistic regression to predict compliance with cholesterol guidelines goals in patients with coronary artery disease.

    Science.gov (United States)

    Dubey, Anil K

    2003-01-01

    Coronary artery disease is a leading cause of death and disability in the United States and throughout the developed world. Results from large randomized, blinded, placebo-controlled trials have demonstrated clearly the benefit of lowering LDL cholesterol in lowering the risk for coronary artery disease. Unfortunately, despite the quantity of evidence, and the availability of medications that can efficiently lower LDL cholesterol with few side effects, not everyone who could benefit from cholesterol lowering interventions actually receives them. Despite the dissemination of national care guidelines for the evaluation and treatment of cholesterol levels (NCEP - National Cholesterol Education Program), compliance with such guidelines is suboptimal. There clearly is room for improvement in narrowing the gap between evidence based guidelines and actual clinical practice. The ability to classify those patients who are or will likely to be noncompliant on the basis of patient data routinely collected during patient care could be potentially useful by enabling the focusing of limited health care resources to those who are or will be at high risk of being under treated. In order to explore this possibility further, we attempted to create such classifiers of cholesterol guideline compliance. To do this, we obtained data from an ambulatory electronic medical record system at use at the MGH adult primary care practices for over 20 years. We obtained the data from this hierarchically-structured EMR using its own native query language, called MQL (Medical Query Language). Next, we applied to the collected data the machine learning techniques of rough set theory, neural networks (feed forward backpropagation nets), and logistic regression. We did this by using commonly available software that for the most part is freely available via the internet. We then compared the accuracy of the classifier models using the receiver operating characteristic (ROC) area and C-index summary

  6. Automatic sets and Delone sets

    International Nuclear Information System (INIS)

    Barbe, A; Haeseler, F von

    2004-01-01

    Automatic sets D part of Z m are characterized by having a finite number of decimations. They are equivalently generated by fixed points of certain substitution systems, or by certain finite automata. As examples, two-dimensional versions of the Thue-Morse, Baum-Sweet, Rudin-Shapiro and paperfolding sequences are presented. We give a necessary and sufficient condition for an automatic set D part of Z m to be a Delone set in R m . The result is then extended to automatic sets that are defined as fixed points of certain substitutions. The morphology of automatic sets is discussed by means of examples

  7. Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids): a protocol for establishing a core outcome set for children with chronic kidney disease.

    Science.gov (United States)

    Tong, Allison; Samuel, Susan; Zappitelli, Michael; Dart, Allison; Furth, Susan; Eddy, Allison; Groothoff, Jaap; Webb, Nicholas J A; Yap, Hui-Kim; Bockenhauer, Detlef; Sinha, Aditi; Alexander, Stephen I; Goldstein, Stuart L; Gipson, Debbie S; Hanson, Camilla S; Evangelidis, Nicole; Crowe, Sally; Harris, Tess; Hemmelgarn, Brenda R; Manns, Braden; Gill, John; Tugwell, Peter; Van Biesen, Wim; Wheeler, David C; Winkelmayer, Wolfgang C; Craig, Jonathan C

    2016-08-12

    Children with chronic kidney disease (CKD), requiring dialysis or kidney transplantation, have a mortality rate of up to 30-fold higher than the general aged-matched population, and severely impaired quality of life. Symptoms such as fatigue and pain are prevalent and debilitating. Children with CKD are at risk of cognitive impairment, and poorer educational, vocational, and psychosocial outcomes compared with their well peers, which have consequences through to adulthood. Treatment regimens for children with CKD are long-term, complex, and highly intrusive. While many trials have been conducted to improve outcomes in children with CKD, the outcomes measured and reported are often not relevant to patients and clinicians, and are highly variable. These problems can diminish the value of trials as a means to improve the lives of children with CKD. The Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids) study aims to develop a core outcome set for trials in children and adolescents with any stage of CKD that is based on the shared priorities of all stakeholders. SONG-Kids involves five phases: a systematic review to identify outcomes (both domains and measures) that have been reported in randomised controlled trials involving children aged up to 21 years with CKD; focus groups (using nominal group technique) with adolescent patients and caregivers of paediatric patients (all ages) to identify outcomes that are relevant and important to patients and their family and the reasons for their choices; semistructured key informant interviews with health professionals involved in the care of children with CKD to ascertain their views on establishing core outcomes in paediatric nephrology; an international three-round online Delphi survey with patients, caregivers, clinicians, researchers, policy-makers, and members from industry to develop consensus on important outcome domains; and a stakeholder workshop to review and finalise the set of core outcome

  8. Côte d'Ivoire Dual Burden of Disease (CoDuBu): Study Protocol to Investigate the Co-occurrence of Chronic Infections and Noncommunicable Diseases in Rural Settings of Epidemiological Transition.

    Science.gov (United States)

    Eze, Ikenna C; Esse, Clémence; Bassa, Fidèle K; Koné, Siaka; Acka, Felix; Yao, Loukou; Imboden, Medea; Jaeger, Fabienne N; Schindler, Christian; Dosso, Mireille; Laubhouet-Koffi, Véronique; Kouassi, Dinard; N'Goran, Eliézer K; Utzinger, Jürg; Bonfoh, Bassirou; Probst-Hensch, Nicole

    2017-10-27

    comparative studies at different levels of epidemiological transition. An HDSS setting is ideal as a basis for longitudinal studies since their sustainable field work teams hold close contact with the local population. The collaboration between research institutions, public health organizations, health care providers, and staff from the Taabo HDSS in this study assures that the synthesized evidence will feed into health policy towards integrated infectious disease-NCD management. The preparation of health systems for the dual burden of disease is pressing in low- and middle-income countries. The established biobank will strengthen the local research capacity and offer opportunities for biomarker studies to deepen the understanding of the cross-talk between infectious diseases and NCDs. International Standard Randomized Controlled Trials Number (ISRCTN): 87099939; http://www.isrctn.com/ISRCTN87099939 (Archived by WebCite at http://www.webcitation.org/6uLEs1EsX). ©Ikenna C Eze, Clémence Esse, Fidèle K Bassa, Siaka Koné, Felix Acka, Loukou Yao, Medea Imboden, Fabienne N Jaeger, Christian Schindler, Mireille Dosso, Véronique Laubhouet-Koffi, Dinard Kouassi, Eliézer K N’Goran, Jürg Utzinger, Bassirou Bonfoh, Nicole Probst-Hensch. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 27.10.2017.

  9. Residu Fungisida Tembaga (Cu pada Pucuk Teh

    Directory of Open Access Journals (Sweden)

    Christanti Sumardiyono

    1996-12-01

    Full Text Available The study was done to know copper residue on tea due to blister blight control by copper fungicides. The experiment was done at Pagilaran Tea Plantation, Batang, Pekalongan. Tea plants were sprayed 8 times, with 8 days interval at the dosages of 0. 75, 150, and 300 g/ha respectively. Shoot sample was taken at 8 and 16 days after spraying. The copper residue war analyzed by Atomic Adsorbtion Spectrophotometer at 324 nm. The result showed that the higher dosage of spraying gives higher copper residue. At the dosage of 300 g/ha was detected 23,52 ppm of copper residue at 8 days after spraying. The residue was reduced to 12,96 ppm at 16 days after spraying. At that dosage the blister blight disease intensity reduced by 59,97%. The detected residue of copper fungicides due to blister blight control is not higher than MRL ( 150 ppm.

  10. Minimal residual disease monitoring by quantitative RT-PCR in core binding factor AML allows risk stratification and predicts relapse: results of the United Kingdom MRC AML-15 trial.

