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Journal articles on the topic 'Raised median'
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Schultz, Grant G., Daniel J. Thurgood, Andrew N. Olsen, and C. Shane Reese. "Analyzing Raised Median Safety Impacts Using Bayesian Methods." Transportation Research Record: Journal of the Transportation Research Board 2223, no. 1 (January 2011): 96–103. http://dx.doi.org/10.3141/2223-12.
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King, Michael R., Jon A. Carnegie, and Reid Ewing. "Pedestrian Safety Through a Raised Median and Redesigned Intersections." Transportation Research Record: Journal of the Transportation Research Board 1828, no. 1 (January 2003): 56–66. http://dx.doi.org/10.3141/1828-07.
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Documentation was done on the effect of a raised median, signalized and redesigned intersections, curbs, and sidewalks on vehicle speed, pedestrian exposure risk, driver predictability, and vehicle volume along a four-lane suburban roadway in central New Jersey. The analysis used both quantitative tools (speed and volume counts, timing runs) and qualitative methods (pedestrian tracking, video, before-and-after photography). The results are that the 85th-percentile vehicle speed fell by 2 mi/h and pedestrian exposure risk decreased by 28%. Also, the median allows pedestrians to cross one direction of traffic at a time and signals, curbs, median, redesigned intersections, and striping patterns work together to manage driver behavior. In regard to vehicles, it was found that vehicle volumes were not affected and that vehicle speeds acted independently of vehicle volumes. A collision analysis projected a savings of $1.7 million over the next 3 years in direct and indirect costs. The goal of the report was to produce a simple and straightforward analysis tool for similar projects in the area. Some of the benefits of roadway projects such as these can be quantified numerically, whereas others rely on qualitative analyses. For example, before-and-after speeds are easily gathered and compared, whereas before-and-after pedestrian behavior at the raised median requires a more in-depth approach made easier by digital cameras. Together, before-and-after data and before-and-after imaging present a more holistic picture of the benefits and limitations of a project.
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Eisele, William L., and William E. Frawley. "Estimating the Safety and Operational Impact of Raised Medians and Driveway Density." Transportation Research Record: Journal of the Transportation Research Board 1931, no. 1 (January 2005): 108–16. http://dx.doi.org/10.1177/0361198105193100114.
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This paper describes research sponsored by the Texas Department of Transportation to investigate the operational and safety impact of raised medians and driveway consolidation. Operational effects (travel time, speed, and delay) were investigated through microsimulation on three field test corridors and three theoretical corridors. Safety effects were investigated along 11 test corridors to estimate relationships between crash rates and access point densities as well as the presence of raised medians or two-way left-turn lanes (TWLTLs). The research demonstrates that access management effects are case specific and that microsimulation can assess these unique operational effects. For the case studies investigated, replacing a TWLTL with a raised median resulted in an increase in travel time on two test corridors and a decrease on one test corridor. Small increases in travel time were found with the theoretical corridors as well. The travel time differences are based on the traffic level and location and number of the raised median openings. When present, the relatively small increases in travel time, and subsequent speed and delay, appear to be outweighed by the reduction in the number of conflict points and increased safety. Detailed crash analysis on 11 test corridors indicated that as access point density increases, crash rates increase. This trend holds regardless of the median type. For test corridors in which crash data were investigated before and after the raised median installation, a reduction in the crash rate was always found. Finally, future research needs are identified, including the need to investigate operational and safety impact over a broader range of geometric conditions and longer corridors than investigated here.
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FAITHFULL, D. K., and J. F. PETCHELL. "Occult Injury of the Median Nerve." Journal of Hand Surgery 20, no. 2 (April 1995): 210–11. http://dx.doi.org/10.1016/s0266-7681(05)80052-x.
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A case of median nerve injury caused by an unsuspected foreign body is described. The mechanism was not recognized at the time of injury. The suspicion of a penetrating missile injury was raised only with the aid of radiographs. At operation the foreign body was found in the substance of the median nerve.
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Qu, Wenrui, Tao Tao, Qun Zhao, Qiao Sun, and Yi Qi. "Two-way left turn lane or raised median? A truck safety based study." Journal of Safety Research 74 (September 2020): 109–17. http://dx.doi.org/10.1016/j.jsr.2020.04.013.
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Dixon, Karen K., Raul E. Avelar, and Yanfen Zhou. "Effective Measures to Restrict Vehicle Turning Movements." Transportation Research Record: Journal of the Transportation Research Board 2638, no. 1 (January 2017): 45–54. http://dx.doi.org/10.3141/2638-06.
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This study evaluated alternatives to raised and nontraversable medians on driveways and approaches. Raised medians are often effective for limiting direct left turns at significant conflict points. Raised medians also improve corridor aesthetics. This research reviewed a variety of turn restrictions to determine how effectively they address the operational needs of the transportation network while addressing contextual sensitivities. The turn restrictions evaluated in the study were separated into three broad categories: turn restrictions located only at the access point, turn restrictions located only in the roadway (typically some type of median configuration), and combined turn restriction configurations. Field evaluations in Oregon and Texas were performed to determine the effectiveness of various turn restriction configurations. In addition, microsimulation evaluations were used to identify the operational impacts of the various turn maneuver restrictions.
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Bonneson, James A., and Patrick T. Mccoy. "Effect of Median Treatment on Urban Arterial Safety: An Accident Prediction Model." Transportation Research Record: Journal of the Transportation Research Board 1581, no. 1 (January 1997): 27–36. http://dx.doi.org/10.3141/1581-04.
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The development of a model for predicting the safety of an urban arterial street with a specified median treatment is described. The median treatments considered are raised-curb median, two-way left-turn lane (TWLTL), and undivided cross section. The model calibration was based on maximum-likelihood techniques, an assumed negative binomial distribution of the residuals, and a nonlinear relationship between accident frequency and daily traffic demand and segment length. Several conclusions were formulated on the basis of the model developed. One conclusion is that average daily traffic demand, driveway density, unsignalized public street approach density, median type, and adjacent land use are significantly correlated with accident frequency. In general, accidents are more frequent on street segments with higher traffic demands, driveway densities, or public street densities. Accidents are also more frequent when the land use is business or office as opposed to residential or industrial. The undivided cross section was shown to have a significantly higher accident frequency than the TWLTL or raisedcurb median treatment when parallel parking is allowed on the undivided street. When there is no parking allowed on either type of street, the difference between the undivided, TWLTL, and raised-curb median treatments is less distinct; however, the raised-curb median treatment tends to yield the lowest accident frequency in most situations.
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Elpus, Kenneth, and Adam Grisé. "Music Booster Groups: Alleviating or Exacerbating Funding Inequality in American Public School Music Education?" Journal of Research in Music Education 67, no. 1 (February 5, 2019): 6–22. http://dx.doi.org/10.1177/0022429418812433.
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As fundraising has become a key component of American public school music educators’ professional responsibilities, in many places, parent organizations have taken an increasingly outsized role in raising private funds to supplement public school music budgets. The purpose of this study was to understand the finances of public school music parents’ associations and music booster groups and to understand the relation between the socioeconomic status of school communities and the amount of money raised by their local music booster groups. Using Internal Revenue Service (IRS) fiscal 2015 data for 5,575 music booster groups throughout the United States, we found evidence that, collectively, music booster groups raised at least $215 million in support of public school music education. At least four groups raised over $1,000,000; at least 31 raised over $500,000; and at least 723 raised over $100,000 each. We found that total booster revenues were significantly associated with local median household income. Each additional $1,000 of local median household income was associated with an additional $305 in revenue for booster groups filing IRS Form 990-EZ (“short form”) and with an additional $1,637 in revenue for booster groups filing the full IRS Form 990.
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Beetsma, Roel, Alex Cukierman, and Massimo Giuliodori. "Political Economy of Redistribution in the United States in the Aftermath of World War II—Evidence and Theory." American Economic Journal: Economic Policy 8, no. 4 (November 1, 2016): 1–40. http://dx.doi.org/10.1257/pol.20140193.
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We present legislative, historical and statistical evidence of a substantial upward ratchet in transfers and taxes in the US due to World War II. This finding is explained within a political-economy framework with defense spending responding to a war threat and a median voter in the population who interacts with a (richer) agenda setter in Congress in setting redistribution. While the setter managed to cap redistribution before the War, the War itself raised the status quo tax burden and improved tax collection technology, strengthening the bargaining power of the median voter as defense spending receded. This permanently raised the level of redistribution. (JEL D72, H11, H23, H56, N32, N42)
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Gunther, Karen E., and Bernice Dhlamini. "D Dimer Levels Are Markedly Raised in HIV-Related TTP." Blood 106, no. 11 (November 16, 2005): 2173. http://dx.doi.org/10.1182/blood.v106.11.2173.2173.
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Abstract Background Thrombotic Thrombocytopenic Purpura (TTP) is now being seen with increasing frequency in association with HIV infection. Successful treatment depends on early institution of plasma infusion or plasmapheresis and it is often necessary to make the diagnosis in the presence of a microangiopathic haemolytic anaemia (MIAHA) and thrombocytopenia alone before the full diagnostic pentad of features has emerged. This requires exclusion of other possible causes for the clinical picture including Disseminated Intravascular Coagulopathy (DIC). The absence of abnormalities on a coagulation (DIC) screen is therefore often quoted as an important diagnostic criterion. However, although other coagulation parameters appear normal, we have frequently observed extremely high D-Dimer levels in patients with HIV related TTP. This study was done to analyze the results of coagulation screening in patients with HIV related TTP and to compare these with the findings in HIV negative patients with TTP. Materials and Methods The HIV status and results of DIC screens done on consecutive patients diagnosed with TTP at the Johannesburg Hospital between August 2002 and January 2005 were reviewed. Patients were identified from records of haematology consults received during this period. The diagnosis of TTP required at least the presence of MIAHA and thrombocytopaenia in the absence of other possible causes. Laboratory data was retrieved from the hospital computer system. HIV status was confirmed on ELISA testing Results Fifteen patients with HIV related TTP and 3 patients with Idiopathic TTP were identified. Two patients with pregnancy related TTP who suffered spontaneous abortions prior to assessment were excluded as alterations in coagulation parameters in these patients were not solely dependent on the TTP process. The median haemoglobin and platelet levels at diagnosis were 5.4g/dl and 11x10^9/l respectively for the patients with HIV related TTP and 8.0g/dl and 19X10^9/l respectively for the patients with idiopathic TTP. Median INR, PTT and Antithrombin levels were normal and not significantly different between the 2 groups (INR 1.14 vs1.12, PTT 29.9 vs31.5 secs, Antithrombin 103 vs12 IU). However the median D-Dimer level was significantly higher in the HIV related TTP group (3.66 mg/l, range 0.95–6.95 vs.0.28mg/l, range 0.22–0.3. p=0.0024) Discussion This study confirms our clinical impression that extremely high D-Dimer levels, in the absence of any other abnormalities in coagulation parameters, appear to be a consistent feature of HIV related TTP. In our experience this finding is often helpful in suggesting the diagnosis. The D-Dimer levels appear to be significantly higher than those in patients with idiopathic TTP although the small numbers of HIV negative patients in this study limits the reliability of the comparison and few reported case series give sufficiently detailed data to confirm this finding. It is possible that the very high D-Dimer levels noted in HIV positive patients reflect differences in the pathogenesis of TTP in HIV infection. Endothelial damage with loss of its antithrombotic properties may result in both localized coagulation activation (as evidenced by raised D-Dimer levels) and release of stored Von Willebrand Factor. The consequent relative deficiency of Von Willebrand Cleaving Protease could then result in accumulation of high molecular weight multimers and platelet activation with clinical outcomes similar to that seen in “classical” TTP where an absolute deficiency in the protease (either congenital or acquired due to the presence of antibodies) is implicated.
