Terpene-Enriched CBD oil for treating autism-derived symptoms unresponsive to pure CBD: Case report

Cannabidiol (CBD) rich products are successfully used in some countries for treating symptoms associated with autism spectrum disorder (ASD). Yet, CBD provides insufficient intervention in some individuals, or for some characterizing symptoms of ASD, raising the need for improved compositions. The current study presents a case wherein pure CBD was sufficient for treating ASD during childhood and early adolescence. However, it became insufficient during puberty accompanied by increased hyperactivity, agitation, and frequent severe aggressive behavior. Increasing the CBD dose did not result in significant improvement. Enriching the pure CBD with a carefully selected blend of anxiolytic and calming terpenes, resulted in gradual elimination of those aggressive events. Importantly, this was achieved with a significantly reduced CBD dose, being less than one-half the amount used when treating with pure CBD. This case demonstrates a strong improvement in efficacy due to terpene enrichment, where pure CBD was not sufficient. Combined with terpenes' high safety index and the ease with which they can be incorporated into cannabinoid-containing products, terpene-enriched CBD products may provide a preferred approach for treating ASD and related conditions. The careful selection of terpenes to be added enables maximizing the efficacy and tailoring the composition to particular and changing needs of ASD subjects, e.g., at different times of the day (daytime vs nighttime products).

Bayesian Classification of Vasculitis: A Simulation Study

New classification criteria for vasculitic disorders have recently been proposed by the American College of Rheumatology. These classification criteria have limitations inherent to the method employed in their development. We propose a different approach to the quantitative analysis of the manifestations of vasculitis, which may improve the precision of classification criteria in this domain. Bayesian classifiers were developed for six vasculitides using literature-derived quantitative descriptions of these syndromes. These clinical data were also used in computer programs designed to generate simulations of vasculitis and control cases. The performance of Bayesian classifiers of vasculitis was then compared to that of the American College of Rheumatology criteria, using series of computer-simulated vasculitis cases. Bayesian classifiers identified simulated vasculitis cases with greater accuracy than those of the corresponding American College of Rheumatology 1990 vasculitis criteria in all six diseases studied. As predicted by theoretical considerations, Bayesian classifiers have the potential to identify vasculitis cases more accurately than the proposed American College of Rheumatology 1990 criteria.

Graphic Representation of Sequential Bayesian Analysis

Previously undescribed algebraic transforms of Bayes’ theorem define families of operating points in the receiver operating characteristic (ROC) space which, at given pre-test probability, produce constant post-test probabilities. These isopredictive operating points form straight lines in the ROC space. The lines can be used to emulate Bayesian sequential analysis in a strictly graphic procedure, which can be applied in clinical work and medical education.

How to switch the motor on: RNA polymerase initiation steps at the single-molecule level

RNA polymerase (RNAP) is the central motor of gene expression since it governs the process of transcription. In prokaryotes, this holoenzyme is formed by the RNAP core and a sigma factor. After approaching and binding the specific promoter site on the DNA, the holoenzyme-promoter complex undergoes several conformational transitions that allow unwinding and opening of the DNA duplex. Once the first DNA basepairs (∼10 bp) are transcribed in an initial transcription process, the enzyme unbinds from the promoter and proceeds downstream along the DNA while continuously opening the helix and polymerizing the ribonucleotides in correspondence with the template DNA sequence. When the gene is transcribed into RNA, the process generally is terminated and RNAP unbinds from the DNA. The first step of transcription-initiation, is considered the rate-limiting step of the entire process. This review focuses on the single-molecule studies that try to reveal the key steps in the initiation phase of bacterial transcription. Such single-molecule studies have, for example, allowed real-time observations of the RNAP target search mechanism, a mechanism still under debate. Moreover, single-molecule studies using Förster Resonance Energy Transfer (FRET) revealed the conformational changes that the enzyme undergoes during initiation. Force-based techniques such as scanning force microscopy and magnetic tweezers allowed quantification of the energy that drives the RNAP translocation along DNA and its dynamics. In addition to these in vitro experiments, single particle tracking in vivo has provided a direct quantification of the relative populations in each phase of transcription and their locations within the cell.

