Clinical Subcategories Research Articles

Mental health concerns during pregnancy associated with the risk of preterm birth: A retrospective cohort study

BackgroundsThere are multiple risk factors for preterm birth (PTB), one of the most important of which is mood disorders during pregnancy. We aimed to comprehensively investigate the association of both total mental health concerns and ten specific psychiatric symptoms with PTB risk. MethodsA cohort study was performed consisting of 25,175 pregnant women who participated in Women and Children's Hospital of Chongqing Medical University between 2020 and 2022. The Symptom Checklist 90 (SCL-90) was utilized to assess the psychiatric symptoms. Multivariable or multinomial logistic regression was applied to investigate mental health concerns associated with risk of PTB or its different clinical sub-categories, respectively. Sensitivity analyses were further performed to validate the results. Results8336 women who met the inclusion criteria were included; of these, 547 (6.6 %) had preterm deliveries, and 2542 (30.5 %) had mental health concerns. Compared with women with healthy minds, women with total mental health concerns had a 29.0 % higher risk of overall PTB (OR = 1.28, 95%CI = 1.07–1.54), medical-induced PTB (OR = 1.49, 95%CI = 1.05–2.13) and spontaneous PTB with premature rupture of membranes (OR = 1.33, 95%CI = 1.01–1.74). As to the specific psychological symptoms, hostility pregnant women had a 55.0 % higher risk of PTB (OR = 1.55, 95%CI = 1.14–2.11). Similar results were observed in most of the sensitivity analyses. LimitationsThis is a single-center study, thus the extrapolation of the results may be limited. ConclusionsPregnant women with mental health symptoms, especially hostility, have an increased risk of PTB. The findings underscore that integrating mental health services into routine maternal care may be a strategy to prevent PTB.

Opening new vistas on obsessive-compulsive disorder with the observing response task

Obsessive-compulsive disorder (OCD), a highly prevalent and debilitating disorder, is incompletely understood in terms of underpinning behavioural, psychological, and neural mechanisms. This is attributable to high symptomatic heterogeneity; cardinal features comprise obsessions and compulsions, including clinical subcategories. While obsessive and intrusive thoughts are arguably unique to humans, dysfunctional behaviours analogous to those seen in clinical OCD have been examined in nonhuman animals. Genetic, ethological, pharmacological, and neurobehavioural approaches all contribute to understanding the emergence and persistence of compulsive behaviour. One behaviour of particular interest is maladaptive checking, whereby human patients excessively perform checking rituals despite these serving no purpose. Dysfunctional and excessive checking is the most common symptom associated with OCD and can be readily operationalised in rodents. This review considers animal models of OCD, the neural circuitries associated with impairments in habit-based and goal-directed behaviour, and how these may link to the compulsions observed in OCD. We further review the Observing Response Task (ORT), an appetitive instrumental learning procedure that distinguishes between functional and dysfunctional checking, with translational application in humans and rodents. By shedding light on the psychological and neural bases of compulsive-like checking, the ORT has potential to offer translational insights into the underlying mechanisms of OCD, in addition to being a platform for testing psychological and neurochemical treatment approaches.

Congenital Microcephaly: A Debate on Diagnostic Challenges and Etiological Paradigm of the Shift from Isolated/Non-Syndromic to Syndromic Microcephaly.

Congenital microcephaly (CM) exhibits broad clinical and genetic heterogeneity and is thus categorized into several subtypes. However, the recent bloom of disease-gene discoveries has revealed more overlaps than differences in the underlying genetic architecture for these clinical sub-categories, complicating the differential diagnosis. Moreover, the mechanism of the paradigm shift from a brain-restricted to a multi-organ phenotype is only vaguely understood. This review article highlights the critical factors considered while defining CM subtypes. It also presents possible arguments on long-standing questions of the brain-specific nature of CM caused by a dysfunction of the ubiquitously expressed proteins. We argue that brain-specific splicing events and organ-restricted protein expression may contribute in part to disparate clinical manifestations. We also highlight the role of genetic modifiers and de novo variants in the multi-organ phenotype of CM and emphasize their consideration in molecular characterization. This review thus attempts to expand our understanding of the phenotypic and etiological variability in CM and invites the development of more comprehensive guidelines.

