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Selected AbstractsWorsening of Left Ventricular End-Systolic Volume and Mitral Regurgitation without Increase in Left Ventricular Dyssynchrony on Acute Interruption of Cardiac Resynchronization TherapyECHOCARDIOGRAPHY, Issue 7 2009Suman S. Kuppahally M.D. Background: Responders to cardiac resynchronization therapy (CRT) have greater left ventricular (LV) dyssynchrony than nonresponders prior to CRT. Aim: We conducted this study to see whether the long term responders have more worsening of LV dyssynchrony and LV function on acute interruption of CRT. Materials and Methods: We identified 22 responders and 13 nonresponders who received CRT as per standard criteria for 23.73 ± 7.9 months (median 24.5 months). We assessed the acute change in LV function, mitral regurgitation (MR) and compared LV dyssynchrony in CRT on and off modes. Results: On turning off CRT, there was no significant worsening of LV dyssynchrony in both responders and nonresponders. The dyssynchrony measurements by SPWMD, TDI and 3D echocardiography did not correlate significantly. LVESV increased (p = 0.02) and MR (p = 0.01) worsened in CRT-off mode in responders only without significant change in LVEF or LV dimensions. Discussion and Conclusion: In long-term responders to CRT, there is alteration in the function of remodeled LV with acute interruption of CRT, without significant worsening of LV dyssynchrony. The role of different echocardiographic parameters in the assessment of LV dyssynchrony remains controversial. Even after long-term CRT reversely remodels the LV, the therapy needs to be continued uninterrupted for sustained benefits. [source] Prevalence and Characteristics of Left Ventricular Noncompaction in a Community Hospital Cohort of Patients with Systolic DysfunctionECHOCARDIOGRAPHY, Issue 1 2008Roopinder Sandhu M.D. Background: Left ventricular noncompaction (LVNC) is felt to be a rare form of cardiomyopathy, although its prevalence in a nonreferred population is unknown. We examined the prevalence and clinical characteristics of LVNC in a community hospital cohort of adult patients with echocardiographic evidence of left ventricular (LV) systolic dysfunction. Methods: All adult echocardiograms with global LV dysfunction and an LVEF , 45% over a 1-year period were reviewed for signs of LV noncompaction. Its presence was confirmed by the consensus of at least 2/3 readers specifically searching for this using standard criteria for noncompaction. Results: A 3.7% prevalence of definite or probable LVNC was found in those with LVEF, 45% and a 0.26% prevalence for all patients referred for echocardiography during this period. This is appreciably higher than prior reports from tertiary centers. Conclusion: Noncompaction may not be a rare phenomenon and is comparable to other more widely recognized but less common causes of heart failure such as peripartum myopathy, connective tissue diseases, chronic substance abuse and HIV disease. [source] Headache and Psychological Functioning in Children and AdolescentsHEADACHE, Issue 9 2006Scott W. Powers PhD Headache can affect all aspects of a child's functioning, leading to negative affective states (eg, anxiety, depression, anger) and increased psychosocial problems (for instance, school absences, problematic social interactions). For children and adolescents who experience frequent headache problems, comorbid psychological issues are a well-recognized, but poorly understood, clinical phenomenon. The confusion surrounding the relationship between pediatric headache and psychopathology exists for several reasons. First, in some cases, headache has been inappropriately attributed to psychological or personality features based on anecdotal observations or interpretations that go beyond the available data. Additionally, measures of psychopathology have not always adhered to the American Psychiatric Association's diagnostic criteria, thus reducing the reliability of diagnostic judgments. Furthermore, the diagnosis of headache has not always followed standard criteria, and has been complicated by the emergence of new terms and evolving measures. Finally, methodological shortcomings, such as incomplete descriptions of the procedures and criteria used for the study, inadequate descriptions of headache severity, lack of a control group for comparison with individuals without headaches, reliance primarily on cross-sectional research designs that are often discussed with inferences to causal hypotheses, and the use of unstandardized assessment measures, have significantly limited the validity of research findings. The goal of the current review is to examine the extant literature to provide the most up-to-date picture on what the research has made available about the