Correlation of cancer risk evaluation and early detection (CADET) scores with abnormal ultrasonographic ovarian findings

OBJECTIVE

To determine the utility of a modified version of ovarian cancer-focused cancer risk evaluation and early detection (CADET) scores as a screening tool for ultrasonographic ovarian findings.

STUDY DESIGN

Prospective pilot study.

MAIN OUTCOME MEASURES

CADET scores were compared with abnormal ultrasonographic ovarian findings of peri- and postmenopausal women who attended their gynecologist for a routine check-up. The women filled in the CADET questionnaire before seeing their gynecologists who were blinded to the CADET results. The women whom they referred for pelvic transvaginal ultrasonographic examination comprised the study group. The results of their scans were compared with their CADET scores.

RESULTS

Of the 181 peri- and postmenopausal women who were candidates for this study, 154 were referred for ultrasonography, of whom 38 (24%, Group A) had abnormal ovarian scans (30 simple cysts and 8 complex findings). The other 116 (76%) women had normal sonograms (Group B). Demographic characteristics were similar for both groups. Thirteen Group A women (34%) and 52 Group B women (45%) had positive CADET scores (p = NS). The average group CADET scores were also not significantly different (0.8 +/- 1.7 for Group A and 1.7 +/- 2.5 for Group B).

CONCLUSION

CADET scores did not correlate with abnormal ultrasonographic ovarian findings.

Serotonin (5-HT) enhances the activity of amphotericin B against Aspergillus fumigatus in vitro

We investigated the in vitro synergistic antifungal potential of combining serotonin (5-HT) and sertraline with amphotericin B and itraconazole against clinical isolates of Aspergillus spp. Synergy tests were performed using the chequerboard microdilution method. Activity was measured against Aspergillus fumigatus (n = 7), Aspergillus flavus (n = 3) and Aspergillus terreus (n = 2), and compared with that for Candida albicans and Candida parapsilosis. The fractional inhibitory concentration (FIC) indices ranged between 0.25 and 3 for the various isolates tested. 5-HT was shown to enhance the activity of amphotericin B against Aspergillus spp. Combination studies with 5-HT and itraconazole and with sertraline and itraconazole or amphothericin B showed different activities for the various strains, including synergism (FIC < 1.0), additivity (FIC = 1), and indifference (FIC between 1.0 and 2.0). 5-HT and sertraline showed antagonistic activity (FIC > 2) with amphotericin B and itraconazole against C. parapsilosis.

Congestive heart failure in pregnancy: a case of peripartum cardiomyopathy

A healthy 28-year-old woman developed full-blown pulmonary oedema in the 36th week of gestation. Echocardiography revealed a globally enlarged heart with reduced systolic function. A remarkable dinical response with regain of normal ventricular function was noted with early medical intervention. This case report illustrates peripartum cardiomyopathy, a unique form of dilated cardiomyopathy affecting women during/following gestation. Clinician familiarity with this entity increases the probability of prompt appropriate treatment, offering patients the best possible prognosis.

The value of stress thallium-201 single photon emission CT imaging as a predictor of outcome and long-term prognosis after CABG

This study examined the capability of rest-redistribution 201Tl single photon emission CT imaging (TSPECT) done shortly after coronary artery bypass grafting (CABG) to predict outcome and long- term prognosis. Results of TSPECT at 5.5+/-0.7 (range 4 - 8) months postoperatively were correlated during a 4-year follow-up period wit mortality, major surgical and nonsurgical cardiac events and cardiac event-free survival in 170 patients who underwent CABG. Ten (5.8%) patients died during follow-up: 4 had a documented cardiac death (all of them with large or moderate reversible filling defects). In the survivors, there were 10 nonfatal myocardial infarctions and 11 revascularization interventions. Patients who eventually required and underwent revascularization procedures demonstrated large or moderate reversible filing defects, in contrast with those who had no need for an additional procedure (15.7% versus 2.5%, p < 0.001). Postoperative TSPECT carried out soon after CABG had definite prognostic value and should be performed routinely to help decide treatment protocol.

