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Student's T Test (student t + test)
Selected AbstractsDo patients with normal tension glaucoma have a thinner conjunctiva?ACTA OPHTHALMOLOGICA, Issue 2009R VAN GINDERDEUREN Purpose The central cornea is thinner in patients with normal tension glaucoma (NTG). We had developed the surgical impression of thinner conjunctivas in patients with NTG. The purpose of this study was to determine whether there is a difference between the conjunctival thickness of patients with NTG and those with high tension primary open-angle glaucoma (POAG). Methods In this prospective study, 40 patients scheduled for trabeculectomy were categorized into NTG and POAG based on maximum intraocular pressure (IOP) as measured by Goldmann applanation tonometry. Ten (10) patients with NTG (max. IOP,21mmHg) and 30 patients with high tension POAG (max IOP>21mmHg) were included in the study. Conjunctival biopsies taken from the inferior fornix one month prior to trabeculectomy were fixed in formalin and embedded in Historesin. The conjunctival thickness was measured on a standardised way and compared between the two groups. Non-paired Student T test for two-tailed groups with equal variance was used for statistical analysis. Results The difference in mean conjunctival thickness between patients with NTG (66.4,±21.1) and patients with high tension POAG (104.6,±44.3) was statistically significant (P=0.045). The mean CCT in NTG (537,6±19.6) was lower than in POAG (548.3±38.0), but did not reach significancy in this study. Conclusion Patients with NTG have a thinner conjunctiva than those with high tension POAG [source] Olanzapine in the Treatment of Refractory Migraine and Chronic Daily HeadacheHEADACHE, Issue 6 2002Stephen D. Silberstein MD Background.,Olanzapine, a thienobenzodiazepine, is a new "atypical" antipsychotic drug. Olanzapine's pharmacologic properties suggest it would be effective for headaches, and its propensity for inducing acute extrapyramidal reactions or tardive dyskinesia is relatively low. We thus decided to assess the value of olanzapine in the treatment of chronic refractory headache. Methods.,We reviewed the records of 50 patients with refractory headache who were treated with olanzapine for at least 3 months. All previously had failed treatment with at least four preventative medications. The daily dose of olanzapine varied from 2.5 to 35 mg; most patients (n = 19) received 5 mg or 10 mg (n = 17) a day. Results.,Treatment resulted in a statistically significant decrease in headache days relative to baseline, from 27.5 ± 4.9 before treatment to 21.1±10.7 after treatment (P < .001, Student t test). The difference in headache severity (0 to 10 scale) before treatment (8.7±1.6) and after treatment (2.2 ± 2.1) was also statistically significant (P < .001). Conclusion.,Olanzapine may be effective for patients with refractory headache, including those who have failed a number of other prophylactic agents. Olanzapine should receive particular consideration for patients with refractory headache who have mania, bipolar disorder, or psychotic depression or whose headaches previously responded to other neuroleptic medications. [source] The role of Doppler sonography in predicting severity of acute pancreatitisJOURNAL OF CLINICAL ULTRASOUND, Issue 3 2008Naile Bolca Topal MD Abstract Purpose To investigate the role of Doppler sonography (DUS) examination of major abdominal arteries in predicting severity of acute pancreatitis (AP). Methods Twenty-nine patients diagnosed with AP and 14 controls were blindly and prospectively evaluated with Doppler sonography. Disease severity was defined clinically according to acute physiology and chronic health evaluation (APACHE II) score and was classified as severe for APACHE II score ,8. DUS examination included the measurement of peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) of the celiac artery (CA) and superior mesenteric artery (SMA). Statistical analysis included Mann-Whitney U test, Student t test, and receiver operating characteristic curve analysis. Results Twelve patients had severe AP and 17 had mild AP. PSV, EDV, and PI of the CA and RI of the SMA were higher in the severe AP group than in the mild AP and control groups (p < 0.001 and p < 0.0001, respectively). The sensitivity and specificity were 100% and 94%, respectively, for a 87 cm/second CA PSV cutoff value, 75% and 100%, respectively, for a 22 cm/second CA EDV cutoff value, 92% and 82%, respectively, for a 1.29 CA PI cutoff value, and 100% and 100%, respectively, for a 0.86 SMA RI cutoff value. Conclusion DUS can be useful in predicting the severity of AP in the early period of admission phase of the disease. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2008 [source] Attitude of hospital personnel faced with living liver donation in a Spanish center with a living donor liver transplant programLIVER TRANSPLANTATION, Issue 7 2007A. Ríos In Spain, despite its high rate of cadaveric donation, death while on the liver transplant waiting list is high. For this reason, living liver donation is being encouraged despite of the risk of morbidity for the donor. The objective of this study was to analyze attitudes toward living liver donation among hospital personnel in a hospital with a recently authorized living donor liver transplantation program. A random sample was taken and was stratified by type of service and job category (n = 1,262). Attitude was evaluated by means of a validated psychosocial questionnaire. The questionnaire was completed anonymously and was self-administered. Statistical analysis included the Student t test, the ,2 test, and logistical regression analysis. The questionnaire completion rate was 93% (n = 1,168). Only 15% (n = 170) of respondents were in favor of living liver donation if it were unrelated. An additional 65% (n = 766) were in favor if this donation, but only for relatives. Of the rest, 9% (n = 107) did not agree with living liver donation, and the remaining 11% (n = 125) were undecided. The variables related to this attitude were age (P = 0.044); job category (P = 0.002); type of service (according to whether it is related to organ donation and transplantation) (P = 0.044); participation in prosocial activities (P = 0.026); attitude toward cadaveric organ donation (P <0.001); attitude of a respondent's partner toward organ donation (P = 0.010); a respondent's belief that in the future, he or she may need a transplant (P < 