magnitude, specificity, and causes of psychopathology in children and adolescents with headache, in an effort to further elucidate their relationship and prompt a more methodologically rigorous study of these issues. [source] The c.43_44insCTG variation in PCSK9 is associated with low plasma LDL-cholesterol in a Caucasian population,,HUMAN MUTATION, Issue 5 2006Pin Yue Abstract The genetic etiology of familial hypobetalipoproteinemia (FHBL) is unclear in the majority of cases. Mutations in apolipoprotein B (APOB) are the only confirmed causes of FHBL. Recently, loss-of-function mutations of PCSK9 gene have been shown to be associated with the hypocholesterolemia phenotype. Our primary goal was to confirm that mutations in PCSK9 could be another cause of FHBL. Using the sequencing approach, we found that the c.43_44insCTG variation in PCSK9, a common in-frame insertion in both African American and Caucasian populations, is associated with the hypocholesterolemia phenotype in three FHBL families. Then we tested whether this variation could be associated with lower cholesterol levels in the general population. A total of 403 subjects from a Caucasian population, in which hypobetalipoprotein (HBL) and normal groups were classified using standard criteria, were sequenced for this variation. The allele frequency of this variation in the HBL group was 0.186, but was only 0.128 in the normal lipid group. The mean plasma low-density lipoprotein (LDL)-cholesterol level in subjects heterozygous for this variant is significantly lower than that in the normal group (p<0.01). Heterozygous subjects also had higher high-density lipoprotein (HDL)-cholesterol levels (p<0.01). In general, LDL-cholesterol concentration in individuals with PCSK9 c.43_44insCTG variation was ,10,15 mg/dL lower than that in normal individuals. We conclude that the c.43_44insCTG variant plays a role in lowering cholesterol in the general population. Hum Mutat 27(5), 460,466, 2006. Published 2006 Wiley-Liss, Inc. [source] Type 2 Diabetes Mellitus and Risk of Developing Urinary IncontinenceJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2005Karen L. Lifford MD Objectives: To evaluate the association between type 2 diabetes mellitus (DM) and development of urinary incontinence in women. Design: Prospective, observational study. Setting: The Nurses' Health Study cohort. Participants: Eighty-one thousand eight hundred forty-five women who reported information on urinary function in 1996. Measurements: Self-reported, physician-diagnosed DM was ascertained using questionnaire from 1976 to 1996 and confirmed using standard criteria. Self-reported urinary incontinence, defined as leakage at least weekly, was ascertained in 1996 and 2000. Logistic regression models were used to calculate multivariate-adjusted relative risks (RRs) and 95% confidence intervals (CIs) for the relationship between DM (as of 1996) and prevalent and incident incontinence. Results: The risk of prevalent incontinence (multivariate RR=1.28, 95% CI=1.18,1.39) and incident incontinence (multivariate RR=1.21, 95% CI=1.02,1.43) was significantly greater in women with DM than women without. Using a validated severity index, risk of developing severe incontinence was even more substantial in women with DM than in those without (multivariate RR=1.40, 95% CI=1.15,1.71 for leakage enough to wet the underwear; RR=1.97, 95% CI=1.24,3.12 for leakage enough to wet the outer clothing). In addition, risk of incontinence increased with duration of DM (P -trend=.03 for prevalent incontinence; P=.001 for incident incontinence). Conclusion: DM independently increases risk of urinary incontinence in women. Because risk of incontinence appeared associated with longer duration of DM, even delaying the onset of DM could have important public health implications. [source] Nasogastric Aspiration and Lavage in Emergency Department Patients with Hematochezia or Melena Without HematemesisACADEMIC EMERGENCY MEDICINE, Issue 2 2010Nicholas Palamidessi MD Abstract Objectives:, The utility of nasogastric aspiration and lavage in the emergency management of patients with melena or hematochezia without hematemesis is controversial. This evidence-based emergency medicine review evaluates the following question: does nasogastric aspiration and lavage in patients with melena or hematochezia and no hematemesis differentiate an upper from lower source of gastrointestinal (GI) bleeding? Methods:, MEDLINE, EMBASE, the Cochrane Library, and other databases were searched. Studies were selected for inclusion in the review if the authors had performed nasogastric aspiration (with or without lavage) in all patients with hematochezia or melena and performed esophagogastroduodenal endoscopy (EGD) in all patients. Studies were excluded if they enrolled