    Science.gov (United States)

    Yin, John A Liu; O'Brien, Michelle A; Hills, Robert K; Daly, Sarah B; Wheatley, Keith; Burnett, Alan K

    2012-10-04

    The clinical value of serial minimal residual disease (MRD) monitoring in core binding factor (CBF) acute myeloid leukemia (AML) by quantitative RT-PCR was prospectively assessed in 278 patients [163 with t(8;21) and 115 with inv(16)] entered in the United Kingdom MRC AML 15 trial. CBF transcripts were normalized to 10(5) ABL copies. At remission, after course 1 induction chemotherapy, a > 3 log reduction in RUNX1-RUNX1T1 transcripts in BM in t(8;21) patients and a > 10 CBFB-MYH11 copy number in peripheral blood (PB) in inv(16) patients were the most useful prognostic variables for relapse risk on multivariate analysis. MRD levels after consolidation (course 3) were also informative. During follow-up, cut-off MRD thresholds in BM and PB associated with a 100% relapse rate were identified: for t(8;21) patients BM > 500 copies, PB > 100 copies; for inv(16) patients, BM > 50 copies and PB > 10 copies. Rising MRD levels on serial monitoring accurately predicted hematologic relapse. During follow-up, PB sampling was equally informative as BM for MRD detection. We conclude that MRD monitoring by quantitative RT-PCR at specific time points in CBF AML allows identification of patients at high risk of relapse and could now be incorporated in clinical trials to evaluate the role of risk directed/preemptive therapy.

  11. Residual-stress measurements

    Energy Technology Data Exchange (ETDEWEB)

    Ezeilo, A.N.; Webster, G.A. [Imperial College, London (United Kingdom); Webster, P.J. [Salford Univ. (United Kingdom)

    1997-04-01

    Because neutrons can penetrate distances of up to 50 mm in most engineering materials, this makes them unique for establishing residual-stress distributions non-destructively. D1A is particularly suited for through-surface measurements as it does not suffer from instrumental surface aberrations commonly found on multidetector instruments, while D20 is best for fast internal-strain scanning. Two examples for residual-stress measurements in a shot-peened material, and in a weld are presented to demonstrate the attractive features of both instruments. (author).

  12. Composition of carbonization residues

    Energy Technology Data Exchange (ETDEWEB)

    Hupfer; Leonhardt

    1943-11-27

    This report compared the composition of samples from Wesseling and Leuna. In each case the sample was a residue from carbonization of the residues from hydrogenation of the brown coal processed at the plant. The composition was given in terms of volatile components, fixed carbon, ash, water, carbon, hydrogen, oxygen, nitrogen, volatile sulfur, and total sulfur. The result of carbonization was given in terms of (ash and) coke, tar, water, gas and losses, and bitumen. The composition of the ash was given in terms of silicon dioxide, ferric oxide, aluminum oxide, calcium oxide, magnesium oxide, potassium and sodium oxides, sulfur trioxide, phosphorus pentoxide, chlorine, and titanium oxide. The most important difference between the properties of the two samples was that the residue from Wesseling only contained 4% oil, whereas that from Leuna had about 26% oil. Taking into account the total amount of residue processed yearly, the report noted that better carbonization at Leuna could save 20,000 metric tons/year of oil. Some other comparisons of data included about 33% volatiles at Leuna vs. about 22% at Wesseling, about 5 1/2% sulfur at Leuna vs. about 6 1/2% at Leuna, but about 57% ash for both. Composition of the ash differed quite a bit between the two. 1 table.

  13. Designing with residual materials

    NARCIS (Netherlands)

    Walhout, W.; Wever, R.; Blom, E.; Addink-Dölle, L.; Tempelman, E.

    2013-01-01

    Many entrepreneurial businesses have attempted to create value based on the residual material streams of third parties. Based on ‘waste’ materials they designed products, around which they built their company. Such activities have the potential to yield sustainable products. Many of such companies

  14. Residues Of Streptomycin Antibiotic In Commercial Layers In ...

    African Journals Online (AJOL)

    Some of the muscle samples recorded residue concentration levels higher than the W.H.O recommended maximum residue level for streptomycin antibiotic in muscle tissue of food animals. In view of the importance of antibiotics in the treatment of bacterial diseases in both human and animals, it is advocated that the use of ...

  15. Risk and maximum residue limits: a study of hops production

    Science.gov (United States)

    This paper examines how maximum residue limits (MRLs) affect the optimal choice by growers of chemical applications to control pests and diseases. In practice, growers who export balance both yield risk and pesticide residue uncertainty when making chemical application decisions. To address these is...

  16. Minimal residual disease or cure in MPNs?

    DEFF Research Database (Denmark)

    Bjørn, Mads Emil; Hasselbalch, Hans Carl

    2017-01-01

    INTRODUCTION: The therapeutic landscape of the Philadelphia-negative myeloproliferative neoplasms (MPNs) is markedly changing consequent to the development of JAK-inhibitors and the use of ruxolitinib (RUX) in patients with myelofibrosis (MF) and patients with polycythemia vera (PV) who develop...

  17. Measurement properties of a novel survey to assess stages of organizational readiness for evidence-based interventions in community chronic disease prevention settings

    Directory of Open Access Journals (Sweden)

    Stamatakis Katherine A

    2012-07-01

    research. These preliminary results help fill this gap by describing the reliability and measurement properties of a theory-based tool; the short, user-friendly instrument may be useful to researchers and practitioners seeking to assess organizational readiness for EBIs across a variety of chronic disease prevention programs and settings.

  18. [Waste over history: perceptions about residues].

    Science.gov (United States)

    Velloso, Marta Pimenta

    2008-01-01

    This article describes how Man, over history, felt about the residues produced by human activity. The text is divided into three parts: In the first part it tells the story of the black plague pandemic during the XIV century, showing how this disease was associated with the residues produced by the human body. In the second part it explains how the first notions of waste were, and still are, related to dirt, disease and death. Finally, in the third part, it describes the first measures of hygiene in the Renaissance and refers to the first public health actions at the beginning of the XX century, starting to combat the agents of infectious diseases and their vectors.

  19. Anxiety is associated with freezing of gait and attentional set-shifting in Parkinson's disease: A new perspective for early intervention.

    Science.gov (United States)

    Martens, K A Ehgoetz; Hall, J M; Gilat, M; Georgiades, M J; Walton, C C; Lewis, S J G

    2016-09-01

    Previous research has shown that anxiety in Parkinson's disease (PD) is associated with freezing of gait (FOG), and may even contribute to the underlying mechanism. However, limited research has investigated whether PD patients with FOG (PD+FOG) have higher anxiety levels when compared directly to non-freezing PD patients (PD-NF) and moreover, how anxiety might contribute to FOG. The current study evaluated whether: (i) PD+FOG have greater anxiety compared to PD-NF, and (ii) anxiety in PD is related to attentional set-shifting, in order to better understand how anxiety might be contributing to FOG. In addition, we explored whether anxiety levels differed between those PD patients with mild FOG (PD+MildFOG) compared to PD-NF. Four hundred and sixty-one patients with PD (231 PD-NF, 180 PD+FOG, 50 PD+MildFOG) were assessed using the Freezing of Gait Questionnaire item 3 (FOG-Q3), Hospital Anxiety and Depression Scale (HADS), Digit Span Test, Logical Memory Retention Test and Trail Making Tests. Compared to PD-NF, PD+FOG had significantly greater anxiety (panxiety as the PD+FOG. In all patients, the severity of anxiety symptoms was significantly correlated to their degree of self-reported FOG on FOG-Q3 (panxiety in FOG and also suggest that anxiety might be a promising biomarker for FOG. Future research should consider whether treating anxiety with pharmacological and/or cognitive behavioural therapies at early stages of gait impairment in PD may alleviate troublesome FOG. Copyright © 2016 Elsevier B.V. All rights reserved.

  20. Disability weights from a household survey in a low socio-economic setting: how does it compare to the global burden of disease 2010 study?

    Directory of Open Access Journals (Sweden)

    Ian Neethling

    2016-08-01

    Full Text Available Background: The global burden of disease (GBD 2010 study used a universal set of disability weights to estimate disability adjusted life years (DALYs by country. However, it is not clear whether these weights can be applied universally in calculating DALYs to inform local decision-making. This study derived disability weights for a resource-constrained community in Cape Town, South Africa, and interrogated whether the GBD 2010 disability weights necessarily represent the preferences of economically disadvantaged communities. Design: A household survey was conducted in Lavender Hill, Cape Town, to assess the health state preferences of the general public. The responses from a paired comparison valuation method were assessed using a probit regression. The probit coefficients were anchored onto the 0 to 1 disability weight scale by running a lowess regression on the GBD 2010 disability weights and interpolating the coefficients between the upper and lower limit of the smoothed disability weights. Results: Heroin and opioid dependence had the highest disability weight of 0.630, whereas intellectual disability had the lowest (0.040. Untreated injuries ranked higher than severe mental disorders. There were some counterintuitive results, such as moderate (15th and severe vision impairment (16th ranking higher than blindness (20th. A moderate correlation between the disability weights of the local study and those of the GBD 2010 study was observed (R2=0.440, p<0.05. This indicates that there was a relationship, although some conditions, such as untreated fracture of the radius or ulna, showed large variability in disability weights (0.488 in local study and 0.043 in GBD 2010. Conclusions: Respondents seemed to value physical mobility higher than cognitive functioning, which is in contrast to the GBD 2010 study. This study shows that not all health state preferences are universal. Studies estimating DALYs need to derive local disability weights using

  1. Cardiovascular Disease Population Risk Tool (CVDPoRT): predictive algorithm for assessing CVD risk in the community setting. A study protocol.