0.001); and a willingness to receive a donated living liver organ if one were needed (P < 0.001). There is also a close relationship between attitude toward living kidney donation and living liver donation (P < 0.001). In the multivariate analysis, the only common independent variable from the bivariate analysis was a willingness to receive a living donor liver transplant if one were needed (odds ratio = 9.3). Attitude toward living liver donation among hospital personnel in a hospital with a solid organ transplant program is favorable and is affected by factors related to cadaveric donation, altruistic activity, and feelings of reciprocity. Physicians and the youngest hospital workers are those who are most in favor, which leads us to think that there is a promising future for living liver transplantation, which is essential given the cadaveric organ deficit and the high mortality rate while on the waiting list. Liver Transpl 13:1049,1056, 2007. © 2007 AASLD. [source] Lateral Tympanoplasty for Total or Near-Total Perforation: Prognostic Factors,THE LARYNGOSCOPE, Issue 9 2006Dr. Simon I. Angeli MD Abstract Objective: To identify prognostic factors affecting outcome in lateral tympanoplasty for total or near-total tympanic membrane perforation. Study Design: Retrospective case series. Methods: Patients were those presenting with total or near-total tympanic membrane perforation undergoing lateral tympanoplasty from 1999 to 2004. We systematically collected demographic, clinical, audiologic, and outcome information. Student t test was used to determine group differences. Logistic regression analysis was used to examine the relationship between success of grafting (dependent variable) and the independent variables. Multiple regression analysis was used to examine the relationship between postoperative air-bone gap (ABG) and independent variables. Results: There were seventy-seven cases (58 primary and 19 revision cases) with average follow-up of 17 months. Successful tympanic membrane grafting occurred in 91% of cases. None of the independent variables studied was predictive of the success of graft incorporation (P > .05). The mean preoperative ABG was 29.8 ± 10 dB and improved to a postoperative ABG of 16.5 ± 11 dB (P < .001). Smaller preoperative ABG and normal malleus handle were associated with smaller postoperative ABG. In revision cases, mastoidectomy was associated with better functional results. Conclusions: Successful grafting of near-total and total tympanic membrane perforations occurred in 91% of the cases and was independent of demographic, disease, and technical variables. Disease variables (preoperative ABG and status of malleus handle) had a greater prognostic value on postoperative ABG than other variables. In revision tympanoplasty, mastoidectomy is associated with a better functional outcome. [source] Prospective analysis of carotid artery flow in breast cancer patients treated with supraclavicular irradiation 8 or more years previously,CANCER, Issue 2 2008No increase in ipsilateral carotid stenosis after radiation noted Abstract BACKGROUND. To the authors' knowledge, the effects of supraclavicular fossa radiation on the carotid artery are not well described. In the current study, the authors performed a prospective study to examine the long-term risk of carotid artery stenosis after supraclavicular irradiation for breast cancer. METHODS. A total of 46 breast cancer patients who were treated with adjuvant radiation to the supraclavicular fossa with >8 years of follow-up underwent bilateral Doppler imaging of the carotid artery. Two independent cardiologists interpreted each ultrasound study with no knowledge of which side was treated. RESULTS. The median follow-up from the date of diagnosis was 14.6 years and the mean patient age at the time of ultrasound was 55 years. The median prescribed dose to the supraclavicular fossa was 50 grays. Four patients were found to have clinically relevant, asymptomatic carotid stenosis, for which a cardiology referral was necessary. Only 1 of these 4 patients had stenosis involving the irradiated carotid artery only; 1 patient had bilateral stenosis and 2 patients had only contralateral stenosis. There was no difference noted with regard to isolated ipsilateral versus contralateral medial intimal thickening of the carotid artery (5 patients vs 6 patients, respectively). Furthermore, there were no differences noted with regard to ipsilateral versus contralateral peak systolic flow in the internal (83.5 vs 85.6 cm/seconds; P = .522 by the Student t test and P = .871 by the signed rank test) or common (74.4 vs 77.0 cm/seconds; P = .462 by the Student t test and P = .246 by the signed rank test) carotid artery. CONCLUSIONS. In this prospective study of breast cancer patients with long follow-up, there was no evidence of late, clinically relevant stenosis, increased intimal thickening, or increased peak systolic carotid artery flow secondary to supraclavicular irradiation. Cancer 2008. © 2007 American Cancer Society. [source] Androgen ablation therapy for prostate carcinoma suppresses the immunoreactive telomerase subunit hTERTCANCER, Issue 2 2004Kenneth A. Iczkowski M.D. Abstract BACKGROUND Telomerase is a ribonucleoprotein complex that protects the ends of chromosomes from degradation. Its catalytic subunit, hTERT, controls its activity. Prior data in prostate carcinoma cases indicated that immunohistochemical hTERT reactivity increases with tumor grade and may be absent in lower grade cases. The effect of complete androgen ablation (CAA) on tumor hTERT expression was uncertain. METHODS hTERT immunostaining was performed on the cancerous pretreatment biopsy tissue of 30 men who consecutively underwent CAA with bicalutamide and goserelin acetate for 30 days prior to undergoing radical prostatectomy, and on their tumor tissue from radical prostatectomy. As controls, biopsy and prostatectomy samples from 30 untreated men were studied. Nuclear staining was evaluated by two observers, and the change in staining between biopsy and prostatectomy samples was evaluated using the Student t test in both groups. RESULTS The percent of reactive tumor nuclei in treated men declined from 36.7% to 13.2% (P = 0.0001), and declined from 19.8% to 16.1% in untreated men (P = 0.4). The greater mean hTERT reactivity in the treated men's biopsy specimens was attributed to an increased proportion of higher (Gleason score , 7) grade tumors. The decline in hTERT immunostaining remained