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Clinical Implications (clinical + implication)
Kinds of Clinical Implications Selected AbstractsREVIEW ARTICLE: Clinical Implication of Natural Killer Cells and ReproductionAMERICAN JOURNAL OF REPRODUCTIVE IMMUNOLOGY, Issue 5 2008Joanne Kwak-Kim The regulation of natural killer (NK) cells in the peripheral blood and endometrial layers has been associated with reproductive immunopathology such as recurrent spontaneous abortions (RSA), infertility of implantation failures, or pre-eclampsia. The placenta has a complex anatomical structure and different subsets of NK cells with various functional roles can directly interact with trophoblasts. NK cell subpopulations and their functions, putative roles of NK cells in peripheral blood and endometrium are reviewed in relation to RSA and infertility. An increase in NK cell numbers and /or activity in pre- or post-conceptional period in women with RSA or infertility with multiple implantation failures are a significant clinical concern. In addition, immuno-phenotypic characteristics of NK cells in these women support the changes for their increased activity status. Further studies are needed to explore underlying mechanism of NK cells in RSA, infertility, and other reproductive immunopathologies. Possible neurological and hormonal control of NK cells and NK cell interaction with various leukocyte populations need further investigation in women with reproductive failures. [source] Evidence-Based Understanding of Medication-Overuse Headache: Clinical Implications,A CommentHEADACHE, Issue 6 2007Gunther Haag MD No abstract is available for this article. [source] Clinical Implications of Reconnection Between the Left Atrium and Isolated Pulmonary Veins Provoked by Adenosine Triphosphate after Extensive Encircling Pulmonary Vein IsolationJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2007HITOSHI HACHIYA M.D. Introduction: Dormant pulmonary vein (PV) conduction can be provoked by adenosine triphosphate (ATP) after extensive encircling pulmonary vein isolation (EEPVI). However, the clinical implication of reconnection between the left atrium (LA) and isolated PVs provoked by ATP (ATP-reconnection) remains unknown. Methods and Results: We studied the clinical consequences of ATP-reconnection during intravenous isoproterenol infusion (ISP-infusion). EEPVI severs conduction between the LA and ipsilateral PVs at their junction. Radiofrequency energy is applied at a distance from the PV ostia guided by double Lasso catheters placed within the ipsilateral superior and inferior PVs. This study comprised 82 patients (67 men, 56 ± 9 years old) with atrial fibrillation (AF) who underwent injection of ATP during ISP infusion after successful EEPVI (ATP(+) group). We compared clinical characteristics of 170 patients who underwent earlier EEPVI prior to our use of ATP injection after successful EEPVI (ATP(N/D) group) with those of ATP(+) group patients who underwent one session of EEPVI. ATP-reconnection occurred in 34 (41%) of 82 ATP(+) group patients. Additional radiofrequency applications were performed to eliminate ATP-reconnection in all ipsilateral PVs. Continuous ATP-reconnection of more than 20 seconds duration occurred in six (7.3%) of 82 patients. A total of 102 (60%) of 170 patients in the ATP(N/D) group had no recurrence of AF, whereas 60 (73%) of 82 ATP(+) group patients who underwent only one EEPVI session have had no recurrence of AF in a 6.1 ± 3.3-month follow-up period (P = 0.04). Conclusion: Radiofrequency application for provoked ATP-reconnection may reduce clinical AF recurrence. [source] Precision of Fit of Two Margin Designs for Metal-Ceramic CrownsJOURNAL OF PROSTHODONTICS, Issue 4 2007Penwadee Limkangwalmongkol DDS Statement of Problem: Although metal-ceramic restorations are widely used, there is a lack of information about how the fit is affected by margin designs. Purpose: This study measured and compared the precision of fit of metal-ceramic crowns with two margin designs. Material and Methods: Thirty-two extracted human premolar teeth were prepared for complete-coverage restorations with an internally rounded shoulder preparation. Impressions were made from all teeth, and master dies were poured with improved stone type V. MC crowns were fabricated with a porcelain-butt margin on the buccal aspect (n = 32) and a feather-edge metal margin on the lingual aspect (n = 32), which served as a control group. Precision of fit was measured three times at the mid-buccal and mid-lingual margins of each crown with a profilometer. The data were statistically analyzed with the paired t -test (, < .05). Results: Mean marginal gap size of porcelain-butt margins was 27.93 ,m (±15.84) and of feather-edge metal margins 42.43 ,m (±24.12). The marginal gap size of feather-edge metal margins was statistically significantly greater than that of porcelain-butt margins (p = 0.0045). Conclusion: The marginal fit of porcelain-butt margins was significantly better than that of feather-edge