Utility of B-type natriuretic peptide in the diagnosis of congestive heart failure in an urgent-care setting

OBJECTIVES

The goal of this study was to evaluate the utility of a rapid "bedside" technique for measurement of B-type natriuretic peptide (BNP) in the diagnosis of congestive heart failure (CHF) in an urgent-care setting.

BACKGROUND

B-type natriuretic peptide is a protein secreted from the cardiac ventricles in response to pressure overload. One potential application of measurements of BNP in blood is distinguishing dyspnea due to CHF from other causes.

METHODS

B-type natriuretic peptide concentrations were measured in a convenience sample of 250 predominantly male (94%) patients presenting to urgent-care and emergency departments of an academic Veteran's Affairs hospital with dyspnea. Results were withheld from clinicians. Two cardiologists retrospectively reviewed clinical data (blinded to BNP measurements) and reached a consensus opinion on the cause of the patient's symptoms. This gold standard was used to evaluate the diagnostic performance of the BNP test.

RESULTS

The mean BNP concentration in the blood of patients with CHF (n = 97) was higher than it was in patients without (1,076 +/- 138 pg/ml vs. 38 +/- 4 pg/ml, p < 0.001). At a blood concentration of 80 pg/ml, BNP was an accurate predictor of the presence of CHF (95%); measurements less than this had a high negative predictive value (98%). The overall C-statistic was 0.97. In multivariate analysis, BNP measurements added significant, independent explanatory power to other clinical variables in models predicting which patients had CHF. The availability of BNP measurements could have potentially corrected 29 of the 30 diagnoses missed by urgent-care physicians.

CONCLUSIONS

B-type natriuretic peptide blood concentration measurement appears to be a sensitive and specific test to diagnose CHF in urgent-care settings.

Emotional functioning in eating disorders: attentional bias, emotion recognition and emotion regulation

BACKGROUND

Interpersonal processes, anxiety and emotion regulation difficulties form a key part of conceptual models of eating disorders (EDs), such as anorexia nervosa (AN) and bulimia nervosa (BN), but the experimental findings to support this are limited.

METHOD

The Reading the Mind in the Eyes task, the Difficulties in Emotion Regulation Scale (DERS) and a computerized pictorial (angry and neutral faces) Stroop task were administered to 190 women [50 with AN, 50 with BN and 90 healthy controls (HCs)].

RESULTS

Those with an ED showed attentional biases to faces in general (medium effect), but specifically to angry faces over neutral faces (large effect) compared to HCs. The ED group also reported significantly higher emotion regulation difficulties (large effect) than HCs. There was a small difference between the ED and HC groups for the emotion recognition task (small-medium effect), particularly in the restricting AN (RAN) group. Depression and attentional bias to faces significantly predicted emotion regulation difficulties in a regression model.

CONCLUSIONS

The data provide support for conceptualizations of EDs that emphasize the role of emotional functioning in the development and maintenance of EDs. Further research will concentrate on exploring whether these findings are state or trait features of EDs.

Masticatory function - a review of the literature. III. Masticatory performance and efficiency

A review and evaluation of the literature on mastication has been undertaken. Part I discusses the form of the masticatory cycle in the natural and artificial dentitions, including the controversial question of whether tooth contact occurs during function. Part II reviews the literature concerning the speed of movement of the mandible, rate of chewing, and the forces developed in chewing. Part III describes masticatory efficiency and performance, the effect of food on masticatory function, and incorporates a summary of all these three papers.

Denture fracture--a survey

The fracture of dentures is an unresolved problem. Despite increasing costs incurred by the nation on the repair of these prostheses, very little has been documented on the type of fracture encountered. This survey was carried out to determine the prevalence of type of fracture by the distribution of questionnaires to three different laboratories. Results obtained showed that 33% of the repairs carried out were due to debonded/detached teeth. Twenty-nine per cent were repairs to midline fractures, more commonly seen in upper complete dentures. The remaining 38% were other types of fractures, the majority of which constituted repairs to upper partial dentures. The latter involved detachment of acrylic resin saddles from the metal in metal based dentures and the fractures of connectors in the all-acrylic resin partial dentures.