significant after normalizing it to that of the untreated group (P = 0.002). The original Gleason scores, corresponding declines in the percentage of reactive tumor nuclei, and significance were: Gleason score , 6: 11% (P = 0.03); Gleason score of 7: 23% (P < 0.006); and Gleason score , 8: 46% (P < 0.005) (from a mean 63% to 17%). CONCLUSIONS CAA for prostate carcinoma can be considered an antitelomerase therapy. The steepest reduction in telomerase activity was noted in the highest grade tumors. Cancer 2004;100:294,9. © 2003 American Cancer Society. [source] Tutorials in Clinical Research: Part VII.THE LARYNGOSCOPE, Issue 9 2003Part A: General Concepts of Statistical Significance, Understanding Comparative Statistics (Contrast) Abstract Objectives/Hypothesis The present tutorial is the seventh in a series of Tutorials in Clinical Research. The specific purpose of the tutorial (Part A) and its sequel (Part B) is to introduce and explain three commonly used statistical tools for assessing contrast in the comparison between two groups. Study Design Tutorial. Methods The authors met weekly for 10 months discussing clinical research studies and the applied statistics. The difficulty was not in the material but in the effort to make the report easy to read and as short as possible. Results The tutorial is organized into two parts. Part A, which is the present report, focuses on the fundamental concepts of the null hypothesis and comparative statistical significance. The sequel, Part B, discusses the application of three common statistical indexes of contrast, the ,2, Mann-Whitney U, and Student t tests. Conclusions Assessing the validity of medical studies requires a working knowledge of research design and statistics; obtaining this knowledge need not be beyond the ability of the busy surgeon. The authors have tried to construct an accurate, easy-to-read, easy-to-apply, basic introduction to comparing two groups. The long-term goal of the present tutorial and others in the series is to facilitate basic understanding of clinical research, thereby stimulating reading of some of the numerous well-written research design and statistical texts. This knowledge may then be applied to the continuing educational review of the literature and the systematic prospective analysis of individual practices. [source] L-asparaginase as a marker of chemotherapy dose modification in children with acute lymphoblastic leukemiaCANCER, Issue 12 2005Jacques Baillargeon Ph.D. Abstract BACKGROUND The objective of the current study was to compare chemotherapy dose modifications in obese (a body mass index [BMI] > 95%) and nonobese (a BMI , 95%) pediatric patients with acute lymphoblastic leukemia (ALL). METHODS The study cohort was comprised of 199 pediatric patients diagnosed with ALL who were treated at 1 of 2 South Texas pediatric oncology centers between 1990,2000. The relative chemotherapy dose modification during the induction phase of chemotherapy was calculated as the ratio of 1) the actual administered dose of L-asparaginase and 2) the protocol-calculated dose of L-asparaginase. The extent to which the chemotherapy dose modification varied according to obesity status was assessed using stratified Student t tests and an ordinary least-squares regression analysis. RESULTS Obese ALL patients were found to exhibit a 7% decrease in the mean relative modification of L-asparaginase during induction chemotherapy compared with their nonobese counterparts. This finding was statistically significant (P = 0.009), even after adjustment for gender, age, ethnicity, and clinical institution. CONCLUSIONS To the authors' knowledge, the current study is the first published report of an obesity-associated chemotherapy dose modification in pediatric patients with ALL, the most common childhood malignancy. It will be important to examine whether these findings are consistent with those observed in future studies, and ultimately to assess the association between obesity-related dose modifications and long-term cancer outcomes. Cancer 2005. © 2005 American Cancer Society. [source] Phosphate regulates uranium(VI) toxicity to Lemna gibba L. G3ENVIRONMENTAL TOXICOLOGY, Issue 1 2007Martin Mkandawire Abstract The influence of phosphate on the toxicity of uranium to Lemna gibba G3 was tested in semicontinuous culture with synthetic mine water developed as an analogue of surface water of two abandoned uranium mining and ore processing sites in Saxony, Germany. Six concentrations of uranium were investigated under five different supply regimes of PO43, at constant pH (7.0 ± 0.5) and alkalinity (7.0 ± 1.6 mg L,1 total CO32,). The results showed significant inhibition of specific growth rates in cultures exposed to the highest uranium concentrations (3500 and 7000 ,g U L,1) at lowest PO43, supply of 0.01 mg L,1. An increase of phosphate concentration from 0.01 to 8.0 mg L,1 resulted in an increase of EC50 from 0.9 ± 0.2 to 7.4 ± 1.9 mg L,1 (significant with Student's t test, P > 0.05). The accumulation of uranium in L. gibba increased exponentially with the increase in uranium concentration in cultures with 0.01 and 0.14 mg PO43, L,1. Accumulation also increased significantly when PO43, supply was increased from 0.14 to 1.36 mg PO43, L,1 for all uranium concentrations. However, as the supply of PO43, gradually increased from 1.36 to 8.0 mg PO43, L,1, uranium bioaccumulation increased slightly but insignificantly before leveling off. Uranium speciation modeling with PhreeqC geochemical code predicted increases in the proportions of uranyl phosphate species when PO43, concentrations increase in the media. Most of these uranyl phosphate species have a high probability of precipitation [saturation indices (SI) > 0.93]. Therefore, the alleviation of uranium toxicity to L. gibba with phosphates is due to interactions among components of the media, mainly uranyl and phosphate which results in precipitation. Consequently, bioavailable fractions of uranium to L. gibba are reduced. This might explain lack of consistent EC50 values for uranium to most aquatic organisms. © 2007 Wiley Periodicals, Inc. Environ Toxicol 22: 9,16, 2007. [source] The Contribution of Chemoreflex Drives to Resting Breathing in ManEXPERIMENTAL PHYSIOLOGY, Issue 1 2001Safraaz Mahamed The contribution of automatic drives to breathing at rest, relative to behavioural drives such as ,wakefulness', has been a subject of debate. We measured the combined central and peripheral chemoreflex contribution to