Analysis of complement system gene expression and outcome across the subtypes of glioma

Glioma is a malignant and poorly understood cancer that occurs in the glial cells of the brain. Gliomas consist of two clinical subcategories: low-grade glioma (LGG) and glioblastoma (GBM). Based on gene expression profile analysis, gliomas are also divided into four transcriptional subtypes and two mutational subclasses based on IDH expression. These subtypes are associated with differing prognoses, histology, and gene profiles. The complement system, a branch of the innate immune system traditionally associated with inflammation and opsonization, has various pro-tumor effects, including immunosuppression, maintenance of glial stem cells, and hypoxic signaling. We analyzed the expression of complement system genes across the transcriptional and IDH-mutational subtypes of LGG and GBM to determine whether these genes are differentially expressed concerning mutation status and transcriptional subclasses. We performed differential gene expression analysis and analyzed the results for gene set enrichments and correlations with outcome status. The results showed that complement system genes are differentially expressed with varying outcomes across different glioma subtypes. Within the transcriptional subtypes, the complement system genes tended to be overexpressed in subtypes with poor response to treatment or increased tumor malignancy. These results suggest that dysregulation of the complement system may significantly contribute to the categorization of transcriptional subtypes and further, may play a role in treatment response and/or overall patient outcome, although more research is needed to confirm this. These findings could help elucidate the interplay between the immune system, gene expression, and glioma pathogenesis.

Metastatic Death Based on Presenting Features and Treatment for Advanced Intraocular Retinoblastoma: A Multicenter Registry-Based Study

Purpose:To evaluate presenting features, tumor size, and treatment methods for risk of metastatic death due to advanced intraocular retinoblastoma (RB).Design:International, multicenter, registry-based retrospective case series.Participants:A total of 1841 patients with advanced RB.Methods:Advanced RB was defined by 8th edition American Joint Committee on Cancer (AJCC) categories cT2 and cT3 and new AJCC-Ophthalmic Oncology Task Force (OOTF) Size Groups (1: < 50% of globe volume, 2: > 50% but < 2/3, 3: > 2/3, and 4: diffuse infiltrating RB). Treatments were primary enucleation, systemic chemotherapy with secondary enucleation, and systemic chemotherapy with eye salvage.Main Outcome Measures:Metastatic death.Results:The 5-year Kaplan–Meier cumulative survival estimates by patient-level AJCC clinical subcategories were 98% for cT2a, 96% for cT2b, 88% for cT3a, 95% for cT3b, 92% for cT3c, 84% for cT3d, and 75% for cT3e RB. Survival estimates by treatment modality were 96% for primary enucleation, 89% for systemic chemotherapy and secondary enucleation, and 90% for systemic chemotherapy with eye salvage. Risk of metastatic mortality increased with increasing cT subcategory (P < 0.001). Cox proportional hazards regression analysis confirmed a higher risk of metastatic mortality in categories cT3c (glaucoma, hazard ratio [HR], 4.9; P = 0.011), cT3d (intraocular hemorrhage, HR, 14.0; P < 0.001), and cT3e (orbital cellulitis, HR, 19.6; P < 0.001) than in category cT2a and with systemic chemotherapy with secondary enucleation (HR, 3.3; P < 0.001) and eye salvage (HR, 4.9; P < 0.001) than with primary enucleation. The 5-year Kaplan–Meier cumulative survival estimates by AJCC-OOTF Size Groups 1 to 4 were 99%, 96%, 94%, and 83%, respectively. Mortality from metastatic RB increased with increasing Size Group (P < 0.001). Cox proportional hazards regression analysis revealed that patients with Size Group 3 (HR, 10.0; P = 0.002) and 4 (HR, 41.1; P < 0.001) had a greater risk of metastatic mortality than Size Group 1.Conclusions:The AJCC-RB cT2 and cT3 subcategories and size-based AJCC-OOTF Groups 3 (> 2/3 globe volume) and 4 (diffuse infiltrating RB) provided a robust stratification of clinical risk for metastatic death in advanced intraocular RB. Primary enucleation offered the highest survival rates for patients with advanced intraocular RB.

Whole-Exome Sequencing-Based Approach for Germline Mutations in Patients with Inborn Errors of Immunity.