The reinforcement of dentures

The material most commonly used for the fabrication of complete dentures is poly (methyl methacrylate) (PMMA). This material is not ideal in every respect and it is the combination of virtues rather than one single desirable property that accounts for its popularity and usage. Despite its popularity in satisfying aesthetic demands it is still far from ideal in fulfilling the mechanical requirements of a prosthesis. The fracture of dentures may be due to the mechanical properties of the acrylic resin or may be due to a multiplicity of factors leading to failure of the denture base material. Generally, there are three routes which have been investigated to improve the impact properties of PMMA: the search for, or development of, an alternative material to PMMA; the chemical modification of PMMA such as by the addition of a rubber graft copolymer; and the reinforcement of PMMA with other materials such as carbon fibres, glass fibres and ultra-high modulus polyethylene. The following review of attempts to improve the mechanical properties of denture base material takes account of papers published during the last 30 years.

Neoadjuvant hormonal therapy improves the therapeutic ratio in patients with bulky prostatic cancer treated with three-dimensional conformal radiation therapy

PURPOSE

To determine the extent of reduction of volume of normal tissue structures exposed to high doses of radiation therapy (RT) after administration of neoadjuvant hormonal therapy (NHT) in patients with bulky, geometrically unfavorable prostatic cancers.

METHODS AND MATERIALS

Twenty-two patients with bulky prostatic cancers were treated with a 3 month course of neoadjuvant leuprolide acetate and eulexin prior to three-dimensional (3-D) conformal radiotherapy. Patients were included if 3-D treatment planning revealed that either > 30% of the rectal wall would receive 95% of the prescription dose (D95) (n = 13); > or = 50% of the bladder wall would receive D95 (n = 10); or that any volume of small bowel would receive > or = 65% of the prescription dose (n = 16). All patients underwent simulation and conformal treatment planning before and after NHT. Pre and posthormone cumulative dose volume histogram (DVH) calculations for all normal tissue structures were analyzed and compared for each patient.

RESULTS

The median percentage of target volume reduction after NHT was 25% (range: 3-52%). Ten of 13 patients (78%) whose prehormone rectal DVH demonstrated > 30% of the rectal wall receiving D95 responded to NHT with a median 25% (range: 16-48%) reduction of rectal volume receiving the D95. A median reduction of 50% (range: 6-64%) of the bladder volume receiving D95 was observed in nine of ten patients (90%), while 13 of 16 (81%) showed a reduction of small bowel volume to a median percentage of 88% (range: 67-100%) of the prehormonal values.

CONCLUSION

Neoadjuvant hormonal therapy is an effective method for decreasing the size of bulky prostatic tumors as well as for optimizing the geometry of the target volume in relation to the adjacent normal tissue structures prior to radiation therapy. Such an approach allows for reduction of the volume of normal tissues exposed to high doses in the majority of treated patients. Currently, studies are underway to determine whether NHT will lead to a decreased likelihood of long-term complications associated with radiotherapy of bulky, geometrically unfavorable prostatic tumors, and permit the safe delivery of escalated dose levels using conformal treatment techniques.

Concussion May Increase the Risk of Subsequent Lower Extremity Musculoskeletal Injury in Collegiate Athletes

BACKGROUND

Laboratory-based studies on neuromuscular control after concussion and epidemiological studies suggest that concussion may increase the risk of subsequent musculoskeletal injury.

OBJECTIVE

The purpose of this study was to determine if athletes have an increased risk of lower extremity musculoskeletal injury after return to play from a concussion.

METHODS

Injury data were collected from 2006 to 2013 for men's football and for women's basketball, soccer and lacrosse at a National Collegiate Athletic Association Division I university. Ninety cases of in-season concussion in 73 athletes (52 male, 21 female) with return to play at least 30 days prior to the end of the season were identified. A period of up to 90 days of in-season competition following return to play was reviewed for time-loss injury. The same period was studied in up to two control athletes who had no concussion within the prior year and were matched for sport, starting status and position.