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Sze, Shirley, Pierpaolo Pellicori, Jufen Zhang, and Andrew L. Clark. "Malnutrition, congestion and mortality in ambulatory patients with heart failure." Heart 105, no. 4 (August 18, 2018): 297–306. http://dx.doi.org/10.1136/heartjnl-2018-313312.
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BackgroundIn patients with chronic heart failure (CHF), malnutrition might be related to right heart dysfunction and venous congestion, which predispose to bowel oedema and malabsorption, thereby leading to malnutrition. We explored the relation between congestion, malnutrition and mortality in a large cohort of ambulatory patients with CHF.MethodsWe assessed malnutrition using the Geriatric Nutritional Risk Index (GNRI). Congestion was defined by echocardiography (raised right atrial pressure (RAP)=dilated inferior vena cava≥21 mm/raised pulmonary artery systolic pressure (PAsP)=transtricuspid gradient of ≥36 mm Hg/right ventricular systolic dysfunction (RVSD)=tricuspid annular plane systolic excursion <17 mm).ResultsOf the 1058 patients enrolled, CHF was confirmed in 952 (69% males, median age 75 (IQR: 67–81) years, median N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) 1141 (IQR: 465–2562) ng/L). 39% had HF with -reduced ejection fraction (left ventricular ejection fraction, LVEF <40%) and 61% had HF with normal (HeFNEF, LVEF ≥40% and NT-pro-BNP >125 ng/L) ejection fraction. Overall, 14% of patients were malnourished (GNRI ≤98). 35% had raised RAP, 23% had raised PAsP and 38% had RVSD. Congestion was associated with malnutrition. During a median follow-up of 1683 days (IQR: 1096–2230 days), 461 (44%) patients died. Malnutrition was an independent predictor of mortality. Patients who were malnourished with both RVSD and increased RAP had much worse outcome compared with non-malnourished patients without RVSD who had normal RAP.ConclusionMalnutrition and congestion are modestly correlated and each is independently associated with increased mortality in patients with CHF. Patients with HF with both malnutrition and congestion as evidenced by right heart dysfunction should be managed with additional vigilance.
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Maury, C. P., and A. M. Teppo. "Raised serum levels of cachectin/tumor necrosis factor alpha in renal allograft rejection." Journal of Experimental Medicine 166, no. 4 (October 1, 1987): 1132–37. http://dx.doi.org/10.1084/jem.166.4.1132.
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A sensitive radioimmunoassay was used for monitoring serum levels of endogenous cachectin/tumor necrosis factor alpha (TNF) in 10 renal transplant recipients. Acute allograft rejections were associated with marked elevations of circulating TNF. The peak levels of TNF (median 140 pg/ml) were in the same concentration range as previously reported in parasitic infections. The results show that the release of TNF into circulation is an early event in renal allograft rejection and that raised levels of TNF in man can also be induced by noninfectious stimuli.
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Kearns, Pamela R., Rob Pieters, M. M. Antoinette Rottier, Andrew D. J. Pearson, and Andrew G. Hall. "Raised blast glutathione levels are associated with an increased risk of relapse in childhood acute lymphocytic leukemia." Blood 97, no. 2 (January 15, 2001): 393–98. http://dx.doi.org/10.1182/blood.v97.2.393.
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Abstract A preliminary study has linked raised blast glutathione levels with chemoresistance in acute myeloid and lymphoblastic leukemia in adults and children. In this study, therefore, the relationship between leukemic blast glutathione levels and prognosis in childhood acute lymphoblastic leukemia (ALL) was investigated. A total of 77 childhood ALL samples were analyzed, 62 at initial presentation and 15 at relapse. A 20-fold interindividual variation in glutathione levels at presentation (median, 6.54 nmol/mg protein; range, 1.37 to 27.9) was demonstrated. The median level in T-lineage ALL was 2.3-fold higher than in B-lineage ALL (Mann-Whitney test,P < .0001). There was a significant correlation between presenting white cell count (WBC) and glutathione level (Spearman rank correlation coefficient, ρ = 0.45, P = .001). A high DNA index correlated with low glutathione levels (Mann-Whitney test,P = .013). There was no significant relationship between glutathione levels and in vitro drug sensitivity. Patients with glutathione levels above the median had a significantly greater risk of relapse (log-rank test statistic, 5.55; P = .018), and the overall survival rate was significantly reduced (log-rank test statistic, 4.38; P = .04). Multivariate analysis demonstrated that glutathione concentration was of independent prognostic value when assessed in conjunction with age, gender, WBC, and immunophenotype. The association of elevated blast glutathione levels with an increased risk of relapse suggests that glutathione-depleting agents may be of therapeutic value in patients who present with a high WBC.
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Tan, Shi Zhuan, Kenneth Yau, Laura R. Steeples, Jane Ashworth, Cecilia Fenerty, and Nicholas Jones. "Incidence, management and outcome of raised intraocular pressure in childhood-onset uveitis at a tertiary referral centre." British Journal of Ophthalmology 103, no. 6 (July 18, 2018): 748–52. http://dx.doi.org/10.1136/bjophthalmol-2018-312498.
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Background/aimsTo investigate the incidence, management and outcome of uveitis and raised intraocular pressure (IOP) in children treated at the Manchester Uveitis Clinic (MUC).MethodsThis was a retrospective, observational study of patients who presented with uveitis under the age of 16 to the MUC from July 2002 to June 2016.ResultsA total of 320 children were included in the study. Out of these, 55 (17.2%) patients (75 eyes) were found to have raised IOP requiring treatment. The mean age at diagnosis of uveitis and at first recorded raised IOP was 8.2±4.3 and 10.8±3.6 years, respectively. The pre-treatment IOP was 32.3±6.6 mm Hg and the IOP at the final visit was 15.5±3.7 mm Hg (median follow-up period, 43.7 months) on a median number of 0 medications. Twenty-eight eyes (37.3%) required glaucoma drainage surgery, and eight eyes (12.5%) had cyclodiode laser before this. Kaplan-Meier analysis showed that 11.5% of eyes required glaucoma surgery at 1 year after diagnosis of raised IOP, increasing to 50.0% by 5 years. The best-corrected visual acuity at diagnosis of uveitis was 0.26±0.42 logMAR, which remained stable at 0.28±0.65 logMAR at final follow-up visit. Four eyes (5.3%) from four patients fulfilled the definition of blindness by the WHO criteria. The mean cup:disc ratio at final follow-up was 0.4.ConclusionOur cohort of children with raised IOP appeared to have a good outcome overall through aggressive medical and surgical management. Regular long-term follow-up is recommended, and early surgical intervention in eyes with uncontrolled IOP can prevent loss of vision.
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Gosselin, Benoit J., and Louise Davies. "S109 – N-2 MPG in Groin Flaps Subjected to Vein Occlusion." Otolaryngology–Head and Neck Surgery 139, no. 2_suppl (August 2008): P113—P114. http://dx.doi.org/10.1016/j.otohns.2008.05.282.
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Objectives In a prior communication, we showed that ischemic rat groin flaps exposed to the free radical scavenger N-2 mercaptopropionylglycine (MPG) at the time of arterial and venous occlusion had a higher rate of survival than untreated flaps. In this study, the objective is to test the efficacy and timing of administration of MPG in salvaging rat groin flaps subjected to venous occlusion alone. Methods Randomized controlled trial. Main outcome is mean percentage of flap survival at 7 days. 30 mature Sprague-Dawley rats were randomized to 3 groups based on timing of treatment with MPG: 1- flap raised, no MPG, no venous occlusion (sham group); 2- flap raised, no MPG, 10-hour period of venous occlusion (control group); 3- flap raised, MPG after 10 hours venous occlusion (post-reperfusion group). Results There was no statistical difference noted in mean survival of venous occluded flaps when comparing the control and post-reperfusion groups, after 7 days. Specifically, the mean flap survival in the control group at 7 days was 10.9% (median 0%, range 0–100%). The mean flap survival in the post-reperfusion group was 14.6% (median 0%, range 0–100%). The mean flap survival in the sham group was 90.0% (median 100%, range 0–100%). Conclusions Post-reperfusion MPG administration is not helpful for flaps subjected to venous occlusion alone. The free-radical scavenger activity of MPG is potentiated within the tissues prior to vein occlusion. Potential applications for free flap salvage would need further study.
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Brett, B. T., S. C. Smith, C. V. Bouvier, D. Michaeli, D. Hochhauser, B. R. Davidson, T. R. Kurzawinski, et al. "Phase II Study of Anti–Gastrin-17 Antibodies, Raised to G17DT, in Advanced Pancreatic Cancer." Journal of Clinical Oncology 20, no. 20 (October 15, 2002): 4225–31. http://dx.doi.org/10.1200/jco.2002.11.151.