patients with history of esophageal varices or included patients with hematemesis or coffee ground emesis (unless the data for patients without hematemesis or coffee ground emesis could be separated out). The outcome was identifying upper GI hemorrhage (active bleeding or high-risk lesions potentially responsible for hemorrhage) and the rate of complications associated with the nasogastric tube insertion. Quality of the included studies was assessed using standard criteria for diagnostic accuracy studies. Results:, Three retrospective studies met our inclusion and exclusion criteria. The prevalence of an upper GI source for patients with melena or hematochezia without hematemesis was 32% to 74%. According to the included studies, the diagnostic performance of the nasogastric aspiration and lavage for predicting upper GI bleeding is poor. The sensitivity of this test ranged from 42% to 84%, the specificity from 54% to 91%, and negative likelihood ratios from 0.62 to 0.20. Only one study reported the rate complications associated with nasogastric aspiration and lavage (1.6%). Conclusions:, Nasogastric aspiration, with or without lavage, has a low sensitivity and poor negative likelihood ratio, which limits its utility in ruling out an upper GI source of bleeding in patients with melena or hematochezia without hematemesis. ACADEMIC EMERGENCY MEDICINE 2010; 17:126,132 © 2010 by the Society for Academic Emergency Medicine [source] Assessment and diagnosis of depression in people with intellectual disabilityJOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2003J. A. McBrien Abstract Background Despite widespread acceptance that depression can occur in adults with intellectual disability (ID), the difficulties encountered in its assessment and diagnosis have hampered the individual clinician, and meant that questions of prevalence, treatment choice and outcome remain problematic. Method The present paper reviews the progress in this field since three reviews, all published in the mid-1990s, recommended further attention to three interlinked issues: diagnostic criteria, the symptoms of depression in this group and the lack of rating scales. Results Despite a further 11 published papers and other studies in progress, the method of diagnosis for people with severe and profound ID remains debatable, with some authors advocating adherence to standard criteria, others suggesting adding criteria to the standard ones and yet others believing that substitute criteria are called for. However, for those with mild to moderate ID, a consensus is emerging that standard diagnostic criteria are appropriate. There has been progress in examining some of the symptoms which might constitute depression in people with ID. New diagnostic criteria issued by the Royal College of Psychiatrists are to be welcomed. There is an assumption in much of the research that symptoms of behaviour commonly termed challenging or maladaptive must be atypical symptoms of depression, but none of the studies reviewed demonstrate this effectively. This is compounded by methodological flaws in the way that depressed samples are arrived at for further study. Although new rating scales have emerged, there is as yet no gold standard diagnostic tool for depression amongst people with ID. Conclusions It is suggested that, given these difficulties, the validity of the conceptual frameworks for depression is still in doubt. It remains the case that large-scale, collaborative, prospective studies are called for. [source] Medico-legal assessment of disability in narcolepsy: an interobserver reliability studyJOURNAL OF SLEEP RESEARCH, Issue 1 2008FRANCESCA INGRAVALLO Summary Impairment because of narcolepsy strongly limits job performance, but there are no standard criteria to assess disability in people with narcolepsy and a scale of disease severity is still lacking. We explored: (1) the interobserver reliability among Italian Medical Commissions making disability and handicap benefit decisions for people with narcolepsy, searching for correlations between the recognized disability degree and patients' features; (2) the willingness to report patients to the driving licence authority and (3) possible sources of variance in judgement. Fifteen narcoleptic patients were examined by four Medical Commissions in simulated sessions. Raw agreement and interobserver reliability among Commissions were calculated for disability and handicap benefit decisions and for driving licence decisions. Levels of judgement differed on percentage of disability (P < 0.001), severity of handicap (P = 0.0007) and the need to inform the driving licence authority (P = 0.032). Interobserver reliability ranged from Kappa = ,0.10 to 0.35 for disability benefit decision and from Kappa = ,0.26 to 0.36 for handicap benefit