Prevalence and pattern of perceived intelligibility changes in Parkinson's disease

BACKGROUND

Changes to spoken communication are inevitable in Parkinson's disease (PD). It remains unclear what consequences changes have for intelligibility of speech.

AIMS

To establish the prevalence of impaired speech intelligibility in people with PD and the relationship of intelligibility decline to indicators of disease progression.

METHODS

125 speakers with PD and age matched unaffected controls completed a diagnostic intelligibility test and described how to carry out a common daily activity in an "off drug" state. Listeners unfamiliar with dysarthric speech evaluated responses.

RESULTS

69.6% (n = 87) of people with PD fell below the control mean of unaffected speakers (n = 40), 51.2% (n = 64) by more than -1 SD below. 48% (n = 60) were perceived as worse than the lowest unaffected speaker for how disordered speech sounded. 38% (n = 47) placed speech changes among their top four concerns regarding their PD. Intelligibility level did not correlate significantly with age or disease duration and only weakly with stage and severity of PD. There were no significant differences between participants with tremor dominant versus postural instability/gait disorder motor phenotypes of PD.

CONCLUSIONS

Speech intelligibility is significantly reduced in PD; it can be among the main concerns of people with PD, but it is not dependent on disease severity, duration or motor phenotype. Patients' own perceptions of the extent of change do not necessarily reflect objective measures.

Foreign accent syndrome: Not such a funny turn

In foreign accent syndrome (FAS) it appears as if someone who previously spoke with one accent has suddenly started speaking with a different one; usually foreign, but sometimes another accent of the same language. This can occur in people who have never spoken with a different accent, never lived abroad and have no psychological reasons for speaking differently, although these are all factors to consider in differential diagnosis.

Visual function at baseline and 1 month in acute optic neuritis: predictors of visual outcome

OBJECTIVE

To identify cutpoints for visual measures at baseline and 1 month predictive of abnormal 6-month vision that could be used as eligibility criteria in a clinical trial to test potential neuroprotection or myelin repair agents in patients with optic neuritis. To determine whether moderate-to-severe dysfunction in one or more visual measures at baseline or 1 month correlates with having major vision loss at 6 months.

METHODS

We used the Optic Neuritis Treatment Trial database to evaluate various cutpoints for baseline and 1-month vision levels that predicted abnormal 6-month vision. For selected cutpoints, we computed a 95% CI for positive predictive value and the required sample size if the cutpoint was to be used for clinical trial eligibility. We evaluated whether the degree of visual loss at baseline, 1 month, or change in visual function from baseline to 1 month correlated with 6-month visual acuity, contrast sensitivity, or threshold visual field.

RESULTS

The best cutpoints for baseline and 1 month were visual acuity <or= 20/50, contrast sensitivity < 1.0 log units, and visual field mean deviation <or= -15 dB. The same levels of visual dysfunction at 1 month, but not at baseline, correlated with having 6-month moderate-to-severe loss for each of these measures (p = 0.01). A trial could require as few as 100 subjects for an outcome variable of one or more abnormal measures. Cutpoints at 1 month were highly predictive of abnormal 6-month vision, but the proportion of patients who would be eligible for a trial would be small.

CONCLUSION

Provided data can be used either for the clinician to counsel patients on expected visual outcome or for designing studies to test therapies that might reduce the amount of permanent optic nerve damage due to optic neuritis in high-risk patients.

Changes in estrogen receptor (ER), progesterone receptor (PR) and HER2/neu status with time: Discordance rates between primary and metastatic breast pathology samples

