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Selected AbstractsChanges in lung function and health status in patients with COPD treated with tiotropium or salmeterol plus fluticasoneRESPIROLOGY, Issue 2 2009Kazuyoshi KURASHIMA ABSTRACT Background and objective: The effects of tiotropium, a long-acting anticholinergic drug, were compared with those of the combination of salmeterol, a long-acting ,2 -agonist, and fluticasone, an inhaled corticosteroid, in patients with COPD. Methods: A 4-month, randomized, open cross-over study of tiotropium, 18 µg once daily, versus salmeterol, 50 µg, plus fluticasone, 200 µg, twice daily, was conducted in patients with COPD. Efficacy was assessed by spirometry and responses to the St George's Respiratory Questionnaire (SGRQ). After 4 months, patients were asked to select their subsequent therapy and indicate the reasons for their selection. Results: A total of 78 patients completed the study. There were no significant differences in the improvements in FEV1 or SGRQ scores between the therapies. Similar numbers of patients selected tiotropium (42.3%) and salmeterol plus fluticasone (57.7%). However, those who preferred one of the therapies demonstrated greater improvements in SGRQ scores with that therapy. One subgroup of patients (30.8%) showed greater improvements in dyspnoea and FEV1 in response to tiotropium, and the other subgroup of patients (35.9%) showed greater improvements in dyspnoea and FEV1 in response to salmeterol plus fluticasone. Some patients (14.1%) selected salmeterol plus fluticasone because of positive effects on sputum expectoration. Conclusions: The study was unblinded and the results need to be interpreted with caution. However, tiotropium and salmeterol plus fluticasone had similar overall effects on pulmonary function and SGRQ scores in patients with COPD. Responses to the two therapies were heterogeneous, and the patients who showed greater improvements in FEV1 or SGRQ scores with one of the therapies preferred it for their subsequent treatment. [source] Child behaviour and adult personality: comparisons between criminality groups in Finland and SwedenCRIMINAL BEHAVIOUR AND MENTAL HEALTH, Issue 3 2000Professor Lea Pulkkinen Background; Lately there has been an increasing interest in whether personality traits are associated with criminal behaviour in male and female subjects. Criminality and alcohol abuse are often associated. Delinquent adolescents are impulsive and danger seeking. Childhood aggression may be a precursor of adult criminality. Method Using longitudinal data, adult personality and childhood behaviours were examined for groups of non-criminals and criminals of Finnish (n = 268) and Swedish (n + 169) samples, and crime groups were compared in the two cultures. Karolinska Scales of Personality (KSP) were given at adult age and the participants had been observed and rated by their teachers in respect of behaviour in childhood (at age 8 years and 13 years, respectively). Results Male offenders with alcohol problems (Finnish and Swedish) had significantly higher scores on psychopathy-related personality traits in adulthood than other subgroups, as indicated by higher impulsivity, muscular tension and lower socialization. They also displayed higher scores on teacher-rated aggressiveness in childhood than the non-criminal groups. The female subgroup displaying criminal activity was small. It did not differ significantly from non-offenders in adult personality characteristics. Female offenders, however, showed early indications of lower sociability (in Finland) and higher aggressiveness and disharmony in childhood than non-offenders (in Sweden). Discussion The study suggests that early problem behaviours are precursors of subsequent criminal activity in at least two cultures. The results emphasize the importance of longitudinal research programmes. Copyright © 2000 Whurr Publishers Ltd. [source] Grading Functional Mitral Regurgitation by Tissue Doppler,Derived Isovolumic Acceleration Parameters in Patients with Nonischemic Dilated CardiomyopathyECHOCARDIOGRAPHY, Issue 7 2010Tansu Karaahmet M.D. Functional mitral regurgitation (FMR) is relatively common in heart failure and it is associated with adverse prognosis. The severity of FMR is usually assessed by echocardiography. Tissue Doppler echocardiography is used to acquire signals to determine