Owing to recent technological advancements, using next-generation sequencing (NGS) and the accumulation of clinical experiences worldwide, more than 420 genes associated with inborn errors of immunity (IEI) have been identified, which exhibit large genotypic and phenotypic variations. Consequently, NGS-based comprehensive genetic analysis, including whole-exome sequencing (WES), have become more valuable in the clinical setting and have contributed to earlier diagnosis, improved treatment, and prognosis. However, these approaches have the following disadvantages that need to be considered: a relatively low diagnostic rate, high cost, difficulties in the interpretation of each variant, and the risk of incidental findings. Thus, the objective of this study is to review our WES results of a large number of patients with IEI and to elucidate patient characteristics, which are related to the positive WES result. We performed WES for 136 IEI patients with negative conventional screening results for candidate genes and classified these variants depending on validity of their pathogenicity. We identified disease-causing pathogenic mutations in 36 (26.5%) of the patients which were found in known IEI-causing genes. Although the overall diagnostic rate was not high and was not apparently correlated with the clinical subcategories and severity, we revealed that earlier onset with longer duration of diseases were associated with positive WES results, especially in pediatric cases. Most of the disease-causing germline mutations were located in the known IEI genes which could be predicted using patients' clinical characteristics. These results may be useful when considering appropriate genetic approaches in the clinical setting.

Sémiologie motrice oubliée : les crises non épileptiques psychogènes

Psychogenic Non Epileptic Seizure (PNES) are defined as paroxysmal and transient behavioral manifestations, suggestive of epileptic seizures, but without the concomitant electro physiological activity linked to an epileptic seizure. There is a net female predominance (75 %). The beginning of illness is typically in the second or third decade. About 80 % patients have antecedents of traumatisms. The understanding of PNES requires the analysis of three types of factors (3P): predisposing, precipitating, and perpetuating factors. These factors all are not always found. There would be a correlation between the dysfunction of some cerebral networks and the dissociation for patients suffering from PNES. There would be a complex emotional dysfunction for some patients suffering from PNES. The semiological analysis in video-EEG allows to identify characteristic associations of signs during seizure allowing to differentiate five clinical subcategories which linked to the semiological analysis of 3 P allow to diagnose PNES. The diagnostic announcement of PNES is a delicate stage, but important to start a first therapeutic stage: it conditions the forecast of the patients suffering from PNES. The diagnostic announcement and the taking care require a close collaboration between neurologists and psychiatrists.

Urinary Bisphenol A Levels during Pregnancy and Risk of Preterm Birth.

BackgroundPreterm birth (PTB), a leading cause of infant mortality and morbidity, has a complex etiology with a multitude of interacting causes and risk factors. The role of environmental contaminants, particularly bisphenol A (BPA), is understudied with regard to PTB.ObjectivesIn the present study we examined the relationship between longitudinally measured BPA exposure during gestation and PTB.MethodsA nested case–control study was performed from women enrolled in a prospective birth cohort study at Brigham and Women’s Hospital in Boston, Massachusetts, during 2006–2008. Urine samples were analyzed for BPA concentrations at a minimum of three time points during pregnancy on 130 cases of PTB and 352 randomly assigned controls. Clinical classifications of PTB were defined as “spontaneous,” which was preceded by spontaneous preterm labor or preterm premature rupture of membranes, or “placental,” which was preceded by preeclampsia or intrauterine growth restriction.ResultsGeometric mean concentrations of BPA did not differ significantly between cases and controls. In adjusted models, urinary BPA averaged across pregnancy was not significantly associated with PTB. When examining clinical classifications of PTB, urinary BPA late in pregnancy was significantly associated with increased odds of delivering a spontaneous PTB. After stratification on infant’s sex, averaged BPA exposure during pregnancy was associated with significantly increased odds of being delivered preterm among females, but not males.ConclusionsThese results provide little evidence of a relationship between BPA and prematurity, though further research may be warranted given the generalizability of participant recruitment from a tertiary teaching hospital, limited sample size, and significant associations among females and within the clinical subcategories of PTB.CitationCantonwine DE, Ferguson KK, Mukherjee B, McElrath TF, Meeker JD. 2015. Urinary bisphenol A levels during pregnancy and risk of preterm birth. Environ Health Perspect 123:895–901; http://dx.doi.org/10.1289/ehp.1408126

Ocular vascular occlusive disorders: natural history of visual outcome.

