Gonadal function is associated with cardiometabolic health in pre-pubertal boys with Klinefelter syndrome

The most common sex chromosome aneuploidy, Klinefelter syndrome (KS), is associated with primary gonadal failure and increased morbidity and mortality from cardiometabolic disorders in adulthood. Children with KS also have a high prevalence of metabolic syndrome (MetS) features. To assess the relationship of gonadal and cardiometabolic function in children with KS, we evaluated serum hormones [gonadotropins, inhibin B (INHB), anti-mullerian hormone (AMH), total testosterone (TT)], and features of MetS (waist circumference, fasting lipid panel, fasting blood glucose (FBG), and blood pressure) in 93 pre-pubertal boys with KS age 4-12 years (mean 7.7 ± 2.5 years). The cohort was grouped by age and tanner stage, and biomarkers were compared to normal ranges. A total of 80% of this pre-pubertal cohort had ≥1 feature of metabolic syndrome (MetS) and 11% had ≥3 features of MetS. Risk of MetS was independent of age and body mass index. Sertoli cell dysfunction was common with 18% having an INHB below the normal range. A low INHB was associated with higher FBG, triglycerides, LDL, and lower HDL (p < 0.05). An INHB <50 ng/dL yielded a sensitivity of 83% and a specificity of 79% for having ≥3 features of MetS. INHB and AMH positively correlated with each other (p < 0.001), and high AMH was protective of MetS. TT was below the lower limit of normal in 49% of subjects, with mean values significantly lower than expected (3.3 ng/dL vs. 4.9 ng/dL, p < 0.0001), however, no convincing relationship between TT and MetS was seen. In conclusion, gonadal and cardiometabolic dysfunction are prevalent in pre-pubertal boys with KS. Although the relationship of testosterone deficiency and MetS is well-known, this study is the first to report an association between impaired Sertoli cell function and cardiometabolic risk.

Günther Tulip inferior vena cava filter retrieval using a bidirectional loop-snare technique

Many advanced techniques have been reported in the literature for difficult Günther Tulip filter removal. This report describes a bidirectional loop-snare technique in the setting of a fibrin scar formation around the filter leg anchors. The bidirectional loop-snare technique allows for maximal axial tension and alignment for stripping fibrin scar from the filter legs, a commonly encountered complication of prolonged dwell times.

Compression of Visual Space before Saccades

We studied how the human visual system recalibrates visual coordinates to compensate for saccadic eye movements. Observers made 20 horizontal saccades to a target on an otherwise featureless red screen, and reported the apparent position of a vertical green bar that was briefly displayed before, during, or after the saccade. Bars presented 50 ms before the beginning of the saccade, or after its completion, were perceived accurately and veridically. However, bars presented immediately prior to the saccade were systematically mislocated, either in the direction of the saccade or in the opposite direction, depending on the spatial position of the bar. This result has been verified by various techniques including Vernier offset estimation, and a forced-choice annulling task. When four bars (straddling the saccade target) were displayed in the interval −25 to 0 ms, they were seen to be merged into 1 bar (forced choice). None of these effects could be mimicked by causing the scene to move at saccadic speeds and amplitudes. The results suggest that each saccade is accompanied by a non-visual signal that displaces the retinal coordinate system, and a momentary compression of visual space. The perceptual compression may be instrumental in ensuring a smooth transition from fixation to fixation.

Effects of Saccades on Perceived Time

Saccades produce errors in locating objects in space. The question here examined is whether they also produce errors of location in time. Observers judged whether flashed bars appeared before, during, or after saccades, the order of appearance of two bars flashed in sequence, and the apparent interval between two points of light flashed at a SOA of 100 ms.

We found that (1) bars displayed up to 150 ms before saccades were often judged as during saccades, later bars veridically; (2) the accuracy of judgements of order dropped just before saccades; (3) apparent intervals were shorter before saccades, reaching control levels at onset. We conclude that perceived time is foreshortened immediately before saccades. This could be due to selective suppression of magnocellular activity and may function to hide saccades and their effects.

Routine screening for pain combined with a pain treatment protocol in head and neck cancer: a randomised controlled trial

BACKGROUND

We compared the effectiveness and cost of a pain screening and treatment program, with usual care in head and neck cancer patients with significant pain.

METHODS

Patients were screened for the presence of pain and then randomly assigned to either an intervention group, consisting of a pain treatment protocol and an education program, or to usual care. Primary outcome was change in the Pain Severity Index (PSI) over three months.