    Science.gov (United States)

    Taljaard, Monica; Tuna, Meltem; Bennett, Carol; Perez, Richard; Rosella, Laura; Tu, Jack V; Sanmartin, Claudia; Hennessy, Deirdre; Tanuseputro, Peter; Lebenbaum, Michael; Manuel, Douglas G

    2014-10-23

    Recent publications have called for substantial improvements in the design, conduct, analysis and reporting of prediction models. Publication of study protocols, with prespecification of key aspects of the analysis plan, can help to improve transparency, increase quality and protect against increased type I error. Valid population-based risk algorithms are essential for population health planning and policy decision-making. The purpose of this study is to develop, evaluate and apply cardiovascular disease (CVD) risk algorithms for the population setting. The Ontario sample of the Canadian Community Health Survey (2001, 2003, 2005; 77,251 respondents) will be used to assess risk factors focusing on health behaviours (physical activity, diet, smoking and alcohol use). Incident CVD outcomes will be assessed through linkage to administrative healthcare databases (619,886 person-years of follow-up until 31 December 2011). Sociodemographic factors (age, sex, immigrant status, education) and mediating factors such as presence of diabetes and hypertension will be included as predictors. Algorithms will be developed using competing risks survival analysis. The analysis plan adheres to published recommendations for the development of valid prediction models to limit the risk of overfitting and improve the quality of predictions. Key considerations are fully prespecifying the predictor variables; appropriate handling of missing data; use of flexible functions for continuous predictors; and avoiding data-driven variable selection procedures. The 2007 and 2009 surveys (approximately 50,000 respondents) will be used for validation. Calibration will be assessed overall and in predefined subgroups of importance to clinicians and policymakers. This study has been approved by the Ottawa Health Science Network Research Ethics Board. The findings will be disseminated through professional and scientific conferences, and in peer-reviewed journals. The algorithm will be accessible

  2. Revascularization Techniques for Acute Basilar Artery Occlusion : Technical Considerations and Outcome in the Setting of Severe Posterior Circulation Steno-Occlusive Disease.

    Science.gov (United States)

    Siebert, Eberhard; Bohner, Georg; Zweynert, Sarah; Maus, Volker; Mpotsaris, Anastasios; Liebig, Thomas; Kabbasch, Christoph

    2018-04-12

    To describe the clinical and radiological characteristics, frequency, technical aspects and outcome of endovascular treatment of acute basilar artery occlusion (ABO) in the setting of vertebrobasilar steno-occlusive disease. Retrospective analysis of databases of two universitary stroke centers including all consecutive patients from January 2013 until May 2017 undergoing thrombectomy for a) acute stroke due to basilar artery occlusion and either significant basilar artery stenosis or vertebral artery stenosis/occlusion as well as b) presumed embolic basilar artery occlusions. Demographics, stroke characteristics, time metrics, recanalization results and outcome were recorded. Interventional strategies were evaluated concerning the thrombectomy technique, additional angioplasty, type of approach with respect to lesion pattern (ipsilateral to steno-occlusive VA lesion: dirty road or contralateral: clean road) and sequence of actions. Out of 157 patients treated for ABO 38 (24.2%) had associated significant vertebrobasilar steno-occlusive lesions. An underlying significant basilar artery stenosis was present in 23.7% and additionally significant steno-occlusive vertebral lesions were present in 81.5%. Thrombectomy was performed with primary aspiration in 15.8% and with stent-retrievers in 84.2%. Successful revascularization (TICI 2b-3) was achieved in 86.8%. In 52.6% additional stent angioplasty was performed, in 7.9% balloon angioplasty only. The clean road approach was used in 22.5% of cases, the dirty road in 77.4%. Final modified Rankin scale (mRS) was 0-2 in 6 patients (15.8%) and 3-5 in 32 (84.2%). The in-hospital mortality was 36.8%. There were no statistically significant differences in outcome compared to presumed cases of embolisms. Endovascular treatment of ABO with underlying significant vertebrobasilar steno-occlusive lesions is effective and reasonably safe. Specific procedural strategies apply depending on individual patient pathology and anatomy

  3. Determination of Pesticide Residues in Cannabis Smoke

    Directory of Open Access Journals (Sweden)

    Nicholas Sullivan

    2013-01-01

    Full Text Available The present study was conducted in order to quantify to what extent cannabis consumers may be exposed to pesticide and other chemical residues through inhaled mainstream cannabis smoke. Three different smoking devices were evaluated in order to provide a generalized data set representative of pesticide exposures possible for medical cannabis users. Three different pesticides, bifenthrin, diazinon, and permethrin, along with the plant growth regulator paclobutrazol, which are readily available to cultivators in commercial products, were investigated in the experiment. Smoke generated from the smoking devices was condensed in tandem chilled gas traps and analyzed with gas chromatography-mass spectrometry (GC-MS. Recoveries of residues were as high as 69.5% depending on the device used and the component investigated, suggesting that the potential of pesticide and chemical residue exposures to cannabis users is substantial and may pose a significant toxicological threat in the absence of adequate regulatory frameworks.

  4. An analysis on the level changing of UET and SET in blood and urine in early stage of kidney disease caused by diabetes

    International Nuclear Information System (INIS)

    Liu Juzhen; Yang Wenying; Cai Tietie

    2001-01-01

    Objective: To study the relationship between UET and SET variation and early changes of diabetic nephropathy. Methods: UET and SET were measured in 24 patients with diabetes, 19 with early stage diabetic nephropathy, 21 with advanced diabetic nephropathy and 30 normal as contrast. Results: Apparent uprise of UET and SET was observed in all patients when compared to normal contrasts (P 2 -macroglobulin was revealed (P<0.05). Conclusion: UET and SET levels uprose as long as diabetic nephropathy deteriorated. As a result, UET and SET may act as sensitive indices in diagnosing early stage diabetic nephropathy

  5. Simplified flow cytometric assay to detect minimal residual disease in childhood with acute lymphoblastic leukemia Detecção de doença residual mínima em crianças com leucemia linfoblástica aguda por citometria de fluxo

    Directory of Open Access Journals (Sweden)

    Elizabete Delbuono

    2008-08-01

    Full Text Available The detection of minimal residual disease (MRD is an important prognostic factor in childhood acute lymphoblastic leukemia (ALL providing crucial information on the response to treatment and risk of relapse. However, the high cost of these techniques restricts their use in countries with limited resources. Thus, we prospectively studied the use of flow cytometry (FC with a simplified 3-color assay and a limited antibody panel to detect MRD in the bone marrow (BM and peripheral blood (PB of children with ALL. BM and PB samples from 40 children with ALL were analyzed on days (d 14 and 28 during induction and in weeks 24-30 of maintenance therapy. Detectable MRD was defined as > 0.01% cells expressing the aberrant immunophenotype as characterized at diagnosis among total events in the sample. A total of 87% of the patients had an aberrant immunophenotype at diagnosis. On d14, 56% of the BM and 43% of the PB samples had detectable MRD. On d28, this decreased to 45% and 31%, respectively. The percentage of cells with the aberrant phenotype was similar in both BM and PB in T-ALL but about 10 times higher in the BM of patients with B-cell-precursor ALL. Moreover, MRD was detected in the BM of patients in complete morphological remission (44% on d14 and 39% on d28. MRD was not significantly associated to gender, age, initial white blood cell count or cell lineage. This FC assay is feasible, affordable and readily applicable to detect MRD in centers with limited resources.A detecção de doença residual mínima (DRM é um importante fator prognóstico na leucemia linfóide aguda (LLA infantil e fornece informações sobre a resposta ao tratamento e o risco de recaída. Entretanto, os altos custos das técnicas utilizadas limitam seu uso nos países em desenvolvimento. Desta forma, realizamos um estudo prospectivo para avaliar a citometria de fluxo (CF, utilizando três fluorescências e um painel limitado de anticorpos monoclonais, como método de detec

  6. Residual stresses in material processing

    Science.gov (United States)

    Kozaczek, K. J.; Watkins, T. R.; Hubbard, C. R.; Wang, Xun-Li; Spooner, S.