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PURPOSE: The prognosis for advanced pancreatic cancer remains poor. Gastrin acts as a growth factor for pancreatic cancer. We describe the first study of the antigastrin immunogen G17DT in pancreatic cancer. Our aims were to determine the antibody response, safety, tolerability, and preliminary evidence of efficacy of G17DT in advanced pancreatic cancer. PATIENTS AND METHODS: Thirty patients with advanced pancreatic cancer were immunized with three doses of either 100 μg or 250 μg of G17DT. RESULTS: In the whole group, 20 (67%) of 30 patients produced an antibody response. The 250-μg dose resulted in a significantly greater response rate of 82% compared with 46% for the 100-μg group (P = .018). The most significant side effects, seen in three patients, were local abscess and/or fever. The median survival for the whole group from the date of the first immunization was 187 days; median survival was 217 days for the antibody responders and 121 days for the antibody nonresponders. The difference in survival between the antibody responders and nonresponders was significant (P = .0023). CONCLUSION: Patients with advanced pancreatic cancer are able to mount an adequate antibody response to G17DT. The 250-μg dose is superior to the 100-μg dose, and it appears to be generally well tolerated. Antibody responders demonstrate significantly greater survival than antibody nonresponders. Phase III studies are currently underway in order to determine efficacy.
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Grover, Phulwinder K., Rosemary L. Ryall, and Villis R. Marshall. "Effect of Urate on Calcium Oxalate Crystallization in Human Urine: Evidence for a Promotory Role of Hyperuricosuria in Urolithiasis." Clinical Science 79, no. 1 (July 1, 1990): 9–15. http://dx.doi.org/10.1042/cs0790009.
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1. The effect of hyperuricosuria, simulated by increasing the concentration of dissolved urate, on the crystallization of calcium oxalate in human urine was examined. 2. Twenty urine samples were studied. Ten of these, designated type A, spontaneously precipitated calcium oxalate dihydrate crystals upon the addition of a solution of sodium urate solution which raised the median urate concentration from 3.1 to 7.0 mmol/l. 3. Adding dissolved urate to the remaining type B samples raised the median urate concentration from 2.2 to 6.2 mmol/l, but did not cause the precipitation of calcium oxalate. This was induced in these samples by the addition of a standard load of oxalate above an empirically determined metastable limit. 4. In the type B urine samples, the addition of urate decreased the median metastable limit from 125 to 66 μmol of oxalate, trebled the median volume of crystalline calcium oxalate deposited from 35 000 to 105 000 μm3/μl and significantly increased the overall size of the particles precipitated. Calcium oxalate monohydrate was exclusively precipitated, and the individual crystals deposited in the presence of urate were markedly smaller, more numerous, and more highly aggregated than those produced in its absence. 5. These results constitute the most convincing evidence yet obtained that hyperuricosuria may be a powerful promoter of calcium oxalate stone formation.
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Connolly, DJ, J. Cannata, A. Boswood, J. Archer, E. A. Groves, and R. Neiger. "Cardiac troponin I in cats with hypertrophic cardiomyopathy." Journal of Feline Medicine and Surgery 5, no. 4 (August 2003): 209–16. http://dx.doi.org/10.1016/s1098-612x(03)00007-x.
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The molecular structure of cardiac troponin I (cTnI) is highly conserved across mammalian species and assays developed for its measurement in human patients have been validated in a number of veterinary species. A raised concentration of circulating cTnI is a sensitive and specific marker of cardiac myocyte injury. Raised levels have been documented in a variety of cardiac diseases in both human and veterinary patients. This study compared serum cTnI concentrations between 16 cats diagnosed with hypertrophic cardiomyopathy (HCM) using echocardiography and 18 control cats. The results show that cats with HCM have significantly higher concentration of serum cTnI (median 0.95 ng/ml, range 0.2–4.1 ng/ml) than control cats (median <0.2 ng/ml, range <0.2–0.25 ng/ml) [ P<0.0001]. Furthermore in cats with cardiomyopathy a weak correlation was found between the thickness of the left ventricular freewall in diastole measured by ultrasound and serum cTnI concentration (r2=0.28; P=0.036). These results suggest that measurement of serum cTnI concentration may enable cats with cardiomyopathy to be distinguished from normal cats using the assay described here.
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Conti-Ramsden, Frances, Michael McEwan, Rachel Hill, Julie Wade, Georgina Abraham, Olivia Buckeldee, Catherine Williamson, Caroline L. Knight, Joanna Girling, and Lucy C. Chappell. "Detection of additional abnormalities or co-morbidities in women with suspected intrahepatic cholestasis of pregnancy." Obstetric Medicine 13, no. 4 (September 2, 2019): 185–91. http://dx.doi.org/10.1177/1753495x19868873.
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Background Current guidelines recommend viral, autoimmune, coagulation and liver ultrasound testing in intrahepatic cholestasis of pregnancy to exclude alternative diagnoses. Methods Electronic health records were searched for investigations and diagnoses in women with raised bile acid concentrations (>10 µmol/L) between January 2016 and December 2017 at two UK maternity units. Results Five hundred and thirty-one women had a raised bile acid concentration (median (IQR): 18 (13–32 µmol/L)) at a median gestation of 35.1 (IQR 31.8–37.0) weeks. Out of 531 women, 250 (47.1%) had full virology, autoimmune and ultrasound tests, and 348 (65.5%) had coagulation performed. Positive hepatitis B and C results were previously known. No new Epstein–Barr virus, cytomegalovirus or hepatitis A diagnoses were made. There were 11 positive autoimmune results, but no new diagnoses. No woman had an unexplained prolonged prothrombin time. No ultrasound liver ( n = 38) or gallbladder ( n = 85) abnormalities were of acute clinical significance. Conclusion Intrahepatic cholestasis of pregnancy investigations provided no new diagnoses that influenced clinical management during pregnancy.
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Sinha, T. P., S. Bhoi, M. Rodha, A. Bhasin, and S. Kumar. "(P2-73) Ocular Nerve Sheath Diameter for Evaluation of Raised Intracranial Pressure in Patients Presenting to the Emergency Department - A Prospective, Observational Study." Prehospital and Disaster Medicine 26, S1 (May 2011): s159. http://dx.doi.org/10.1017/s1049023x11005176.
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BackgroundUltrasonography of optic nerve sheath diameter (ONSD) may be useful in detecting raised intracranial pressure (ICP) in head injury (HI). There is limited data from India.ObjectiveThe objective of this study was to evaluate the utility of measuring ONSD for diagnosis of raised intracranial pressure in HI victims in the emergency department.MethodsFifty-two HI patients presenting between February to August 2009 were included, A CT head scan was performed and simultaneous ocular ultrasound was done by an emergency physician who had underwent goal-directed training in ophthalmic sonography by a linear probe of 10 MHz. An ONSD greater than > 5 mm for patients > 15 years of age, 4.5 mm for 1–15 years of age, and 4 mm for infants were considered abnormal. The two modalities of diagnosis were compared.ResultsThe median age was 30 years (Range = 0.25–72 years). A total of 90.4% were male and 9.6% were female. A total of 71.2% had severe HI, 19.2% had moderate HI, and 9.6% had mild HI. A raised ICP based on CT findings was present in 42 (80.8%) patients. Mean optic nerve diameter in patients with raised ICP was 5.11 + 1.56 mm compared to 5.04 + 1.6 mm in patients with no features of raised ICP. Sensitivity and specificity of ONSD as a screening test for detection of raised intracranial pressure were 57.1% and 40%, respectively with a positive predictive value and negative predictive value of 80% and 18.1%, respectively.ConclusionsThe evaluation of the ONSD diameter is a simple and non-invasive potential tool in initial assessment of raised intracranial pressure.
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Kim, Kyung Min, Mitsuru Saito, Grant G. Schultz, and Dennis L. Eggett. "Evaluating Safety Impacts of Access Management Alternatives with the Surrogate Safety Assessment Model." Transportation Research Record: Journal of the Transportation Research Board 2672, no. 17 (May 14, 2018): 120–28. http://dx.doi.org/10.1177/0361198118773505.
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In a traditional safety impact analysis, it is necessary to have crash data on existing roadway conditions and a few years must pass before accumulating additional crash data to evaluate the safety impact of an improvement. This is a time-consuming approach and there remains uncertainty in the crash data integrity. The surrogate safety assessment model (SSAM) was developed for resolving these issues. With SSAM, a conflict analysis is performed in a simulated environment. A planned improvement alternative is modeled and no physical installation of the alternative is needed. This study evaluated if SSAM can be used to assess the safety of a highway segment in terms of the number and type of conflicts and to compare the safety effects of multiple access management alternatives. An evaluation of the effect of converting a two-way left-turn lane (TWLTL) into a raised median on a section of an urban street was performed using SSAM working on VISSIM simulation’s trajectory files. The analysis showed that a raised median would be much safer than a TWLTL median for the same level of traffic volume, with approximately 32 to 50 percent reduction in the number of crossing conflicts. The analysis showed that about 34,000 to 38,000 veh/day would be the demand level where the median conversion is recommended for the four-lane study section. The study concluded that the combination of a simulation software program with SSAM could be a viable surrogate analysis approach for evaluating and comparing the safety effects of multiple access management alternatives.
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Wilson, A. W., C. J. C. Kirk, and A. W. Goode. "The effect of weight loss, operation and parenteral nutrition on fat clearance in patients with colorectal cancer." Clinical Science 73, no. 5 (November 1, 1987): 497–500. http://dx.doi.org/10.1042/cs0730497.
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1. Fractional fat clearance rate (K2) in 21 patients with colorectal cancer was studied using the intravenous fat tolerance test. 2. K2 showed a negative correlation with weight change(r = −0.736, P < 0.001) with the tumour in situ. 3. Fourteen patients were retested 12 weeks after curative resection of their tumours. Eight of the fourteen patients had raised K2 values pre-operatively; in all these the K2 values were reduced post-operatively (pre-operative median 3.94%/min, range 2.63–7.20%/min, postoperative median 2.31%/min, range 1.57–5.36%/min, P < 0.01 by Wilcoxon's signed rank test). A high preoperative K2 value was associated with a large reduction in K2 post-operatively (r = − 0.844, P < 0.001). 4. Seven patients with relatively high K2 values received a pre-operative course of intravenous nutrition after which K2 values were significantly reduced (pre-feeding median 7.20%/min, range 4.72–12.12%/min, post-feeding median 4.44%/min, range 2.17–6.83%/min, P < 0.05).
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Brown, J. S., P. C. Wheeler, K. T. Boyd, M. R. Barnes, and M. J. Allen. "Chronic exertional compartment syndrome of the forearm: a case series of 12 patients treated with fasciotomy." Journal of Hand Surgery (European Volume) 36, no. 5 (February 21, 2011): 413–19. http://dx.doi.org/10.1177/1753193410397900.