RESULTS

We screened 1074 patients of whom 156 were randomized to either intervention or usual care. Mean PSI was reduced over three months in both groups, with no significant difference between the two groups. The Pain Management Index (PMI) at three months, was significantly improved in the intervention group compared with usual care (P<0.001), as was Patient Satisfaction (mean difference in scores was statistically significant: -0.30 [-0.60 to -0.15]). All subjects reported clinically significant levels of anxiety and depression throughout the study. Treatment costs were significantly higher for intervention (mean=£400) compared with usual care (£200), with a low likelihood of being cost-effective.

CONCLUSIONS

There was no difference in the Pain Severity Index between the two groups. However there were significant improvements in the intervention group in patient satisfaction and PMI. The pain screening process itself was effective. Sufficient benefit was demonstrated as a result of the intervention to allow continued development of pain treatment pathways, rather than allowing pain treatment to be left to nonformalised ad hoc arrangements.

Attitudes, Perceptions, and Utilization of Evidence-Based Practices in Residential Care

This study reports on results of a national survey conducted in the United States about the attitudes, perceptions and utilization of evidence-based practices (EBPs) in residential care settings. Seventy-five of 118 member agencies (63.6% response rate) of a voluntary national residential care association responded to a web-administered structured survey, which included the Evidence-Based Practices Attitude Scale (Aarons, 2004). Results show overwhelmingly positive attitudes toward EBPs. Concerns were reported mainly with regard to cost and impeding a client-driven practice approach. The study also showed a high degree of utilization of EBPs with over 88 percent of programs reporting the use of at least one practice they considered to be evidence-based. Altogether 53 different practices were reported although it is unknown at this point whether practices were delivered with fidelity. Behaviorally-based and trauma-focused interventions constituted the most common interventions used by residential care agencies. Practices were subsequently validated against four national clearinghouse sites, indicating that only slightly over half of all reported practices had been evaluated by at least one clearinghouse and rated as having some research evidence for effectiveness. Divergent views about what practices are evidence-based point to the need for continued discussion between the practice and research fields about conceptualizations of evidence.

Diagnosing urinary tract infections in febrile infants and children: when evidence-based medicine and clinical practice collide

The management of febrile pediatric patients is challenging, and the literature is replete with articles describing diverse diagnostic and therapeutic strategies. As many as 5% of infants and young children presenting with fever will be diagnosed with urinary tract infection. Many controversies exist concerning the management of these infections, the most important being: how to make the diagnosis. The financial and time costs of emergency department management must be balanced against the potential future costs of investigations and complications.

Cocaine-induced transmural myocardial infarction in a Yorkshire swine with normal coronary arteries: Evidence for microvascular and/or epicardial coronary artery spasm

Cocaine-induced myocardial infarction with normal coronary arteries is well documented in humans. The exact mechanism of action remains speculative. We report one case of cocaine-induced myocardial infarction with normal coronaries in one swine. Systemic hemodynamics and angiographic, electrocardiographic, echocardiographic, and histopathologic data are presented. Intravenous cocaine (1, 3, 10 mg/kg) produced significant decreases in mean arterial pressure, heart rate, stroke volume, coronary blood flow, and coronary reserve, whereas pulmonary artery diastolic pressure and coronary vascular resistances increased. Left anterior descending and left circumflex coronary artery cross-sectional area decreased by 31% and 64%, respectively, without localized vasospasm. Electrocardiographic changes occurred (3 mm ST elevation in leads II, III, AVF). Peak creatine phosphokinase was 17,220 IU/L. The echocardiogram revealed severe hypokinesis of the inferior wall and normal ventricular function. The animal survived the acute phase of the infarction and the swine was restudied 12 weeks later. Upon rechallenge, systemic and coronary hemodynamics shoved changes similar to those in the previous study. The swine developed ventricular fibrillation and expired after the 10 mg/kg cocaine dose. Macroscopic examination of the external surface of the heart revealed marked diffuse fibrosis in the posteroinferior and lateral left ventricular wall. Our data suggest that the infarct induced by cocaine may have resulted from severe vasoconstriction or spasm at the level of the microcirculation, and/or the epicardial coronary arteries, which shoved slight but significant narrowing throughout their lengths.

Induction of globin mRNA in Friend leukemia virus-infected cells and its presence in viral 60S RNA