    Material manufacturing processes often introduce residual stresses into the product. The residual stresses affect the properties of the material and often are detrimental. Therefore, the distribution and magnitude of residual stresses in the final product are usually an important factor in manufacturing process optimization or component life prediction. The present paper briefly discusses the causes of residual stresses. It then addresses the direct, nondestructive methods of residual stress measurement by X ray and neutron diffraction. Examples are presented to demonstrate the importance of residual stress measurement in machining and joining operations.

  7. Sustainable System for Residual Hazards Management

    International Nuclear Information System (INIS)

    Kevin M. Kostelnik; James H. Clarke; Jerry L. Harbour

    2004-01-01

    Hazardous, radioactive and other toxic substances have routinely been generated and subsequently disposed of in the shallow subsurface throughout the world. Many of today's waste management techniques do not eliminate the problem, but rather only concentrate or contain the hazardous contaminants. Residual hazards result from the presence of hazardous and/or contaminated material that remains on-site following active operations or the completion of remedial actions. Residual hazards pose continued risk to humans and the environment and represent a significant and chronic problem that require continuous long-term management (i.e. >1000 years). To protect human health and safeguard the natural environment, a sustainable system is required for the proper management of residual hazards. A sustainable system for the management of residual hazards will require the integration of engineered, institutional and land-use controls to isolate residual contaminants and thus minimize the associated hazards. Engineered controls are physical modifications to the natural setting and ecosystem, including the site, facility, and/or the residual materials themselves, in order to reduce or eliminate the potential for exposure to contaminants of concern (COCs). Institutional controls are processes, instruments, and mechanisms designed to influence human behavior and activity. System failure can involve hazardous material escaping from the confinement because of system degradation (i.e., chronic or acute degradation) or by external intrusion of the biosphere into the contaminated material because of the loss of institutional control. An ongoing analysis of contemporary and historic sites suggests that the significance of the loss of institutional controls is a critical pathway because decisions made during the operations/remedial action phase, as well as decisions made throughout the residual hazards management period, are key to the long-term success of the prescribed system. In fact

  8. SRC Residual fuel oils

    Science.gov (United States)

    Tewari, Krishna C.; Foster, Edward P.

    1985-01-01

    Coal solids (SRC) and distillate oils are combined to afford single-phase blends of residual oils which have utility as fuel oils substitutes. The components are combined on the basis of their respective polarities, that is, on the basis of their heteroatom content, to assure complete solubilization of SRC. The resulting composition is a fuel oil blend which retains its stability and homogeneity over the long term.

  9. Dissociating Stimulus-Set and Response-Set in the Context of Task-Set Switching

    Science.gov (United States)

    Kieffaber, Paul D.; Kruschke, John K.; Cho, Raymond Y.; Walker, Philip M.; Hetrick, William P.

    2014-01-01

    The primary aim of the present research was to determine how stimulus-set and response-set components of task-set contribute to switch costs and conflict processing. Three experiments are described wherein participants completed an explicitly cued task-switching procedure. Experiment 1 established that task switches requiring a reconfiguration of both stimulus- and response-set incurred larger residual switch costs than task switches requiring the reconfiguration of stimulus-set alone. Between-task interference was also drastically reduced for response-set conflict compared with stimulus-set conflict. A second experiment replicated these findings and demonstrated that stimulus- and response-conflict have dissociable effects on the “decision time” and “motor time” components of total response time. Finally, a third experiment replicated Experiment 2 and demonstrated that the stimulus- and response- components of task switching and conflict processing elicit dissociable neural activity as evidence by event-related brain potentials. PMID:22984990

  10. Composition of carbonization residues

    Energy Technology Data Exchange (ETDEWEB)

    Hupfer; Leonhardt

    1943-11-30

    This report gave a record of the composition of several samples of residues from carbonization of various hydrogenation residue from processing some type of coal or tar in the Bergius process. These included Silesian bituminous coal processed at 600 atm. with iron catalyst, in one case to produce gasoline and middle oil and in another case to produce heavy oil excess, Scholven coal processed at 250 atm. with tin oxalate and chlorine catalyst, Bruex tar processed in a 10-liter oven using iron catalyst, and a pitch mixture from Welheim processed in a 10-liter over using iron catalyst. The values gathered were compared with a few corresponding values estimated for Boehlen tar and Gelsenberg coal based on several assumptions outlined in the report. The data recorded included percentage of ash in the dry residue and percentage of carbon, hydrogen, oxygen, nitrogen, chlorine, total sulfur, and volatile sulfur. The percentage of ash varied from 21.43% in the case of Bruex tar to 53.15% in the case of one of the Silesian coals. Percentage of carbon varied from 44.0% in the case of Scholven coal to 78.03% in the case of Bruex tar. Percentage of total sulfur varied from 2.28% for Bruex tar to a recorded 5.65% for one of the Silesian coals and an estimated 6% for Boehlen tar. 1 table.

  11. Reduced-Intensity Delayed Intensification in Standard-Risk Pediatric Acute Lymphoblastic Leukemia Defined by Undetectable Minimal Residual Disease: Results of an International Randomized Trial (AIEOP-BFM ALL 2000).

    Science.gov (United States)

    Schrappe, Martin; Bleckmann, Kirsten; Zimmermann, Martin; Biondi, Andrea; Möricke, Anja; Locatelli, Franco; Cario, Gunnar; Rizzari, Carmelo; Attarbaschi, Andishe; Valsecchi, Maria Grazia; Bartram, Claus R; Barisone, Elena; Niggli, Felix; Niemeyer, Charlotte; Testi, Anna Maria; Mann, Georg; Ziino, Ottavio; Schäfer, Beat; Panzer-Grümayer, Renate; Beier, Rita; Parasole, Rosanna; Göhring, Gudrun; Ludwig, Wolf-Dieter; Casale, Fiorina; Schlegel, Paul-Gerhardt; Basso, Giuseppe; Conter, Valentino

    2018-01-20

    Purpose Delayed intensification (DI) is an integral part of treatment of childhood acute lymphoblastic leukemia (ALL), but it is associated with relevant toxicity. Therefore, standard-risk patients of trial AIEOP-BFM ALL 2000 (Combination Chemotherapy Based on Risk of Relapse in Treating Young Patients With ALL) were investigated with the specific aim to reduce treatment intensity. Patients and Methods Between July 2000 and July 2006, 1,164 patients (1 to 17 years of age) with standard-risk ALL (defined as the absence of high-risk cytogenetics and undetectable minimal residual disease on days 33 and 78) were randomly assigned to either experimental reduced-intensity DI (protocol III; P-III) or standard DI (protocol II; P-II). Cumulative drug doses of P-III were reduced by 30% for dexamethasone and 50% for vincristine, doxorubicin, and cyclophosphamide, which shortened the treatment duration from 49 to 29 days. The study aimed at noninferiority of reduced-intensity P-III; analyses were performed according to treatment given. Results For P-III and P-II, respectively, the 8-year rate of disease-free survival (± SE) was 89.2 ± 1.3% and 92.3 ± 1.2% ( P = .04); cumulative incidence of relapse, 8.7 ± 1.2% and 6.4 ± 1.1% ( P = .09); and overall survival, 96.1 ± 0.8% and 98.0 ± 0.6% ( P = .06). Patients with ETV6-RUNX1-positive ALL and patients 1 to 6 years of age performed equally well in both arms. The incidence of death during remission was comparable, which indicates equivalent toxicity. The 8-year cumulative incidence rate of secondary malignancies was 1.3 ± 0.5% and 0.6 ± 0.4% for P-III and P-II, respectively ( P = .37). Conclusion Although the criteria used for the standard-risk definition in this trial identified patients with exceptionally good prognosis, reduction of chemotherapy was not successful mainly because of an increased rate of relapse. The data suggest that treatment reduction is feasible in specific subgroups, which underlines the biologic

  12. Return to Work Rates After Single-level Cervical Fusion for Degenerative Disc Disease Compared With Fusion for Radiculopathy in a Workers' Compensation Setting.

