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Neuropsychiatric dysfunction in patients with chronic hepatitis and liver cirrhosis

HEPATOLOGY RESEARCH, Issue 11 2008
Kojiro Michitaka
Aim:, The aim of this study is to clarify the cerebral functions in patients with chronic hepatitis (CH) as well as those with liver cirrhosis (LC). Methods:, We studied 58 patients with CH (20 in fibrosis stage F1, 20 in F2, 18 in F3), 77 with LC (46 rated as Child,Pugh class A, 24 as B, 7 as C), and 20 healthy volunteers (HV). Computer-aided quantitative neuropsychiatric function test systems, including eight neuropsychiatric tests were performed. Results:, Subjects with results over the cut-off value for healthy subjects ranged from 11.1,28.6% in CH and 19.5,36.4% in LC. The percentages with abnormality in at least one test in CH and LC were 72.4% and 80.6%, respectively, which were significantly higher than that in the HV group (35.0%) (P = 0.003, P = 0.0003, respectively). Among CH subjects, those with three or more abnormal results in the F1, F2 and F3 subgroups were 15.0%, 20.0% and 38.9%, respectively. Among LC subjects, those with three or more abnormal results in the Child,Pugh class A, B and C subgroups comprised 30.4%, 50.0% and 57.1%, respectively. The rate in the CH F3 subgroup (P = 0.011) and in all three LC subgroups (P = 0.023, P = 0.001, P = 0.002, respectively) were significantly higher than that in the HV group. Conclusion:, The percentage of patients with neuropsychiatric function impairment was high in both LC and CH, especially in stage F3. Neuropsychiatric dysfunction may initiate in CH in a considerable number of patients. [source]

Host adaptation to potato and tomato within the US,1 clonal lineage of Phytophthora infestans in Uganda and Kenya

PLANT PATHOLOGY, Issue 5 2000
M. E. Vega-Sánchez
Twenty isolates of Phytophthora infestans from potato and twenty-two from tomato, collected in Uganda and Kenya in 1995, were compared for dilocus allozyme genotype, mitochondrial DNA (mtDNA) haplotype, mating type and restriction fragment length polymorphism (RFLP) fingerprint using probe RG57. Based on RFLP fingerprint and mtDNA haplotype, all isolates were classified in the US,1 clonal lineage. Nonetheless, isolates from potato differed from isolates from tomato in several characteristics. Isolates from potato had the 86/100 glucose-6-phosphate isomerase (Gpi) genotype, while those from tomato were 100/100, which represents a variant of US,1 that had been identified previously as US,1.7. Furthermore, while pure cultures of the pathogen were acquired from infected potato leaflets by first growing the isolates on potato tuber slices, this approach failed with infected tomato tissue because the isolates grew poorly on this medium. Tomato isolates were eventually purified using a selective medium. Six isolates from each host were compared for the diameter of lesions they produced on three tomato and three potato cultivars in one or two detached-leaf assays (four isolates from the first test were repeated in the second). On potato leaflets, isolates from potato caused larger lesions than isolates from tomato. On tomato leaflets, isolates from that host caused larger lesions than did isolates from potato, but the difference was significant in only one test. The interaction between source of inoculum (potato or tomato) and inoculated host (potato or tomato) was significant in both tests. Isolates from tomato were highly biotrophic on tomato leaflets, producing little or no necrosis during the seven days following infection, even though abundant sporulation could be seen. In contrast, isolates from potato sporulated less abundantly on tomato leaflets and produced darkly pigmented lesions that were most visible on the adaxial side of the leaflets. Nonetheless, all isolates infected and sporulated on both hosts, indicating that host adaptation is not determined by an ability to cause disease but rather by quantitative differences in pathogenic fitness. Assessment of Gpi banding patterns, mtDNA haplotype and RFLP fingerprint of 39 isolates from potato collected in Uganda and Kenya in 1997 indicated that the population had not changed on this host. The population of P. infestans from Kenya and Uganda provides an interesting model for the study of quantitative host adaptation. [source]

A comparative analysis of a modified picture frame test for characterization of woven fabrics

POLYMER COMPOSITES, Issue 4 2010
A.S. Milani
An experimental, finite-element analysis framework is utilized to estimate the deformation state in a modified version of the picture frame test. During the analysis, the effect of fiber misalignment and the deformation heterogeneity in the tested fabric, a 2 × 2 PP/E-Glass twill, is accounted for and a force prediction model is presented. Using an equivalent stress,strain normalization scheme, the comparison of the modified test with the conventional (original) picture frame and bias-extension tests is also made, and results reveal similarities and differences that should receive attention in the identification of constitutive models of woven fabrics using these basic tests. Ideally, the trellising behavior should not change from one test to another but results show that in the presence of fiber misalignment, the modified picture frame test yields a behavior closer to that of the bias-extension test, while the general form of the test's repeatability, measured by a signal-to-noise metric, remains similar to the original picture frame test. POLYM. COMPOS., 2010. © 2009 Society of Plastics Engineers [source]