metal margins. Clinical Implications: Porcelain-butt margins in this study had a better marginal fit than feather-edge metal margins, and thus have given clinicians evidence to prefer the use of porcelain-butt margins. [source] The Pathophysiology of ,Brain Shrinkage' in Alcoholics , Structural and Molecular Changes and Clinical ImplicationsALCOHOLISM, Issue 6 2005Clive Harper This article represents a symposium of the 2004 ISBRA Congress held in Mannheim. The presentations were: Review of the neuropathological and neurochemical changes seen in alcohol-related ,brain shrinkage' by Clive Harper; In Vivo Detection of Macrostructural and Microstructural Markers of Brain Integrity in Human Alcoholism and a Rodent Model of Alcoholism by Adolf Pfefferbaum, Elfar Adalsteinsson and Edith Sullivan; Gene and Protein Changes in the Brains of Alcoholics with ,Brain Shrinkage' by Joanne Lewohl and Peter Dodd; Cross sectional and longitudinal MR spectroscopy studies of chronic adult alcoholics by Michael Taylor; Brain Atrophy Associated with Impairment on a Simulated Gambling Task in Long-Term Abstinent Alcoholics by George Fein and Bennett Landman. [source] Breed Associations for Canine Exocrine Pancreatic InsufficiencyJOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 2 2007Daniel J. Batchelor Background:Knowledge of breed associations is valuable to clinicians and researchers investigating diseases with a genetic basis. Hypothesis:Among symptomatic dogs tested for exocrine pancreatic insufficiency (EPI) by canine trypsin-like immunoreactivity (cTLI) assay, EPI is common in certain breeds and rare in others. Some breeds may be overrepresented or underrepresented in the population of dogs with EPI. Pathogenesis of EPI may be different among breeds. Animals:Client-owned dogs with clinical signs, tested for EPI by radioimmunoassay of serum cTLI, were used. Methods:In this retrospective study, results of 13,069 cTLI assays were reviewed. Results:An association with EPI was found in Chows, Cavalier King Charles Spaniels (CKCS), Rough-Coated Collies (RCC), and German Shepherd Dogs (GSD) (all P < .001). Chows (median, 16 months) were younger at diagnosis than CKCS (median, 72 months, P < .001), but not significantly different from GSD (median, 36 months, P= .10) or RCC (median, 36 months, P= .16). GSD (P < .001) and RCC (P= .015) were younger at diagnosis than CKCS. Boxers (P < .001), Golden Retrievers (P < .001), Labrador Retrievers (P < .001), Rottweilers (P= .022), and Weimaraners (P= .002) were underrepresented in the population with EPI. Conclusions and Clinical Implications: An association with EPI in Chows has not previously been reported. In breeds with early-onset EPI, immune-mediated mechanisms are possible or the disease may be congenital. When EPI manifests later, as in CKCS, pathogenesis is likely different (eg, secondary to chronic pancreatitis). Underrepresentation of certain breeds among dogs with EPI has not previously been recognized and may imply the existence of breed-specific mechanisms that protect pancreatic tissue from injury. [source] Prolonged antigen-exposure with carbohydrate particle based vaccination prevents allergic immune responses in sensitized miceALLERGY, Issue 6 2009S. Thunberg Background:, Defined particles carrying tightly bound allergens at high density have been suggested as alternatives in allergy vaccination. Carbohydrate based particles (CBP), sized 2 ,m, provide a platform for covalent coupling of allergens. Objective:, To investigate the mechanisms of antigen presentation by CBP, as well as cellular and humoral responses after vaccination with the major cat allergen Fel d 1, covalently coupled to CBP. Methods:, Mice (n = 10/group) were subcutaneously vaccinated with CBP-rFel d 1, CBP or phosphate buffer saline (PBS) before sensitization with rFel d 1 and challenged with cat dander extract. Fluorescent and 75Se-radiolabeled tracking of allergens and particles were performed with flow cytometry and whole-body autoradiography. Humoral, cellular and regulatory immune responses were analyzed by ELISA and flow cytometry. Cytokines were measured in bronchoalveolar lavage fluid and splenocyte cultures. Results:, CBP-rFel d 1 prevented induction of airway inflammation and induced allergen-specific T-cell anergy. CBP-rFel d 1 also induced rapid IgM and IgG1-responses compared with soluble rFel d 1. Particles were phagocytosed by antigen-presenting cells and transported to draining lymph nodes and spleen. Moreover, antigen coupled to CBP remained longer at the injection site compared with alum. Conclusions:, Covalent coupling of rFel d 1 to CBP induces rapid antibody production, prevents induction of allergic immune responses and systemic allergen spreading. Thus, CBP comprise several attractive adjuvant features for use in allergy vaccination. Clinical Implications:, Prolonged allergen exposure through covalent coupling to particles suitable for phagocytosis, provides an adjuvant for safer and efficient allergy vaccination. [source] Developmental