    Science.gov (United States)

    Faour, Mhamad; Anderson, Joshua T; Haas, Arnold R; Percy, Rick; Woods, Stephen T; Ahn, Uri M; Ahn, Nicholas U

    2016-07-15

    A retrospective comparative cohort study. To compare return to work (RTW) rates for patients who underwent single-level cervical fusion for radiculopathy compared with fusion for degenerative disc disease (DDD) as an indication for surgery. Studies have shown that workers' compensation subjects have less favorable surgical and functional outcomes compared with the general population. Cervical decompression and fusion have provided great results with relieving radicular symptoms. Fusion for DDD, however, remains controversial. We retrospectively collected data of 21 169 subjects with cervical comorbidities who filed their claims for work-related injuries with Ohio Bureau of Workers' Compensation (BWC) between 1993 and 2011. The primary outcome was whether subjects met RTW criteria within 3-year follow-up after fusion. The secondary outcome measures and data on presurgical characteristics and secondary outcomes of each cohort were also collected. Successful RTW status was affected by a number of presurgical risk factors: DDD as an indication for surgery, age of more than 50 years, out of work for more than 6 months, psychological evaluation, opioid use, legal litigation, and permanent disability. The DDD group had lower rate of successful RTW status (50.9%) and was less likely to have a sustained RTW status (odds ratio = 0.61, 95% confidence interval: 0.48-0.79, P = 0.0001) compared with the radiculopathy group (successful RTW rate 62.9%). RTW rate within 1 year after surgery was lower in the DDD group (39.9%) compared with the radiculopathy group (53.1%; P = 0.0001). DDD patients were absent 112 days more on average after surgery compared with radiculopathy patients (P = 0.0003). Cervical fusion for DDD is associated with lower rate of successful RTW status when compared with fusion for radiculopathy in a worker's compensation setting. The decision to include surgical intervention in the management plan of cervical DDD should be approached with

  13. Quadratic residues and non-residues selected topics

    CERN Document Server

    Wright, Steve

    2016-01-01

    This book offers an account of the classical theory of quadratic residues and non-residues with the goal of using that theory as a lens through which to view the development of some of the fundamental methods employed in modern elementary, algebraic, and analytic number theory. The first three chapters present some basic facts and the history of quadratic residues and non-residues and discuss various proofs of the Law of Quadratic Reciprosity in depth, with an emphasis on the six proofs that Gauss published. The remaining seven chapters explore some interesting applications of the Law of Quadratic Reciprocity, prove some results concerning the distribution and arithmetic structure of quadratic residues and non-residues, provide a detailed proof of Dirichlet’s Class-Number Formula, and discuss the question of whether quadratic residues are randomly distributed. The text is a valuable resource for graduate and advanced undergraduate students as well as for mathematicians interested in number theory.

  14. DISEASES

    DEFF Research Database (Denmark)

    Pletscher-Frankild, Sune; Pallejà, Albert; Tsafou, Kalliopi

    2015-01-01

    Text mining is a flexible technology that can be applied to numerous different tasks in biology and medicine. We present a system for extracting disease-gene associations from biomedical abstracts. The system consists of a highly efficient dictionary-based tagger for named entity recognition...... of human genes and diseases, which we combine with a scoring scheme that takes into account co-occurrences both within and between sentences. We show that this approach is able to extract half of all manually curated associations with a false positive rate of only 0.16%. Nonetheless, text mining should...... not stand alone, but be combined with other types of evidence. For this reason, we have developed the DISEASES resource, which integrates the results from text mining with manually curated disease-gene associations, cancer mutation data, and genome-wide association studies from existing databases...

  15. Symptoms and quality of life in patients with chronic obstructive pulmonary disease treated with aclidinium in a real-life setting

    DEFF Research Database (Denmark)

    Lange, Peter; Godtfredsen, Nina Skavlan; Olejnicka, Beata

    2016-01-01

    Introduction: Chronic obstructive pulmonary disease (COPD) is a progressive disease with symptoms that can have a major impact on patients' physical health. The aim of this study was to evaluate quality of life (QoL), symptom severity and dyspnoea in COPD patients treated with aclidinium up to 24...

  16. Sharing Residual Liability

    DEFF Research Database (Denmark)

    Carbonara, Emanuela; Guerra, Alice; Parisi, Francesco

    2016-01-01

    Economic models of tort law evaluate the efficiency of liability rules in terms of care and activity levels. A liability regime is optimal when it creates incentives to maximize the value of risky activities net of accident and precaution costs. The allocation of primary and residual liability...... the virtues and limits of loss-sharing rules in generating optimal (second-best) incentives and allocations of risk. We find that loss sharing may be optimal in the presence of countervailing policy objectives, homogeneous risk avoiders, and subadditive risk, which potentially offers a valuable tool...

  17. Adjacent segment level disease in Klippel-Feil syndrome patients with congenital cervical fusion in the setting of anterolisthesis: Should management be altered in the presence of anterolisthesis?

    Directory of Open Access Journals (Sweden)

    Fernando Alonso

    2017-03-01

    Conclusion: Our follow-up was limited, but this study does not support the assumption that a congenitally fused segment predisposes a patient to a rate of adjacent segment level disease similar to patient who has undergone an anterior cervical discectomy and fusion. We found no increased risk of symptomatic adjacent segment level disease in KFS patients who had anterolisthesis adjacent to a congenitally fused segment.

  18. Beta lactam antibiotics residues in cow's milk: comparison of efficacy of three screening tests used in Bosnia and Herzegovina.

    Science.gov (United States)

    Fejzic, Nihad; Begagic, Muris; Šerić-Haračić, Sabina; Smajlovic, Muhamed

    2014-08-27

    Beta lactam antibiotics are widely used in therapy of cattle, particularly for the treatment of mastitis.  Over 95% of residue testing in dairies in Bosnia and Herzegovina is for Beta lactams. The aim of this paper is to compare the efficacy of three most common screening tests for Beta lactam residues in cow's milk in our country. The tests used in the study are SNAP β Lactam test (Idexx), Rosa Charm β Lactam test and Inhibition MRL test. Study samples included: standardized concentrations of penicillin solution (0, 2, 3, 4, 5 and 6 ppb). In addition we tested milk samples from three equal size study groups (not receiving any antibiotic therapy, treated with Beta lactams for mastitis and treated with Beta lactams for diseases other than mastitis). Sensitivity and specificity were determined for each test, using standard penicillin concentrations with threshold value set at concentration of 4 ppb (Maximum residue level - MLR). Additionally we determined proportions of presumably false negative and false positive results for each test using results of filed samples testing. Agreement of test results for each test pair was assessed through Kappa coefficients interpreted by Landis-Koch scale. Detection level of all tests was shown to be well below MRL. This alongside with effects of natural inhibitors in milk contributed to finding of positive results in untreated and treated animals after the withholding period. Screening tests for beta lactam residues are important tools for ensuring that milk for human consumption is free from antibiotics residues.

  19. Antibiotic Residues - A Global Health Hazard

    Directory of Open Access Journals (Sweden)

    Nisha A.R.

    Full Text Available Use of Antibiotic that might result in deposition of residues in meat, milk and eggs must not be permitted in food intended for human consumption. If use of antibiotics is necessary as in prevention and treatment of animal diseases, a withholding period must be observed until the residues are negligible or no longer detected. The use of antibiotics to bring about improved performance in growth and feed efficiency, to synchronize or control of reproductive cycle and breeding performance also often lead to harmful residual effects. Concern over antibiotic residues in food of animal origin occurs in two times; one which produces potential threat to direct toxicity in human, second is whether the low levels of antibiotic exposure would result in alteration of microflora, cause disease and the possible development of resistant strains which cause failure of antibiotic therapy in clinical situations. A withdrawal period is established to safeguard human from exposure of antibiotic added food. The withdrawal time is the time required for the residue of toxicological concern to reach safe concentration as defined by tolerance. It is the interval from the time an animal is removed from medication until permitted time of slaughter. Heavy responsibility is placed on the veterinarian and livestock producer to observe the period for a withdrawal of a drug prior to slaughter to assure that illegal concentration of drug residue in meat, milk and egg do not occur. Use of food additives may improve feed efficiency 17% in beef cattle, 10% in lambs, 15% in poultry and 15% in swine. But their indiscriminate use will produce toxicity in consumers. WHO and FAO establish tolerances for a drug, pesticide or other chemical in the relevant tissues of food producing animals. The tolerance is the tissue concentration below, which a marker residue for the drug or chemical must fall in the target tissue before that animal edible tissues are considered safe for human

  20. (99m)Tc-MDP SPECT/CT as the one-stop imaging modality for the diagnosis of early setting of Kienbock's disease.