Correlation of Findings on Direct Laryngoscopy and Bronchoscopy With Presence of Extraesophageal Reflux Disease

THE LARYNGOSCOPE, Issue 9 2000
Michele M. Carr DDS
Abstract Objective To determine the correlation between findings at direct laryngoscopy and bronchoscopy and presence of extraesophageal reflux disease (EERD). Study Design Retrospective chart review Methods Operative notes of 155 children undergoing direct laryngoscopy and bronchoscopy between 1996 and 1999 for airway symptoms for whom there was a suspicion of EERD were examined. Gastroesophageal reflux disease (GERD) was considered present if at least one test was positive (including upper GI series, pH probe, gastric scintiscan, or esophageal biopsy). Results A total of 130 (84%) patients had GERD diagnosed. Ninety percent had at least one laryngotracheal abnormality: 83% had an abnormal larynx and 66% had an abnormal trachea. Laryngeal abnormalities in GERD included postglottic edema, 69%; arytenoid edema, 30%; large lingual tonsil, 16%; vocal fold edema, 12%; vocal fold nodule, 12%; ventricular obliteration, 5%; and hypopharyngeal cobblestoning, 3%. Tracheobronchial abnormalities in GERD included tracheal cobblestoning, 33%; blunting of carina, 12.5%; subglottic stenosis, 11%; increased secretions, 11%; and generalized edema or erythema, 5%. The best sensitivity or specificity was obtained by combining postglottic edema, arytenoid edema, and vocal fold edema, resulting in a sensitivity of 75% and a specificity of 67%. Positive predictive value was 100% for the combination of postglottic edema and any vocal fold or ventricular abnormality. Conclusion Laryngoscopy and bronchoscopy can reveal findings with a high positive predictive value for the presence of GERD. Endoscopy of the upper airway in children with clinical signs and symptoms of EERD is a promising tool for diagnosis. [source]

Sixty-four,slice Computed Tomography of the Coronary Arteries: Cost,Effectiveness Analysis of Patients Presenting to the Emergency Department with Low-risk Chest Pain

ACADEMIC EMERGENCY MEDICINE, Issue 7 2008
Rahul K. Khare MD
Abstract Objectives:, The aim was to use a computer model to estimate the cost,effectiveness of 64-slice multidetector computed tomography (MDCT) of the coronary arteries in the emergency department (ED) compared to an observation unit (OU) stay plus stress electrocardiogram (ECG) or stress echocardiography for the evaluation of low-risk chest pain patients presenting to the ED. Methods:, A decision analytic model was developed to compare health outcomes and costs that result from three different risk stratification strategies for low-risk chest pain patients in the ED: stress ECG testing after OU care, stress echocardiography after OU care, and MDCT with no OU care. Three patient populations were modeled with the prevalence of symptomatic coronary artery disease (CAD) being very low risk, 2%; low risk, 6% (base case); and moderate risk, 10%. Outcomes were measured as quality-adjusted life years (QALYs). Incremental cost,effectiveness ratios (ICERs), the ratio of change in costs of one test over another to the change in QALY, were calculated for comparisons between each strategy. Sensitivity analyses were conducted to test the robustness of the results to assumptions regarding the characteristics of the risk stratification strategies, costs, utility weights, and likelihood of events. Results:, In the base case, the mean (±standard deviation [SD]) costs and QALYs for each risk stratification strategy were MDCT arm $2,684 (±$1,773 to $4,418) and 24.69 (±24.54 to 24.76) QALYs, stress echocardiography arm $3,265 (±$2,383 to $4,836) and 24.63 (±24.28 to 24.74) QALYs, and stress ECG arm $3,461 (±$2,533 to $4,996) and 24.59 (±24.21 to 24.75) QALYs. The MDCT dominated (less costly and more effective) both OU plus stress echocardiography and OU plus stress ECG. This resulted in an ICER where the MDCT arm dominated the stress echocardiography arm (95% confidence interval [CI] = dominant to $29,738) and where MDCT dominated the ECG arm (95% CI = dominant to $7,332). The MDCT risk stratification arm also dominated stress echocardiography and stress ECG in the 2 and 10% prevalence scenarios, which demonstrated the same ICER trends as the 6% prevalence CAD base case. The thresholds where the MDCT arm remained a cost-saving strategy compared to the other risk stratification strategies were cost of MDCT, <$2,097; cost of OU care, >$1,092; prevalence of CAD, <70%; MDCT specificity, >65%; and a MDCT indeterminate rate, <30%. Conclusions:, In this computer-based model analysis, the MDCT risk stratification strategy is less costly and more effective than both OU-based stress echocardiography and stress ECG risk stratification strategies in chest pain patients presenting to the ED with low to moderate prevalence of CAD. [source]