resting ventilation using a modified rebreathing method that included a prior hyperventilation and addition of oxygen to maintain isoxia at a PET,O2 (end-tidal partial pressure of oxygen) of 100 mmHg. During rebreathing, ventilation was unrelated to PET,CO2 (end-tidal partial pressure of carbon dioxide) in the hypocapnic range, but after a threshold PET,CO2 was exceeded, ventilation increased linearly with PET,CO2. We considered the sub-threshold ventilation to be an estimate of the behavioural drives to breathe (mean ± S.E.M. = 3.1 ± 0.5 l min,1), and compared it to ventilation at rest (mean ± S.E.M. = 9.1 ± 0.7 l min,1). The difference was significant (Student's paired t test, P < 0.001). We also considered the threshold PCO2 observed during rebreathing to be an estimate of the chemoreflex threshold at rest (mean ± S.E.M. = 42.0 ± 0.5 mmHg). However, PET,CO2 during rebreathing estimates mixed venous or tissue PCO2, whereas the resting PET,CO2 during resting breathing estimates Pa,CO2 (arterial partial pressure of carbon dioxide). The chemoreflex threshold measured during rebreathing was therefore reduced by the difference in PET,CO2 at rest and at the start of rebreathing (the plateau estimates the mixed venous PCO2 at rest) in order to make comparisons. The corrected chemoreflex thresholds (mean ± S.E.M. = 26.0 ± 0.9 mmHg) were significantly less (paired Student's t test, P < 0.001) than the resting PET,CO2 values (mean ± S.E.M. = 34.3 ± 0.5 mmHg). We conclude that both the behavioural and chemoreflex drives contribute to resting ventilation. [source] Hyaluronan and its receptors in mucoepidermoid carcinomaHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 2 2006Richard O. Wein MD Abstract Background. Hyaluronan (HA) is a prominent extracellular matrix component undergoing continuous production and degradation. Increased HA levels have been described in a variety of tumors. The objective of this study was to examine the staining patterns of HA and two of its associated receptors (CD44 and HARE) in relation to the metastatic potential of mucoepidermoid carcinoma (MC). Immunohistochemical staining of preserved surgical specimens was used. Methods. Tissues from 12 patients with a histologic diagnosis of salivary MC (10 parotid, one submandibular gland, one minor salivary gland) were studied. Half (six of 12) of the patients had regional metastases. Tumor, normal salivary tissue, and regional lymph nodes were stained for HA, CD44, and HARE expression. Specimens were graded for staining intensity and a percent of the specimen stained. Results. Normal salivary tissue did not demonstrate epithelial cell surface HA expression, whereas HA was expressed on tumor cells and in regional lymph nodes containing metastases. These differences were both significant using Student's t test (p < .00002, and p < .0022, respectively). Tumors with positive nodes tended to have greater cell surface HA. Decreased expression or downregulation of HARE was also noted in involved lymph nodes. No differences in CD44 expression were seen between primary specimens and lymph nodes. The observed staining patterns for CD44 and HARE were not reflective of the metastatic potential of the primary MC. Conclusions. Increased HA expression was seen on mucoepidermoid carcinoma cells compared with adjacent normal salivary gland epithelium. This observation may assist in explaining the development of regional metastasis in these tumors. We did not identify specific HA, CD44, or HARE staining patterns in primary lesions that were predictive of regional metastases. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Dialysis adequacy and nutritional status of hemodialysis patientsHEMODIALYSIS INTERNATIONAL, Issue 1 2008Fernanda TEIXEIRA NUNES Abstract To characterize the nutritional status of renal failure patients and its relationship with hemodialysis adequacy measured by Kt/V, a study was carried out with a population of 44 adult patients with renal failure and mean age 51±15 years. Anthropometric data, such as dry weight, height, arm circumference, triceps skinfold thickness, mid-arm muscle circumference, and body mass index were assessed, and biochemical tests were conducted for urea, potassium, creatinine, serum albumin, and phosphorus levels, in addition to hemogram and quarterly urea reduction rate average (Kt/V). In order to evaluate calorie intake, a dietary questionnaire on habitual daily food ingestion was administered, taking into consideration the hemodialysis date. The patients were divided into 2 separate groups for the statistical analysis, with 50% of the patients in each group: A (Kt/V<1.2) and B (Kt/V>1.2). The data were tabulated as mean and standard deviation, with differences tested by Student's t test. The correlations between variables were established by the coefficient p of Pearson. Most of the patients (43%) were considered eutrophic, based on the BMI, and presented inadequate calorie intake, corresponding to 88.5±24% (30.8 kcal/kg actual weight) of the total energy required and adequate protein intake, reaching 109.9±40% of the recommended daily allowance (1.24 g/kg of actual weight). There was a correlation of Kt/V with anthropometric parameters such as body mass index, arm circumference, and mid-arm muscle circumference. The biochemical parameters related to dialysis adequacy were albumin, ferritin, and urea (predialysis). Well-dialyzed patients presented better levels of serum albumin. There was an influence of gender and age on correlations of the analyzed variables. Female and younger patients presented better dialysis adequacy. The dialysis adequacy was related to the nutritional status and influenced by the protein intake and body composition. Gender and age had an important influence in the dialysis adequacy, as men presented lower dialysis adequacy and younger adults presented better dialysis adequacy. Further research is necessary to understand better how to facilitate effective and efficient techniques for the nutritional status assessment of hemodialysis patients. [source] Pulse Pressure Determinants in Chronic Hemodialysis PatientsHEMODIALYSIS INTERNATIONAL, Issue 1 2003V Kovacic Introduction: Hypertension contributes to the cardiovascular morbidity in patients undergoing chronic hemodialysis therapy (PCHD). Pulse pressure (PP) was recognized as a correlate of mortality in PCHD. In order to demonstrate determinants of predialysis and postdialysis PP values in a group of PCHD, we conducted this study. Subjects