    Science.gov (United States)

    Arora, S; Singh Dhull, V; Karunanithi, S; Kumar Parida, G; Sharma, A; Shamim, S A

    2015-01-01

    (99m)Tc-Methylene diphosphonate (MDP) triple phase bone scintigraphy (BS) has a role in early diagnosis of Kienbock's disease, especially when the X-ray is negative. Early diagnosis can result in prompt management of the patient since wrist pain in older individuals due to aging may go unnoticed or be due to other diagnoses with the production of greater damage and eventually a worse prognosis. Herein, we present a case report of a 29-year-old female with Kienbock's disease in whom the X-ray was negative and MRI incorrect. The (99m)Tc-MDP SPECT/CT BS helped the diagnosis of the disease in an early stage (stage 1) and had a clinical impact on the patient's management. Copyright © 2014 Elsevier España, S.L.U. and SEMNIM. All rights reserved.

  1. Effect of restrictive versus liberal transfusion strategies on outcomes in patients with cardiovascular disease in a non-cardiac surgery setting: systematic review and meta-analysis.

    Science.gov (United States)

    Docherty, Annemarie B; O'Donnell, Rob; Brunskill, Susan; Trivella, Marialena; Doree, Carolyn; Holst, Lars; Parker, Martyn; Gregersen, Merete; Pinheiro de Almeida, Juliano; Walsh, Timothy S; Stanworth, Simon J

    2016-03-29

    To compare patient outcomes of restrictive versus liberal blood transfusion strategies in patients with cardiovascular disease not undergoing cardiac surgery. Systematic review and meta-analysis. Randomised controlled trials involving a threshold for red blood cell transfusion in hospital. We searched (to 2 November 2015) CENTRAL, Medline, Embase, CINAHL, PubMed, LILACS, NHSBT Transfusion Evidence Library, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, ISRCTN Register, and EU Clinical Trials Register. Authors were contacted for data whenever possible. Published and unpublished randomised controlled trials comparing a restrictive with liberal transfusion threshold and that included patients with cardiovascular disease. Data extraction was completed in duplicate. Risk of bias was assessed using Cochrane methods. Relative risk ratios with 95% confidence intervals were presented in all meta-analyses. Mantel-Haenszel random effects models were used to pool risk ratios. 30 day mortality, and cardiovascular events. 41 trials were identified; of these, seven included data on patients with cardiovascular disease. Data from a further four trials enrolling patients with cardiovascular disease were obtained from the authors. In total, 11 trials enrolling patients with cardiovascular disease (n=3033) were included for meta-analysis (restrictive transfusion, n=1514 patients; liberal transfusion, n=1519). The pooled risk ratio for the association between transfusion thresholds and 30 day mortality was 1.15 (95% confidence interval 0.88 to 1.50, P=0.50), with little heterogeneity (I(2)=14%). The risk of acute coronary syndrome in patients managed with restrictive compared with liberal transfusion was increased (nine trials; risk ratio 1.78, 95% confidence interval 1.18 to 2.70, P=0.01, I(2)=0%). The results show that it may not be safe to use a restrictive transfusion threshold of less than 80 g/L in patients with ongoing acute coronary syndrome or

  2. Marine Tar Residues: a Review

    OpenAIRE

    Warnock, April M.; Hagen, Scott C.; Passeri, Davina L.

    2015-01-01

    Marine tar residues originate from natural and anthropogenic oil releases into the ocean environment and are formed after liquid petroleum is transformed by weathering, sedimentation, and other processes. Tar balls, tar mats, and tar patties are common examples of marine tar residues and can range in size from millimeters in diameter (tar balls) to several meters in length and width (tar mats). These residues can remain in the ocean environment indefinitely, decomposing or becoming buried in ...

  3. Mapping allostery through computational glycine scanning and correlation analysis of residue-residue contacts.

    Science.gov (United States)

    Johnson, Quentin R; Lindsay, Richard J; Nellas, Ricky B; Fernandez, Elias J; Shen, Tongye

    2015-02-24

    Understanding allosteric mechanisms is essential for the physical control of molecular switches and downstream cellular responses. However, it is difficult to decode essential allosteric motions in a high-throughput scheme. A general two-pronged approach to performing automatic data reduction of simulation trajectories is presented here. The first step involves coarse-graining and identifying the most dynamic residue-residue contacts. The second step is performing principal component analysis of these contacts and extracting the large-scale collective motions expressed via these residue-residue contacts. We demonstrated the method using a protein complex of nuclear receptors. Using atomistic modeling and simulation, we examined the protein complex and a set of 18 glycine point mutations of residues that constitute the binding pocket of the ligand effector. The important motions that are responsible for the allostery are reported. In contrast to conventional induced-fit and lock-and-key binding mechanisms, a novel "frustrated-fit" binding mechanism of RXR for allosteric control was revealed.

  4. Development and Implementation of Nonpharmacologic Protocols for the Management of Patients with Alzheimer's Disease and Their Families in a Multiracial Primary Care Setting

    Science.gov (United States)

    Austrom, Mary Guerriero; Damush, Teresa M.; Hartwell, Cora West; Perkins, Tony; Unverzagt, Frederick; Boustani, Malaz; Hendrie, Hugh C.; Callahan, Christopher M.

    2004-01-01

    Purpose. Most patients and families with dementia are cared for in primary care clinics. These clinics are seldom designed to provide the necessary comprehensive care. The purpose of this article is to describe nonpharmacologic protocols for the management of patients with Alzheimer's disease and their families that are administered as part of a…

  5. Standardised Outcomes in Nephrology-Children and Adolescents (SONG-Kids): a protocol for establishing a core outcome set for children with chronic kidney disease

    NARCIS (Netherlands)

    Tong, Allison; Samuel, Susan; Zappitelli, Michael; Dart, Allison; Furth, Susan; Eddy, Allison; Groothoff, Jaap; Webb, Nicholas J. A.; Yap, Hui-Kim; Bockenhauer, Detlef; Sinha, Aditi; Alexander, Stephen I.; Goldstein, Stuart L.; Gipson, Debbie S.; Hanson, Camilla S.; Evangelidis, Nicole; Crowe, Sally; Harris, Tess; Hemmelgarn, Brenda R.; Manns, Braden; Gill, John; Tugwell, Peter; van Biesen, Wim; Wheeler, David C.; Winkelmayer, Wolfgang C.; Craig, Jonathan C.

    2016-01-01

    Children with chronic kidney disease (CKD), requiring dialysis or kidney transplantation, have a mortality rate of up to 30-fold higher than the general aged-matched population, and severely impaired quality of life. Symptoms such as fatigue and pain are prevalent and debilitating. Children with CKD

  6. Quality of Care for Patients With Chronic Kidney Disease in the Primary Care Setting: A Retrospective Cohort Study From Ontario, Canada.