decision. The raw agreement on driving licence decision ranged from 73% to 100% (Kappa not calculable). Spearman's correlation between percentages of disability and patients' features showed correlations with age, daytime naps, sleepiness, cataplexy and quality of life. This first interobserver reliability study on social benefit decisions for narcolepsy shows the difficulty of reaching an agreement in this field, mainly because of variance in interpretation of the assessment criteria. The minimum set of indicators of disease severity correlating with patients' self assessments encourages a disability classification of narcolepsy. [source] Comparing serum and pleural fluid pro-brain natriuretic peptide (NT-proBNP) levels with pleural-to-serum albumin gradient for the identification of cardiac effusions misclassified by Light's criteriaRESPIROLOGY, Issue 5 2007José M. PORCEL Background and objectives: To assess the diagnostic performance of the amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in pleural fluid and serum for the identification of pleural effusions owing to heart failure, and to determine if these measurements allow better categorization of cardiac effusions that have been misclassified by Light's criteria, than do serum-pleural fluid albumin and protein gradients. Methods: The study prospectively evaluated NT-proBNP in serum and pleural fluid from patients with effusions owing to heart failure (n = 53) and other causes (n = 40). Measurements were made of levels of NT-proBNP by an electrochemiluminiscence immunoassay, and serum-pleural fluid protein and albumin gradients. Results: Using a cut-off value of 1500 pg/mL for serum and pleural samples, the accuracy of NT-proBNP for identifying pleural effusions from cardiac causes was 89% and 90%, respectively. The area under the receiver operating characteristic curve for the diagnosis of pleural effusions from heart failure was similar for pleural fluid (0.931, 95% CI: 0.871,0.991) and serum (0.919, 95% CI: 0.855,0.984) NT-proBNP. Six (75%) of eight patients with cardiac effusions that were misclassified as exudates by Light's criteria would have been correctly categorized by either NT-proBNP or the albumin gradient, whereas only four (50%) would have been correctly classified by the protein gradient. Conclusions: NT-proBNP is a useful marker for the diagnosis of pleural effusions from heart failure when measured in either serum or pleural fluid. At a cut-off of 1500 pg/mL, NT-proBNP is at least as accurate as the albumin gradient to correctly identify cardiac effusions misclassified as exudates by standard criteria, but at much higher cost. [source] Multifactor implied volatility functions for HJM modelsTHE JOURNAL OF FUTURES MARKETS, Issue 8 2006I-Doun Kuo This study evaluates two one-factor, two two-factor, and two three-factor implied volatility functions in the HJM class, with the use of eurodollar futures options across both strike prices and maturities. The primary contributions of this article are (a) to propose and test three implied volatility multifactor functions not considered by K. I. Amin and A. J. Morton (1994), (b) to evaluate models using the AIC criteria as well as other standard criteria neglected by S. Y. M. Zeto (2002), and (c) to .nd that multifactor models incorporating the exponential decaying implied volatility functions generally outperform other models in .tting and prediction, in sharp contrast to K. I. Amin and A. J. Morton, who find the constantvolatility model superior. Correctly specified and calibrated simple constant and square-root factor models may be superior to inappropriate multifactor models in option trading and hedging strategies. © 2006 Wiley Periodicals, Inc. Jrl Fut Mark 26:809,833, 2006 [source] Outcomes and Utilization of Kidneys from Deceased Donors with Acute Kidney InjuryAMERICAN JOURNAL OF TRANSPLANTATION, Issue 2 2009L. K. Kayler Utilization and long-term outcomes of kidneys from donors with elevated terminal serum creatinine (sCr) levels have not been reported. Using data from the Scientific Registry of Transplant Recipients from 1995 to 2007, recipient outcomes of kidneys from adult donors were evaluated stratified by standard criteria (SCD; n = 82 262) and expanded criteria (ECD; n = 16 978) donor type and by sCr ,1.5, 1.6,2.0 and >2.0 mg/dL. Discard rates for SCDs were ascertained. The relative risk of graft loss was similar for recipients of SCD kidneys with sCr of 1.6,2.0 and >2.0 mg/dL, compared to ,1.5 mg/dL. For ECD recipients, the relative risk of graft failure significantly increased with increasing sCr. Of potential SCDs, the adjusted risk of discard was higher with sCr >2.0 mg/dL (adjusted odds ratio [AOR] 7.04, 95% confidence interval [CI] 6.5,7.6) and 1.6,2.0 mg/dL (AOR 2.7; CI 2.5,2.9) relative