1024

Background: The occurrence of changes in tumor receptor profile (ER, PR and HER-2/neu) between primary and metastatic tissue has been recognised and may have significant treatment implications. Previous reports on receptor discordance rates have tended to be from sub-studies of clinical trials. We sought to evaluate the degree of ER, PR and HER-2/neu receptor discordance in patients treated at two Canadian cancer centres. Methods: Archival data was collected on patients for whom tissue from both primary and metastatic sites was available. Patients with recurrences in the breast or axilla were excluded. ER, PR and HER-2/neu status in the primary and metastasis were compared. Additional information including adjuvant therapy and time to metastasis biopsy was gathered. Results: To date, data is available on 80 patients. Hormone receptor (HR) status was available for 96% of primaries and 56% of metastases. HR status on both the primary and the metastasis was performed in 51% of cases. The discordance rate for ER was 21% (2-sided p=0.0096). 12% of patients changed from ER+ to ER- and 9% changed from ER- to ER+. The discordance rate for PR was 37% (2-sided p=0.0001), with all of these patients changing from PR+ to PR-. No significant HR discordance was found among different adjuvant hormone therapy subgroups. There was no correlation between HR discordance and time to rebiopsy. No discordance for HER-2/neu was found. Conclusions: Significant discordance for HR status was observed, 21% for ER and 37% for PR. HER-2/neu discordance was not observed. We are currently exploring the practical implications of these discordance rates on the management of advanced breast cancer patients in a prospective trial.

No significant financial relationships to disclose.

Influence of listening conditions and listener characteristics on intelligibility of dysarthric speech

Little is known about the effects of listener characteristics or listening conditions on intelligibility scores. This study compared intelligibility scores of dysarthric speech achieved under a standard listening condition with those obtained in non-standard conditions and investigated the effect of listener age, gender and familiarity with speaker accent on intelligibility scores. No differences were observed in the mean intelligibility scores across standard and non-standard listening conditions. However, mean range of scores in the standard condition was lower than in the non-standard condition (t = 3.07, df 90, p<.003; 95% CI 2.04-9.76). No main effects of listener age, gender or familiarity of accent were observed. When composite effects were examined increased age in male listeners was associated with reduced intelligibility scores. Results from the current study suggest that when conducting intelligibility research listening conditions should be standardised and that adult listeners of either gender and any age may be used to test intelligibility outcomes providing hearing acuity is taken into consideration.

Renal histopathology of stone-forming patients with distal renal tubular acidosis

To define the renal tissue changes in stone-forming patients with distal renal tubular acidosis (dRTA), we performed intra-operative papillary and cortical biopsies in five patients. The main abnormalities were plugging of inner medullary collecting ducts (IMCD) and Bellini ducts (BD) with deposits of calcium phosphate in the form of apatite; epithelial cell injury and loss was marked. Plugged ducts were surrounded by interstitial fibrosis, but the fibrosis was generalized, as well, and was a main feature of the histopathology even when plugging was not present. In contrast, common idiopathic calcium oxalate stone formers (SF) never manifest intra-tubule crystals or interstitial fibrosis. Patients with brushite (calcium monohydrogen phosphate) stones and those with cystine stones have many fewer IMCD and BD plugged with apatite (or cystine, in cystinuria), and interstitial fibrosis is limited to the regions around plugged ducts. Patients with dRTA often present a radiographic picture of nephrocalcinosis. Our direct surgical observations reveal that these may be surgically removable stones, especially in patients with well preserved renal function. In all, dRTA SF have a more diffuse papillary renal disease than other SF thus studied, and are also unusual for the degree of interstitial fibrosis.

OLIVER: an online library of images for veterinary education and research

As part of a strategic move by the University of Sydney toward increased flexibility in learning, the Faculty of Veterinary Science undertook a number of developments involving Web-based teaching and assessment. OLIVER underpins them by providing a rich, durable repository for learning objects. To integrate Web-based learning, case studies, and didactic presentations for veterinary and animal science students, we established an online library of images and other learning objects for use by academics in the Faculties of Veterinary Science and Agriculture. The objectives of OLIVER were to maximize the use of the faculty's teaching resources by providing a stable archiving facility for graphic images and other multimedia learning objects that allows flexible and precise searching, integrating indexing standards, thesauri, pull-down lists of preferred terms, and linking of objects within cases. OLIVER offers a portable and expandable Web-based shell that facilitates ongoing storage of learning objects in a range of media. Learning objects can be downloaded in common, standardized formats so that they can be easily imported for use in a range of applications, including Microsoft PowerPoint, WebCT, and Microsoft Word. OLIVER now contains more than 9,000 images relating to many facets of veterinary science; these are annotated and supported by search engines that allow rapid access to both images and relevant information. The Web site is easily updated and adapted as required.