    Science.gov (United States)

    Nash, Danielle M; Brimble, Scott; Markle-Reid, Maureen; McArthur, Eric; Tu, Karen; Nesrallah, Gihad E; Grill, Allan; Garg, Amit X

    2017-01-01

    Patients with chronic kidney disease may not be receiving recommended primary renal care. To use recently established primary care quality indicators for chronic kidney disease to determine the proportion of patients receiving recommended renal care. Retrospective cohort study using administrative data with linked laboratory information. The study was conducted in Ontario, Canada, from 2006 to 2012. Patients over 40 years with chronic kidney disease or abnormal kidney function in primary care were included. In total, 11 quality indicators were assessed for chronic kidney disease identified through a Delphi panel in areas of screening, monitoring, drug prescribing, and laboratory monitoring after initiating an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB). We calculated the proportion and cumulative incidence at the end of follow-up of patients meeting each indicator and stratified results by age, sex, cohort entry, and chronic kidney disease stage. Less than half of patients received follow-up tests after an initial abnormal kidney function result. Most patients with chronic kidney disease received regular monitoring of serum creatinine (91%), but urine albumin-to-creatinine monitoring was lower (70%). A total of 84% of patients age 66 and older did not receive a non-steroidal anti-inflammatory drug prescription of at least 2-week duration. Three quarters of patients age 66 and older were on an ACE inhibitor or ARB, and 96% did not receive an ACE inhibitor and ARB concurrently. Among patients 66 to 80 years of age with chronic kidney disease, 65% were on a statin. One quarter of patients age 66 and older who initiated an ACE inhibitor or ARB had their serum creatinine and potassium monitored within 7 to 30 days. This study was limited to people in Ontario with linked laboratory information. There was generally strong performance across many of the quality of care indicators. Areas where more attention may be needed are

  7. Network of vascular diseases, death and biochemical characteristics in a set of 4,197 patients with type 1 diabetes (The FinnDiane Study

    Directory of Open Access Journals (Sweden)

    Wadén Johan

    2009-10-01

    Full Text Available Background Cardiovascular disease is the main cause of premature death in patients with type 1 diabetes. Patients with diabetic kidney disease have an increased risk of heart attack or stroke. Accurate knowledge of the complex inter-dependencies between the risk factors is critical for pinpointing the best targets for research and treatment. Therefore, the aim of this study was to describe the association patterns between clinical and biochemical features of diabetic complications. Methods Medical records and serum and urine samples of 4,197 patients with type 1 diabetes were collected from health care centers in Finland. At baseline, the mean diabetes duration was 22 years, 52% were male, 23% had kidney disease (urine albumin excretion over 300 mg/24 h or end-stage renal disease and 8% had a history of macrovascular events. All-cause mortality was evaluated after an average of 6.5 years of follow-up (25,714 patient years. The dataset comprised 28 clinical and 25 biochemical variables that were regarded as the nodes of a network to assess their mutual relationships. Results The networks contained cliques that were densely inter-connected (r > 0.6, including cliques for high-density lipoprotein (HDL markers, for triglycerides and cholesterol, for urinary excretion and for indices of body mass. The links between the cliques showed biologically relevant interactions: an inverse relationship between HDL cholesterol and the triglyceride clique (r P -16, a connection between triglycerides and body mass via C-reactive protein (r > 0.3, P -16 and intermediate-density cholesterol as the connector between lipoprotein metabolism and albuminuria (r > 0.3, P -16. Aging and macrovascular disease were linked to death via working ability and retinopathy. Diabetic kidney disease, serum creatinine and potassium, retinopathy and blood pressure were inter-connected. Blood pressure correlations indicated accelerated vascular aging in individuals with kidney disease

  8. Adaptive residual DPCM for lossless intra coding

    Science.gov (United States)

    Cai, Xun; Lim, Jae S.

    2015-03-01

    In the Differential Pulse-code Modulation (DPCM) image coding, the intensity of a pixel is predicted as a linear combination of a set of surrounding pixels and the prediction error is encoded. In this paper, we propose the adaptive residual DPCM (ARDPCM) for intra lossless coding. In the ARDPCM, intra residual samples are predicted using adaptive mode-dependent DPCM weights. The weights are estimated by minimizing the Mean Squared Error (MSE) of coded data and they are synchronized at the encoder and the decoder. The proposed method is implemented on the High Efficiency Video Coding (HEVC) reference software. Experimental results show that the ARDPCM significantly outperforms HEVC lossless coding and HEVC with the DPCM. The proposed method is also computationally efficient.

  9. Probability-scale residuals for continuous, discrete, and censored data.

    Science.gov (United States)

    Shepherd, Bryan E; Li, Chun; Liu, Qi

    2016-12-01

    We describe a new residual for general regression models, defined as pr ( Y * y ), where y is the observed outcome and Y * is a random variable from the fitted distribution. This probability-scale residual can be written as E {sign( y , Y * )} whereas the popular observed-minus-expected residual can be thought of as E ( y - Y * ). Therefore, the probability-scale residual is useful in settings where differences are not meaningful or where the expectation of the fitted distribution cannot be calculated. We present several desirable properties of the probability-scale residual that make it useful for diagnostics and measuring residual correlation, especially across different outcome types. We demonstrate its utility for continuous, ordered discrete, and censored outcomes, including current status data, and with various models including Cox regression, quantile regression, and ordinal cumulative probability models, for which fully specified distributions are not desirable or needed, and in some cases suitable residuals are not available. The residual is illustrated with simulated data and real datasets from HIV-infected patients on therapy in the southeastern United States and Latin America.

  10. Evaluation of residue-residue contact predictions in CASP9

    KAUST Repository

    Monastyrskyy, Bohdan

    2011-01-01

    This work presents the results of the assessment of the intramolecular residue-residue contact predictions submitted to CASP9. The methodology for the assessment does not differ from that used in previous CASPs, with two basic evaluation measures being the precision in recognizing contacts and the difference between the distribution of distances in the subset of predicted contact pairs versus all pairs of residues in the structure. The emphasis is placed on the prediction of long-range contacts (i.e., contacts between residues separated by at least 24 residues along sequence) in target proteins that cannot be easily modeled by homology. Although there is considerable activity in the field, the current analysis reports no discernable progress since CASP8.

  11. Linking of the American Academy of Orthopaedic Surgeons Distal Radius Fracture Clinical Practice Guidelines to the International Classification of Functioning, Disability, and Health; International Classification of Diseases; and ICF Core Sets for Hand Conditions.

    Science.gov (United States)

    Esakki, Saravanan; MacDermid, Joy; Vajravelu, Saipriya

    2016-09-01

    Background: American Academy of Orthopaedic Surgeons (AAOS) distal radius fracture (DRF) clinical practice guidelines (CPG) are readily available to clinicians, patients, and policymakers. International Classification of Functioning, Disability, and Health (ICF) provides a framework for describing the impact of health conditions. The International Classification of Diseases-10th Revision (ICD-10) is a classification system to classify health conditions as specific disease or disorders. The aim of this study is to analyze and describe the scope and focus of the AAOS DRF CPG using the ICF and ICD-10 as a basis for content analysis, and to compare the content of the CPG with the ICF hand core sets as the reference standard. Methods: Established linking rules were used by 2 independent raters to analyze the 29 recommendations of the AAOS DRF CPG. ICD-10 codes were assigned in the same process. Summary linkage statistics were used to describe the results for ICF and the hand core sets. Results: Among the 29 recommendations of the AAOS DRF CPG, 5 meaningful concepts were linked to the ICF codes. Of these, 5 codes appeared on the comprehensive ICF core set and only 3 codes appeared in the brief ICF core set, and 7 conditions were covered in ICD-10 codes. Conclusions: The AAOS DRF CPG focuses on surgical interventions and has minimal linkage to the constructs of the ICD-10 and ICF. It does not address activity or participation (disability), and is not well linked to key concepts relevant to hand conditions.

  12. A random set scoring model for prioritization of disease candidate genes using protein complexes and data-mining of GeneRIF, OMIM and PubMed records

    DEFF Research Database (Denmark)

    Jiang, Li; Edwards, Stefan M.; Thomsen, Bo

    2014-01-01

    Background: Prioritizing genetic variants is a challenge because disease susceptibility loci are often located in genes of unknown function or the relationship with the corresponding phenotype is unclear. A global data-mining exercise on the biomedical literature can establish the phenotypic...... from PubMed abstracts, OMIM, and GeneRIF records. We also investigated the validity of several vocabulary filters and different likelihood thresholds for predicted protein-protein interactions in terms of their effect on the network-based gene-prioritization approach, which relies on text-mining...... of the phenotype data. Our method demonstrated good precision and sensitivity compared with those of two alternative complex-based prioritization approaches. We then conducted a global ranking of all human genes according to their relevance to a range of human diseases. The resulting accurate ranking of known...