Ocular vascular occlusive disorders collectively constitute the most common cause of visual disability. Before a disease can be managed, it is essential to understand its natural history, so as to be able to assess the likely effectiveness of any intervention. I investigated natural history of visual outcome in prospective studies of 386 eyes with non-arteritic anterior ischemic optic neuropathy (NA-AION), 16 eyes with non-arteritic posterior ischemic optic neuropathy, 697 eyes with central retinal vein occlusion (CRVO), 67 eyes with hemi-CRVO (HCRVO), 216 eyes with branch retinal vein occlusion (BRVO), 260 eyes with central retinal artery occlusion (CRAO), 151 eyes with branch retinal artery occlusion (BRAO) and 61 eyes with cilioretinal artery occlusion (CLRAO). My studies have shown that every one of these disorders consists of multiple distinct clinical sub-categories with different visual findings. When an ocular vascular occlusive disorder is caused by giant cell arteritis, which is an ophthalmic emergency, it would be unethical to do a natural history study of visual outcome in them, because in this case early diagnosis and immediate, intensive high-dose steroid therapy is essential to prevent any further visual loss, not only in the involved eye but also in the fellow, normal eye. In NA-AION in eyes seen ≤2 weeks after the onset, visual acuity (VA) improved in 41% of those with VA 20/70 or worse, and visual field (VF) improved in 26% of those with moderate to severe VF defect. In non-ischemic CRVO eyes with VA 20/70 or worse, VA improved in 47% and in ischemic CRVO in 23%; moderate to severe VF defect improved in 79% in non-ischemic CRVO and in 27% in ischemic CRVO. In HCRVO, overall findings demonstrated that initial VA and VF defect and the final visual outcome were different in non-ischemic from ischemic HCRVO - much better in the former than the latter. In major BRVO, in eyes with initial VA of 20/70 or worse, VA improved in 69%, and moderate to severe VF defect improved in 52%. In macular BRVO with 20/70 or worse initial VA, it improved in 53%, and initial minimal-mild VF defect was stable or improved in 85%. In various types of CRAO there are significant differences in both initial and final VA and VF defects. In CRAO eyes seen within 7 days of onset and initial VA of counting fingers or worse, VA improved in 82% with transient non-arteritic CRAO, 67% with non-arteritic CRAO with cilioretinal artery sparing, 22% with non-arteritic CRAO. Central VF improved in 39% of transient non-arteritic CRAO, 25% of non-arteritic CRAO with cilioretinal artery sparing and 21% of non-arteritic CRAO. Peripheral VF improved in non-arteritic CRAO in 39% and in transient non-arteritic CRAO in 39%. In transient CRAO, finally peripheral VFs were normal in 93%. In non-arteritic CRAO eyes initially 22% had normal peripheral VF and in the rest it improved in 39%. Final VA of 20/40 or better was seen in 89% of permanent BRAO, and in 100% of transient BRAO and non-arteritic CLRAO. In permanent BRAO eyes, among those seen within 7 days of onset, central VF defect improved in 47% and peripheral VF in 52%, and in transient BRAO central and peripheral VFs were normal at follow-up. My studies showed that AION, CRVO, BRVO, CRAO and BRAO, each consist of multiple distinct clinical sub-categories with different visual outcome. Contrary to the prevalent impression, these studies on the natural history of visual outcome have shown that there is a statistically significant spontaneous visual improvement in each category. The factors which influence the visual outcome in various ocular vascular occlusive disorders are discussed.