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Chronic exertional compartment syndrome of the forearm is rare in the published literature. We report the outcome of a series of 12 patients treated with fasciotomy over a 14 year period. All patients underwent dynamic intra-compartmental pressure testing using a slit catheter technique before surgery. Raised intra-compartmental pressures on exercise, typical symptoms and the absence of other diagnoses were criteria for offering surgical intervention. The superficial flexor, deep flexor and extensor compartments were released. Median follow-up was 9.5 years (range 7 months to 12 years). Median patient-reported percentage improvement after surgery was 88% (range 0%–100%). Median time to return to full activity was 9 weeks. Eleven out of 12 patients were satisfied, very satisfied or extremely satisfied with the outcome of surgery. Fasciotomy can be an effective treatment for chronic exertional compartment syndrome of the forearm.
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Athanasou, James A. "Acquired Brain Injury and Return to Work in Australia and New Zealand." Australian Journal of Career Development 12, no. 1 (April 2003): 58–65. http://dx.doi.org/10.1177/103841620301200108.
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The purpose of this paper is to review the return-to-work rates following acquired brain injury in Australia and New Zealand (ANZ). The reported return-to-work rates for the nine ANZ studies varied from 29% to 64% with a median of 46% and for 23 international studies the return-to-work rates varied from 19% to 88% (median also 46%). When the results of all ANZ studies were combined to form a total of 1010 subjects then the overall return-to-work rate was 44%. A number of methodological concerns were raised and it was estimated that only about 7–10% of persons with an acquired brain injury are likely to return to the same job.
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Tursi, Antonio, Claudio Cassieri, Raffaele Colucci, Walter Elisei, Marcello Picchio, and Giovanni Brandimarte. "Budesonide MMX Is Effective in Patients Having Persistent Symptoms and Raised Fecal Calprotectin Following Treatments for Diverticular Disease." Journal of Gastrointestinal and Liver Diseases 28 (January 8, 2020): 45–48. http://dx.doi.org/10.15403/jgld-559.
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Background and Aim: Although rifaximin and mesalazine seem to be effective in treating the majority of people suffering from diverticular disease (DD), some patients still experience symptoms following those treatments. The aim of this study was to assess the efficacy of budesonide MMXTM in managing symptoms and raised fecal calprotectin (FC) in patients with endoscopic diagnosis of DD and not responding to standard treatments.
Methods: We performed a post-hoc analysis of the patients enrolled in the DICA prospective study. All patients were at the first diagnosis of DD, scored according to DICA classification. We assessed abdominal pain, meteorism, constipation and diarrhea (scored from 0 to 10) and FC expression at baseline and after six months. Patients were treated with budesonide MMXTM for 4 weeks (9 mg/day for 2 weeks, followed by 9 mg every other day for further 2 weeks), followed by mesalazine 2.4 grams/day for further 5 months.
Results: We studied 24 patients (18 females and 6 males, median age 64, inter quartile range (IQR): 57.5- 73.5), previously treated with mesalazine and/or rifaximin (equally subdivided between DICA 2 and DICA 3). At 6-month follow-up, a significant reduction of all symptoms assessed was observed (abdominal pain and meteorism: p<0.001; constipation: p=0.007; diarrhea: p=0.009). Median (IQR) FC level was 244.5 (171.5- 322.0) μg/g at baseline and 51.0 (IQR: 35.5-61.5) μg/g (p< 0.001) after 6 months. No side effects were recorded.
Conclusions: Treatment with budesonide MMXTM seems to be effective in obtaining symptoms’ control and dropping of FC in patients with DD and not responding to standard treatments.
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Kinoshita, Osamu, Masayoshi Nakanishi, Yasutoshi Murayama, Yoshiaki Kuriu, Yukihito Kokuba, and Eigo Otsuji. "Flattened Tumor Requires a More Careful Attention for Residual Distal Cancer Spread in Locally Advanced Lower Rectal Carcinoma after Chemoradiotherapy." Digestive Surgery 32, no. 3 (2015): 159–65. http://dx.doi.org/10.1159/000371586.
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Background/Aims: Limited data are available on distal resection margin (DRM) for lower rectal cancer (LRC) after preoperative chemoradiotherapy (pre-CRT); thus, we aimed to establish the criteria for DRMs as estimated by the macroscopic tumor appearance. Methods: This was a pathological study using whole-mount sections that included the entire circumference of tumor. Residual cancer spread located most distally from the macroscopic tumor border was mainly evaluated. Results: A retrospective cohort of 42 consecutive patients with locally advanced LRC after pre-CRT was enrolled, and 38 patients were eligible for this study. According to the macroscopic tumor appearance, 18 patients had raised-type and 20 had flattened-type tumors. Patients with flattened-type tumors were closely associated with histopathological regression grade. Residual distal cancer spread (RDCS) was located ≤4.0 mm (median, 0.1 mm) in the raised-type tumors and ≤17.1 mm (median, 4.2 mm) in the flattened-type tumors. RDCS in flattened-type tumors was distributed diffusely and distally from the tumor border (p = 0.022). Conclusion: Even in patients evaluated as pre-CRT responders, flattened tumors often accompanied distally located residual cancer that had spread from the tumor border and require more careful attention in order to ensure cancer clearance.
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Ahmed, Ashar E., Derek Lowe, Jennifer A. Kirton, Mary R. O’Brien, Ayren Mediana, Helen Frankland, Hannah Bruce, Tom Kennedy, Simon N. Rogers, and Robert J. Moots. "Development of a Rheumatology-specific Patient Concerns Inventory and Its Use in the Rheumatology Outpatient Clinic Setting." Journal of Rheumatology 43, no. 4 (February 15, 2016): 779–87. http://dx.doi.org/10.3899/jrheum.150068.
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Objective.Successful management of rheumatic conditions involves increasing complexity of care. Delivering this in a holistic way is a growing challenge. The aim of our study was to develop a Patient Concerns Inventory (PCI) and assess it in the rheumatology clinic setting.Methods.This observational exploratory study occurred with 2 phases. In phase I, the PCI was developed after a systematic literature search, expert opinion, and 3 patient focus group discussions. In phase II, the PCI was piloted in a general rheumatology clinic.Results.Fifty-four patients were assessed in the pre-PCI group and 51 in the post-PCI group. Median (IQR) duration of consultation was 8 min (5–14) without PCI and 15 min (10–20) with PCI. The pre-PCI group raised 335 concerns from 50 patients, median (IQR) of 5 (3–10) per patient, rising post-PCI to 521 concerns, median (IQR) of 9 (5–16) from 51 patients, p = 0.002. Additional concerns predominantly arose from “physical and functional well-being” and “social care and well-being” domains. Most patients rated their experience with their doctor in the consultation as excellent or outstanding across all 11 questions in the questionnaire, both before and after the introduction of the PCI to the clinic setting.Conclusion.The PCI is a useful holistic needs assessment tool for rheumatology clinics. Although its use may initially prolong the consultation slightly, patients can raise a significantly higher number of concerns, which does not occur at the expense of patient satisfaction. This may help in identifying areas of unmet needs that previously went unnoticed.
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Kumar, Sharma Sushil, and Rastogi Parag. "Factors of raised C-reactive protein as a potential determinant of Diabetic patients and Risk factor for Coronary Heart Disease." International Journal Of Medical Science And Clinical Invention 5, no. 3 (March 20, 2018): 3656–61. http://dx.doi.org/10.18535/ijmsci/v5i3.18.
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Elevated C-reactive protein (CRP) levels have previously been described before the onset of type 1 diabetes and gestational diabetes. We hypothesized that inflammation, as reflected by elevated CRP levels, can help predict development of islet autoimmunity or type 1 diabetes. The outcome of this research is to establish potential determinants of raised CRP concentrations in type 1 diabetic patients. Sensitive assay showed ‘low-level’ CRP concentrations in 147 type 1 patients (83M, 64F, median age 30 years, range 13–67). We have done step by step variant examination to relate these CRP levels to known cardiovascular risk factors and demographic data. Only four patients had established Coronary Heart Disease (median CRP 3.43 mg/l vs. 0.85 mg/l, p=0.035). In subjects without overt CHD, multivariate analysis revealed increase in subject age (p=0.0027), BMI (p=0.001) and HbA1 (p=0.013) to be associated with a higher CRP concentration, as was female sex (p=0.025) and a history of CHD in a first-degree relative (p=0.018, n=58). Elevated CRP levels were positively associated with cardiovascular and renal risk factors: age, body mass index, blood pressure, serum cholesterol level, smoking, plasma glucose level and elevated urinary albumin excretion and presence of hypertension were unrelated. This research work advises that certain of the risk factors connected with CHD in type 1 patients are also individually predictive of high CRP concentrations. The reasons for this, and whether intervention would prove valuable, require further analysis
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Pellicori, Pierpaolo, Jufen Zhang, Joe Cuthbert, Alessia Urbinati, Parin Shah, Syed Kazmi, Andrew L. Clark, and John G. F. Cleland. "High-sensitivity C-reactive protein in chronic heart failure: patient characteristics, phenotypes, and mode of death." Cardiovascular Research 116, no. 1 (July 26, 2019): 91–100. http://dx.doi.org/10.1093/cvr/cvz198.
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Abstract Aims Plasma concentrations of high-sensitivity C-reactive protein (hsCRP) are often raised in chronic heart failure (CHF) and might indicate inflammatory processes that could be a therapeutic target. We aimed to study the associations between hsCRP, mode and cause of death in patients with CHF. Methods and results We enrolled 4423 patients referred to a heart failure clinic serving a local population. CHF was defined as relevant symptoms or signs with either a reduced left ventricular ejection fraction <40% or raised plasma concentrations of amino-terminal pro-B type natriuretic peptide (NT-proBNP >125 pg/mL). The median [interquartile range (IQR)] plasma hsCRP for patients diagnosed with CHF (n = 3756) was 3.9 (1.6–8.5) mg/L and 2.7 (1.3–5.1) mg/L for those who were not (n = 667; P < 0.001). Patients with hsCRP ≥10 mg/L (N = 809; 22%) were older and more congested than those with hsCRP <2 mg/L (N = 1117, 30%). During a median follow-up of 53 (IQR 28–93) months, 1784 (48%) patients with CHF died. Higher plasma hsCRP was associated with greater mortality, independent of age, symptom severity, creatinine, and NT-proBNP. Comparing a hsCRP ≥10 mg/L to <2 mg/L, the hazard ratio for all-cause mortality was 2.49 (95% confidence interval 2.19–2.84; P < 0.001), for cardiovascular (CV) mortality was 2.26 (1.91–2.68; P < 0.001), and for non-CV mortality was 2.96 (2.40–3.65; P < 0.001). Conclusion In patients with CHF, a raised plasma hsCRP is associated with more congestion and a worse prognosis. The proportion of deaths that are non-CV also increases with higher hsCRP.