TB or not TB: cavitary bronchiolitis obliterans organizing pneumonia mimicking pulmonary tuberculosis

Two patients with subacute symptoms and signs compatible with pulmonary tuberculosis (TB) had right upper lobe cavitary infiltrates shown on chest radiography. In both patients, purified protein derivative and microbiologic testing excluded TB, and tissue examination yielded typical histologic changes of bronchiolitis obliterans organizing pneumonia (BOOP). Glucocorticoid therapy led to clinical and radiologic resolution. Though probably rare in this situation, BOOP should be considered in the differential diagnosis of patients presenting with clinical and radiologic features of pulmonary TB.

The impact of myocardial viability as determined by rest-redistribution 201Tl single photon emission CT imaging and the choice of therapy on prognosis in patients with left ventricular dysfunction

While thallium-201 (201Tl) single-photon emission CT (TSPECT) scintigraphy is a commonly used method for determining the viability of the myocardium, its value for predicting outcome is limited. The diagnosis of myocardial viability in patients with ischemic systolic left ventricular dysfunction might indicate which of them will benefit more from surgical revascularization. Forty patients (mean +/- SD aged 64.5 +/- 12 years, 33 males and 7 females) with impaired systolic left ventricular function (ejection fraction < or = 45%) underwent TSPECT examination. Twenty patients were surgically revascularized and 20 were treated medically. The patients were followed-up for a 34 +/- 10-month period and the cardiac long-term prognosis was evaluated. The significant viability percentage (SVP), defined as the percentage of the total number of segments showing a normal uptake of 201Tl redistribution divided by the total number of segments evaluated, was > or =55: this was observed in 18 patients. Among them, the cardiac event-free survival was 100% in the surgical group versus 22% in the medical group. However, in patients with non-SVP, the survival was lower and not significantly different in the two treatment groups. Surgical revascularization is the preferred method of treatment in patients with ischemic systolic left ventricular dysfunction and myocardial viability as defined by TSPECT scintigraphy.

Dysphagia with multiple autoimmune disease

Myasthenia gravis (MG) and polymyositis (PM) are organ-specific autoimmune diseases. Occasional reports describe patients with clinical and pathologic features of both. Achalasia is idiopathic in nature, but autoimmune and inflammatory mechanisms have been proposed for this disorder as well. We describe a patient with dysphagia who was diagnosed at different points in time with all these three rare conditions. Despite at least putatively having immune mechanisms in common, an association between the three has not been previously described.

Short- and long-term follow-up after coronary bypass grafting for single-vessel coronary artery disease

Short-term outcome and 10-year clinical outcome were reviewed in 114 consecutive patients after coronary artery bypass grafting (CABG) for single-vessel coronary artery disease (CAD). Gated equilibrium radionuclide cineangiography was performed soon after CABG in all cases, and revealed very good early graft patency rates. There was no perioperative mortality, and very low morbidity. During follow-up there were seven late deaths, two from cardiac disease and five from non-cardiac causes. Cumulative survival at 10 years was 93%. Cumulative freedom from additional cardiac invasive procedures was 96%, 93% and 80% at 1, 5, and 10 years, respectively, and cumulative freedom from angina was 93%, 80% and 73%. Conventional single-vessel CABG thus can be safely performed, with minimal postoperative morbidity and no mortality, providing good long-term relief of angina and circumventing need for additional invasive procedures.

Graphic representation of sequential Bayesian analysis

Previously undescribed algebraic transforms of Bayes' theorem define families of operating points in the receiver operating characteristic (ROC) space which, at given pre-test probability, produce constant post-test probabilities. These isopredictive operating points form straight lines in the ROC space. The lines can be used to emulate Bayesian sequential analysis in a strictly graphic procedure, which can be applied in clinical work and medical education.