the myocardial systolic functional parameters, including systolic ejection velocity and the systolic isovolumic acceleration (IVAs) rate. We investigated the utility of isovolumic acceleration parameters to grade the severity of FMR in nonischemic dilated cardiomyopathy (DC) patients. We analyzed the left ventricular systolic IVA rate, systolic isovolumic contraction (IVCs) velocity, and IVA duration (IVAd) values in 73 patients with DC. Patients were subgrouped according to FMR grade (Group I = mitral regurgitation mild and moderate; Group II = mitral regurgitation severe). IVAs was similar between two groups; however IVCs and IVAd were significantly higher in Group II than Group I. The IVCs cutoff value to predict severe FMR was 1.2 cm/sec (sensitivity 75% and specificity 70%). The IVAd cutoff value to predict severe FMR was 33 ms (sensitivity 77% and specificity 77%). Patients with IVCs , 1.2 cm/sec and IVAd , 33 ms had significantly higher FMR volume than the other subgroups. IVCs and IVAd values are useful to determine FMR severity in patients with DC. (Echocardiography 2010;27:815-822) [source] Color M-Mode Regurgitant Flow Propagation Velocity: A New Echocardiographic Method for Grading of Mitral RegurgitationECHOCARDIOGRAPHY, Issue 9 2005Ramazan Akdemir M.D. Purpose: The aim of this study was to evaluate the reliability of mitral regurgitation color M-mode regurgitant flow propagation velocity (RFPV) in grading mitral regurgitation (MR).Methods: We prospectively examined 52 consecutive patients with grades of MR mild in 10 patients, moderate in 19 patients, and severe in 23 patients with quantitative pulse Doppler echocardiography. MR was evaluated by vena contracta diameter (VCD), regurgitant jet area (RJA), and RFPV. These qualitative and quantitative methods were compared with the pulsed Doppler quantitative flow measurements and concordance of these three methods was determined.Results: The mean RFPV for mild, moderate, and severe MR were 26.4 ± 7 cm/sec, 43.3 ± 7 cm/sec, and 60.3 ± 7.3 respectively (P < 0.001). RFPV is highly sensitive and moderately specific in differentiating mild and severe MR from other subgroups. Sensitivity and specificity were 92.1%,64.3% for mild and 100%,68.5% for severe MR, respectively. Significant correlation was observed between pulse Doppler quantitative grades, RFPV, VC, and RJA (P < 0.0001, r = 0.87; P < 0.0001, r =,0.84; P < 0.0001, r = 0.76, respectively).Conclusion: This results show that RFPV is a reliable and simple semiquantitative new method that can be used for determining severity of MR. [source] Topical treatment with thiazolidinediones, activators of peroxisome proliferator-activated receptor-,, normalizes epidermal homeostasis in a murine hyperproliferative disease modelEXPERIMENTAL DERMATOLOGY, Issue 3 2006Marianne Demerjian Abstract:, In a murine model of epidermal hyperplasia reproducing some of the abnormalities of several common skin disorders, we previously demonstrated the antiproliferative and pro-differentiating effects of peroxisome proliferator-activated receptor (PPAR),, PPAR,/,, and liver X receptor activators. Unlike other subgroups of PPAR activators, thiazolidinediones (TZDs), a family of PPAR, ligands, did not inhibit keratinocyte proliferation in normal murine skin. Here, we studied the effects of two TZDs, namely ciglitazone (10 mM) and troglitazone (1 mM), in the same murine model where epidermal hyperproliferation was reproduced by repeated barrier abrogation with tape stripping. Topical treatment with ciglitazone and troglitazone resulted in a marked and significant decrease in epidermal thickness. Furthermore, in all TZD-treated groups, we observed a significant decrease in keratinocyte proliferation using proliferating cell nuclear antigen, 5-bromo-2,-deoxyuridine, and tritiated thymidine incorporation. However, using the terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling assay, we found no difference in apoptosis between different treatments, emphasizing that it is the antiproliferative role of these activators that accounts for the decrease of epidermal thickness. Finally, using immunohistochemical methods, we determined the effects of ciglitazone on keratinocyte differentiation in this hyperproliferative model. We observed an increased expression of involucrin and filaggrin following ciglitazone treatment, suggesting a