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van Staaveren, Nienke, Emily M. Leishman, Sarah M. Adams, Benjamin J. Wood, Alexandra Harlander-Matauschek, and Christine F. Baes. "Housing and Management of Turkey Flocks in Canada." Animals 10, no. 7 (July 8, 2020): 1159. http://dx.doi.org/10.3390/ani10071159.
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An increased understanding of the turkey sector and how farmers manage flocks can help maintain and improve the health and welfare of turkeys. We conducted a cross-sectional survey among turkey farmers in Canada to gain information regarding general farm characteristics, housing aspects (incl. lighting, ventilation), litter management, feed and water management, flock characteristics, and flock health management. The survey was distributed to 500 farmers through the Turkey Farmers of Canada in April–December 2019. A total of 83 final responses (response rate approx. 20%) were used for a descriptive analysis to determine the frequency of housing and management practices (77 commercial flocks, 6 breeder flocks). Hen flocks (n = 53) had a median age of eight weeks (IQR: 7–12 weeks) and tom flocks (n = 30) had a median age of 12 weeks (IQR: 9–14 weeks). Turkey flocks within Canada are typically kept in indoor barn systems on a concrete floor (87.5%), with bedding (e.g., straw, wood shavings) provided (100%). The majority followed a brood and move growing system (68.8%), and a large proportion of farmers indicated that they raised turkeys under the ‘Raised Without Antibiotics/Antibiotic Free’ or the ‘Responsible Use of Antibiotics’ certification (70.5%). Possible room for improvement could be found in terms of litter management and biosecurity practices, however, further research is needed to make clear recommendations.
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Dubost, Clément, Agnès Le Gouez, Viridiana Jouffroy, Sandrine Roger-Christoph, Dan Benhamou, Frédéric J. Mercier, and Thomas Geeraerts. "Optic Nerve Sheath Diameter Used as Ultrasonographic Assessment of the Incidence of Raised Intracranial Pressure in Preeclampsia." Anesthesiology 116, no. 5 (May 1, 2012): 1066–71. http://dx.doi.org/10.1097/aln.0b013e318246ea1a.
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Background In some cases of severe preeclampsia/eclampsia, brain imaging displays signs compatible with raised intracranial pressure. We aimed to estimate the incidence of raised intracranial pressure in preeclampsia using ocular ultrasonography. Methods Optic nerve sheath diameter (ONSD) measurements were compared in 26 preeclamptic and 25 healthy pregnant women. For each optic nerve, two measurements were made (transverse plane and sagittal plane) using a 7.5 MHz ultrasound linear probe. Preeclamptic patients were followed-up until postpartum day 7. Results Median ONSD values were significantly greater in preeclamptic patients compared with healthy pregnant women at delivery (5.4 mm (95% CI: 5.2, 5.7) vs. 4.5 mm (95% CI: 4.3, 4.8), P < 0.0001). At delivery, 5/26 (19%) of preeclamptic patients had ONSD values above 5.8 mm (value associated in the literature with 95% risk of raised intracranial pressure) whereas none of the healthy pregnant group had such high ONSD values. In the preeclamptic group, ONSD decreased after the third postpartum day. ONSD values at day 7 were not significantly different from those obtained in the normal pregnancy group (P = 0.10). Conclusion In about 20% of preeclamptic patients, ONSD reaches values compatible with intracranial pressure above 20 mmHg. Further work is needed to confirm this incidence and to better understand the diagnostic and therapeutic usefulness of this easy-to-do monitoring technique.
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Nguyen, Ryan, Nasser H. Hanna, and Laura Vater. "Crowdfunding for lung cancer costs." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e18340-e18340. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18340.
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e18340 Background: Online crowdfunding, where individuals create campaigns to solicit donations, has grown as an avenue to combat the financial toxicities of cancer. The online platform GoFundMe hosts more than 80% of the global market for crowdfunding and has raised over US $5 billion from more than 50 million donors. While medical expenses are the leading cause of crowdfunding campaigns, limited research is available on the use of crowdfunding for cancer costs. Further, no studies have evaluated the use of crowdfunding for patients with lung cancer. Methods: In January 2019, we reviewed the first 200 consecutive campaigns that resulted for “lung cancer” on GoFundMe. Campaigns were included for analysis if their description stated funds were to be used for medical costs for a patient with lung cancer in the United States. Standardized data was collected from each campaign. Descriptive statistics were used to aggregate results. Multivariable linear regression analysis were performed to examine predictors of funds raised, adjusting for campaign duration. Results: The 157 included campaigns raised a total of US $1.2 million (mean $8,364) from 11,919 donors (median 53). Compared to a similar 2018 study, our study showed lung cancer campaigns raised less than breast cancer (mean $16,026) but more than prostate cancer (mean $1,449) campaigns. Nine campaigns that were seeking funds for alternative treatment raised a total of $119,660 (mean $13,296). Narratives of financial need that were significantly associated with greater funds raised were family financial need (+$7,416), medical costs not covered by insurance (+$7,369), and the campaign stating the patient was a never-smoker (+$8,162) (all P values < 0.05). Conclusions: Lung cancer has received less research funding relative to other cancer types and our study suggests a similar disparity with crowdfunding for medical costs. The “blame-the-victim” attitude that contributes to this funding disparity also exists within lung cancer crowdfunding as evidenced by the significantly greater amount of funds raised for campaigns that explicitly stated the patient was a non-smoker. Efforts to study crowdfunding for cancer costs should address the ethical implications of exacerbating funding disparities and funding for alternative treatments.
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Rahman, Md Anisur, Md Mostarshid Billah, Palash Mitra, Md Emtiaz Hossan, Md Jakir Hossain, Wasim Md Mohosin Ul Haque, and Md Abul Mansur. "Raised Arterial Pressure and Microalbuminuria in Type 2 Diabetic Subjects with Familial Hypertension." Bangladesh Critical Care Journal 4, no. 1 (June 1, 2016): 14–18. http://dx.doi.org/10.3329/bccj.v4i1.27973.
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Background and Aims : Microalbuminuria is claimed to be an early marker of nephropathy in type 2 diabetes.The raised arterial pressure is an important factor in the progression of diabetic nephropathy. There is a significant correlation between blood pressure and the progression of albuminuria in both type 1 and type 2 diabetes. This study in Bangladeshi type 2 diabetic patients was to evaluate whether microalbuminuria and raised arterial pressure are influenced by familial predisposition to hypertension.Methods : Sixty three newly diagnosed Bangladeshi type 2 diabetic patients were investigated. The diabetic subjects were divided into two groups as diabetes with family history of hypertension (n=37) and diabetes without family history of hypertension (n=26). Diabetic subjects were further divided into normotensive (n= 46) and hypertensive (n= 17); diabetic normoalbuminuric (n 44) and diabetic microalbuminuric (n 19) subgroups. Serum glucose was measured by glucose-oxidase; blood urea, serum creatinine and urinary creatinine by enzymatic-colorimetric method and urinary albumin by immunoturbidimetry method.Results : systolic blood pressure (SBP), diastolic blood pressure (DBP) and microalbuminuria were significantly elevated in diabetic subjects with familial predisposition to hypertension when compared to diabetic subjects without familial predisposition to hypertension [SBP (127±16 vs 110±14) mmHg P= 0.001; DBP (81±9 vs 72±11) mmHg P= 0.001; Microalbuminuria 2.23(0.28-9.43) vs 1.52(.29-3.91) mg/mmol p<0.03]. When diabetic normotensive subjects were compared with diabetic hypertensive subjects for microalbuminuria, no significant difference was found among themselves [median (range) 1.67(0.17-8.62) vs 1.70(.28-9.43) mg/mmol p = NS]. Comparison of blood pressure was found no significant difference between diabetic normoalbuminuric and diabetic microalbuminuric subjects [systolic blood pressure (117±17 vs 125±17) mmHg p= NS ; diastolic blood pressure (76±11 vs 82±10) mmHg p= NS ].Conclusion : Microalbuminuria, a marker of early diabetic nephropathy and raised arterial pressure, a progression factor of nephropathy are more influenced by familial predisposition to hypertension in diabetic population irrespective of presence or absence of microalbuminuria and hypertension.Bangladesh Crit Care J March 2016; 4 (1): 14-18
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Bryan, Larry E., Sallene Wong, Don E. Woods, David AB Dance, and W. Chaowagul. "Passive Protection of Diabetic Rats with Antisera Specific for the Polysaccharide Portion of the Lipopolysaccharide Isolated fromPseudomonas pseudomallei." Canadian Journal of Infectious Diseases 5, no. 4 (1994): 170–78. http://dx.doi.org/10.1155/1994/856850.
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Polyclonal and monoclonal antisera raised to tetanus toxoid-conjugated polysaccharide of lipopolysaccharide (lps) and purifiedlpsofPseudomonas pseudomalleithat reacted with a collection of 41 strains of this bacterium from 23 patients are described. The common antigen recognized by these sera was within the polysaccharide component of thelpsof the cells. The sera were specific forP pseudomalleiin that none of 37 strains of other bacteria, including 20 Gram-negative and three Gram-positive species, were recognized, although cross-reaction occurred using the anticonjugate serum with some strains ofPseudomonas cepaciaserotype A, a closely related bacterium. Passive protection studies using a diabetic rat model ofP pseudomalleiinfection showed that partially purified rabbit polyclonal and mouse monoclonal antisera were protective when the median lethal dose was raised by four to five orders of magnitude. The wide distribution of the polysaccharide antigen among isolates ofP pseudomalleiused in this study and the protective role of antibody to the conjugated polysaccharide antigen suggest potential as a vaccine.