Pulmonary arterial hypertension: bridging the present to the future

The past decade has witnessed extensive progress in basic and clinical research in the field of pulmonary hypertension (PH), a group of chronic conditions characterised by high pressure in the pulmonary circulation. National and international PH registries have achieved much to advance our understanding of the epidemiology, demographics, aetiology, clinical course, haemodynamics, disease management and treatment outcomes of PH [1–7]. Therapies available to target the pathology of pulmonary arterial hypertension (PAH) have expanded considerably and more options are expected in the near future [8, 9]. Although this progress has steadily improved the outlook for PAH patients, there remains a need for further developments to ensure that advances continue to be made. The articles and case reports in this issue of the European Respiratory Review discuss key and current issues in the management of patients with PH. The authors, all experts in the field of PH, delivered the presentations upon which the articles are based at the 11th International Pulmonary Hypertension Forum in Dublin, Ireland on May 12–13, 2012. This annual platform for the exchange of knowledge and experience among clinicians and researchers was attended by over 1,000 healthcare professionals from all over the world, highlighting the continuing interest in this devastating group of diseases. The European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines provide a clear classification of the major clinical subcategories of PH [10, 11], based on shared pathophysiological mechanisms, similar clinical presentations and therapeutic approaches [12]. It is Group 1 PH, namely PAH, that has been subject to the most rapid advancement in terms of knowledge and treatment options in the past decade. Because this group of patients is treatable, accurate and prompt diagnosis are particularly critical; PAH patients receiving treatment in World …

Paroxysmal nocturnal hemoglobinuria: natural history of disease subcategories

AbstractThe natural history of paroxysmal nocturnal hemoglobinuria (PNH) clinical subcategories (classic PNH and aplastic anemia [AA]/PNH syndrome) is still unknown. We retrospectively studied 460 PNH patients diagnosed in 58 French hematologic centers from 1950 to 2005. The median (SE) follow-up time was 6.8 (0.5) years. The median survival time (SE) was 22 (2.5) years. We identified 113 patients with classic PNH, 224 patients with AA-PNH syndrome, and 93 (22%) intermediate patients who did not fit within these 2 categories. At presentation, classic PNH patients were older, with more frequent abdominal pain and displayed higher levels of GPI-AP–deficient granulocytes. A time-dependent improved survival was observed. In classic PNH, diagnoses before 1986 (hazard ratio [HR]: 3.6; P = .01) and increasing age (P < .001) were associated with worse survival prognoses, whereas use of androgens within the first year after diagnosis was protective (HR, 0.17; P = .01). Transfusions before 1996 (HR, 2.7; P = .007) led to lower survival rates in patients with AA-PNH syndrome, whereas immunosuppressive treatment was associated with better outcomes (HR, 0.33; P = .03). Evolution to thrombosis affected survival in both subcategories (classic PNH: HR, 7.8 [P < .001]; AA-PNH syndrome: HR, 33.0 [P < .001]). Evolution to bicytopenia or pancytopenia for classic PNH (HR, 7.3, P < .001) and malignancies for AA-PNH syndrome (HR, 48.8; P < .001) were associated with worse outcomes. Although clinical presenta-tion and prognosis factors are different, classic PNH and AA-PNH syndrome present roughly similar outcomes, affected mainly by complications.

Anticoagulation therapy in the antiphospholipid syndrome: recent advances

The antiphospholipid syndrome is currently best treated with anticoagulation. This review discusses the recent literature addressing the duration, intensity, and appropriateness of anticoagulation or antiplatelet therapy in various clinical subcategories of this syndrome. Several recent articles reaffirm the benefits of long-term anticoagulation in patients with venous thromboembolism or undergoing renal transplantation and support recommendations for usual International Normalized Ratio targets. Aspirin seems to confer benefits similar to those of anticoagulation in arterial stroke. Appropriate anticoagulation strategies for pregnancy are controversial. Anticoagulation will remain the mainstay of treatment for most patients with antiphospholipid syndrome. The optimal therapy for specific subgroups of patients will, however, require further good-quality studies.

Identification of progression markers in B-CLL by gene expression profiling

B-cell chronic lymphocytic leukemia is a heterogeneous disease with a pronounced variation in the clinical course. With the purpose of identifying genes that could be related to disease progression, we have performed gene expression profiling on B-CLL patients with an indolent disease and patients with a progressive disease with need for therapy. we applied the Affymetrix GeneChip technique to 11 B-CLL patients with stable and 10 patients with clinically progressive disease. Supervised and unsupervised clustering methods with different algorithms were used to identify genes that tend to give a distinction between stable and progressive disease. The supervised learning procedures identified groups of genes with a combined power to discriminate samples from progressive and stable disease with 70-90% accuracy. The gene for protein phosphatase 2 regulatory subunit B' (B56) gamma isoform (PPP2R5C) and the gene for retinoblastoma-like 2 (p130) (RBL2) were included among the best discriminators; both genes were downregulated in progressive as compared to stable B-CLL. In a hierarchical clustering analysis based on gene expression pattern three clinical subcategories could be identified: one with a more severe clinical outcome, a second one with good prognosis, and a third one that was intermediate between the other two groups. Our application of microarray analysis on a clinically well defined material has identified a number of genes with combined expression patterns related to stable or progressive disease in general. Unsupervised clustering suggested the existence of subclasses of samples in the progressive group that may be identifiable through gene expression patterns.