pathways in food allergy: a new theoretical frameworkALLERGY, Issue 4 2009A. DunnGalvin Background:, To date, there is no model of psychosocial development based on empirical food allergy (FA) research. This limits the ability of clinicians, researchers and policy-makers to predict and evaluate the real impact of FA on the child, with implications for prevention, treatment, intervention and health policy. Objectives:, To provide an integrated conceptual framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour, with particular attention to transition points. Method:, Fifteen focus groups meetings were held with 62 children (6,15 years). Developmentally appropriate techniques were designed to stimulate discussion, maintain interest and minimize threat to children's self-esteem. Data were analysed using grounded theory. Results:, FA impacts directly on children's normal trajectory of psychological development in both an age- and disease-specific manner. Six key themes emerged from the analysis: ,meanings of food'; ,autonomy, control and self-efficacy'; ,peer relationships'; ,risk and safety'; ,self/identity'; and ,coping strategies'. Conclusions:, Coping with FA is more than simply a strategy, it is a cumulative history of interactive processes (age, gender and disease specific) that are embedded in a child's developmental organization. Clinical Implications:, The early recognition and incorporation of an FA-specific developmental framework into a treatment plan is essential and sets the stage for an effective medical care and the eventual transition from paediatric to adult care. Capsule Summary:, This study represents a first attempt to provide an integrated developmental framework to explain the onset, development and maintenance of FA-related cognitions, emotions and behaviour. [source] Clinical Implications of a Close Vicinity of Nervus Dorsalis Penis/Clitoridis and Os PubisTHE JOURNAL OF SEXUAL MEDICINE, Issue 7 2008ABSTRACT Introduction., Close relation of nervus dorsalis penis/clitoris and os pubis has a major impact in surgical disciplines. Aim., To summarize a current knowledge about this region, represented by the course of sulcus nervi dorsalis penis/clitoridis. Methods., Literature search of years 1970,2007. Main Outcome Measures., In male, it accommodates nervus dorsalis penis whereas in female nervus et arteria dorsalis clitoridis. Lateral border of sulcus nervi dorsalis penis corresponds to vertical ridge and lateral border of sulcus nervi dorsalis clitoridis to ventral arc,two parameters, which are parts of the Phenice's method for sexing of isolated os pubis. Results., Exact preparation of nervus dorsalis penis is crucial in correct performance of conversion of genitalia in patients with transsexualism, in reconstruction of posterior urethra, in hypospadia, during performance of penile blockade during circumcision and in revascularization surgery of erectile dysfunction. Possible role of the sulcus nervi dorsalis penis in the Alcock's syndrome is discussed. Similarly, it is advisable to take care of nervus dorsalis clitoridis during reduction clitoridoplasty in patients with adrenogenital syndrome and during the insertion of transobturator vaginal tape. Injury of nervus dorsalis penis/clitoridis leads to hypestesia or anestesia of glans penis/clitoridis. The injury to arteria dorsalis clitoridis leads to bleeding and/or hematoma. Conclusions., Clinical anatomy of sulci is important in several situations in urologic surgery. It is possible to use sulcus nervi dorsalis penis/clitoridis for sexing of isolated pubis for antropological or forensic purposes.,edý J, Na,ka O, ,pa,ková J, and Jarolím L. Clinical implications of a close vicinity of nervus dorsalis penis/clitoridis and os pubis. J Sex Med 2008;5:1572,1581. [source] Clinical Implications of Advances in the Basic Science of Liver Repair and RegenerationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2009S. J. Karp Recent advances in our understanding of the basic mechanisms that control liver regeneration and repair will produce the next generation of therapies for human liver disease. Insights gained from large-scale genetic analysis are producing a new framework within which to plan interventions. Identification of specific molecules that drive regeneration will increase the options for live-donor liver transplantation, and help treat patients with small-for-size syndrome or large tumors who would otherwise have inadequate residual mass after resection. In a complementary fashion, breakthroughs in the ability to manipulate various cell types to adopt the hepatocyte or cholangiocyte phenotype promise to revolutionize therapy for acute liver failure and metabolic liver disease. Finally, elucidating the complex interactions of liver cells with each other and various matrix components during the response to injury is essential for fabricating a liver replacement device. This focused review will discuss how a variety of important scientific advances are likely to impact the treatment