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Lado-Abeal, J., J. Rodriguez-Arnao, J. D. C. Newell-Price, L. A. Perry, A. B. Grossman, G. M. Besser, and P. J. Trainer. "Menstrual Abnormalities in Women with Cushing’s Disease Are Correlated with Hypercortisolemia Rather Than Raised Circulating Androgen Levels." Journal of Clinical Endocrinology & Metabolism 83, no. 9 (September 1, 1998): 3083–88. http://dx.doi.org/10.1210/jcem.83.9.5084.
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Menstrual irregularity is a common complaint at presentation in women with Cushing’s syndrome, although the etiology has been little studied. We have assessed 45 female patients (median age, 32 yr; range, 16–41 yr) with newly diagnosed pituitary-dependent Cushing’s syndrome. Patients were subdivided into 4 groups according to the duration of their menstrual cycle: normal cycles (NC; 26–30 days), oligomenorrhea (OL; 31–120 days), amenorrhea (AM; >120 days), and polymenorrhea (PM; <26 days). Blood was taken at 0900 h for measurement of LH, FSH, PRL, testosterone, androstenedione, dehydroepiandrosterone sulfate, estradiol (E2), sex hormone-binding globulin (SHBG), and ACTH; cortisol was sampled at 0900, 1800, and 2400 h. The LH and FSH responses to 100 μg GnRH were analyzed in 23 patients. Statistical analysis was performed using the nonparametric Mann-Whitney U and Spearman tests. Only 9 patients had NC (20%), 14 had OL (31.1%), 15 had AM (33.3%), and 4 had PM (8.8%), whereas 3 had variable cycles (6.7%). By group, AM patients had lower serum E2 levels (median, 110 pmol/L) than OL patients (225 pmol/L; P < 0.05) or NC patients (279 pmol/L; P < 0.05), and higher serum cortisol levels at 0900 h (800 vs. 602 and 580 nmol/L, respectively; P < 0.05) and 1800 h (816 vs. 557 and 523 nmol/L, respectively; P < 0.05) and higher mean values from 6 samples obtained through the day (753 vs. 491 and 459 nmol/L, respectively; P < 0.05). For the whole group of patients there was a negative correlation between serum E2 and cortisol at 0900 h (r = −0.50; P < 0.01) and 1800 h (r = −0.56; P < 0.01) and with mean cortisol (r = −0.46; P < 0.05). No significant correlation was found between any serum androgen and E2 or cortisol. The LH response to GnRH was normal in 43.5% of the patients, exaggerated in 52.1%, and decreased in 4.4%, but there were no significant differences among the menstrual groups. No differences were found in any other parameter. In summary, in our study 80% of patients with Cushing’s syndrome had menstrual irregularity, and this was most closely related to serum cortisol rather than to circulating androgens. Patients with AM had higher levels of cortisol and lower levels of E2, while the GnRH response was either normal or exaggerated. Our data suggest that the menstrual irregularity in Cushing’s disease appears to be the result of hypercortisolemic inhibition of gonadotropin release acting at a hypothalamic level, rather than raised circulating androgen levels.
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Bawaskar, Himmatrao Saluba, Parag Himmatrao Bawaskar, and Pramodini Himmatrao Bawaskar. "RBC acetyl cholinesterase: A poor man’s early diagnostic biomarker for familial alzheimer’s and Parkinson’s disease dementia." Journal of Neurosciences in Rural Practice 6, no. 01 (January 2015): 033–38. http://dx.doi.org/10.4103/0976-3147.143187.
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ABSTRACT Objective: Analysis of red blood cell acetyl cholinesterase (AChE) in a familial Alzheimer’s diseases (AD) Parkinson’s disease dementia (PDD) and their first generation. Setting: General hospital, Mahad district, Raigad. Patients and Methods: Clinically diagnosed patients of AD and PDD and their asymptomatic relatives. Their blood was collected in EDTA tube and transferred to laboratory at Mumbai. Result: Median red blood cell (RBC) cholinesterase levels amongst PDD, their first generation asymptomatic relatives, familial AD, asymptomatic relatives of AD, healthy controls, farmers exposed to pesticides (positive control) and other neurological condition without dementia (hypertension with TIA 1, sub-dural hematoma 2, hypothyroid 1, non-familial unilateral parkinsonism without dementia 3, writers cramps 2, hyponitremia 1 and cerebral palsy with non-fluent aphasia 1). Median values of RBC AChE were 19086.78 U/L, 15666.05 U/L, 9013.11 U/L, 7806.19 U/L, 14334.57 U/L, 9785.05 U/L and 13162.60 U/L, respectively. As compared to controls, RBC AChE levels were statistically significant among PDD (P = 0.004) and significantly lowered among familial AD patients (P = 0.010), relatives of patients (P = 0.010). Interpretations: Below the normal RBC AChE level is a potential biomarker in asymptomatic relatives of familial AD patients. RBC AChE is raised than normal level in patients suffering from PDD, where AChE inhibitors are helpful. However, RBC AChE level below the normal where AChE inhibitor may not be effective.
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Tran, Anna Thi Huyen, Paula Mandall, Ric Swindell, Peter Hoskin, David Bottomley, and James Wylie. "Biochemical outcomes for patients with intermediate-risk, organ-confined prostate cancer treated with I-125 interstitial brachytherapy monotherapy." Journal of Clinical Oncology 30, no. 5_suppl (February 10, 2012): 192. http://dx.doi.org/10.1200/jco.2012.30.5_suppl.192.
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192 Background: Treatment with low dose rate brachytherapy (LDR-BT) monotherapy is well established for low risk prostate cancer. The routine use of LDR-BT in intermediate risk (IR) is more controversial and is often combined with additional external beam radiotherapy (EBXRT). We report the biochemical outcome of a large cohort of patients with IR disease treated with LDR-BT monotherapy. Methods: A multi-institutional prospective database identified 615 patients with IR prostate cancer treated with I-125 interstitial BT between 2003–2007. IR was defined using Memorial Sloan-Kettering Cancer Centre (MSKCC) definition of either T2b, or Gleason score (GS) 7 or raised initial PSA (iPSA) 10.1-20ng/ml. Patients receiving additional EBXRT were excluded. Biochemical failure was defined by both ASTRO (3 rises past nadir) and Phoenix criteria (nadir plus 2). Kaplan-Meier methods were used to estimate biochemical no evidence of disease rates (bNED) and univariate analyses used to identify potential prognostic factors. Results: The median age was 64 years (range 49–82). Forty-three patients had stage T2b, 180 had iPSA 10.1-20 and 392 had GS 7 disease. Only 108 received androgen deprivation therapy (ADT) prior to implant. Median follow up was 5.0 years. The 5-year bNED rates (95% confidence interval) by ASTRO are 85.5% (82.0–88.3%) and for Phoenix 83.7% (80.0–86.7%). Use of ADT, GS 3+4 versus 4+3, and dosimetric indices were not significant prognostic variables. When stratified by risk factor (T2b, GS7 or raised iPSA) raised iPSA correlated to poorer outcome only by Phoenix criteria (by Phoenix p=0.001, by ASTRO p=0.311). Conclusions: We have demonstrated good biochemical control for IR patients treated with LDR-BT alone. No additional benefit was seen with the use of ADT. We believe LDR-BT alone is an effective treatment option in selected IR prostate cancer patients with comparable outcome to other treatment modalities such as surgery or EBXRT.
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GONZÁLEZ-MORENO, ALEJANDRA, SANTIAGO BORDERA, and HUGO DELFIN. "A new species of Endasys Förster (Hymenoptera, Ichneumonidae, Cryptinae) from Mexico." Zootaxa 2648, no. 1 (October 18, 2010): 61. http://dx.doi.org/10.11646/zootaxa.2648.1.4.
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A new species of Endasys Förster (Ichneumonidae, Cryptinae), E. gibbosus sp. nov., is described. Material was collected with Malaise traps functioning along one year in a dry forest in southeastern Mexico. The new species is similar to E. julianus Luhman, 1990 and E. subclavatus Say, 1835, but differs by having a strongly raised median lobe of mesonotum, with rugulose sculpturing and coarse dense punctures, metapleuron aerolate-rugose, area superomedia with strongly elevated longitudinal wrinkles, and malar space very reduced. A complement is provided to Luhman’s key to the Nearctic species of Endasys.
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Ono, Hiroshi, and Linda Lillakas. "Proximal Stimulus for Brewster’s Phenomenon is Equivalent to That of Wheatstone’s Stereogram." Perception 46, no. 5 (January 6, 2017): 632–37. http://dx.doi.org/10.1177/0301006616683478.
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We examined Brewster’s perceptual phenomenon that is produced by the same binocularly equivalent proximal stimulus as Wheatstone’s stereogram. We then constructed and observed the perceptual effect created by another distal stimulus that also created an equivalent binocular proximal stimulus. All three stimulus situations produced the appearance of a tilted line in the median plane which is consistent with Hering’s rule that the average of the two local signs and binocular eye position determine visual direction. The characteristics of the proximal stimulus are also relevant to the question raised by Helmholtz regarding the empirical vertical horopter.
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Hoy, Kyle A., Irene M. Xiarchos, Timothy W. Kelsey, Kathryn J. Brasier, and Leland L. Glenna. "Marcellus Shale Gas Development and Farming." Agricultural and Resource Economics Review 47, no. 3 (February 5, 2018): 634–64. http://dx.doi.org/10.1017/age.2017.28.
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We study changes in farming in the Marcellus region associated with unconventional natural gas drilling activity. Due to concerns raised by the popular press, we consider 18 different county-level agricultural variables. While we find no significant changes in the number of farms or land in farms in drilling counties relative to non-drilling counties, there is an increase in median farm sizes, indicating potential consolidation in drilling counties. Despite anecdotal evidence suggesting a transition away from dairy farming to either beef or hay production, we find no support for this at the county level.
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HUANG, Y., K. XU, D. F. REN, J. AI, H. JI, A. H. GE, C. J. BAO, et al. "Probable longer incubation period for human infection with avian influenza A(H7N9) virus in Jiangsu Province, China, 2013." Epidemiology and Infection 142, no. 12 (February 24, 2014): 2647–53. http://dx.doi.org/10.1017/s0950268814000272.