Long-term follow-up after coronary artery bypass grafting reoperation

BACKGROUND

Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency.

OBJECTIVE

To determine the clinical outcome and the long-term results of a second CABG.

SETTING

An 1100-bed urban university-affiliated hospital.

DESIGN

Retrieval of data on selected parameters from medical records before surgery and prospective follow-up afterwards.

PATIENTS AND METHODS

We studied the outcomes of 498 consecutive patients who underwent CABG reoperation in our institution from January 1978 to December 1989 and who were followed postoperatively. Their perioperative mortality, morbidity, and long-term follow-up results were re-evaluated. The end points of the study were December 1997, 15 years of follow-up, or the patient's death.

RESULTS

The perioperative mortality rate was 3%. The cumulative survival rates were 90.1%, 74%, and 63.4% at the 5-year, 10-year, and 15-year follow-ups, respectively. The cardiac event-free survival rates were 91.5%, 83.4%, and 67.8% at the 5-year, 10-year, and 15-year follow-ups, respectively. The risk factors adversely affecting long-term survival were advanced age, hypertension, and a low left ventricular ejection fraction (LVEF).

CONCLUSIONS

The long-term results of cumulative survival and cardiac event-free survival in patients who underwent CABG reoperation are good. Although this reoperation is safe overall, advanced age, hypertension, and a decreased LVEF significantly increase the surgical risk.

CaDet, a computer-based clinical decision support system for early cancer detection

Cancer risk evaluation and early detection are subject to serious limitations mainly related to human factors and to characteristics of the data involved. To help overcome these problems, a computer-based system was designed to provide the physician with a clearer clinical picture and aid in directing patients to appropriate measures. Clinical and epidemiological data related to early cancer detection and to cancer risk factors was collected from the literature and incorporated in a database, together with heuristic rules for evaluating this data. Individual data obtained from patients through a questionnaire are input into CaDet, a computerized clinical decision support system. A report summarizing patient data and cancer hypotheses, with a scoring system that reflects degrees of alarm, is generated. The CaDet system, as well as some preliminary results of the clinical experience accumulated in its use, are described. These preliminary results suggest that the approach may be useful in improving cancer risk assessment and screening in primary care setups.

Impact of early exercise radionuclide cineangiography on long-term prognosis after CABG

BACKGROUND

The immediate benefits of coronary artery bypass grafting might be only transient. This prospective study examined the capability of exercise radionuclide cineangiography done shortly after coronary artery bypass grafting to predict outcome and long-term prognosis.

METHODS

Results of exercise radionuclide cineangiography at 5.5 +/- 0.7 months (range, 4 to 8 months) postoperatively were correlated with mortality, major surgical and nonsurgical cardiac events, and cardiac event-free survival in 100 consecutive patients who underwent coronary artery bypass grafting. Stepwise logistic regression analysis was used to evaluate the incremental value of radionuclide cineangiography beyond the commonly used variables.

RESULTS

Left ventricular ejection fraction at rest was normal (> or = 0.45) in 72 patients and increased on exercise in 58. The exercise radionuclide variables that correlated with future cardiac events were change and fractional change in heart rate, ST segment changes, anginal pain and congestive heart symptoms during exercise, rest ejection fraction, and change and fractional changes in ejection fraction. Predictors of event-free survival were exercise heart rate, rest ejection fraction, and change and fractional change in ejection fraction during exercise. Logistic regression analysis revealed that change in ejection fraction was an independent predictor of cardiac death and surgical interventions, whereas resting ejection fraction was a predictor of nonsurgical cardiac events.

CONCLUSIONS

Postoperative exercise radionuclide cineangiography carried out soon after coronary artery bypass grafting had definite independent prognostic value and should be performed routinely to help decide treatment protocol.