Effect of Stage of Lactation and Parity on Mammary Gland Cell Renewal

Milk production is a function of the number and activity of mammary epithelial cells, regardless of stage of lactation. Milk yield is generally higher in multiparous cows than in primiparous cows, but persistency is usually greater in the latter group. We compared several measures related to metabolic activity, apoptosis, and endocrine control of mammary cell growth in 8 primiparous and 9 multiparous cows throughout lactation. Mammary gland biopsies were taken in early [10 d in milk (DIM)], peak (50 DIM), and late (250 DIM) lactation to evaluate gene expression and determine DNA and fatty acid synthase (FAS) content. Milk samples taken the day before the biopsies were used to detect protease activities and to determine stanniocalcin-1 (STC) concentrations. Blood samples served to measure insulin-like growth factor-1, prolactin, and STC concentrations. Milk yield was higher in multiparous cows than in primiparous cows at the 10 DIM (32.8 +/- 1.3 and 25.2 +/- 0.8 kg/d) and 50 DIM (38.0 +/- 1.2 and 29.8 +/- 1.1 kg/d), but it was the same for both groups at 250 DIM (23.9 +/- 1.5 and 23.8 +/- 1.1 kg/d). Except for stearoyl-coenzyme A desaturase, expression of genes related to milk synthesis was not affected by stage of lactation. However, gene expression of acetyl-coenzyme A carboxylase, beta-casein, and FAS was lower in early lactation in primiparous cows. Expression of both proapoptotic bax and antiapoptotic bcl-2 genes was higher in primiparous cows, whereas the bax-to-bcl-2 ratio was not changed. Mammary DNA concentration was higher in multiparous cows, as was the amount of FAS protein in early lactation. Two bands of protease activity were found in milk samples, and one of the bands had an apparent molecular weight similar to gelatinase A and was dependent on the stage of lactation. Serum insulin-like growth factor-1 increased with day of lactation and was higher in primiparous cows. Serum prolactin decreased in late lactation, but peak values were observed in early lactation for primiparous cows and peak lactation for multiparous cows. Milk STC content increased with advancing lactation. The results are consistent with a lower degree of differentiation and a greater capacity for cell renewal in the mammary gland of primiparous cows.

Hard to swallow: dysphagia in Parkinson's disease

BACKGROUND

swallowing changes occur from the earliest stages of Parkinson's disease (PD), even in cases asymptomatic for dysphagia. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them.

OBJECTIVE

to establish if and how changes in swallowing impact on the lives of people with PD.

DESIGN

in-depth interviews with qualitative analysis of content.

SETTING

community.

SUBJECTS

a total of 23 men and 14 women and their carers.

METHODS

participants were purposively sampled to give a mix of men, women, family circumstances, stage and duration of PD and severity of swallowing symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to participants for confirmation and clarification.

RESULTS

two broad themes emerged: (i) effects on swallowing of underlying physical changes, with subthemes of oral-pharyngeal-laryngeal changes, manual changes, effects of fatigue and (ii) psychosocial impact, with subthemes of alterations to eating habits, feelings of stigma, need for social adjustment and carers' issues. Coping strategies could aid swallowing problems but often to the detriment of others in the family through altered demands on preparation and organisation. Presence of significant impact was not necessarily associated with abnormal range scores on objective swallowing assessments.

CONCLUSIONS

the psychosocial consequences of the physical changes concerned people most. The importance of the early detection of changes for health and quality of life is underlined.

Molecular profiling techniques and bioinformatics in cancer research

AIMS

Our aim was to describe the commonly used molecular profiling techniques in cancer research, to examine their limitations and to discuss the challenges of bioinformatics.

METHODS

A literature search was performed using the PubMed database to identify publications relevant to this review. Citations from these articles were also examined to yield further relevant publications.

