Use of quantitative assessment scales in cervical spondylotic myelopathy--survey of clinician's attitudes

BACKGROUND

There is considerable uncertainty regarding the selection criteria of patients and timing of surgery for cervical spondylotic myelopathy (CSM). Attempts have been made to quantify CSM severity using various assessment scales to provide an adjunct to clinical decision-making. The aim of the present study was to determine, by means of a 7-item questionnaire the attitudes of clinicians regarding the importance of quantitative assessment scales in the management of CSM, their actual use in clinical practice and how current scales fall short of the ideal.

FINDINGS

Clinical history, examination, radiological imaging and quantitative functional assessment were regarded by 117 clinicians as being almost equally important in the management of CSM. However, only 22 (19%) of clinicians admitted to using an assessment scale in clinical practice and 4 (3%) believed there was a 'gold-standard' assessment scale. These clinicians also considered 'ease of use' to be the most important attribute of an ideal assessment scale, followed by 'reproducibility', 'sensitivity to change' and 'validity'.

CONCLUSIONS

The discrepancy between the importance attached to quantitative measurement and its actual use suggests that current scales are under-utilised or unsuitable for clinical practice. A new easy-to use scale may be required that better reflects clinical requirements.

Pulsatile tinnitus

Pulsatile tinnitus is an uncommon otological symptom. Objective pulsatile tinnitus has numerous causes, including benign intracranial hypertension, glomus tumours and atherosclerotic carotid artery disease. History and physical examination can give important information as to the underlying diagnosis. Radiographic evaluation is essential in all patients with pulsatile tinnitus. Many patients have a treatable underlying aetiology. Early diagnosis and appropriate intervention may save patients from unnecessary morbidity.

Steroids in rhinoplasty: a survey of current UK otolaryngologists' practice

The use of steroids during rhinoplasty to reduce post-operative periorbital oedema and ecchymosis has been advocated. A number of randomized controlled trials have demonstrated the benefit of steroids in rhinoplasty. The aim of this study was to determine current UK practice in the use of steroids during rhinoplasty performed by otolaryngologists.

A postal survey of consultant otolaryngologists in the UK was conducted. We received 203 responses, with 115 consultants performing 12 or more rhinoplasties per year. Only 28 consultants (24 per cent) used steroids routinely in patients undergoing rhinoplasty and of these 11 used a protocol, although this was unpublished. Dexamethasone was the most common steroid used (82 per cent), being administered as a single intravenous dose of 8 mg in the majority of cases (54 per cent). There was no correlation between the use of steroids and the number of rhinoplasties performed by individual consultants.

Despite the evidence supporting the use of steroids to reduce post-operative sequelae following rhinoplasty, only a minority of consultants in the UK appear to use them as part of their practice.

Protective effect of quercetin on alcohol abstinence-induced anxiety and convulsions

Chronic administration of ethanol (2 g/kg, p.o.) on days 1-6 and its withdrawal produced an anxiogenic reaction in mice as assessed in the mirrored-chamber test. Daily administration of quercetin (25 or 50 mg/kg, p.o.) prior to ethanol for 6 days prevented withdrawal-induced anxiety in mice. However, acute administration of a single dose of quercetin (50 mg/kg) to animals withdrawn from ethanol, i.e., on day 7, did not prevent withdrawal-induced anxiety. Ethanol withdrawal also induced a significant increase in the locomotor activity of mice indicating an anxiogenic response. Daily administration of quercetin (25 or 50 mg/kg, p.o.) prior to ethanol for 6 days prevented withdrawal-induced increased locomotor activity. Ethanol withdrawal also sensitized the convulsogenic reaction to pentylenetetrazole (PTZ). A non-convulsive dose (40-60 mg/kg) of PTZ produced full-blown convulsions and increased mortality in ethanol-withdrawn mice. Both acute and chronic administration of quercetin (25 or 50 mg/kg, p.o.) produced a significant protection against ethanol withdrawal-induced reduction in PTZ threshold in mice. The result suggests the protective effect of this safe drug, quercetin, in the management of ethanol withdrawal reactions.

Alterations in carbohydrates and the protein metabolism of the harmful freshwater vector snail Lymnaea acuminata induced by the Euphorbia tirucalli latex extract

To know the short- as well as long-term effect of aqueous latex extracts of Euphorbia tirucalli on carbohydrate and protein metabolism, the snail Lymnaea acuminata was exposed to sublethal doses of 0.37 and 0.55 mg/L for a 24-h and 0.20 and 0.31 mg/L for a 96-h exposure period. Significant (P<0.05) alterations in the glycogen, pyruvate, lactate, total protein, and free amino acid level, as well as in the activity of enzyme lactic dehydrogenase, succinic dehydrogenase, cytochrome oxidase, protease, aspartate aminotransaminase, and alanine aminotransaminase were observed in the nervous, hepatopancreatic, and ovotestis tissues of the freshwater vector snail L. acuminata exposed to sublethal doses of E. tirucalli latex extract. The alterations in all biochemical parameters were significantly (P<0.05) time and dose dependent. After the 7th day of the withdrawal of treatment, there was significant (P<0.05) recovery in glycogen, pyruvate, lactate, total protein, and the free amino acid level and in the activity of the lactic dehydrogenase, succinic dehydrogenase, cytochrome oxidase, protease, aspartate aminotransaminase and alanine aminotransaminase enzymes in all three of the studied tissues of the snail, which supports the view that the plant product is safe for use as a molluscicide for the control of harmful freshwater vector snails in the aquatic environment.