RESULTS

Lower extremity musculoskeletal injuries occurred at a higher rate in the concussed athletes (45/90 or 50 %) than in the non-concussed athletes (30/148 or 20 %; P < 0.01). The odds of sustaining a musculoskeletal injury were 3.39 times higher in the concussed athletes (95 % confidence interval 1.90-6.05; P < 0.01). Overall, the number of days lost because of injury was similar between concussed and non-concussed athletes (median 9 versus 15; P = 0.41).

CONCLUSIONS

The results of this study demonstrate a relationship between concussion and an increased risk of lower extremity musculoskeletal injury after return to play, and may have implications for current medical practice standards regarding evaluation and management of concussion injuries.

Neural Systems Underlying Arousal and Attention: Implications for Drug Abusea

The monoaminergic and cholinergic systems are implicated in different forms of behavioral arousal that can be dissected in terms of their forebrain targets and the nature of the behavioral processes they modulate in distinct regions. Thus, evidence in rats with selective neurochemical manipulations tested behaviorally using an analog of an attentional task developed for human subjects indicates that the coeruleo-cortical noradrenergic system is implicated in divided and selective attention, the basal forebrain cholinergic system in stimulus detection, the mesostriatal and mesolimbic dopaminergic systems in response speed and vigor, and the mesencephalic serotoninergic or 5-HT systems in response inhibition. Our recent studies have focused on fractionating, in the same task, the differential contributions of the dorsal and median raphé 5-HT systems as well as elucidating the functions of the mesocortical dopaminergic system, each of which may be relevant to understanding the behavioral and cognitive sequelae of cocaine administration in human subjects as well as in experimental animals.

Dimerization of the highly conserved light chain shared by dynein and myosin V

The Mr 8,000 light chain originally identified in Chlamydomonas flagellar dynein is also a component of both cytoplasmic dynein and myosin V. Furthermore, this small protein has been implicated as an inhibitor of neuronal nitric oxide synthase, suggesting that it may play multiple regulatory roles within the cell. Covalent cross-linking of both dynein and myosin V using 1,5-difluoro-2, 4-dinitrobenzene revealed that this light chain exists as a dimer in situ. This observation was confirmed using two additional amine-selective cross-linking reagents (dimethyl pimelimidate and disuccinimidyl suberate). When expressed as a C-terminal fusion with maltose-binding protein, the presence of the light chain caused the recombinant molecule to dimerize. Analysis of fusions containing truncated light chains identified the predicted amphiphilic helix (residues 14-32) as sufficient to cause dimerization; cross-linking required a second helical segment (residues 33-46). Together the data presented suggest that two light chains interact to form a parallel dimeric structure. This arrangement has significant implications for the potential functions of this highly conserved molecule and suggests a mechanism by which it might dissociate nitric oxide synthase.

Identification of the t complex-encoded cytoplasmic dynein light chain tctex1 in inner arm I1 supports the involvement of flagellar dyneins in meiotic drive

The cytoplasmic dynein light chain Tctex1 is a candidate for one of the distorter products involved in the non-Mendelian transmission of mouse t haplotypes. It has been unclear, however, how the t-specific mutations in this protein, which is found associated with cytoplasmic dynein in many tissues, could result in a male germ cell-specific phenotype. Here, we demonstrate that Tctex1 is not only a cytoplasmic dynein component, but is also present both in mouse sperm and Chlamydomonas flagella. Genetic and biochemical dissection of the Chlamydomonas flagellum reveal that Tctex1 is a previously undescribed component of inner dynein arm I1. Combined with the recent identification of another putative t complex distorter, Tctex2, within the outer dynein arm, these results support the hypothesis that transmission ratio distortion (meiotic drive) of mouse t haplotypes involves dysfunction of both flagellar inner and outer dynein arms but does not require the cytoplasmic isozyme.

Neoadjuvant androgen ablation prior to radiotherapy for prostate cancer: reducing the potential morbidity of therapy

OBJECTIVES

To determine the impact of neoadjuvant hormonal therapy (NHT) prior to conformal radiotherapy on the reduction of volume of normal tissue structures exposed to high doses of radiation therapy and to evaluate the overall late toxicity and response to treatment among patients treated with this approach.