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SUMMARYHuman infection with the emerging avian influenza A(H7N9) virus in China in 2013 has raised global concerns. We conducted a retrospective descriptive study of 27 confirmed human influenza A(H7N9) cases in Jiangsu Province, to elaborate poultry-related exposures and to provide a more precise estimate of the incubation periods of the illness. The median incubation period was 6 days (range 2–10 days) in cases with single known exposure and was 7·5 days (range 6·5–12·5 days) in cases with exposures on multiple days, difference between the two groups was not significant (Z = −1·895, P = 0·058). The overall median incubation period for all patients was estimated to be 7·5 days (range 2–12·5 days). Our findings further highlight the necessity for public health authorities to extend the period of medical surveillance from 7 days to 10 days.
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Kasuya, Nao, Tetsuya Sanda, Katsuyuki Hamasaki, Shigeki Dan, and Shuichi Kitada. "Upper thermal tolerance of early juveniles of six terrestrial hermit crab species." Animal Biology 70, no. 1 (2020): 39–53. http://dx.doi.org/10.1163/15707563-20191119.
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Abstract Because temperature strongly influences biological processes of ectotherms, they must adapt to the thermal conditions of their habitats. We evaluated the upper thermal tolerance of early juveniles of six terrestrial hermit crab species in the family Coenobitidae (genera Birgus and Coenobita), B. latro, C. brevimanus, C. cavipes, C. purpureus, C. rugosus, and C. violascens, that occur in the northwestern Pacific region of Japan. A total of 30 laboratory-raised juveniles (approximately 1 mm in shield length) carrying gastropod shells were individually stocked in small plastic cups with sandy bottoms in temperature-controlled incubation chambers at ∼27°C. The temperature was increased by 1°C every 48 h, and the juveniles were observed until all the crabs had died. The median upper lethal temperature was estimated as the temperature at which 50% of the test juveniles had died. The median upper lethal temperature estimates significantly varied among the species. Coenobita violascens, which mainly occurs in mangrove estuaries with lower thermal conditions, had the lowest median upper lethal temperature values. The median upper lethal temperature values estimated for B. latro were slightly lower than those for the other Coenobita species, probably reflecting its cryptic nature in natural habitats during the juvenile stage. The most northerly distributed species, C. purpureus, had the highest median upper lethal temperature values, suggesting the existence of common physiological mechanisms that regulate both upper and lower thermal tolerance abilities.
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Ng, L. L., M. Harker, and E. D. Abel. "Mechanisms of leucocyte sodium influx in essential hypertension." Clinical Science 75, no. 5 (November 1, 1988): 521–26. http://dx.doi.org/10.1042/cs0750521.
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1. Leucocyte Na+ influx in media containing 10 mmol/l Na+ was studied directly using a triple-isotope method for measuring initial 22Na uptake rates in 20 normal and 18 untreated hypertensive subjects. The effects of 1 mmol/l amiloride (a Na+-H+-antiport inhibitor) and 0.1 mmol/l bumetanide (a Na+, K+, Cl−-symport inhibitor) were also examined. 2. The total, amiloride-sensitive and bumetanide-sensitive influx rates were raised in hypertensive compared with normotensive subjects [median (range): total 0.63 (0.25–1.82) vs 0.40 (0.09–0.65) mmol min−1 l−1, P < 0.002; amiloride-sensitive 0.43 (0.18–1.56) vs 0.26 (0.04–0.48) mmol min−1 l−1, P < 0.002; bumetanide-sensitive 0.12 (−0.03 to 0.83) vs 0.02 (−0.25 to 0.21) mmol min−1 l−1, P < 0.005]. 3. We conclude that hypertensive patients have a raised leucocyte total Na+ influx when measured in media containing 10 mmol/l Na+ and that this is contributed mainly by amiloride-sensitive and bumetanide-sensitive Na+ influx mechanisms.
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Bentley, Sian, Sukeshi Makhecha, Siobhan Carr, Ian Balfour-Lynn, and Jane Davies. "24 Comparison of the tolerability of posaconazole versus voriconazole in children with cystic fibrosis." Archives of Disease in Childhood 103, no. 2 (January 19, 2018): e2.27-e2. http://dx.doi.org/10.1136/archdischild-2017-314585.33.
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BackgroundTriazole antifungals (itraconazole and voriconazole), are commonly used for treating isolates of Aspergillus, or in combination with corticosteroids for the empiric treatment of Allergic Bronchopulmonary Aspergillosis (ABPA) in children with cystic fibrosis (CF). Posaconazole is a newer triazole that is as effective, but better tolerated than voriconazole and itraconazole in immunocompromised patients1 though there is no published use in CF and it is not licensed in children<18 years old. It is used as a 3rd line agent for Aspergillus or ABPA in our institution.AimOur aim was to evaluate why posaconazole was needed in some children, and to assess its tolerability. Given the difficulty in reaching therapeutic drug levels of triazoles in children with CF2 we also reviewed posaconazole blood levels.MethodA retrospective case note review of all children with CF who had received voriconazole or posaconazole from April 2014 to May 2015 in a tertiary paediatric CF centre with a clinic population of 350 children. Children were identified from pharmacy records and clinical data was collected from case notes and computerised laboratory records. We compared reported adverse effects for both drugs, and for the posaconazole group documented reason for use and blood levels (therapeutic >0.7 mg/L).ResultsVoriconazole was used in 10 children with a median age of 13.5 years (range 12–16), for median 8 weeks. Adverse effects were experienced in 5/10 (50%) of children (photosensitivity – 4; hallucinations and nausea – 1), and 2 children had raised liver functions tests (LFTs). Posaconazole was used in 7 children with a median age of 14 years (range 13–16) for median 37 weeks. No adverse effects were reported but LFTs were raised in 1 child. Posaconazole was commenced in 6/7 (85%) children due to severe photosensitivity with voriconazole. Of these, posaconazole was indicated for concurrent Scedosporium isolates in 2 children, and therapeutic failure with itraconazole in 4 children. Posaconazole levels were consistently therapeutic in 5/7 (71%) children (range 0.7–2.47 mg/L). Levels in 1 child fell to <0.2 mg/L following the introduction of an interacting drug (rifampicin), and a level of 2.47 mg/L was associated with raised LFTs in another, resulting in discontinuation of posaconazole.ConclusionIn this small cohort, posaconazole was better tolerated than voriconazole for the treatment of Aspergillus or ABPA in children with CF, due mainly to the lack of photosensitivity associated with its use. Posaconazole levels attained from our patients indicate that therapeutic levels can be readily obtained in this patient population. Larger studies are needed to support these conclusions.ReferencesDoring M, Blume O, Haufe S, et al. Comparison of itraconazole, voriconazole, and posaconazole as oral antifungal prophylaxis in paediatric patients following allogeneic hematopoietic stem cell transplantation. Eur J Clin Microbiol Infect Dis2014;33(4):629–38.Bentley S, Gupta A, Balfour-Lynn IM. Subtherapeutic itraconazole and voriconazole levels in children with cystic fibrosis. J Cyst Fibros2013;12:418–9.
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Giudice, Ilaria Del, Francesca Romana Mauro, Maria Stefania De Propris, Simona Santangelo, Marilisa Marinelli, Nadia Peragine, Valeria Di Maio, et al. "A Prospective Study of Young Chronic Lymphocytic Leukemia (CLL) Patients Investigated at Diagnosis: Distribution and Clinical Significance of Prognostic Factors." Blood 112, no. 11 (November 16, 2008): 3121. http://dx.doi.org/10.1182/blood.v112.11.3121.3121.
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Abstract In chronic lymphocytic leukemia (CLL) the distribution and prognostic impact of genetic and molecular markers has been assessed on retrospective series of patients in different phases of the disease. Our aim was to assess the distribution and clinical significance of a comprehensive panel of clinical and biologic parameters prospectively evaluated at presentation in all young patients diagnosed with CLL at our Institution, taking advantage of the fact that in Italy individuals with a lymphocytosis are referred to the hematologist for the diagnostic work-up. From November 2002 to June 2008, 105 young CLL patients (<60 years-old) were diagnosed with CLL and included in this study. There were 56 males and 49 females, with a median age of 52 years-old. 81% were in Binet stage A, 19% in stages B/C. Rai stage 0 was recorded in 63% of patients, I/II in 31%, III/IV in 6%. The median white blood cell (WBC) count was 18.8 × 109/L (range 5.8–236.6). Prognosis was evaluated as the time from diagnosis to first treatment (TFI, treatment-free interval), since only 3 patients died after a median follow-up of 32.4 months (range 1 to 88). The median TFI was 43.9 months. Clinical features included: gender, WBC count, Binet and Rai stage. Serological and biologic parameters included: beta2-microglobulin, LDH, IgG immunoglobulin levels, lymphocyte morphology, T-cell subsets, IgVH mutational status, CD38 and ZAP-70 expression, cytogenetic abnormalities evaluated by FISH, p53 protein expression and p53 gene sequencing (exon 5 to 8). The distribution of the prognostic markers is summarized in the table. Raised beta2-microglobulin and LDH were present only in 5% and 15% of cases, respectively. The CD4/CD8 ratio was normal in almost all cases. The proportion of unmutated IgVH, CD38 and ZAP-70 positive cases was about one third of the cohort of CLL patients at diagnosis. The incidence of del(17p) (cut off >20% cells) and del(11q) (cut off >10% cells) was 2% and 7%, respectively. Patients with del(17p) or del(11q) exclusively showed unmutated IgVH and ZAP-70+, and were mostly CD38+. p53 mutations were present in 4 cases, 3 with unmutated IgVH and del(17p) and 1 with mutated IgVH and no del(17p). In univariate analysis, the following variables resulted associated to a short TFI: advanced stage Binet B/C and Rai I/IV (<0.0001), WBC count (<0.0001), proportion of CD3+ cells <16% (0.0002), raised beta2-microglobulin (<0.0001) and LDH (<0.0001), unmutated IgVH (<0.0001), CD38+ (<0.0001), ZAP-70+ (<0.0018), adverse cytogenetic abnormalities (del(17p), del(11q), +12) (<0.0001). Atypical CLL morphology showed a trend for significance (0.06). Multivariate analysis on TFI - including WBC count (as continuous variable), CD3 %, LDH, IgVH mutation status, ZAP-70 and CD38 expression and corrected with interaction between WBC and IgVH status - was focused on the 84 patients with Binet stage A. High WBC count, raised LDH, unmutated IgVH resulted as unfavorable prognostic factors, whilst the proportion of CD3+ cells was associated with a better outcome. Neither ZAP-70 or CD38 showed an independent prognostic value. In CLL cases with discordant expression of ZAP-70 and IgVH mutation status (25% of cases), the latter appeared to be more relevant than ZAP-70 in determining the TFI. In conclusion, unmutated IgVH, raised LDH, WBC count and a low proportion of CD3+ cells at diagnosis are significant predictors of TFI in early stage CLL. This group represents about one third of young patients at diagnosis. Adverse FISH abnormalities are present only in a small subgroup of cases in the early phases of the disease. Young CLL patients at diagnosis N° of cases % Raised beta2-microglobulin (>3400 ng/l) 5/102 5% Raised LDH 16/105 15% Hypo IgG 21/98 21% Atypical morphology 27/104 26% CD3+ cells (<16%) 60/105 57% CD4/CD8 (<1) 3/101 3% IgVH mutated (≥98%) 67/103 65% IgVH unmutated (<98%) 36/103 35% CD38 ≥7% 25/104 24% ZAP-70 ≥10% 39/100 39% Del(17p) >20% 2/104 2% Del(11q) >10% 7/104 7% +12 >5% 7/104 7% Del(13q) >5% isolated 59/104 57% Normal (none of the above) 29/104 28% p53 protein expression 3/100 3% p53 gene mutation 4/105 4%
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Nagai, H., K. Fujita, A. Sakai, T. Nuimura, and T. Tadono. "Climatic and topographic influences on glacier distribution in the Bhutan Himalaya." Cryosphere Discussions 8, no. 1 (February 25, 2014): 1305–36. http://dx.doi.org/10.5194/tcd-8-1305-2014.