pro-differentiating action of TZDs in this model. In summary, topical TZDs significantly reduce epidermal keratinocyte proliferation while promoting differentiation in a murine model of hyperproliferative epidermis. Together, these results suggest that in addition to their metabolic effects currently in use in the treatment of type 2 diabetes, topical TZDs could be considered as potential alternative therapeutic agents in hyperproliferative skin diseases such as psoriasis. [source] Recent trends in breast cancer incidence among 6 Asian groups in the Greater Bay Area of Northern California,INTERNATIONAL JOURNAL OF CANCER, Issue 6 2007Theresa H.M. Keegan Abstract Asians and Pacific Islanders are typically aggregated in United States (US) cancer statistics even though the few studies that have considered subgroups separately have found marked differences in cancer incidence. The objective of this study was to evaluate trends in breast cancer incidence rates separately for US Chinese, Japanese, Filipino, Korean, South Asian and Vietnamese women overall and by age at diagnosis, histologic subtype and stage at diagnosis. Age-adjusted incidence rates and annual percent changes (APC) of new, primary breast cancer diagnosed in the Greater Bay Area Cancer Registry of Northern California (1990,2002) were calculated using SEER*Stat. In women under 50 years of age, annual incidence rates decreased for Japanese (APC = ,4.1, p = 0.02) and Filipinas (APC = ,1.9, p = 0.11), and increased or fluctuated in other subgroups over the study period. In women 50 years or older, rates of invasive breast cancer increased for most subgroups, except Filipinas (APC = ,1.3, p = 0.32), and in Japanese until 1998,2000. Rates of breast cancer in situ increased in most subgroups from 1990 to 2002, as did rates of lobular breast cancer for Chinese (APC = +7.46, p < 0.01) women. In Japanese women, rates of lobular breast cancer were highest in 1995,1997 and decreased thereafter. Our data support the notion that the prevalence of established risk factors influence breast cancer incidence, as breast cancer rates increased for more recently immigrated groups and decreased among more established groups, and may suggest leads into other avenues of research, such as genetic differences, that may explain differences in incidence rates among Asian subgroups. © 2006 Wiley-Liss, Inc. [source] Prognostic value of c-erbB2 expression in breast cancerJOURNAL OF SURGICAL ONCOLOGY, Issue 4 2002Shinichi Tsutsui MD Abstract Background and Objectives An overexpression of c-erbB2 has been reported to be associated with a poor clinical outcome in breast cancer, however, its prognostic value remains controversial especially in patients with node negative breast cancer, and regarding the estrogen receptor (ER) status. Methods Immunohistochemical staining for c-erbB2 was performed on the primary breast cancer from 698 Japanese patients with a mean follow-up duration of 54 months. Results The c-erbB2 expression was positive in 120 (17.2%) of 698 cases, which inversely correlated with the ER status. Both univariate and multivariate analyses indicated the c-erbB2 expression to be a significant prognostic factor for the disease-free survival (DFS) and overall survival (OS), while the same efffect was also seen in the patient groups with node negative as well as node positive breast cancer. A univariate anlysis also indicated a subgroup with the positive c-erbB2 and negative ER to have both a worse DFS and OS than the other subgroups. The patients with positive c-erbB2 had a significantly worse DFS and OS than the patients with negative c-erbB2 in all patient groups stratified according to the adjuvant therapies, while the prognostic significance of c-erbB2 on DFS was also found in the patients with the node negative breast cancer who received adjuvant tamoxifen alone. Conclusions The c-erbB2 expression is an independent significant factor for breast cancer and the prognostic significance remains in the node negative as well as node positive breast cancer, while the same effect was also found in all subgroups stratified according to the adjuvant therapies. In addition, the combination of c-erbB2 and ER made it possible to identify the subgroup with the worst clinical outcome. J. Surg. Oncol. 