Structural requirements for rapid inactivation and voltage dependence in splice variants of lobster Shaker potassium channels

We studied the properties of currents generated in Xenopus oocytes by nine splice variants of the spiny lobster Shaker gene. These isoforms differ in their amino termini and in the P-loop region of the pore. Both the voltage dependence and kinetic properties of the currents varied significantly, depending on which amino terminus was present. A cluster of net positive charges at the N-terminus was not necessary for rapid inactivation: negatively charged N-termini also inactivated rapidly. There was no obvious correlation between N-terminus length and inactivation rate. These N-terminal effects were additive with a separate set of voltage and kinetic properties controlled by the two alternative P-loop exons.

High-resolution mapping, cloning and molecular characterization of the Pi-k ( h ) gene of rice, which confers resistance to Magnaporthe grisea

In order to understand the molecular mechanisms involved in the gene-for-gene type of pathogen resistance, high-resolution genetic and physical mapping of resistance loci is required to facilitate map-based cloning of resistance genes. Here, we report the molecular mapping and cloning of a dominant gene (Pi-k ( h )) present in the rice line Tetep, which is associated with resistance to rice blast disease caused by Magnaporthe grisea. This gene is effective against M. grisea populations prevalent in the Northwestern Himalayan region of India. Using 178 sequence tagged microsatellite, sequence-tagged site, expressed sequence tag and simple sequence repeat (SSR) markers to genotype a population of 208 F(2) individuals, we mapped the Pi-k ( h ) gene between two SSR markers (TRS26 and TRS33) which are 0.7 and 0.5 cM away, respectively, and can be used in marker-assisted-selection for blast-resistant rice cultivars. We used the markers to identify the homologous region in the genomic sequence of Oryza sativa cv. Nipponbare, and a physical map consisting of two overlapping bacterial artificial chromosome and P1 artificial chromosome clones was assembled, spanning a region of 143,537 bp on the long arm of chromosome 11. Using bioinformatic analyses, we then identified a candidate blast-resistance gene in the region, and cloned the homologous sequence from Tetep. The putative Pi-k ( h ) gene cloned from Tetep is 1.5 kbp long with a single ORF, and belongs to the nucleotide binding site-leucine rich repeat class of disease resistance genes. Structural and expression analysis of the Pi-k ( h ) gene revealed that its expression is pathogen inducible.

A Rare Case of Odontogenic Myxoma in a Dog

A case of odontogenic myxoma in an old Doberman bitch involving the periodontal region of the mandible was recorded. Grossly, the tumour mass was soft and slimy, having brownish-black foci on cut surface. Histopathologically, the tumour predominantly consisted of mesenchyme-like cells with prominent nuclei and nucleoli. The tumour had abundant ground substance, rich in acid mucopolysaccharides.

Propagation of Chandipura virus in chick embryos

Stocks of three Indian Chandipura virus (CHPV) isolates; one isolate from an adult febrile case in 1965 from Chandipura town, Maharashtra, and two isolates from two pediatric encephalitis cases from Andhra Pradesh, 2003 were inoculated in 10-day-old chick embryos by allantoic route. All three virus isolates replicated in chick embryos showing titre of log 10(12) to log 10(13) EID50. The results demonstrated that chick embryos are susceptible to CHPV and virus grows to high titres in this system. Therefore chick embryos can be used as an alternative host system for cultivation and isolation of CHPV as they are less expensive than laboratory animals and have several other advantages over cell cultures. Also this system can be used for the development of vaccine and diagnostic reagents.

A new self-administered questionnaire to determine patient experience with voice prostheses (Blom-Singer valves)

AIM

To obtain information about valved speech and related issues in patients who have undergone total laryngectomy with the help of a new structured questionnaire on voice prosthesis.

SETTINGS AND DESIGN

A questionnaire-based pilot study set at a tertiary referral head and neck cancer unit.

MATERIALS AND METHODS

Twenty-five patients using voice prostheses, who showed no signs of recurrence after having undergone total laryngectomy were interviewed with the help of a questionnaire that assessed issues such as voice quality, valve maintenance, leakage, quality of life, humidification and hands-free system over the preceding seven days. The data was analyzed using non-parametric tests (Mann-Whitney and Spearman rank).