Very early onset of acute amiodarone pulmonary toxicity presenting with hemoptysis

A case of amiodarone pulmonary toxicity (APT) occurring within days of the start of therapy and presenting with hemoptysis is reported. Both the very early onset and the presenting symptom are highly unusual in this entity. Implications in the diagnosis of APT are discussed.

Bayesian classification of vasculitis: a simulation study

New classification criteria for vasculitic disorders have recently been proposed by the American College of Rheumatology. These classification criteria have limitations inherent to the method employed in their development. We propose a different approach to the quantitative analysis of the manifestations of vasculitis, which may improve the precision of classification criteria in this domain. Bayesian classifiers were developed for six vasculitides using literature-derived quantitative descriptions of these syndromes. These clinical data were also used in computer programs designed to generate simulations of vasculitis and control cases. The performance of Bayesian classifiers of vasculitis was then compared to that of the American College of Rheumatology criteria, using series of computer-simulated vasculitis cases. Bayesian classifiers identified simulated vasculitis cases with greater accuracy than those of the corresponding American College of Rheumatology 1990 vasculitis criteria in all six diseases studied. As predicted by theoretical considerations, Bayesian classifiers have the potential to identify vasculitis cases more accurately than the proposed American College of Rheumatology 1990 criteria.

Bibliometric study of cardiology in Israel in 1978, 1983 and 1988

This work presents the results of the first bibliometric study of scientific papers in the field of cardiology in Israel. Using a computer-aided search (Medline), papers published in three selected years (1978, 1983 and 1988) were compared with respect to quantity, type and topic of publication and impact factor. An activity index was designed to measure the relative academic effort devoted to the field of cardiology in Israel. A survey of several cardiological publications worldwide was also carried out. The impact factor and the activity index of Israeli publications markedly increased from 1978 to 1983 but decreased between 1983 and 1988. The ratio of Israeli to world cardiological publications increased from 1978 to 1983, but remained unchanged between 1983 and 1988.

Felty's syndrome without concomitant arthritis: a variant

A young female patient who had documented seropositive rheumatoid arthritis and was treated consecutively with aspirin, diclofenac, and gold salts was admitted years later for severe neutropenia. On examination she had, in addition, fever, positive rheumatoid factor, reversible swan-neck deformity of the fingers but otherwise normal joint findings. The patient responded to prednisone therapy. This case would appear to be a most unusual variant of Felty's syndrome.

Patients with prolonged bleeding time of undefined etiology, and their response to desmopressin

Between 1981 and 1986, we evaluated 59 patients who presented with isolated prolongation of bleeding time with normal platelet counts, platelet aggregation and coagulation parameters (including von Willebrand's factor), and without evidence of liver or kidney disease, or exposure to anti-platelet agents. These patients, termed as vascular fragility syndrome (VFS), were analyzed to further characterize their bleeding patterns. The pattern of bleeding manifestations was similar to that of patients with platelet dysfunction, such as mucocutaneous bleeding or excessive post-operative bleeding. In 16 patients, desmopressin (1-desamino-8-d-arginine vasopressin, DDAVP) was infused to control active bleeding or as a part of pre-surgical evaluation. Bleeding time improved (pre-DDAVP bleeding time 15.3 +/- 3.4 min, mean +/- S.D.; post-DDAVP bleeding time 10.7 +/- 3.9 min; p less than 0.01) within 30 minutes following the DDAVP infusion with either satisfactory arrest of acute bleeding or good control of subsequent hemostasis with surgery. Side effects with DDAVP were transient and minor, i.e. facial flushing, or conjunctival erythema. These findings indicate that VFS with isolated prolongation of bleeding time is a frequently encountered bleeding disorder and that DDAVP is effective in achieving hemostasis for the management of acute bleeding and may be useful prior to surgical procedures.