2002;79:216,223. © 2002 Wiley-Liss, Inc. [source] Network influences on scholarly communication in developmental dyslexia: A longitudinal follow-upJOURNAL OF THE AMERICAN SOCIETY FOR INFORMATION SCIENCE AND TECHNOLOGY, Issue 14 2003Claudia A. Perry Author cocitation analysis was used to explore ongoing changes in the intellectual structure of the hybrid problem area of developmental dyslexia for the period 1994,1998, and to address ambiguities in results raised by an earlier study of these researchers for the years 1976,1993. Results suggest that: (1) discrepancies between the structure of the sociometric (personal) and author cocitation networks reflect real differences, not temporal factors; (2) differences between cocitation patterns and reports in the literature, and corresponding delays in the visibility of emerging perspectives, are likely due to the "inertia" of aggregate cocitation data and/or by shifts by neuroscience-vision researchers to publication in more prominent journals; (3) a sharp rise in link density for the neuroscience-vision subgroup indicates increased cohesiveness and growing maturation for this emerging perspective; (4) shifts in subgroup membership, link density, patterns of coauthorship, and multiple factor loadings suggest possible convergence between other subgroups in the network and identify individuals who may play boundary-spanning roles within the network; and (5) changing patterns of cocitation throughout the network suggest the increasing influence of studies relating to neurobiological mechanisms underlying dyslexia. The possible contributions of such boundary spanners in addressing the substantial information and communication challenges posed by the increased interdisciplinary character of scholarship in general, also are discussed. [source] Nodular melanomas: Analysis of the casistic and relationship with thick melanomas and diagnostic delayTHE JOURNAL OF DERMATOLOGY, Issue 10 2008Roberto BETTI ABSTRACT The present study aimed to: (i) define thick melanomas related to nodular melanomas and other melanoma subgroups; and (ii) establish diagnostic delay in relation to the biological behavior of these melanomas and prevention programs. Cutaneous primary melanomas were studied. Nodular melanoma (NM), lentigo maligna melanoma (LMM) and superficial spreading melanoma (SSM) were selected. A further category named vertical growth melanoma (VGM) was also utilized. Analysis for sex, age, different values of thickness (1,2 mm, >2 mm; 1,3 mm, >3 mm; >4 mm), delay to diagnosis and patterns of detection were performed in all of the different subtypes. Eighty-seven patients with melanomas more than 1 mm of Breslow's thickness out of 506 melanoma were collected. Twenty-six were nodular cases, 39 SSM, five LMM and 17 VGM. Of those patients with NM, 42% had a thickness of more than 1,2 mm, 34% of 2,4 mm, 23% of more than 4 mm; and 54% with 1,3, 46% with more than 3 mm; and 58% with more than 2 mm. Even considering different values of thickness of more than 1 mm, a delay to diagnosis was significantly lower in NM (4.79 months) than in other subgroups. The value of more than 1 mm of Breslow's thickness may be sufficient to consider a melanoma to be thick. The lower diagnostic delay of NM suggests that they represent faster growing lesions probably with a different biological behavior than other melanoma subtypes. VGM should not be confused with NM, having a longer delay and different clinical features compared with the latter. They represent an area of diagnostic carelessness than potentially be improved. [source] Effect of Gabapentin on the Sensation and Impact of Tinnitus,THE LARYNGOSCOPE, Issue 5 2006Carol A. Bauer MD Abstract Objectives/Hypothesis: This study evaluated the effectiveness of gabapentin in treating chronic tinnitus in two populations: participants with tinnitus with associated acoustic trauma and participants with tinnitus without associated acoustic trauma. The hypothesis was that gabapentin would decrease both subjective and objective features of tinnitus in the trauma group but would be less effective in the nontrauma group. Study Design: Prospective, placebo-controlled, single-blind clinical trial. Methods: Pure-tone audiograms and personal histories were used to categorize tinnitus etiology as either secondary to acoustic trauma or not associated with acoustic trauma. Participants were restricted to those with moderate to severe tinnitus for at least 1 year. All