RESULTS

Twenty-five patients (16 males) with a median age of 65 years (IQ range: 59-70 years) had been using the prosthesis for a median of 6 years (IQ range: 5-10 years). The majority of the patients (n=20) were fully informed about their valve size and diameter and most were able to remove and replace their own prosthesis. Fourteen patients (60%) had leakage-related issues. Women were less satisfied with their voice quality as compared to men. Overall, there appeared to be an improvement in quality of life with the use of the voice prosthesis.

CONCLUSIONS

The subjects were fairly well informed about their valve and experienced a high level of satisfaction with their voice. This questionnaire serves as a valuable tool for monitoring voice rehabilitation in patients who have undergone laryngectomy.

The effects of hyaluronic acid on articular chondrocytes

The purpose of this study was to examine the effects of hyaluronic acid supplementation on chondrocyte metabolism in vitro. The clinical benefits of intra-articular hyaluronic acid injections are thought to occur through improved joint lubrication. Recent findings have shown that exogenous hyaluronic acid is incorporated into articular cartilage where it may have a direct biological effect on chondrocytes through CD44 receptors.Bovine articular chondrocytes were isolated and seeded into alginate constructs. These were cultured in medium containing hyaluronic acid at varying concentrations. Samples were assayed for biochemical and histological changes. There was a dose-dependent response to the exposure of hyaluronic acid to bovine articular chondrocytes in vitro. Low concentrations of hyaluronic acid (0.1 mg/mL and 1 mg/mL) significantly increase DNA, sulphated glycosaminoglycan and hydroxyproline synthesis. Immunohistology confirmed the maintenance of cell phenotype with increased matrix deposition of chondroitin-6-sulphate and collagen type II. These findings confirm a stimulatory effect of hyaluronic acid on chondrocyte metabolism.

Patient reported outcomes in a trial of combination therapy with etanercept and methotrexate for rheumatoid arthritis: the TEMPO trial

OBJECTIVE

To compare patient reported measures of function, health related quality of life (QoL), and satisfaction with medication among patients with rheumatoid arthritis (RA) treated with methotrexate (MTX), etanercept, or both for up to 1 year.

METHODS

In a 52 week, double blind, clinical trial, patients with active RA were randomised to receive etanercept 25 mg twice weekly, methotrexate up to 20 mg weekly, or combination therapy. The Health Assessment Questionnaire (HAQ) disability index, EuroQoL health status visual analogue scale (EQ-5D VAS), patient global assessment, and patient general health VAS were administered at baseline and weeks 2, 4, 8, 12, 16, 20, 24, 32, 40, 48, and 52. Satisfaction with the medication was compared at 52 weeks.

RESULTS

Of 682 enrolled patients, 522 completed 52 weeks of treatment. Mean improvement from baseline in HAQ score was 0.65, 0.70, and 1.0 for MTX, etanercept, and the combination, respectively. The mean percentage and absolute improvement in the HAQ was significantly higher (p<0.01) for combination therapy than for either of the monotherapies. Combination therapy produced significantly more rapid achievement of HAQ < or =0.5 sustained for 6 months than either of the monotherapies (p<0.01). Compared with patients receiving monotherapy, those receiving combination therapy achieved a significantly better (p<0.05) health state as measured by the EQ-5D VAS (mean (SD) 63.7 (3.2), 66.8 (3.2), 72.7 (3.1) for MTX, etanercept, and the combination, respectively). Results were similar for other assessments (p<0.01). Patients in combination and etanercept groups were significantly more likely (p<0.0001, p = 0.0009, respectively) to report satisfaction with the medication.

CONCLUSIONS

Combination therapy with etanercept and methotrexate improved function, QoL, and satisfaction with the medication significantly more than monotherapy.

Effect of dermal exposure to paraphenylenediamine and linear alkylbenzene sulphonate in guinea pigs

OBJECTIVE

To study the effects of paraphenylenediamine (PPD) and linear alkylbenzene sulphonate (LAS) alone and in combination on the skin.

METHODS

Forty-eight guinea pigs were divided equally into 4 groups and exposed to PPD (4 mg/kg), LAS (12 mg/kg) and PPD (4 mg/kg) plus LAS (12 mg/kg) for 30 days. The biochemical parameters such as acid phosphatase, gtutathione-s-transferase, glutathione peroxidase, glutathione, lipid peroxidation and histamine contents in exposed skin were estimated. The histopathological examination of the exposed skin was also carried out.

RESULTS

The skin enzymes, lipid peroxidation, and histamine increased while glutathione decreased in skin. The simultaneously exposed group showed additive toxic effects. The histopathological examination showed severe hyperkeratosis, thickening of collagen fibres and vacuolisation of epidermal cells in PPD plus LAS exposed skin.

CONCLUSION

The findings of the present study suggest that simultaneous exposure to PPD and LAS has additive toxic effects.