and methods: Study subjects were 23 PCHD. Study time was 15 months. One hundred thirty six single hemodialysis (HD) treatments were processed. PP was computed as systolic-diastolic blood pressure (mmHg). Statistical methods used were Student's t test for independent data, multivariate analysis of variance, Pearson's correlation, and forward stepwise multiple regression analysis. Results: Postdialysis and predialysis PPs differed significantly (65.51 ± 19.00 vs. 60.55 ± 19.35, p = 0.002). We did not find gender differences in PP before and after HD. PP before HD was in negative correlation with phosphorus concentration (r = , 0.244, p = 0.002), parathyroid hormone (PTH)(r = , 0.177, p = 0.020), hemoglobin (r = , 0.301, p < 0.001), single HD duration (r = , 0.162, p = 0.030), ultrafiltration rate per HD (r = , 0.290, p = 0.001), years on the chronic hemodialysis treatment (r = , 0.261, p = 0.001) and ultrafiltration volume/dry body mass ratio (UF/W)(r = , 0.222, p = 0.005) and in positive concentration with weekly erythropoietin (r = 0.391, p < 001) and age (r = 0.285, p < 0.001). PP after HD was in significant negative correlation with phosphorus concentration (r = , 0.205, p = 0.009), PTH (r = , 0.187, p = 0.015), hemoglobin (r = , 0.238, p = 0.005), ultrafiltration per HD (r = , 0.370, p < 0.001), dry body mass index (r = , 0.225, p = 0.003), years of the chronic hemodialysis treatment (r = 0.330, p < 0.001), UF/W (r = , 0.340, p < 0.001) and in positive concentration with weekly erythropoietin (r = 0.361, p < 0.001) and age (r = 0.227, p = 0.004). Multiple regression analyses unveiled the strongest and negative correlations between PP after HD and UF/W ratio (, = , 0.41, p < 0.001). The strongest, but positive correlation was found between PP before HD and erythropoietin per week (, = 0.51, p < 0.001). Conclusion: Determinants of the pre/post PP values are similar. Ultrafiltration is a strong predictor of postdialysis PP value. [source] Nonalcoholic fatty pancreas diseaseHPB, Issue 4 2007Abhishek Mathur Abstract Background. Obesity leads to fat infiltration of multiple organs including the heart, kidneys, and liver. Under conditions of oxidative stress, fat-derived cytokines are released locally and result in an inflammatory process and organ dysfunction. In the liver, fat infiltration has been termed nonalcoholic fatty liver disease, which may lead to nonalcoholic steatohepatitis. No data are available, however, on the influence of obesity on pancreatic fat and cytokines, and nonalcoholic fatty pancreas disease (NAFPD) has not been described. Therefore, we designed a study to determine whether obesity is associated with increased pancreatic fat and cytokines. Materials and methods. Thirty C57BL/6J lean control and 30 leptin-deficient obese female mice were fed a 15% fat diet for 4 weeks. At 12 weeks of age all animals underwent total pancreatectomy. Pancreata from each strain were pooled for measurement of a) wet and dry weight, b) histologic presence of fat, c) triglycerides, free fatty acids (FFAs), cholesterol, phospholipids, and total fat, and d) interleukin (IL)-1, and tumor necrosis factor-alpha (TNF-,). Data were analyzed by Student's t test and Fisher's exact test. Results. Pancreata from obese mice were heavier (p<0.05) and had more fat histologically (p<0.05). Pancreata from obese mice had more triglycerides, FFAs, cholesterol, and total fat (p<0.05). Triglycerides represented 11% of pancreatic fat in lean mice compared with 67% of pancreatic fat in obese mice (p<0.01). Cytokines IL-1, and TNF-, also were elevated in the pancreata of obese mice (p<0.05). Conclusions. These data suggest that obese mice have 1) heavier pancreata, 2) more pancreatic fat, especially triglycerides and FFAs, and 3) increased cytokines. We conclude that obesity leads to nonalcoholic fatty pancreatic disease. [source] Bone mineralization defects and vitamin D deficiency: Histomorphometric analysis of iliac crest bone biopsies and circulating 25-hydroxyvitamin D in 675,patientsJOURNAL OF BONE AND MINERAL RESEARCH, Issue 2 2010Matthias Priemel Abstract Parathyroid hormone (PTH) is only one measurable index of skeletal health, and we reasoned that a histomorphometric analysis of iliac crest biopsies would be another and even more direct approach to assess bone health and address the required minimum 25-Hydroxyvitamin D [25(OH)D] level. A cohort from the northern European population with its known high prevalence of vitamin D deficiency therefore would be ideal to answer the latter question. We examined 675 iliac crest biopsies from male and female individuals, excluding all patients who showed any signs of secondary bone diseases at autopsy. Structural histomorphometric parameters, including osteoid indices, were quantified using the Osteomeasure System according to ASBMR standards, and serum 25(OH)D levels were measured for all patients. Statistical analysis was performed by Student's t test. The histologic results demonstrate an unexpected high prevalence of mineralization defects, that is, a pathologic increase in osteoid. Indeed, 36.15% of the analyzed patients presented with an osteoid surface per bone surface (OS/BS) of more than 20%. Based on the most conservative threshold that defines osteomalacia at the histomorphometric level with a pathologic increase in osteoid volume per bone volume (OV/BV) greater than 2% manifest mineralization defects were present in 25.63% of the patients. The latter were found independent of bone volume per trabecular volume (BV/TV) throughout all ages and affected both sexes equally. While we could not establish a minimum 25(OH)D level that was inevitably associated with mineralization defects, we did not find pathologic accumulation of osteoid in any patient with circulating 25(OH)D above 75,nmol/L. Our data demonstrate that pathologic mineralization defects of bone occur in patients with a serum 25(OH)D below 75,nmol/L and strongly argue that in conjunction with a sufficient calcium intake, the dose of vitamin D supplementation should ensure that circulating levels of 25(OH)D reach this minimum threshold (75,nmol/L or 30,ng/mL) to maintain skeletal health. © 2010 American Society for Bone and Mineral Research [source] Patients with thrombotic thrombocytopenic purpura commonly develop metabolic alkalosis during therapeutic plasma exchangeJOURNAL OF CLINICAL APHERESIS, Issue 3 2001Marisa B. Marques Abstract Thrombotic thrombocytopenic purpura (TTP) and myasthenia gravis (MG) are