RESULTS

We describe the use of DNA microarrays, comparative genomic hybridisation, tissue microarrays and digital differential display. The limitations of these technologies, their contribution to cancer research and the challenges of bioinformatics are also discussed.

CONCLUSIONS

Although these high throughput technologies each have their own limitations they are rapidly developing and contributing significantly to our understanding of cancer genetics. They have also led to the emergence of bioinformatics as a rapidly developing and vital field.

Evolution of sensory complexity recorded in a myxobacterial genome

Myxobacteria are single-celled, but social, eubacterial predators. Upon starvation they build multicellular fruiting bodies using a developmental program that progressively changes the pattern of cell movement and the repertoire of genes expressed. Development terminates with spore differentiation and is coordinated by both diffusible and cell-bound signals. The growth and development of Myxococcus xanthus is regulated by the integration of multiple signals from outside the cells with physiological signals from within. A collection of M. xanthus cells behaves, in many respects, like a multicellular organism. For these reasons M. xanthus offers unparalleled access to a regulatory network that controls development and that organizes cell movement on surfaces. The genome of M. xanthus is large (9.14 Mb), considerably larger than the other sequenced delta-proteobacteria. We suggest that gene duplication and divergence were major contributors to genomic expansion from its progenitor. More than 1,500 duplications specific to the myxobacterial lineage were identified, representing >15% of the total genes. Genes were not duplicated at random; rather, genes for cell-cell signaling, small molecule sensing, and integrative transcription control were amplified selectively. Families of genes encoding the production of secondary metabolites are overrepresented in the genome but may have been received by horizontal gene transfer and are likely to be important for predation.

Retention of the patella in total knee arthroplasty for rheumatoid arthritis

AIM

To determine whether retention of the native patella during total knee arthroplasty is appropriate in patients with rheumatoid arthritis.

METHODS

All patients undergoing total knee arthroplasty with a diagnosis of rheumatoid arthritis were identified between January 1997 and December 2000. Subsequently, each individual underwent both radiological and clinical assessments at a designated follow-up clinic.

RESULTS

A total of 30 total knee arthroplasties were studied in 28 patients. Twenty-six patients (93%) were female with a mean age of 74.7 years (range 60-83 years). The average post-operative interval was 59.4 months (range 46-82 months). All individuals were noted to have satisfactory patellar tracking and bone stock at the time of surgery. No patient subsequently underwent revision surgery during follow-up and no episodes of implant sepsis were identified. The mean Patellar Score at final follow-up was 26.2 (range 22-30) with an average anterior knee pain score of 14.2 (range 10-15). The mean Oxford Knee Score was 18.7 (range 16-23) with a mean pain score component of 5.9. Patients were finally assessed with respect to the Knee Society Score. The mean Knee Score was 83.8 (range 71-96) with a mean Function Score of 79.7 (range 40-90).

CONCLUSION

By retaining the native patella we were still able to obtain highly satisfactory medium-term results in terms of pain relief and function. In addition, the potential complications associated with prosthetic replacement of the patella were avoided.

Speech and language therapy provision for people with Parkinson's disease

Few details are known about the experience of people with Parkinson's disease (PD) and their carers in relation to their need for and access to speech and language therapy (SLT). This study investigated the perceptions of need in relation to maintaining communication and the nature and experience of SLT. Questionnaires were sent to 141people with PD and 78carers living in the community, of whom 123 and 68 respectively responded. Twenty-five people with PD (20%) had had contact with SLT, of whom 71% felt referral was at the right time and 80% felt SLT had helped. Eighty-three percent of all respondents with PD felt that referral should occur before changes posed a problem. Easier and increased access to SLT was needed, focusing on overall management of communication rather than specific impairments. This study contributes to the PD National Institute of Health and Clinical Excellence Guideline (2006) recommendation to articulate best practice in SLT.