of specific types of liver disease. [source] Clinical Implications of Hepatic Preservation Injury After Adult Liver TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 8 2003Matthias Glanemann Several advances in organ preservation have allowed for improved results after liver transplantation; however, little information is available regarding the clinical impact of preservation injury on the postoperative course. The medical records of 889 liver transplants were retrospectively reviewed. Preservation injury was classified according to postoperative aspartate aminotransferase values as minor (<1000 U/L), moderate (1000,5000 U/L), or severe (>5000 U/L). The following criteria were analyzed and compared according to the extent of preservation injury: patient and graft survival, retransplantation rate, duration of hospitalization and postoperative ventilation, as well as incidence of rejection, infection, and hemodialysis. The majority of patients received a liver with minor preservation injury (75.9%), whereas 22.7% and 1.3% of grafts showed moderate or severe injury. Graft survival was significantly lower in patients with severe preservation injury, when compared to minor or moderate injury. The relative risk for initial nonfunction was 39.36-fold increased (95% confidence interval (ci): 10.3,150.2), as it was increased for duration of postoperative ventilation (6.92-fold; 95%ci: 2.1,22.3) and hemodialysis (6.13-fold; 95%ci: 1.9,19.3). Since the incidence of retransplantation was significantly increased (50%), patient survival remained comparable between all groups. Severe preservation injury had a tremendous impact on the postoperative clinical course, requiring the maximum medical effort to achieve adequate patient survival. [source] Gender Differences in ECG Parameters and Their Clinical ImplicationsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 1 2010Arthur J. Moss M.D. No abstract is available for this article. [source] Clinical Implications of QRS Duration and QT Peak Prolongation in Patients with Suspected Coronary Disease Referred for Elective Cardiac CatheterizationANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2008M. Nadeem Attar M.D., M.R.C.P. Background: The electrocardiogram (ECG) remains a simple, universally available, and prognostically powerful investigation in heart failure, and acute coronary syndromes. We sought to assess the prognostic utility of clinical, angiographic, and simple ECG parameters in a large cohort of patients undergoing elective cardiac catheterization (CC) for known or suspected coronary artery disease. Methods: Consecutive consenting patients undergoing CC for coronary disease were enrolled at a single tertiary center. Patient data, drug therapy, catheter reports, and ECG recordings were prospectively recorded in a validated electronic archive. The primary outcome measure was death or nonfatal myocardial infarction (MI) over 1 year or until percutaneous or cardiac surgical intervention. Independent prognostic markers were identified using the Cox proportional hazard model. Results: A total of 682 individuals were recruited of whom 17(2.5%) died or suffered a nonfatal MI in 1 year. In multivariate analysis QRS duration (ms) (HR 1.03 95% CI 1.01,1.05, P = 0.003), extent of coronary disease (HR 2.01 95% CI 1.24,3.58, P = 0.006), and prolonged corrected QT peak interval in lead I (HR 1.02 95% CI 1.00,1.03, P = 0.044) were independently associated with death or nonfatal MI. Receiver-operator characteristic (ROC) analysis for the multivariate model against the primary end point yielded an area under the curve of 0.759 (95% CI 0.660,0.858), P < 0.001. Conclusions: QRS duration and QT peak are independently associated with increased risk of death or nonfatal MI in stable patients attending for coronary angiography. [source] Baroreflex Sensitivity: Measurement and Clinical ImplicationsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2008Maria Teresa La Rovere M.D. Alterations of the baroreceptor-heart rate reflex (baroreflex sensitivity, BRS) contribute to the reciprocal reduction of parasympathetic activity and increase of sympathetic activity that accompany the development and progression of cardiovascular diseases. Therefore, the measurement of the baroreflex is a source of valuable information in the clinical management of cardiac disease patients, particularly in risk stratification. This article briefly recalls the pathophysiological background of baroreflex control, and reviews the most relevant methods that have been developed so far for the measurement of BRS. They include three "classic" methods: (i) the use of vasoactive drugs, particularly the ,-adrenoreceptor agonist phenylephrine, (ii) the Valsalva maneuver, which produces a natural challenge for the baroreceptors by voluntarily increasing intrathoracic and abdominal pressure through straining, and (iii) the neck chamber technique, which allows a selective activation/deactivation of carotid baroreceptors by application of a negative/positive