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Abstract. The locations and extent of mountain glaciers are affected by climatic constraints such as air temperature, precipitation, and solar radiation, as well as by local topography, which influences avalanche accumulation and debris supply. To evaluate these influences on the elevational distribution of glaciers in the Bhutan Himalaya, we created a glacier inventory together with debris-covered area and potential material-supply (PMS) slopes using satellite images with high spatial resolution. The median elevation of a glacier, which is used as a proxy of the equilibrium line altitude (ELA), decreases with increasing annual precipitation, suggesting the influence of climatic factors, according to which the ELA is lowered in relatively warm and humid environments, and raised when the opposite conditions prevail. We found a weak but significant influence of topography on the elevational distribution of glaciers, indicated by the relationship between the deviation of the median elevation of an individual glacier from the regional average and the PMS slope ratio (defined as the ratio of the PMS slope area to glacier area). We further analysed the dependency of the median glacier elevation on the gradient and aspect of PMS slopes. We found that the median elevation is affected by the avalanche-driven redistribution of snow accumulation on debris-free glaciers, and that in debris-covered glaciers the debris supply affects glacier extent through the insulation effect of the debris layer.
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Sazawal, Sudha, Kanwaljeet Singh, Sunita Chhikara, Rekha Chaubey, Manoranjan Mahapatra, and Renu Saxena. "Influence of JAK2V617F allele burden on clinical phenotype of polycythemia vera patients: A study from India." South Asian Journal of Cancer 08, no. 02 (April 2019): 127–29. http://dx.doi.org/10.4103/sajc.sajc_161_18.
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Abstract Background: Elevated JAK2V617F allele burden is associated with enhanced expression of downstream target genes in Philadelphia negative chronic myeloproliferative neoplasms (CMPNs) which include PV, ET & PMF. Previous studies have shown the impact of JAK2V617F allele burden on clinical phenotype of CMPNs. However, there is no data from India regarding the association between JAK2V617F allele burden and clinical phenotype in PV. Aims/Settings and Design: We aimed to investigate the effect of allele burden on clinical phenotype in 90 JAK2V617F positive PV patients and to see its influence on disease related complications. Material and Methods: Allele burden of 90 JAK2V617F positive PV patients was quantified by Real-time polymerase chain reaction (RQ-PCR). Results: 74/90 (82.22%) were males and 16/90 (17.78%) were females (median 45 years, range 35-78). Patients with age >50 years had significantly higher JAK2V617F allele burden (median 40.15%, range 0.49–91.62 %) than patients with ≤ 50 years age (median 48.59 %, range 0.56–86.74 %; P < 0.032). Patients with splenomegaly had significantly higher JAK2V617F allele burden (mean 50.24%, range 6.91–84.17%) than patients without splenomegaly (mean 33.82 %, range 0.49–71.83 %; P < 0.017). Patients with higher allele burden (median 57.20, range 43.4–72.03%) had significantly raised thrombotic events than the patients with lower allele burden (median 37.38, range 0.49–84.17% P < 0.043). 49/90 (54%) were homozygous and 41/90 (46%) were heterozygous. Conclusions: Higher JAK2V617F allele burden showed association with increased age, splenomegaly and thrombotic events. Thus, it may be considered for prognostication and setting up the treatment protocol in PV patients.
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Goel, Ruchika, T. Sathish Kumar, Debashish Danda, George Joseph, Visali Jeyaseelan, Ajith Kumar Surin, and Paul Bacon. "Childhood-onset Takayasu Arteritis — Experience from a Tertiary Care Center in South India." Journal of Rheumatology 41, no. 6 (May 1, 2014): 1183–89. http://dx.doi.org/10.3899/jrheum.131117.
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Objective.To study the clinical profile and outcome of Asian Indian children with childhood-onset Takayasu arteritis (c-TA).Methods.Records were studied of patients with c-TA onset prior to age 16. Disease Extent Index-Takayasu (DEI.TAK), Indian Takayasu Arteritis Score 2010, and Takayasu Arteritis Damage Score (TADS) were calculated retrospectively from electronic records. Cumulative incidence of sustained remission was estimated using the Kaplan-Meier curve.Results.There were 40 patients with c-TA, with median age of onset of 12.5 years (range 1–16) and median diagnostic delay of 11.3 months (range 1–60). The most common presenting features were hypertension, headache, malaise, and fever. Pulseless disease was observed in 25 cases (62.5%). The majority (n = 28) had active disease with raised inflammatory markers, high baseline median DEI.TAK score of 10 (range 3–24), and high median TADS of 7 (range 1–14). Of the 34 patients followed for 21.5 months (range 3–192), remission was attained in 30. However, cumulative sustained remission was achieved in only 29% of them at 5 years. Median period of sustained remission was 22.5 months (95% CI 17.1–26.8). New areas of vessel involvement were observed in 13 patients (38%). Disease progression was arrested in the majority (n = 22, 66%) through aggressive medical management and endovascular intervention. All 11 patients with an increment in TADS of ≥ 4 during followup had persistently active or relapsing disease. There was a single fatality.Conclusion.Despite aggressive immunosuppression, damage progressed in one-third of patients with c-TA in association with persistent inflammation, warranting surveillance with clinical instruments and followup imaging.
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Ghrooda, Esseddeeg, Susan Alcock, and Alan C. Jackson. "Improvement in Thrombolytic Therapy Administration in Acute Stroke with Feedback." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 39, no. 6 (November 2012): 789–92. http://dx.doi.org/10.1017/s0317167100015626.
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Background:The benefits of intravenous recombinant tissue plasminogen activator (rt-PA) in acute ischemic stroke is time dependent. Guidelines recommend a door-to-needle (DTN) time of less than 60 minutes.Methods:A retrospective audit of 730 stroke charts from 2008 - 2011 was conducted at Health Sciences Centre. 158 patients treated with IV rt-PA were identified. The time intervals between Emergency Department (ED) arrival, administration of rt-PA and uninfused brain computed axial tomographic scan (CT) were recorded. From this, CT to needle times were calculated. During November 2010 to January 2011 feedback was given to neurologists, ED physicians, ED nurses, and CT technologists. This raised awareness and emphasized the importance of this time driven protocol.Results:The median DTN times for 2008, 2009, and 2010 were 69, 71 and 76 minutes respectively. The median CT-to-needle time for this time period was 47 minutes. In 2011 (n =58) the median DTN time was 49 minutes and the median CT-to-needle was 18 minutes, which were marked improvements (p<0.00005 and p<0.005, respectively). In 2008-2010 only 31% of treated patients (n=100) received rt-PA within 60 minutes, whereas in 2011 this increased to 64%.Conclusions:Dramatic improvements in DTN times and in the percentage of patients receiving rt-PA treatment within 60 minutes were observed in 2011 after feedback was provided regarding the suboptimal performance. Prior to receiving feedback, DTN times were similar to national median DTN times. All centres administering rt-PA for acute ischemic stroke should monitor their clinical performance and give feedback on a regular basis.
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Sazawal, Sudha, Kanwaljeet Singh, Sunita Chhikara, Rekha Chaubey, Manoranjan Mahapatra, and Renu Saxena. "Influence of JAK2V617F allele burden on clinical phenotype of polycythemia vera patients: A study from India." South Asian Journal of Cancer 08, no. 02 (April 2019): 127–29. http://dx.doi.org/10.4103/sajc.sajc_161_18.
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Abstract Background: Elevated JAK2V617F allele burden is associated with enhanced expression of downstream target genes in Philadelphia negative chronic myeloproliferative neoplasms (CMPNs) which include PV, ET & PMF. Previous studies have shown the impact of JAK2V617F allele burden on clinical phenotype of CMPNs. However, there is no data from India regarding the association between JAK2V617F allele burden and clinical phenotype in PV. Aims/Settings and Design: We aimed to investigate the effect of allele burden on clinical phenotype in 90 JAK2V617F positive PV patients and to see its influence on disease related complications. Material and Methods: Allele burden of 90 JAK2V617F positive PV patients was quantified by Real-time polymerase chain reaction (RQ-PCR). Results: 74/90 (82.22%) were males and 16/90 (17.78%) were females (median 45 years, range 35-78). Patients with age >50 years had significantly higher JAK2V617F allele burden (median 40.15%, range 0.49–91.62 %) than patients with ≤ 50 years age (median 48.59 %, range 0.56–86.74 %; P < 0.032). Patients with splenomegaly had significantly higher JAK2V617F allele burden (mean 50.24%, range 6.91–84.17%) than patients without splenomegaly (mean 33.82 %, range 0.49–71.83 %; P < 0.017). Patients with higher allele burden (median 57.20, range 43.4–72.03%) had significantly raised thrombotic events than the patients with lower allele burden (median 37.38, range 0.49–84.17% P < 0.043). 49/90 (54%) were homozygous and 41/90 (46%) were heterozygous. Conclusions: Higher JAK2V617F allele burden showed association with increased age, splenomegaly and thrombotic events. Thus, it may be considered for prognostication and setting up the treatment protocol in PV patients.