The Friend leukemia virus (FLV)-infected cell line, T-3-Cl-2, undergoes a form of erythroid differentiation in culture when treated with an appropriate inducer, such as dimethylsulfoxide ((CH3)2SO). Thus, whereas untreated cells contain no detectable hemoglobin, treated cells accumulate hemoglobin in quantities comparable to those in the mature mouse red blood cell. We have investigated the mechanism of hemoglobin induction by quantitating the number of globin genes and the amount of globin mRNA in cells before and during the period of hemoglobin accumulation. The results indicate the number of globin genes does not change as the cells accumulate hemogtobin: There are less than 5 globin genes per haploid genome. On the other hand, whereas cells lacking hemoglobin contain little, if any, globin mRNA, hemoglobin-containing cells accumulate, on the average, 8,000 molecules of globin mRNA per cell. The most direct, although, by no means, the only interpretation of these results is that the induction of hemoglobin synthesis involves transcriptional activation of the globin genes. Using this same cell line, we show that mouse globin mRNA sequences are also present in viral particles purified from the culture medium of globin-producing cells. These globin mRNA sequences are absent from viral particles derived from T-3-Cl-2 cells which are not producing globin mRNA. Virus-associated globin mRNA sequences sediment in association with 60S viral RNA complex as well as in free, 9S form. However, under mild denaturing conditions which result in the conversion of viral 60 S RNA to 30S and smaller forms, all the globin sequences sediment as 9S RNA. Appropriate control experiments indicate that the virus-associated globin mRNA is resistant to degradation by exogenous ribonuclease; that exogenously added globin mRNA does not become associated with the 60S viral RNA complex; and that globin mRNA can be detected in virions derived from cells both induced for and constitutively synthesizing globin mRNA. The presence of globin mRNA sequences in FLV particles has important implications in terms of our ability to distinguish between host and viral RNAs in viral particles and in terms of the possible role RNA tumor viruses might play in transduction of genetic information.

Screening and surveillance CT abdomen/pelvis for metastases in patients with soft-tissue sarcoma of the extremity

Objectives

The clinical utility of routine cross sectional imaging of the abdomen and pelvis in the screening and surveillance of patients with primary soft-tissue sarcoma of the extremities for metastatic disease is controversial, based on its questionable yield paired with concerns regarding the risks of radiation exposure, cost, and morbidity resulting from false positive findings.

Methods

Through retrospective review of 140 patients of all ages (mean 53 years; 2 to 88) diagnosed with soft-tissue sarcoma of the extremity with a mean follow-up of 33 months (0 to 291), we sought to determine the overall incidence of isolated abdominopelvic metastases, their temporal relationship to chest involvement, the rate of false positives, and to identify disparate rates of metastases based on sarcoma subtype.

Results

A total of four patients (2.9%) exhibited isolated abdominopelvic metastatic disease during the surveillance period. In all cases of concomitant chest and abdominopelvic disease, chest involvement preceded abominopelvic involvement. There was a significant false positive rate requiring invasive workup.

Conclusions

In the setting of a relative paucity of evidence concerning a rare disease process and in difference to recently published investigations, we add a clinical cohort not supportive of routine cross sectional imaging of the abdomen and pelvis.

Cite this article: Bone Joint Res 2015;4:45–9.

Subsequent neoplasms in survivors of childhood central nervous system tumors: risk after modern multimodal therapy

BACKGROUND

Multimodal therapy has improved survival for some childhood CNS tumors. However, whether risk for subsequent neoplasms (SNs) also increases is unknown. We report the cumulative incidence of, and risk factors for, SNs after a childhood primary CNS tumor and determine whether treatment that combines radiation therapy (RT) with chemotherapy increases risk for SNs.

METHODS

Analyses included 2779 patients with a primary CNS tumor treated at St Jude Children's Research Hospital between 1985 and 2012. Cumulative incidence and standardized incidence ratios (SIRs) were estimated for SNs confirmed by pathology report. Cumulative incidence among the 237 five-year medulloblastoma survivors treated with multimodal therapy (RT + chemotherapy) was compared with a historical cohort of 139 five-year survivors treated with RT but no chemotherapy in the Childhood Cancer Survivor Study.

RESULTS

Eighty-one survivors had 97 SNs. The cumulative incidence of first SN was 3.0% (95% CI: 2.3%-3.9%) at 10 years, and 6.0% (95% CI: 4.6%-7.7%) at 20 years from diagnosis. Risks were highest for subsequent glioma, all grades (SIR = 57.2; 95% CI: 36.2-85.8) and acute myeloid leukemia (SIR = 31.8; 95% CI: 10.2-74.1). Compared with RT alone, RT + chemotherapy did not increase risk for SNs (hazard ratio: 0.64; 95% CI: 0.38-1.06). Among five-year survivors of medulloblastoma treated with multimodal therapy, cumulative incidence of SN was 12.0% (95% CI: 6.4%-19.5%) at 20 years, no different than survivors treated with RT alone (11.3%, P = .44).

CONCLUSION

The cumulative incidence of SNs continues to increase with time from treatment with no obvious plateau, but the risk does not appear to be higher after exposure to multimodal therapy compared with RT alone. Continued follow-up of survivors as they age is essential.