pressure to the neck region. Two more recent methods based on the analysis of spontaneous oscillations of systolic arterial pressure and RR interval are also reviewed: (i) the sequence method, which analyzes the relationship between increasing/decreasing ramps of blood pressure and related increasing/decreasing changes in RR interval through linear regression, and (ii) spectral methods, which assess the relationship (in terms of gain) between specific oscillatory components of the two signals. The limitations of the coherence criterion for the computation of spectral BRS are discussed, and recent proposals for overcoming them are presented. Most relevant clinical applications of BRS measurement are finally reviewed with particular reference to patients with myocardial infarction and heart failure. [source] Location and Clinical Implications of High-Degree Atrioventricular Block During Dipyridamole Infusion: A Case ReportANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2002Mazen Alakhras M.D. We describe a patient with bifascicular block, who developed transient high-degree atrioventricular block during dipyridamole infusion. This patient was subsequently found to have significant His-Purkinje disease at electrophysiology study, and underwent permanent pacemaker implantation. Spontaneous atrioventricular block was documented during follow-up. This case report raises the issue of dipyridamole safety in patients with intraventricular conduction defects, and contributes an additional mechanism to the possible explanation of dipyridamole-induced atrioventricular block. A.N.E. 2002;7(2):174,176 [source] Clinical Implications of Elevated Serum Interleukin-6, Soluble CD40 Ligand, Metalloproteinase-9, and Tissue Inhibitor of Metalloproteinase-1 in Patients with Acute ST-segment Elevation Myocardial InfarctionCLINICAL CARDIOLOGY, Issue 5 2009Alberto Dominguez-Rodriguez MD, FESC No abstract is available for this article. [source] Specific immunotherapy has long-term preventive effect of seasonal and perennial asthma: 10-year follow-up on the PAT studyALLERGY, Issue 8 2007L. Jacobsen Background:, 3-year subcutaneous specific immunotherapy (SIT) in children with seasonal allergic rhinoconjunctivitis reduced the risk of developing asthma during treatment and 2 years after discontinuation of SIT (5-year follow-up) indicating long-term preventive effect of SIT. Objective:, We evaluated the long-term clinical effect and the preventive effect of developing asthma 7-years after termination of SIT. Methods:, One hundred and forty-seven subjects, aged 16,25 years with grass and/or birch pollen allergy was investigated 10 years after initiation of a 3-year course of SIT with standardized allergen extracts of grass and/or birch or no SIT respectively. Conjunctival provocations were performed outside the season and methacholine bronchial provocations were performed during the season and winter. Asthma was assessed by clinical evaluation. Results:, The significant improvements in rhinoconjunctivitis and conjunctival sensitivity persisted at the 10-year follow-up. Significantly less actively treated subjects had developed asthma at 10-year follow-up as evaluated by clinical symptoms [odds ratio 2.5 (1.1,5.9)]. Patients who developed asthma among controls were 24/53 and in the SIT group 16/64. The longitudinal treatment effect when adjusted for bronchial hyper-responsiveness and asthma status at baseline including all observations at 3, 5 and 10 years follow-up (children with or without asthma at baseline, n = 189; 511 observations) was statistically significant (P = 0.0075). The odds ratio for no-asthma was 4.6 95% CI (1.5,13.7) in favor of SIT. Conclusion:, A 3-year course of SIT with standardized allergen extracts has shown long-term clinical effects and the potential of preventing development of asthma in children with allergic rhinoconjunctivitis up to 7 years after treatment. Clinical implication:, Specific immunotherapy has long-term clinical effects and the potential of preventing development of asthma in children with allergic rhino conjunctivitis up to 7 years after treatment termination. [source] Clinical implication of isolated right dominant heart in the fetusPRENATAL DIAGNOSIS, Issue 8 2007Eui Jung Abstract Objective To evaluate the clinical implication of isolated right dominant heart (RDH) in fetal echocardiography. Study design We reviewed the medical records of pregnant women diagnosed with fetal RDH at Asan Medical Center from December 1999 to December 2005. The criteria of RDH were the ratio of right-to-left atrial and ventricular width and the ratio of the diameter of pulmonary artery-to-aorta were greater than 1.5. Fetuses with congenital heart disease, including coarctation of the aorta (CoA), noncardiac anomalies or chromosomal abnormalities were excluded. Results RDH was identified in 44 fetuses. Twenty-nine (66%) were confirmed to have normal heart and 15 (34%) had cardiac anomalies by postnatal echocardiogrphy; 11 CoA, 1 interruption of aortic arch, 1 patent