METHODS

Among 214 patients treated with neoadjuvant leuprolide acetate and flutamide for 3 months prior to three-dimensional conformal radiotherapy (3D-CRT), 45 patients were prospectively evaluated with detailed dose-volume histogram (DVH) analyses to determine the extent of improvement of the geometry of the target volume after NHT. All patients underwent simulation and conformal treatment planning before and after NHT, and the pre- and posthormone DVH calculations for all normal tissue structures were compared for each patient. In addition, toxicity and response to therapy were evaluated in the 214 patients treated with this combined approach.

RESULTS

In the 45 patients evaluated, the median reduction of the rectal and bladder volumes receiving 95% of the prescription dose (D95) were 18% and 46%, respectively, while 91% showed a reduction of small bowel volume in a range of 27% to 100% of the prehormonal values. Among the entire group of 214 patients treated with NHT and 3D-CRT, no grade 3 or 4 toxicity was observed with a median follow-up of 15 months after 3D-CRT. The 3-year actuarial grade 2 late gastrointestinal and genitourinary toxicity rates were 6% and 18%, respectively.

CONCLUSIONS

Neoadjuvant hormonal therapy effectively reduces the volume of normal tissue exposed to high radiation doses in the majority of treated patients and decreases the potential morbidity of therapy.

Simulation of resistance forces acting on surgical needles

High precision in the manual control of needles and biopsy probes in medical treatment requires high skill and dexterity levels. In anaesthesia, force sensation is an important feedback mechanism, and the practitioner needs to refresh or develop skills to improve on the interpretation of needle progress towards the target site. This paper describes an experimental tactile force simulator for uniaxial needle action for which the force resisting progress of the needle is derived from measured data. As an example, the approach taken to develop the simulation of the insertion of epidural needles is described. Adaptation to other procedures would be possible by adopting new reference models based on appropriate measured force data.

Masticatory function--a review of the literature. 1. The form of the masticatory cycle

Recently, the authors realized that an evaluation of the literature on mastication had never been undertaken, and it is hoped that this review presented in three parts, will be of value, not only to the dental clinician, but to other scientists working in associated fields. The first paper discusses the form of the masticatory cycle in the natural and artificial dentitions, including the controversial question of whether tooth contact occurs during function. The second paper reviews the literature concerning the speed of movement of the mandible, rate of chewing and the forces developed in chewing. The final paper describes masticatory efficiency and performance, the effect of food on masticatory function, and incorporates a summary of all these three papers.

Denture cleansing--the best approach

Denture cleanliness is essential to prevent malodour, poor aesthetics and the accumulation of plaque/calculus with its deleterious effects on the mucosa. There are a large number of solutions, pastes and powders available for cleaning dentures with a variety of claims for their relative efficacies. Denture cleansers in common use can broadly be divided into those having mechanical or chemical effects. Surveys show that some denture wearers experience difficulty in cleaning their dentures satisfactorily and many wear dirty dentures. Replacement dentures are sometimes necessary due to general deterioration of the denture base material because of the misuse or abuse of a range of approved denture cleaning methods or do-it-yourself cleaning methods such as the use of household bleach. Current popular cleaning methods used among complete and partial denture wearers are discussed and advice is given on recommended methods of cleaning dentures. The results of a survey conducted to assess patients' knowledge of cleaning procedures and methods and materials used are also presented. Respondents used a variety of combinations of cleaning methods. The findings of this survey that a large number of people do not know how to clean their dentures satisfactorily are in agreement with those of previous surveys. Recommendations are given on suitable methods of cleaning both metal and acrylic resin dentures.

The effect of a series of fixatives on the AgNOR technique

With increasing interest being shown in nucleolar organizer regions (NORs) in pathology, it was considered of great importance to evaluate the effect of some of the more commonly used and more specialized fixatives on the demonstration of these moieties. NORs can be demonstrated in paraffin sections by a silver technique (AgNOR method) which was developed from a method used by cytogeneticists for the demonstration of NORs in chromosome spreads. The degree of staining is dependent on the fixation regime employed and results may vary greatly from one fixative to another. The fixative schedules and post-treatments used in this study were based on standard sequences from the literature. We have shown that, in general, alcohol-based fixatives give optimal results, Carnoy's fluid being especially recommended. Mercurial and dichromate-containing fixatives were found to have highly detrimental effects on NOR staining. 'Routine' 10 per cent formol saline fixation gave adequate results whereas 10 per cent neutral buffered formalin gave optimal staining, similar to alcohol-based fixation.