Segmental air plethysmography in the diagnosis of deep vein thrombosis

The diagnostic accuracy of segmental air plethysmography using a pulse volume recorder in the detection of deep vein thrombosis (DVT) was assessed. Measurements in 25 limbs with phlebographic proof of DVT and 25 limbs with normal phlebographic examination results were used to develop criteria. With these criteria, a prospective analysis of 50 limbs of patients suspected of having DVT was done. High sensitivity and specificity rates were found for proximal DVT. An accurate plethysmographic diagnosis could not be obtained for nonocclusive DVT or thrombosis confined to calf veins. The accuracy of the segmental air technique was comparable with that of other plethysmographic techniques.

Detection of a tyrosine kinase in human sera and blood cells by pp60src antiserum

Using sera of Rous sarcoma virus-tumor bearing rabbits (TBR-sera) as a tool to detect pp60src kinase in immunoprecipitates, we report here that about 10% of our TBR-sera revealed tyrosine kinase activity in human serum, plasma and in soluble extracts of human blood cells. The activity found in serum represents 5-12% of the total kinase activity in blood. Most of the enzyme activity was detected in lymphocytes and polymorphonuclear cells rather than in platelets and erythrocytes. We also demonstrate that the tyrosine kinase in serum is inhibited by quercetin, a potent inhibitor of the viral pp60src protein kinase.

High-output cardiac failure as a presenting symptom of plasma cell leukemia

A patient presented with high-output cardiac failure and was found to have plasma-cell leukemia. No cause for the cardiac failure was found, and there was no response to treatment with diuretics and thiamine. Chemotherapy for the leukemia resulted in resolution of the cardiac failure, suggesting that the latter was caused by the leukemia--a hitherto unreported association.

Assay and properties of IgA protease of Streptococcus sanguis

An assay procedure for streptococcal IgA protease is described which uses isotopically labelled human serum IgA as substrate. Enzyme activity was monitored by the radioactive counts in the Fab alpha product, which was separated from other components in the digestion mixture by electrophoresis. Cleavage of IgA was linear with respect to time using catalytic amounts of the enzyme. Km was calculated to be 5.5 X 10(-6)M, pH optimum 6.0-7.0 at 37 degrees C, and the enzyme was fully inactivated at low concentrations of the metal chelator ethylenediaminetetraacetic acid.

Inclusion body myositis: a distinct variety of idiopathic inflammatory myopathy

We report six cases of inclusion body myositis (IBM), a distinct but infrequently recognized inflammatory disease of skeletal muscle. Clinically, IBM differs from dermatomyositis and polymyositis. It lacks features of collagen-vascular disease, has a relatively benign and protracted course, frequently involves distal muscles, is found mainly in males, and does not improve with corticosteroid treatment. Electronmicroscopic demonstration of abnormal filaments in muscle cells is necessary for definite diagnosis, but IBM may be suspected by the finding on cryostat sections of numerous hematoxylinophilic granules in "lined" vacuoles in muscle cells. These correspond to whorls of cytomembranes. Although in dermatomyositis the capillary network is partly destroyed, in IBM it is usually augmented. A viral etiology of IBM has been suggested but remains unproven.

Direct evidence for the specific fixation of Cl. botulinum A neurotoxin to brain matter

Rat brain homogenate and synaptosomes from rat brain bind botulinum toxin. The binding is accompanied by partial inactivation. The binding decreases with increasing ionic strength. A considerable fixation of tetanus toxin can still be demonstrated under conditions which prevent the fixation of botulinum toxin. 2. Only the grey substance, not the white substance from bovine brain is able to bind the toxin. 3. Upon pretreatment with neuraminidase, synaptosomes lose nearly all of their binding capacity. However, neither gangliosides nor ganglioside-cerebroside mixtures nor brain extracts could replace the synaptosomes. Thus botulinum A toxin closely resembles tetanus toxin in its ability to react with (a) neuraminidase-sensitive site(s) of the grey matter of the CNS. It differs from tetanus toxin by its stronger sensitivity against ionic forces and by its failure to react with certain gangliosides.