  13. A random set scoring model for prioritization of disease candidate genes using protein complexes and data-mining of GeneRIF, OMIM and PubMed records

    DEFF Research Database (Denmark)

    Jiang, Li; Edwards, Stefan M.; Thomsen, Bo

    2014-01-01

    Background: Prioritizing genetic variants is a challenge because disease susceptibility loci are often located in genes of unknown function or the relationship with the corresponding phenotype is unclear. A global data-mining exercise on the biomedical literature can establish the phenotypic...... from PubMed abstracts, OMIM, and GeneRIF records. We also investigated the validity of several vocabulary filters and different likelihood thresholds for predicted protein-protein interactions in terms of their effect on the network-based gene-prioritization approach, which relies on text-mining...... causal genes supported the reliability of our approach. Moreover, these data suggest many promising novel candidate genes for human disorders that have a complex mode of inheritance. Conclusion: We have implemented and validated a network-based approach to prioritize genes for human diseases based...

  14. Follow-Up Consultation Through a Healthcare Kiosk for Patients with Stable Chronic Disease in a Primary Care Setting: A Prospective Study.

    Science.gov (United States)

    Bahadin, Juliana; Shum, Eugene; Ng, Grace; Tan, Nicolette; Sellayah, Pushpavalli; Tan, Sze Wee

    2017-05-01

    The global healthcare kiosk market is growing, and kiosks are projected to be a larger part of healthcare delivery in the coming decades. We developed an unmanned healthcare kiosk that automates the management of stable patients with chronic conditions to complement face-to-face primary care physician (PCP) visits. The aim of our study was to show that the kiosk could be a feasible means of delivering care for stable patients with chronic conditions and could generate cost savings for the management of patients with stable chronic disease. We conducted a prospective single-arm study of 95 participants with well-controlled chronic cardiovascular diseases who visited our clinic in Singapore every 3 months for review and medication refill. During their subsequent appointments for chronic disease management at 3 and 6 months, participants used the kiosk instead of consulting a physician. All participants who used the kiosk were also evaluated by a nurse clinician (NC). The kiosk assessment of whether the patient was well controlled was then compared to the NC's assessment to determine rates of agreement. Patient satisfaction was evaluated through a questionnaire, and any adverse outcomes were documented. Cohen's κ for agreement between the kiosk and the NC assessment of patients' chronic care control was 0.575 (95% CI, 0.437-0.713). The modest agreement was due to differences in systolic blood pressure measurements between the kiosk and the NC. The 96% of participants who completed two kiosk visits were all satisfied with the kiosk as a care delivery alternative. None of the participants managed through the kiosk suffered any adverse outcomes. Use of the kiosk resulted in a reduction of 128 face-to-face PCP visits. Healthcare kiosks can potentially be used to complement primary care clinician visits for managing patients with stable chronic diseases and can generate cost savings.

  15. Randomised clinical trial of an intensive intervention in the primary care setting of patients with high plasma fibrinogen in the primary prevention of cardiovascular disease

    Directory of Open Access Journals (Sweden)

    José Rodríguez Cristóbal Juan

    2012-03-01

    Full Text Available Abstract Background We have studied the possible effects of an intensive lifestyle change program on plasma fibrinogen levels, in patients with no cardiovascular disease, with elevated levels of fibrinogen, normal cholesterol levels, and a moderate estimated risk of coronary heart disease (CHD and we have also analysed whether the effect on fibrinogen is independent of the effect on lipids. Results This clinical trial was controlled, unblinded and randomized, with parallel groups, done in 13 Basic Health Areas (BHA in l'Hospitalet de Llobregat (Barcelona and Barcelona city. The study included 436 patients, aged between 35 and 75 years, with no cardiovascular disease, elevated levels of fibrinogen (> 300 mg/dl, cholesterol The evaluation of the baseline characteristics of the patients showed that both groups were homogenous. Obesity and hypertension were the most prevalent risk factors. After 24 months of the study, statistically significant changes were seen between the adjusted means of the two groups, for the following parameters: fibrinogen, plasma cholesterol, systolic and diastolic blood pressure and body mass index. Conclusion Intensive intervention to achieve lifestyle changes has shown to be effective in reducing some of the estimated CHD factors. However, the effect of intensive intervention on plasma fibrinogen levels did not correlate with the variations in cholesterol. Trial Registration ClinicalTrials.gov: NCT01089530

  16. Landfilling of waste incineration residues

    DEFF Research Database (Denmark)

    Christensen, Thomas Højlund; Astrup, Thomas; Cai, Zuansi

    2002-01-01

    Residues from waste incineration are bottom ashes and air-pollution-control (APC) residues including fly ashes. The leaching of heavy metals and salts from the ashes is substantial and a wide spectrum of leaching tests and corresponding criteria have been introduced to regulate the landfilling...

  17. Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights From the American College of Cardiology's PINNACLE India Quality Improvement Program (PIQIP).

    Science.gov (United States)

    Kalra, Ankur; Pokharel, Yashashwi; Hira, Ravi S; Risch, Samantha; Vicera, Veronique; Li, Qiong; Kalra, Ram N; Kerkar, Prafulla G; Kumar, Ganesh; Maddox, Thomas M; Oetgen, William J; Glusenkamp, Nathan; Turakhia, Mintu P; Virani, Salim S

    2015-05-20

    India has a growing burden of cardiovascular disease (CVD), yet data on the quality of outpatient care for patients with coronary artery disease, heart failure, and atrial fibrillation in India are very limited. We collected data on performance measures for 68 196 unique patients from 10 Indian cardiology outpatient departments from January 1, 2011, to February 5, 2014, in the American College of Cardiology's PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). PIQIP is India's first national outpatient CVD quality-improvement program. In the PIQIP registry, we estimated the prevalence of CVD risk factors (hypertension, diabetes, dyslipidemia, and current tobacco use) and CVD among outpatients. We examined adherence with performance measures established by the American College of Cardiology, the American Heart Association, and the American Medical Association Physician Consortium for Performance Improvement for coronary artery disease, heart failure, and atrial fibrillation. There were a total of 68 196 patients (155 953 patient encounters), with a mean age of 50.6 years (SD 18.2 years). Hypertension was present in 29.7% of patients, followed by diabetes (14.9%), current tobacco use (7.6%), and dyslipidemia (6.5%). Coronary artery disease was present in 14.8%, heart failure was noted in 4.0%, and atrial fibrillation was present in 0.5% of patients. Among eligible patients, the reported use of medications was as follows: aspirin in 48.6%, clopidogrel in 37.1%, and statin-based lipid-lowering therapy in 50.6% of patients with coronary artery disease; RAAS (renin-angiotensin-aldosterone system) antagonist in 61.9% and beta-blockers in 58.1% of patients with heart failure; and oral anticoagulants in 37.0% of patients with atrial fibrillation. This pilot study, initiated to improve outpatient CVD care in India, presents our preliminary results and barriers to data collection and demonstrates that such an initiative is

  18. Cardiovascular Disease Performance Measures in the Outpatient Setting in India: Insights From the American College of Cardiology’s PINNACLE India Quality Improvement Program (PIQIP)

    Science.gov (United States)

    Kalra, Ankur; Pokharel, Yashashwi; Hira, Ravi S; Risch, Samantha; Vicera, Veronique; Li, Qiong; Kalra, Ram N; Kerkar, Prafulla G; Kumar, Ganesh; Maddox, Thomas M; Oetgen, William J; Glusenkamp, Nathan; Turakhia, Mintu P; Virani, Salim S

    2015-01-01

    Background India has a growing burden of cardiovascular disease (CVD), yet data on the quality of outpatient care for patients with coronary artery disease, heart failure, and atrial fibrillation in India are very limited. We collected data on performance measures for 68 196 unique patients from 10 Indian cardiology outpatient departments from January 1, 2011, to February 5, 2014, in the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP). PIQIP is India’s first national outpatient CVD quality-improvement program. Methods and Results In the PIQIP registry, we estimated the prevalence of CVD risk factors (hypertension, diabetes, dyslipidemia, and current tobacco use) and CVD among outpatients. We examined adherence with performance measures established by the American College of Cardiology, the American Heart Association, and the American Medical Association Physician Consortium for Performance Improvement for coronary artery disease, heart failure, and atrial fibrillation. There were a total of 68 196 patients (155 953 patient encounters), with a mean age of 50.6 years (SD 18.2 years). Hypertension was present in 29.7% of patients, followed by diabetes (14.9%), current tobacco use (7.6%), and dyslipidemia (6.5%). Coronary artery disease was present in 14.8%, heart failure was noted in 4.0%, and atrial fibrillation was present in 0