category I indications for therapeutic plasma exchange (TPE). This study was based on the hypothesis that the development of metabolic alkalosis during TPE is more common in TTP than in MG, based on our previous observations. In order to test it, we compared the levels of bicarbonate and potassium in both groups of patients undergoing plasmapheresis. Fifteen patients with TTP (190 procedures) and ten MG patients seen concurrently were studied. While baseline bicarbonate levels were similar among all patients, the post-procedure bicarbonate levels in TTP patients were mostly elevated with a mean ± SD of 29.4 ± 3.5 mEq/L, as opposed to decreased or unchanged in MG patients 26.3 ± 3.1 mEq/L (mean ± SD) (P = 1.4 × 10,8). Furthermore, alkalosis in the TTP group persisted throughout subsequent daily treatments. There was also a significant decrease between pre- and post-TPE potassium levels in TTP patients (P = 3 × 10,21) by paired Student's t test. Additionally, samples with levels <3.3 mEq/L were alkalotic 75% of the time. In the MG group, however, potassium was normal in 85% and 83% of the pre- and post-TPE samples, respectively. Consequently, the hypokalemia was significantly more marked in the TTP group (P = 0.0008). These data confirm that plasmapheresis commonly induces metabolic alkalosis in TTP patients, probably due to high citrate in fresh frozen plasma, the frequency of treatments, and perhaps decreased renal clearance due to disease involvement of the kidneys. J. Clin. Apheresis. 16:120,124, 2001. © 2001 Wiley-Liss, Inc. [source] Comparison of 3-dimensional with 2-dimensional saline infusion sonohysterograms for the evaluation of intrauterine abnormalitiesJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2009Stephanie Terry MD Abstract Objective. To compare 3-dimensional saline infusion sonohysterography (3DSIS) with 2-dimensional sonohysterography (2DSIS) using hysteroscopy and histologic diagnosis as the gold standard. Method. A retrospective analysis of all SIS examination performed between July 1, 2005 and April 30, 2007 in our gynecological sonographic unit. 2DSIS or 3DSIS sonographic techniques were used randomly. Management decisions and operative procedures were done by the referring provider. Patients that had diagnostic hysteroscopy and complete histologic evaluation were included. Concordance between the various assessment methods as well as sensitivity and specificity were compared between 2DSIS and 3DSIS. Student's t test and chi-square test were used for statistical analysis. p < 0.05 was considered statistically significant. Result. Of 804 patients that had SIS, 125 patients met the inclusion criteria. Patient median age was 48 (range 19,82). Also, 77 patients were premenopausal, and 48 patients were postmenopausal. Furthermore, 43 patients had 2DSIS and 82 patients had 3DSIS. 3DSIS was found to correlate with hysteroscopic findings more often than 2DSIS (p < 0.05). A trend for higher specificity of 3DSIS with the different uterine pathologies was seen, but it did not reach statistical significance. No difference in sensitivity of 3DSIS compared with 2DSIS was found for all pathologic diagnoses. Conclusion. 3DSIS correlated better with hysteroscopy than 2DSIS. Specificity for histologic diagnosis appears to be higher with 3DSIS compared with 2DSIS but larger-scale studies are needed to confirm this finding. © 2009 Wiley Periodicals, Inc. J Clin Ultrasound 2009 [source] Differences in sodium voltage-gated channel properties according to myosin heavy chain isoform expression in single muscle fibresTHE JOURNAL OF PHYSIOLOGY, Issue 21 2009F. Rannou The myosin heavy chain (MHC) isoform determines the characteristics and shortening velocity of muscle fibres. The functional properties of the muscle fibre are also conditioned by its membrane excitability through the electrophysiological properties of sodium voltage-gated channels. Macropatch-clamp is used to study sodium channels in fibres from peroneus longus (PL) and soleus (Sol) muscles (Wistar rats, n= 8). After patch-clamp recordings, single fibres are identified by SDS-PAGE electrophoresis according to their myosin heavy chain isoform (slow type I and the three fast types IIa, IIx, IIb). Characteristics of sodium currents are compared (Student's t test) between fibres exhibiting only one MHC isoform. Four MHC isoforms are identified in PL and only type I in Sol single fibres. In PL, maximal sodium current (Imax), maximal sodium conductance (gNa,max) and time constants of activation and inactivation (,m and ,h) increase according to the scheme I,IIa,IIx,IIb (P < 0.05). ,m values related to sodium channel type and/or function, are similar in Sol I and PL IIb fibres (P= 0.97) despite different contractile properties. The voltage dependence of activation (Va,1/2) shows a shift towards positive potentials from Sol type I to IIa, IIx and finally IIb fibres from PL (P < 0.05). These data are consistent with the earlier recruitment of slow fibres in a fast-mixed muscle like PL, while slow fibres of postural muscle such as soleus could be recruited in the same ways as IIb fibres in a fast muscle. [source] Microdebriders Used in Functional Endoscopic Sinus Surgery: Secondary Analysis and Validation of a New Tissue Model,THE LARYNGOSCOPE, Issue 9 2005Sandeep P. Dave MD Abstract Objectives/Hypothesis: To validate a previously reported in vitro tissue model for microdebrider comparison and determine which microdebrider, tissue type, blade type, and suction strength is most efficient. Specifically, the goal of the secondary analysis is to expand on the results of the preliminary analy-sis by increasing the sample size, and introduce an aspiration efficiency score (AES) to facilitate microdebrider comparison. Study Design: Prospective randomized comparison. Methods: A prospective randomized comparison of the Diego Powered Dissector and XPS 3000 Powered ENT System was conducted using a soft tissue and a firm tissue model. In addition to evaluating tissue aspiration with straight and angled blades, clogging rates and clearance times were measured. Both standard wall suction and liposuction were used. Basic statistical analysis, a one-way analysis of variance, and a post hoc Student's t test were performed to compare outcomes. Results: With standard wall suction, the microdebriders were equivalent for the overall microdebrider comparison. For the "head to head" comparison with standard wall suction, the devices were also equivalent when using the