participants received gabapentin in a graduated ascending-descending dose series extending over 20 weeks (peak dose of 2,400 mg/d). Results: There was a significant improvement in tinnitus annoyance for the trauma group (P = .05). Other subjective aspects of tinnitus were not significantly affected in either group. Between-subject variability of therapeutic response was considerable. Nevertheless, in consideration of subjective loudness ratings, 4 of 19 nontrauma participants and 6 of 20 trauma participants showed an improvement of 20% or better. In consideration of psychoacoustic loudness estimates, 3 of 19 nontrauma and 6 of 20 trauma participants showed an improvement of 20 dB HL or greater. Evenly dividing each group into high and low responders revealed significant improvement in loudness at 1,800 and 2,400 mg/day for the trauma high-response subgroup (P = .007). No significant improvement was obtained for other subgroups. Conclusion: Gabapentin is effective in reducing subjective and objective aspects of tinnitus in some individuals, with the best therapeutic response obtained in individuals with associated acoustic trauma. [source] Seasonal birth patterns in myositis subgroups suggest an etiologic role of early environmental exposuresARTHRITIS & RHEUMATISM, Issue 8 2007Leora J. Vegosen Objective To evaluate whether seasonal early environmental exposures might influence later development of autoimmune disease, by assessing distributions of birth dates in groups of patients with idiopathic inflammatory myopathies (IIMs). Methods We assessed birth patterns in groups of patients with juvenile-onset IIM (n = 307) and controls (n = 3,942) who were born between 1970 and 1999, and in groups of patients with adult-onset IIM (n = 668) and controls (n = 6,991) who were born between 1903 and 1982. Birth dates were analyzed as circular data. Seasonal clustering was assessed by the Rayleigh test, and differences between groups by a rank-based uniform scores test. Results The overall birth distributions among patients with juvenile IIM and among patients with adult IIM did not differ significantly from those among juvenile and adult controls, respectively. Some subgroups of patients with juvenile IIM had seasonal birth distributions. Hispanic patients with juvenile-onset IIM had a seasonal birth pattern (mean birth date October 16) significantly different from that of Hispanic controls (P = 0.002), who had a uniform birth distribution, and from that of non-Hispanic patients with juvenile-onset IIM (P < 0.001), who had a mean birth date of May 2. Juvenile dermatomyositis patients with p155 autoantibody had a birth distribution that differed significantly from that of p155 antibody,negative juvenile dermatomyositis patients (P = 0.003). Juvenile IIM patients with the HLA risk factor allele DRB1*0301 had a birth distribution significantly different from those without the allele (P = 0.021). Similar results were observed for juvenile and adult IIM patients with the linked allele DQA1*0501, versus juvenile and adult IIM patients without DQA1*0501, respectively. No significant patterns in birth season were found in other subgroups. Conclusion Birth distributions appear to have stronger seasonality in juvenile than in adult IIM subgroups, suggesting greater influence of perinatal exposures on childhood-onset illness. Seasonal early-life exposures may influence the onset of some autoimmune diseases later in life. [source] English language proficiency and smoking prevalence among California's Asian Americans,CANCER, Issue S12 2005Hao Tang M.D., Ph.D. Abstract The authors documented California's tobacco control initiatives for Asian Americans and the current tobacco use status among Asian subgroups and provide a discussion of the challenges ahead. The California Tobacco Control Program has employed a comprehensive approach to decrease tobacco use in Asian Americans, including ethnic-specific media campaigns, culturally competent interventions, and technical assistance and training networks. Surveillance of tobacco use among Asian Americans and the interpretation of the results have always been a challenge. Data from the 2001 The California Health Interview Survey (CHIS) were analyzed to provide smoking prevalence estimates for all Asian Americans and Asian-American subgroups, including Korean, Filipino, Japanese, South Asian, Chinese, and