An in vitro investigation into the wear effects of unglazed, glazed, and polished porcelain on human enamel

Abrasive wear tests were performed on unglazed, glazed, and polished porcelain stud specimens using human enamel as the opposing plate specimens. The wear tests were carried out on a wear machine that was specifically designed to simulate the masticatory cycle. The amount of enamel wear produced by both glazed and unglazed porcelain was similar; however, that produced by polished porcelain was substantially less. Investigation of the glazed porcelain surface showed that the glaze was removed in less than 2 hours of wear on the machine.

Understanding safe sex: gender narratives of HIV and pregnancy prevention by rural South African school-going youth

In South Africa's HIV/AIDS epidemic, young people, especially women, are at high risk due to an apparent gap between awareness and practice. In repeated peer group discussions with girls aged 14-15 and boys aged 16-19, we explored influences on safe sex behaviour. Separate male and female safe sex paradigms emerged, with boys less likely to perceive themselves as 'at risk' and more likely to use condoms. Girls had not used condoms, would have preferred to delay sexual relationships and feared pregnancy as well as HIV/AIDS. Both sexes deemed it difficult for girls to initiate condom use, although both sexes viewed condoms favourably. Girls saw condoms as a sign of love and protection, whereas boys tended to use them with casual partners. A lack of decision-making autonomy within relationships further constrained girls' ability to practice safer sex. Involvement of peer participants in review of their own narrative data helped to ensure representation of participants' voices in the findings. Overall, these findings point to the need for programmes to address gender inequalities and emphasise behavioural skills in the years before sexual activity begins.

Effect of the curing cycle on residual monomer levels of acrylic resin denture base polymers

It has been shown previously that high levels of residual monomer have a deleterious effect on the properties of denture base polymers. Levels of residual monomer were determined on a homopolymer and a copolymer using gas-liquid chromatography. A wide range of recommended and 'short cut' curing cycles were then investigated which produced values ranging from 0.56 to 18.46%. From the ranges examined an optimum cycle of 7 h at 70 degrees C and 1 h at 100 degrees C was established which was used to polymerize 23 currently available synthetic denture base polymers. Only small differences were found between the materials tested with a range from 0.54 to 1.08% of residual monomer.

Early sexual debut among young men in rural South Africa: heightened vulnerability to sexual risk?

OBJECTIVE

This report examines early sexual debut (<age 15) among young men in rural South Africa including (1) risk behaviours at first sexual experience, and (2) age at first sex as a predictor of later sexual risk.

METHODS

Analysis of sexual behaviour data for men 15-24 years (n = 314) from representative cross sectional household survey.

RESULTS

13.1% of 15-24 year old men experienced sexual debut before age 15. Men with sexual debut at less than age 15 were more likely to report risk behaviours at first sexual experience: no condom use (19%), a casual partner (26.8%), and not feeling they had been "ready and wanted to have sex" (19.5%). In multivariate analysis, early sexual debut was strongly associated with > or = 3 partners in the past 3 years (OR = 10.26, p<0.01).

CONCLUSIONS

Men who initiate sex before age 15 form a distinct risk group in this setting. Specific interventions are needed for young men in the pre-teen years, before sexual debut.

(17) O NMR study of the intrinsic magnetic susceptibility and spin dynamics of the quantum kagome antiferromagnet ZnCu3(OH)(6)Cl(2)

We report, through 17O NMR, an unambiguous local determination of the intrinsic kagome lattice spin susceptibility as well as that created around nonmagnetic defects arising from natural Zn/Cu exchange in the S=1/2 (Cu2+) herbertsmithite ZnCu3(OH)6Cl2 compound. The issue of a singlet-triplet gap is addressed. The magnetic response around a defect is found to markedly differ from that observed in nonfrustrated antiferromagnets. Finally, we discuss our relaxation measurements in the light of Cu and Cl NMR data and suggest a flat q dependence of the excitations.