ductus arteriosus, and 2 ventricular septal defect. Mean gestational age at presentation with RDH was later in normal fetuses as compared to fetuses with CoA (p < 0.005). Only 26% (4/15) of fetuses presenting with RDH during the second-trimester were found to have normal heart postnatally, compared with 86% (25/29) of those diagnosed in the third-trimester. Conclusion RDH in the fetus is a risk factor for postnatal CoA particularly when diagnosed in the second-trimester, and should be an indication for neonatal echocardiography. Copyright © 2007 John Wiley & Sons, Ltd. [source] Clinical implication of routine bacterial culture from epidural catheter tips in postoperative cancer patients: a prospective studyANAESTHESIA, Issue 9 2006S. Mishra Summary We conducted a prospective study to determine the epidural tip culture pattern and its clinical implication in postoperative cancer patients. All patients scheduled to undergo various cancer surgeries requiring epidural analgesia were included. Epidural catheter tips were sent for culture on removal. Of the 466 epidural catheter tips sent for culture, 27 showed a positive culture (5.7%). The commonest organism identified was Staphylococcus aureus. There were no signs of local or epidural space infection in any of the patients. The rates of epidural catheter tip cultures in cancer patients are comparable to those in the general patients and the presence of a positive tip culture is not a predictor of epidural space infection. Hence, we recommend that even in cancer patients, routine culture of epidural catheters is not advisable, provided strict asepsis is maintained at the time of insertion, and patients are constantly monitored for early signs of epidural infection. [source] Childhood trauma, psychosis and schizophrenia: a literature review with theoretical and clinical implicationsACTA PSYCHIATRICA SCANDINAVICA, Issue 5 2005J. Read Objective:, To review the research addressing the relationship of childhood trauma to psychosis and schizophrenia, and to discuss the theoretical and clinical implications. Method:, Relevant studies and previous review papers were identified via computer literature searches. Results:, Symptoms considered indicative of psychosis and schizophrenia, particularly hallucinations, are at least as strongly related to childhood abuse and neglect as many other mental health problems. Recent large-scale general population studies indicate the relationship is a causal one, with a dose-effect. Conclusion:, Several psychological and biological mechanisms by which childhood trauma increases risk for psychosis merit attention. Integration of these different levels of analysis may stimulate a more genuinely integrated bio-psycho-social model of psychosis than currently prevails. Clinical implications include the need for staff training in asking about abuse and the need to offer appropriate psychosocial treatments to patients who have been abused or neglected as children. Prevention issues are also identified. [source] Drinking goal selection and treatment outcome in out-patients with mild-moderate alcohol dependenceDRUG AND ALCOHOL REVIEW, Issue 4 2001SIMON J. ADAMSON Abstract Selection of drinking goal is examined at baseline, post-treatment and at 6 months follow-up for a sample of mild-moderate alcohol-dependent out-patients. Drinking goal is identified as abstinent or controlled drinking, with the latter group being asked to further specify per session and per week drinking limits. Group comparisons for drinking goal post-treatment show those who were not assigned motivational enhancement therapy, had more drinking days and lower scores on the Alcohol Problems Questionnaire and Internal Motivation were more likely to choose controlled drinking. The only variable to predict independently whether or not the controlled drinking goal was within the promoted drinking guidelines was age, with younger participants more likely to choose a goal above this limit. Goal selection was significantly related to drinking outcome, with those aiming to drink within guidelines having better outcome than those aiming for higher limits. There was no significant difference in drinking outcome category when those aiming for within limits were compared to those aiming for abstinence. Clinical implications of these findings are discussed. [source] Depressive tendencies and lower levels of self-sacrifice in mothers, and selflessness in their anorexic daughters,EUROPEAN EATING DISORDERS REVIEW, Issue 3 2008Eytan Bachar Abstract (1) To compare levels of selflessness (the tendency to ignore one's own needs and serve others') and asceticism of parents and daughters, in anorexic and control families. (2) To investigate the relationship between parents' depression and daughters' selflessness. Twenty-eight anorexic daughters and their 28 mothers and 23 fathers were compared to 29 control daughters and their 29 mothers and 28 fathers, participants were administered the Beck Depression Inventory, the Selflessness Scale, the asceticism scale of the Eating Disorder Inventory and the Structured Clinical Interview for DSM-IV. Anorexics' mothers showed significantly lower levels of selflessness and asceticism compared to control mothers; anorexic daughters showed significantly higher levels of selflessness and asceticism compared to control daughters. Depressive tendencies in anorexics' mothers were associated positively and significantly with their daughters' selflessness. The results support the clinical literature that depicts the anorexic daughters' readiness to sacrifice themselves for the family's needs. Clinical implications are drawn. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source] Clinical implications of telomerase detectionHISTOPATHOLOGY, Issue 6 2001P Matthews Clinical implications of telomerase detection In 1994 a sensitive method for the detection of telomerase was described. This assay, which was based on the polymerase chain reaction, suggested that telomerase activity was associated with immortal and cancer cells. Since then more than a thousand studies have documented the expression and activity of the enzyme in diseased tissues, primarily tumours. This review gives an overview of the biological significance of telomerase expression and methods for detecting its activity. This is followed by an organ system-based discussion of expression in normal tissues and disease states. We finish with speculation as to the future role of telomerase detection in diagnostic histopathology. [source] Clinical implications of stopping nevirapine-based antiretroviral therapy: relative pharmacokinetics and avoidance of drug resistanceHIV MEDICINE, Issue 3 2004NE Mackie Objective To determine the pharmacokinetics of cessation of nevirapine (NVP) in order to design clinical protocols which will reduce the risk of resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs). Methods In a case study, NNRTI genotypic resistance was demonstrated in a patient discontinuing therapy for toxicity. Subsequently, nine patients receiving NVP-containing antiretroviral regimens and stopping treatment were recruited. Patients were advised to continue the nucleoside analogue reverse transcriptase inhibitor (NRTI) backbone for 5 days following cessation of NVP. Plasma NVP concentrations were determined over 7,10 days after the last dose. HIV-1 reverse transcriptase genotyping was performed at viral load rebound (approximately day 21 following cessation) to detect mutations associated with reduced NNRTI sensitivity. Results The median predicted time for plasma NVP concentration to fall below the inhibitory concentration (IC)50 of wild-type virus was 168 h (range 108,264 h). De novo genotypic mutations conferring resistance to NRTIs or NNRTIs were not demonstrated following cessation of therapy. Conclusions The prolonged elimination half-life of NVP compared with NRTIs, which persists even after 20 weeks of therapy, raises concern over the development of NNRTI resistance if all three drugs are stopped together. Continuation of the NRTI backbone for a further 5 days, allowing the elimination of NVP, may avoid the development of drug resistance. [source] Affect expression in prenatally psychotropic exposed and nonexposed mother,infant dyadsINFANT MENTAL HEALTH JOURNAL, Issue 4 2002Pratibha N. Reebye This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant,mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother,infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal,infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health. [source] Symbolization and emotional engagement in mothers' reports of child care activitiesINTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES, Issue 1 2010Christopher Christian Abstract This study examines differences in mothers' emotional connection to their children as represented in narratives concerning a range of everyday parenting activities and interactions. First time mothers were interviewed over a period of approximately the first two years of their children's lives, using a semi-structured Parenting Function Interview (PFI), developed for purposes of this research. The new computerized Referential Activity (RA) measure, the Weighted Referential Activity Dictionary (WRAD), was applied to the interview transcripts. Significant differences in RA, representing differences in the symbolizing process and emotional engagement in particular parent,child activities, were found between mothers, and also according to child care topic. On average, mothers' RA was highest for topics of bathing, bedtime and pleasurable events, and lowest for angry and difficult moments. Themes of feeding were relatively low in RA for three of the four mothers, and reports of frightening events showed significantly higher RA than themes of anger for all mothers. Clinical implications of profiles of the mothers' emotional engagement in different topic areas are discussed. Copyright © 2010 John Wiley & Sons, Ltd. [source] Childhood trauma has dose-effect relationship with dropping out from