straight blades, but the XPS 3000 aspirated more tissue when using the angled blades. With liposuction, the XPS 3000 and liposuction independently aspirated more tissue but clogged more often compared with the Diego PD and regular suction. The aspiration efficiency of soft tissue (oysters) and straight blades was superior compared with firm tissue (scallops) and angled blades. For the "head to head" comparison with liposuction, the XPS 3000 aspirated more tissue regardless of tissue type, but the Diego PD clogged less with firm tissue (scallops). Overall, the AES favored the XPS 3000, soft tissue (oysters), straight blades, and liposuction. Conclusion: Our tissue model represents a reliable and reproducible means of microdebrider comparison. Statistically significant differences between the Diego PD and XPS 3000, as well as between tissue types, blade types, and suction strengths, are reported. Using these results, microdebrider manufacturers can adopt similar tissue models, expand on the current AES, and include other commercially available microdebrider devices to test and report product performance to the consumer. Perhaps an optimal open to closed ratio or liposuction pressure can be determined that yields the greatest tissue aspiration with the fewest number of clogs. [source] First trimester urinary placental growth factor and development of pre-eclampsiaBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2009MD Savvidou Objective, To compare urinary placental growth factor (PlGF) concentration at 11+0 to 13+6 weeks of gestation in women who subsequently develop pre-eclampsia with normotensive controls. Design, Nested case,control study within a prospective study for first trimester prediction of pre-eclampsia. Setting, Routine antenatal visit in a teaching hospital. Population, Fifty-two women who developed pre-eclampsia and 52 controls matched for gestational age and sample storage time. Methods, Urinary PlGF concentration and PlGF to creatinine ratio were measured in women who developed pre-eclampsia and their matched controls. Comparisons between groups were performed using Student's t test. Main outcome measures, Development of pre-eclampsia. Results, In the pre-eclampsia group, the median urinary PlGF concentration (20.6 pg/ml, interquartile range [IQR] 9.1,32.0 pg/ml) and median urinary PlGF to creatinine ratio (1.6 pg/mg, IQR 1.2,2.5 pg/mg) were not significantly different from the control group (11.8 pg/ml, IQR 5.5,29.8 pg/ml, P = 0.1 and 1.7 pg/mg, IQR 1.2,2.3 pg/mg, P = 0.3, respectively). There were no significant differences between women with early-onset pre-eclampsia requiring delivery before 34 weeks (n = 13) and those with late-onset pre-eclampsia (n = 39) and between women with pre-eclampsia and fetal growth restriction (FGR) (n = 25) and those with pre-eclampsia and no FGR (n = 27) in either median PlGF concentration or median urinary PlGF to creatinine ratio. Conclusions, The development of pre-eclampsia is not preceded by altered urinary PlGF concentration in the first trimester of pregnancy. [source] High incidence of obstetric interventions after successful external cephalic versionBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2002Louis Yik-Si Chan Objective To investigate the delivery outcome after successful external cephalic version (ECV). Design Case,control study. Setting University teaching hospital. Population The study group consisted of 279 consecutive singleton deliveries at term over a six-year period, all of which had had successful ECV performed. The control group included 28,447 singleton term deliveries during the same six-year period. Methods Between group differences were compared with the Mann,Whitney U test or Student's t test where appropriate. Odds ratio and 95% confidence interval (CI) were calculated for categorical variables. Main outcome measures Incidence of and indications for obstetric interventions. Results The risk of instrumental delivery and emergency caesarean section was higher in the ECV group (14.3%vs 12.8%; OR 1.4; 95% CI 1.0,2.0, and 23.3%vs 9.4%; OR 3.1; 95% CI 2.3,4.1, respectively). The higher caesarean rate was due to an increase in all major indications, namely, suspected fetal distress, failure to progress in labour and failed induction. The higher incidence of instrumental delivery was mainly due to an increase in prolonged second stage. The odds ratio for operative delivery remained significant after controlling for potential confounding variables. There were also significantly greater frequencies of labour induction (24.0%vs 13.4%; OR 2.0; 95% CI 1.5,2.7) and use of epidural analgesia (20.4%vs 12.4%; OR 1.8; 95% CI 1.4,2.4) by women in the ECV group. The higher induction rate is mainly due to induction for post term, abnormal cardiotocography (CTG) and antepartum haemorrhage (APH) of unknown origin. Conclusion The incidence of operative delivery and other obstetric interventions are higher in pregnancies after successful ECV. Women undergoing ECV should be informed about this higher risk of interventions. [source] Randomized trial of parathyroidectomy in mild, asymptomatic primary hyperparathyroidism as measured by the SF-36 health surveyBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 9 2000G. B. Talpos Background Management of patients with asymptomatic primary hyperparathyroidism (HPT) remains controversial despite a National Institutes of Health consensus statement on this issue. As part of the above statement, a randomized clinical trial was recommended since none exist to address this issue. Methods Informed consent was obtained from 53 asymptomatic patients with confirmed primary HPT who agreed to participate in this randomized clinical trial of parathyroidectomy versus observation. Upon entry to the study and 24 months later the patients completed the SF-36 health survey which is an instrument that measures nine different levels of function. Scores were tabulated and the difference over 24 months between operated and non-operated patients was compared with Student's t test. Results Fifty-three patients (42 women and 11 men) with asymptomatic, mild primary HPT (serum calcium 10·1,11·5 mg dl,1) who agreed to participate were randomized into either a surgical group or an observation group. Mean serum calcium for these patients was 10·3 mg dl,1. The only demographic difference between the groups was age; the operated group was older (66·7 versus 62·6 years; P < 0·03). Scores on three of the nine domains (health