to sCr ,1.5 mg/dL. Among potential SCDs, elevated terminal creatinine is a strong independent risk factor for kidney discard; yet, when kidney transplantation is performed elevated donor terminal creatinine is not a risk factor for graft loss. Further research is needed to identify safe practices for the optimal utilization of SCD kidneys from donors with acute kidney injury. [source] Postmarketing surveillance for human teratogenicity: A model approach,BIRTH DEFECTS RESEARCH, Issue 5 2001Christina D. Chambers Background Most congenital defects associated with prenatal exposures are notable for a pattern of major and minor malformations, rather than for a single major malformation. Thus, traditional epidemiological methods are not universally effective in identifying new teratogens. The purpose of this report is to outline a complementary approach that can be used in addition to other more established methods to provide the most comprehensive evaluation of prenatal exposures with respect to teratogenicity. Methods We describe a multicenter prospective cohort study design involving dysmorphological assessment of liveborn infants. This design uses the Organization of Teratology Information Services, a North American network of information providers who also collaborate for research purposes. Procedures for subject selection, methods for data collection, standard criteria for outcome classification, and the approach to analysis are detailed. Results The focused cohort study design allows for evaluation of a spectrum of adverse pregnancy outcomes ranging from spontaneous abortion to functional deficit. While sample sizes are typically inadequate to identify increased risks for single major malformations, the use of dysmorphological examinations to classify structural anomalies provides the unique advantage of screening for a pattern of malformation among exposed infants. Conclusions As the known human teratogens are generally associated with patterns of structural defects, it is only when studies of this type are used in combination with more traditional methods that we can achieve an acceptable level of confidence regarding the risk or safety of specific exposures during pregnancy. Teratology 64:252,261, 2001. © 2001 Wiley-Liss, Inc. [source] The comparative diagnostic accuracy of conventional and liquid-based cytology in a colposcopic settingBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 11 2005T. Hussein Objective This study was conducted to compare the performance of liquid-based cytology (LBC) and conventional cytology (CS) in the high prevalence setting of colposcopy clinic. Design A split sample of matched ThinPrep (TP) and conventional smear from 563 patients were evaluated blindly. The performance of both techniques was compared with the gold standard of biopsy results or normal colposcopy examination in 441 cases. Setting Colposcopy clinic of an inner city hospital for women and children. Sample Five hundred and sixty-three women referred to colposcopy clinic over 14-month period. Methods Cervical smears were taken from 563 women referred for colposcopy. Using the split-sample technique, the material was spread on a conventional (CS) slide and the remaining material rinsed in a PreservCyt solution. A T2000 processor was used to prepare LBC preparations. All women underwent colposcopy/biopsy according to local protocol. Four hundred and forty-one women met the diagnostic standard criteria of the study, which was either a normal colposcopy or histopathology result. Sensitivity, specificity and positive and negative predictive values were calculated for both methods of cytology preparations. Main outcome measures Matched TP and conventional smears, detection of abnormality, matched biopsies, sensitivity, specificity, and positive and negative predictive values. Results Inadequate rates for CS and LBC (TP) were 4.3% and 0.68%, respectively. In 73% of cases, the CS and the LBC preparations showed exact agreement, whereas 77% agreement was seen when comparison was made for amalgamated low grade and high grade abnormalities. Low grade cytological abnormalities accounted for 44% of LBC slides versus 37% in CS slides. High grade cytological abnormalities accounted for 22% of LBC versus 17% seen in CS cases (P < 0.001). LBC showed increased sensitivity in the detection of CIN2 or worse than CS (92% and 83%, respectively) and CS showed greater specificity than LBC (82% and 76%, respectively). Conclusions In high prevalence setting, LBC performed at least as well as CS. The inadequate rate was significantly lower with LBC. The numbers are too small, however, to make confident comments about increased sensitivity and negative predictive value with LBC. Larger studies are required to verify these findings. [source] | |||||||||||||