psychotherapeutic treatment for bulimia nervosa: A replicationINTERNATIONAL JOURNAL OF EATING DISORDERS, Issue 2 2001Jennifer Mahon Abstract Objective The primary goal of this study was to replicate the finding that experiences of childhood trauma have a dose-effect relationship with dropping out from psychotherapeutic treatment for bulimia nervosa. It also aimed to replicate logistic regression findings that parental break-up predicts dropping out. Method The cohort consisted of 114 women consecutively presenting to an outpatient eating disorders clinic with bulimia nervosa or atypical bulimia nervosa. Data were gathered using a retrospective, case-note approach and were analysed using logistic regression (LR). A correlation technique was employed to assess the presence of a dose-effect relationship between experiences of trauma in childhood and dropping out. LR models were double cross-validated between this and an earlier cohort. Results The dose-effect relationship between experiences of childhood trauma and dropping out was confirmed. Witnessing parental break-up in childhood again predicted dropping out of treatment in adulthood. Cross-validation of LR equations was unsuccessful. Discussion These results strongly suggest that experiences of childhood trauma have a dose-effect relationship with dropping out. Parental break-up is a stable predictor of dropping out. It is possible that these experiences influence attachment style, particularly the ability to make and maintain a trusting relationship with a psychotherapist. Clinical implications are discussed. © 2001 by John Wiley & Sons, Inc. Int J Eat Disord 30: 138,148, 2001. [source] Fear of blood, injury, and injections, and its relationship to dental anxiety and probability of avoiding dental treatment among 18-year-olds in NorwayINTERNATIONAL JOURNAL OF PAEDIATRIC DENTISTRY, Issue 3 2008MARGRETHE VIKA Background:, More knowledge about the relationship between blood,injury,injection phobia (BIIP) and dental anxiety (DA) may give new clinically relevant information in the assessment and management of children with DA. Objective:, The aims of this study were to explore the relationships between BIIP and DA, and to explore to what extent the two subtypes of BIIP in combination with DA are related to self-reported probability of avoiding dental treatment if a dental injection is needed. Methods:, The subjects were a random sample of 1385 18-year-olds attending high schools in a county of Norway, and the data were collected by use of questionnaires completed in classrooms. The survey instruments applied were Dental Fear Survey, Injection Phobia Scale-Anxiety, and Mutilation Questionnaire. Results:, About 11% of the subjects with DA and subtypes of BIIP, respectively, reported high probability of avoiding dental treatment in a situation where a dental injection was possibly needed. In multiple regression analysis, only DA contributed to self-reports of high probability of avoiding dental treatment. Conclusion:, The results indicate that among adolescents, BIIP is relatively often connected with DA. Clinical implications are discussed. [source] Cardiac Calsequestrin: The New Kid on the Block in ArrhythmiasJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 10 2009NAGESH CHOPRA M.D. Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a rare inherited disease characterized by physical or emotional stress-induced ventricular arrhythmias in the absence of any structural heart disease or QT prolongation. Thus far, mutations in genes encoding the sarcoplasmic reticulum Ca2+ release channel (RYR2) and the sarcoplasmic reticulum Ca2+ binding protein cardiac calsequestrin (CASQ2) have been identified in CPVT patients. Here, we review the role of cardiac calsequestrin in health and disease, with a particular focus on how calsequestrin deficiency can cause arrhythmia susceptibility. Clinical implications and a promising new drug therapy for CPVT are discussed. [source] Alexithymia and posttraumatic stress: subscales and symptom clusters,JOURNAL OF CLINICAL PSYCHOLOGY, Issue 10 2010Frédéric Declercq Abstract This study examined the relationship between the emotion-regulating factor alexithymia and the occurrence of posttraumatic stress disorder (PTSD) after critical incidents in a nonclinical sample of 136 nurses and ambulance personnel working in military facilities. The results showed that alexythima accounts for variance in PTSD symptoms. Breaking PTSD into its 4 symptom clusters, alexithymia was found to predict numbing and hyperarousal symptoms but not avoidance or reexperiencing symptoms. Finally, the rarely investigated, but clinically relevant, distinctive subdimensions of alexithymia were examined in relation to the 4 PTSD clusters. The difficulty identifying feelings subscale contributed most to the numbing and hyperarousal PTSD subscales. Clinical implications and future research directions are discussed. © 2010 Wiley Periodicals, Inc. J Clin Psychol 66: 1,14, 2010. [source] | ||||||||||||||||||||||||||||||||||||||||