Allopurinol improves endothelial function in sleep apnoea: a randomised controlled study

Increased oxidative stress in obstructive sleep apnoea is thought to contribute to endothelial dysfunction. The objective of this study was to test the hypothesis that inhibition of xanthine oxidase by allopurinol can improve endothelial function in patients with obstructive sleep apnoea. A randomised double-blind placebo-controlled crossover study was performed on 12 patients with moderate-to-severe obstructive sleep apnoea, comparing 300 mg allopurinol daily for 2 weeks with placebo. Endothelial function was assessed using hyperaemia-induced flow-mediated vasodilation (FMD) at baseline and following treatment. Plasma malondialdehyde levels were compared in order to assess significant changes in oxidative stress. Baseline FMD correlated significantly with the severity of sleep apnoea and the time spent with an arterial oxygen saturation of <90%. Allopurinol caused a significant increase in FMD compared to placebo (10.4+/-3.2 versus 7.4+/-2.8%, respectively). Plasma malondialdehyde levels were significantly reduced with allopurinol treatment (1.5+/-0.3 versus 1.2+/-0.3 micromol.L(-1)), consistent with reduced oxidative stress. Allopurinol improves endothelial dysfunction in patients with moderate-to-severe obstructive sleep apnoea. These observations suggest that xanthine oxidase contributes significantly to vasodilatory impairment.

Life with communication changes in Parkinson's disease

BACKGROUND

Acoustic and perceptual changes to speech in Parkinson's disease (PD) have been widely studied. Little empirical evidence exists concerning the individual's own perception of changes, the impact these have on their life and coping strategies to deal with them.

OBJECTIVE

To establish if, and how, changes in communication impact on the lives of people with PD.

DESIGN

In-depth interviews with qualitative analysis of content.

SETTING

Community.

SUBJECTS

Twenty-three men and 14 women with PD.

METHODS

Participants were purposively sampled to give a mix of men, women, family circumstances, stage and duration of PD and severity of speech symptoms. Individuals were interviewed at home. Interviews were transcribed. Emergent themes were identified and fed back to participants for confirmation and clarification.

RESULTS

Participants identified changes to voice and articulation. Language changes featured prominently. Four impact themes: (i) interaction with others, (ii) problems with conversations, (iii) feelings about intelligibility and (iv) voice; and four corresponding coping themes (a) helping others understand, (b) managing conversations, (c) monitoring and adjusting and (d) physical strategies emerged. Of main concern was not the nature of speech-voice-language changes, but how these affected self-concept, participation inside and outside the family and family dynamics. Individuals employed a range of fluid coping strategies moving from background withdrawal to foreground striving strategies.

CONCLUSIONS

Speech and language changes in PD impact upon individual and family life long before frank impairment of intelligibility is apparent. The role of early referral to speech and language therapy is therefore worthy of detailed investigation.

A prospective randomised controlled trial of the Kiwi Omnicup versus conventional ventouse cups for vacuum-assisted vaginal delivery

OBJECTIVE

To evaluate the performance and safety of the Kiwi Omnicup and compare it to conventional vacuum cups in routine clinical practice.

DESIGN

A randomised controlled trial of the Kiwi Omnicup versus conventional vacuum cups.

SETTING

Queen Charlotte's and Chelsea Hospital, a tertiary referral hospital in London from April 2001 to March 2004.

POPULATION

Women requiring assisted vaginal delivery by ventouse.

METHODS

Women were randomised to the Kiwi Omnicup (n=206) or conventional vacuum cups (n=198). Data regarding maternal demographics, labour, mode of delivery and maternal and neonatal outcome were collected.

MAIN OUTCOME MEASURES

Failure of delivery with instrument of first choice.

RESULTS

The Kiwi Omnicup was less successful at delivery with instrument of first choice than the conventional ventouse, failure rate 30.1 versus 19.2% (RR 1.58; 95% CI 1.10-2.24). It was associated with a greater number of cup detachments (mean 0.68 compared with 0.28, with 44% compared with 18% having at least one detachment [P<0.0001]). There was no difference in the incidence of severe maternal trauma, and there were no cases of serious neonatal injury.

CONCLUSIONS

The Kiwi Omnicup is less successful than conventional ventouse in achieving vaginal delivery, but its safety profile is comparable.