Two functional thioredoxins containg redox-senesitive vicinal dithiols from the Chlamydomonas outer dynein arm

We describe here the molecular cloning and analysis of the Mr 14,000 and 16,000 outer arm dynein light chains (DLCs) from Chlamydomonas flagella. Within the outer arm, the Mr 14,000 DLC apparently is associated with the intermediate chains at the base of the soluble dynein particle; the Mr 16,000 DLC interacts directly with the a dynein heavy chain. Sequence analysis indicates that both molecules are novel members of the thioredoxin superfamily and share approximately 30% sequence identity with thioredoxin from Penicillium. Both DLCs have a perfect copy of the thioredoxin active site (WCGPCK); the Mr 16,000 DLC also contains the canonical P-loop motif (AX4GKS). There is a single gene for both DLCs within Chlamydomonas and only single messages that were upregulated more than 10-fold upon deflagellation were observed on Northern blots. Both recombinant DLCs were specifically eluted from a phenylarsine oxide matrix with beta-mercaptoethanol indicating that they contain vicinal dithiols competent to undergo reversible oxidation/reduction. Furthermore, we demonstrate that outer (but not inner) arm dynein may he purified on the basis of its affinity for phenylarsine oxide suggesting that the predicted redox-sensitive vicinal dithiols exist within the native complex.

HIV risk behaviors and the context of sexual coercion in young adults' sexual interactions: results from a diary study in rural South Africa

BACKGROUND

Gender inequalities in relationship power may promote unprotected sexual intercourse.

GOALS

The goal of this study was to gain insight into the specific gender dynamics in the intimate relationships of rural South African young adults that contribute to risk for HIV infection.

STUDY

Using diary methods, 25 female and 25 male secondary school students in rural South Africa provided daily reports (N = 1000) over a 3-week timeframe, including details regarding 466 sexual interactions.

RESULTS

Inconsistent condom use was more likely in relationships in which the male partner had ever used threat or force to engage in sex during this period (unadjusted odds ratio, 13.4; 95% confidence interval, 1.57-114.26). Male sexual coercion was more likely in relationships in which alcohol was ever used in conjunction with sex and when a man's desire to engage in sex was perceived as greater than the woman's.

CONCLUSION

This study adds to the growing evidence that sexual relationships characterized by gender inequality and sexual coercion are contexts of sexual risk.

Evidence for negative association of the chemokine receptor CCR5 d32 polymorphism with rheumatoid arthritis

BACKGROUND

Ligands of chemokine receptor CCR5, including MIP-1 alpha, MIP-1 beta, and RANTES, have been implicated in rheumatoid arthritis.

OBJECTIVE

To test whether CCR5 d32 polymorphism has a negative association with rheumatoid arthritis in a New Zealand cohort.

METHODS

516 white patients with rheumatoid arthritis and 985 healthy controls were investigated by PCR amplification of the region flanking the known CCR5 d32 deletion, and the frequencies of CCR5 d32 compared. An early rheumatoid arthritis (ERA) cohort of 92 patients was followed prospectively for two years; disease severity and outcome were correlated with CCR5 d32 status.

RESULTS

12 control subjects (1.2%) were homozygous for d32; no d32 homozygous rheumatoid patients were detected (p = 0.012); 56 patients (10.9%) were heterozygous for the d32 polymorphism (d32/wt), compared with 169 controls (17.2%) (p = 0.0011). The CCR5 d32 allele frequency was lower in the rheumatoid patients than in the controls (frequencies of 0.054 and 0.098, respectively; p = 3.7 x 10(-5)). The frequency of CCR5 d32 did not differ significantly according to disease severity or outcome in the prospective ERA cohort, nor with HLA-DRB1 status.

CONCLUSIONS

This study provides further evidence for a protective effect of the CCR5 d32 variant on rheumatoid arthritis, consistent with a role for CCR5 and its ligands in disease pathogenesis.