Current Status of Brain Tumor Surveillance in Canada and Why it Matters

The Brain Tumor Foundation of Canada has identified developing a pan-Canadian report on all primary brain tumors as a priority. The objective of this report is to present the history and rationale underlying reporting of brain tumors and to summarize the current status of brain tumor data collection and reporting in Canadian registries. We reviewed the literature on reporting history and rationale, conducted a survey of cancer registries across Canada, and reviewed cancer registry websites and Canadian Cancer Statistics Reports for publicly available descriptive statistics. A brain tumor surveillance system that includes data on both malignant and benign brain tumors is feasible within Canada and will include approximately twice the number of malignant cases currently reported. Once patterns of brain tumors become available, clinicians, researchers, and policy makers will have a clearer understanding of disease burden and how Canadian survival outcomes fare across regions and against other nations. Collaborative efforts on the part of cancer registry and neurooncology stakeholders will serve to enhance the quality and utility of this information for improving the overall patient experience.

Safewards: the empirical basis of the model and a critical appraisal

ACCESSIBLE SUMMARY

In the previous paper we described a model explaining differences in rates of conflict and containment between wards, grouping causal factors into six domains: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. This paper reviews and evaluates the evidence for the model from previously published research. The model is supported, but the evidence is not very strong. More research using more rigorous methods is required in order to confirm or improve this model.

ABSTRACT

In a previous paper, we described a proposed model explaining differences in rates of conflict (aggression, absconding, self-harm, etc.) and containment (seclusion, special observation, manual restraint, etc.). The Safewards Model identified six originating domains as sources of conflict and containment: the patient community, patient characteristics, the regulatory framework, the staff team, the physical environment, and outside hospital. In this paper, we assemble the evidence underpinning the inclusion of these six domains, drawing upon a wide ranging review of the literature across all conflict and containment items; our own programme of research; and reasoned thinking. There is good evidence that the six domains are important in conflict and containment generation. Specific claims about single items within those domains are more difficult to support with convincing evidence, although the weight of evidence does vary between items and between different types of conflict behaviour or containment method. The Safewards Model is supported by the evidence, but that evidence is not particularly strong. There is a dearth of rigorous outcome studies and trials in this area, and an excess of descriptive studies. The model allows the generation of a number of different interventions in order to reduce rates of conflict and containment, and properly conducted trials are now needed to test its validity.

Sexual behaviours on acute inpatient psychiatric units

The purpose of the study was to assess the types and frequency of sexual behaviours displayed by patients during the first 2 weeks of admission to acute psychiatric units and what relationship these have to other challenging patient behaviours. The method used was a survey of sexual behaviours, conflict and containment events carried out by 522 patients during the first 2 weeks of admission in 84 wards in 31 hospitals in the South East of England. Incidents of sexual behaviour were common, with 13% of patients responsible for at least one incident. Although exposure was the most frequent of these behaviours, non-consensual sexual touching, was instigated by 1 in 20 patients. There were no differences in the numbers of sexual events between single sex and mixed gender wards. Few associations were found with the demographic features of perpetrators, although all those engaging in public masturbation were male, and male patients were more likely to sexually touch another without their consent. Single sex wards do not seem to necessarily offer significant protection to potentially vulnerable victims. Perpetrators do not seem to be predictable in advance, nor was there any common set or pattern of disruptive behavioural events indicating that a sexual incident was about to occur.

Synthesis gas production from bio-oil: steam reforming of ethanol as a model compound

Syngas production via ethanol steam reforming has been studied over solid Ru/Ce_0.5Zr_0.5O₂ and alumina supported Ru/Ce_0.4Zr_0.4Sm_0.2O₂ as granulated and monolithic catalysts.

Brain morphology in children with 47, XYY syndrome: a voxel- and surface-based morphometric study

The neurocognitive and behavioral profile of individuals with 47,XYY is increasingly documented; however, very little is known about the effect of a supernumerary Y-chromosome on brain development. Establishing the neural phenotype associated with 47,XYY may prove valuable in clarifying the role of Y-chromosome gene dosage effects, a potential factor in several neuropsychiatric disorders that show a prevalence bias toward males, including autism spectrum disorders. Here, we investigated brain structure in 10 young boys with 47,XYY and 10 age-matched healthy controls by combining voxel-based morphometry (VBM) and surface-based morphometry (SBM). The VBM results show the existence of altered gray matter volume (GMV) in the insular and parietal regions of 47,XYY relative to controls, changes that were paralleled by extensive modifications in white matter (WM) bilaterally in the frontal and superior parietal lobes. The SBM analyses corroborated these findings and revealed the presence of abnormal surface area and cortical thinning in regions with abnormal GMV and WMV. Overall, these preliminary results demonstrate a significant impact of a supernumerary Y-chromosome on brain development, provide a neural basis for the motor, speech and behavior regulation difficulties associated with 47,XYY and may relate to sexual dimorphism in these areas.