perception, emotional problems and social functioning) on the SF-36 were significantly different (P < 0·05), all favouring the operated group. Conclusion Improved function, as measured by the SF-36 health assessment tool, is seen after parathyroidectomy compared with non-operated patients. This work supports surgical management of mild primary HPT at the time of diagnosis since many patients have reversible non-classical symptoms of the disease. © 2000 British Journal of Surgery Society Ltd [source] Measuring Community Coalition Effectiveness Using the ICE© InstrumentPUBLIC HEALTH NURSING, Issue 1 2006Mary E. Cramer ABSTRACT This article presents the development and psychometric testing of the Internal Coalition Effectiveness (ICE) instrument, which was based on the conceptual model Internal Coalition Outcome Hierarchy. Sixty-one items were derived from literature about successful coalitions, and the ICE instrument was tested for reliability and validity. A national panel of eight experts conducted content validity. Remaining tests involved a sample of 61 members and leaders of a large midwestern coalition (77% response rate, n = 47). Content validity involved a two-stage process for rigorous item development and quantification (0.88, p < 0.05). Internal consistency was based on bivariate Pearson's correlation of 0.30,0.70 for two-item scales and Cronbach's ,(, = 0.70). Construct validity was assessed by correlation analysis, independent Student's t tests, and informal coalition feedback. The final 30-item version of ICE is psychometrically sound. Findings were shared with the local coalition, and, in support of the instrument's validity, members and leaders found this information useful for promoting coalition sustainability by identifying internal strengths and areas for improvement. The ICE instrument adds to the body of literature by measuring critical constructs of coalition effectiveness and has significant application for public health nurses working as evaluators for coalitions engaged in community health programing. [source] Aortic and ventricular dilation and myocardial reduction in gestation day 17 ICR mouse fetuses of diabetic mothersBIRTH DEFECTS RESEARCH, Issue 6 2007J. Claudio Gutierrez Abstract BACKGROUND: Maternal diabetes mellitus is associated with increased fetal teratogenesis, including cardiovascular defects. Information regarding cardiovascular changes in late-gestation fetal mice, related to maternal hyperglycemia, is not present in the literature. METHODS: Late-gestation fetal heart and great vessel morphology were analyzed in fetuses from control and diabetic mice. Female ICR mice were injected with streptozocin (200 mg/kg IP) prior to mating to induce diabetes (n = 8). Nonhyperglycemic females were used as controls (n = 8). At day 17 of gestation, females were euthanized and one fetus was arbitrarily selected per litter to analyze the heart and great vessels. Six additional fetuses from different litters, showing external malformations (spina bifida and/or exencephaly), were also evaluated from the diabetic group. Fetal thoraxes were processed using routine histopathologic techniques, and 7-,m transversal sections were stained with hematoxylin-eosin. Digital images of sections were made and analyzed using NIH Image J software to compare regional cardiac development. Student's t tests for means were performed to determine differences between groups (p < .05). RESULTS: Maternal hyperglycemia caused a dilation of late-gestation fetal ventricular chambers, a reduction of total ventricular myocardial area, and an increase in transversal ascending thoracic aortic area. Three of six fetuses that displayed external malformations showed an overt cardiac defect, beyond the ventricular and myocardial changes. CONCLUSIONS: Maternal hyperglycemia altered morphology of the late-gestation fetal mouse heart. Postnatal persistence or consequences of late-gestation heart chamber dilation and myocardial reduction are not yet known. Birth Defects Research (Part A) 2007. © 2007 Wiley-Liss, [source] Lateralised motor behaviour leads to increased unevenness in front feet and asymmetry in athletic performance in young mature Warmblood horsesEQUINE VETERINARY JOURNAL, Issue 5 2010M. C. V. Van HEEL Summary Reason for performing study: Foot stance in grazing significantly influences hoof conformation and development from foal to yearling age. Objectives: To conduct a longitudinal study to establish if the relationship between motor laterality and uneven front feet persisted in 3-year-old horses at the time of studbook selection and to investigate if such laterality and unevenness might influence the horses' ability to perform symmetrically while trotting, cantering and free jumping. Methods: Seventeen clinically sound but untrained (with only minimal experience of handling) and sound Warmblood horses that had participated in a previous study were assessed as per the protocol reported. Laterality was tested in a preference test (PT) and z -values were calculated for analysis purposes. Laterality and hoof unevenness were related to both relative limb length and relative head size, while the ability to perform symmetrically was tested in free trot-canter transitions and free jumping exercises. Differences in performance between horses with and without a limb preference in the PT and those with ,uneven' and ,even' feet were tested for differences in performance metrics using Students' t test, while linearity was tested using a regression analysis (P<0.05). Results: Significant laterality was still present in 24% of the 3-year-old horses and the relationship between laterality and uneven feet pairs was stronger than at foal and yearling stages. Horses with significant motor laterality had almost 4 times more unevenness, a smaller head and longer limbs and the relationship between body conformation and laterality was still present. There was a strong linear relation between unevenness, laterality and a bias or side preference for trot-canter transitions. However, this relationship was not significant during the free jumping exercise. Conclusion: Motor laterality and uneven feet pairs were still present and significantly related in the 3-year-old horses and both variables were also strongly related to sidedness in trot-canter transitions. Potential relevance: Warmblood studbooks should include quantitative data on laterality at the time of studbook admission as part of the selection criteria. [source] | |||||||||||||