Vietnamese. Current smoking prevalence was analyzed by gender and by English proficiency level. Cigarette smoking prevalence among Asian males in general was almost three times of that among Asian females. Korean and Vietnamese males had higher cigarette smoking prevalence rates than males in other subgroups. Although Asian females in general had low smoking prevalence rates, significant differences were found among Asian subgroups, from 1.1% (Vietnamese) to 12.7% (Japanese). Asian men who had high English proficiency were less likely to be smokers than men with lower English proficiency. Asian women with high English proficiency were more likely to be smokers than women with lower English proficiency. Smoking prevalence rates among Asian Americans in California differed significantly on the basis of ethnicity, gender, and English proficiency. English proficiency seemed to have the effect of reducing smoking prevalence rates among Asian males but had just the opposite effect among Asian females. Cancer 2005. © 2005 American Cancer Society. [source] Prophylaxis of posttraumatic endophthalmitisACTA OPHTHALMOLOGICA, Issue 2009A ABU EL ASRAR Infectious endophthalmitis is a devastating complication of open globe injuries. The incidence of culture-positive endophthalmitis after open globe injuries varies between 0.5% and 17%. Several reports have demonstrated that delayed primary repair, dirty wound, breach of lens capsule, retained intraocular foreign body (IOFB), grade 4 injury (presenting visual acuity of worse than 5/200 to light perception), placement of primary intraocular lens, and rural setting are associated with an increased risk of posttraumatic endophthalmitis. Posttraumatic endophthalmitis is associated with its own microbiologic spectrum which is distinct from other subgroups of exogenous endophthalmitis. Posttraumatic endophthalmitis still carries a poor prognosis. Reasons for guarded prognosis include polymicrobial infection and the virulence of the infecting microorganisms. In addition, concomitant injuries may directly result in ocular damage that limits ultimate visual recovery. Because of the substantial incidence of endophthalmitis after open globe injuries, careful consideration should be given to the use of prophylactic antimicrobial therapy. The purpose of prophylaxis is to provide effective antibiotic levels as rapidly as possible against a broad range of organisms. Good coverage for most organisms is obtained with intravenous vancomycin coupled with a third generation cephalosporin, such as ceftazidime, which can penetrate the vitreous cavity in effective levels in inflamed aphakic experimental eyes. Recently, the use of prophylactic intravitreal antibiotic administration in high-risk cases was recommended. [source] Indications for laparoscopic surgery for Crohn's disease using the Vienna ClassificationCOLORECTAL DISEASE, Issue 9 2007K. Okabayashi Abstract Objective, The aim of this study was to investigate the clinical outcome of laparoscopic surgery for Crohn's disease and clarify the indications using the Vienna Classification. Method, Between September 1994 and July 2004, 107 patients with Crohn's disease underwent 124 procedures. Of these, 91 laparoscopic procedures formed the basis of this study. The Vienna Classification, which consists of three subgroups , age at diagnosis (A1-2), location (L1-4) and behaviour (B1-3) , was applied to compare the conversion to open surgery and incidence of postoperative complications. Results, Conversion to open surgery was necessary in 12 (13.2%) patients. Major and minor postoperative complications occurred in five (5.5%) and 13 (19.8%) patients respectively. The conversion rate, major and total complications in the B3L3/4 subgroup were significantly greater than in the other subgroups. Multivariate analysis showed that B3L3/4 was the only predictive factor for all complications. However, the incidence of major and all complications in the B3L3/4 subgroup did not differ between the open and laparoscopic surgery groups. Conclusion, Laparoscopic surgery for Crohn's disease is the procedure of choice for all uncomplicated cases (B2L1-4, B3L1/2). For patients in the complicated group (B3L3/4), laparoscopy is also feasible and justified; however, the surgeon must be aware of the propensity for higher rate of conversion. [source] | ||||||||||||||||||||||