Susceptibility to multiple sclerosis: interplay between genes and environment.

Multiple sclerosis is a complex trait of unknown etiology. Epidemiological data have shown that susceptibility to multiple sclerosis is determined by both genetic and environmental factors. It is unknown whether the clinical subcategories of multiple sclerosis are separate diseases with separate etiologies and causes. Recent theories of the pathogenesis of multiple sclerosis and candidate genes are discussed. Other potential nonchromosomal factors involved in multiple sclerosis susceptibility such as mitochondrial DNA and viral factors such as Chlamydia pneumoniae are reviewed.

Novel Glycine Substitution Mutations in COL7A1 Reveal that the Pasini and Cockayne–Touraine Variants of Dominant Dystrophic Epidermolysis Bullosa Are Allelic

Mutations in the type VII collagen gene (COL7A1) have been shown to underlie dystrophic epidermolysis bullosa (DEB). The dominantly inherited forms of DEB have been divided into two clinical subcategories, the Pasini (DDEB-P) and the Cockayne-Touraine (DDEB-CT) variants, on the basis of the presence or absence of albopapuloid lesions. In this study, we have examined the molecular basis of DDEB in two Japanese families, one with DDEB-P and the other with DDEB-CT. Mutation detection strategy consisted of polymerase chain reaction amplification of COL7A1 from genomic DNA, followed by heteroduplex analysis and direct nucleotide sequencing. The results revealed heterozygous glycine substitution mutations, G2076D and G2034R, in these families, respectively. Thus, these two variants of DDEB are allelic, and subtle differences in the clinical presentation may reflect the precise position of the mutation along the type VII collagen molecule. Alternatively, the nature of the substituting amino acid (D versus R) may influence the clinical phenotype. This is the first demonstration of a COL7A1 mutation in DDEB-P, and brings the total number of dominant DEB variants with underlying glycine substitutions in COL7A1 to five, including the pretibial and localized variants as well as the Bart's syndrome, in addition to DDEB-P and DDEB-CT.

Interobserver consistency of digital rectal examination in clinical staging of localized prostatic carcinoma

A prospective study was undertaken to determine the reproducibility of clinical staging based on digital rectal examination (DRE) in prostate carcinoma. We evaluated 48 consecutive patients diagnosed with localized prostatic cancer. Four urologists performed DRE and sorted the patients according to the 1992 American Joint Committee on Cancer Classification for prostate cancer. Both the percentage observed total agreement among each couple of two different observers and the interobserver variability (Kappa index) were analyzed. The percentage observed total agreement among observers in distinguishing five clinical subcategories (T1c, T2a, T2b, T2c, and T3a) ranged between 38–60% (mean 49%) and the Kappa index showed interobserver agreement was poor (overall Kappa = 0.3 1). All four examiners agreed in assigning the same subcategory in only 21 % of cases, and 90% of them were T I. If only categories are distinguished (T I, T2, or T3), the percentage observed total agreement rises to 60–71% (mean 66%) and the interexaminer agreement improves to good (overall Kappa = 0.4 1). Accurate pathologic staging was obtained in every patient and the percentage observed agreement between every examiner and the pathologist was calculated, excluding cases interpreted as T I c. Regarding subcategories, clinicopathologic agreement ranges between 17–46%. If only categories T2 and9T3 are distinguished, agreement rises to 57–69%. In summary, the ability to reproduce clinical staging based on DRE among multiple examiners is disappointingly low and understandably correlates poorly with pathologic stage.

The Rush-Presbyterian-St. Luke's lumbar spine analysis form: a prospective study of patients with "spinal stenosis".

A form for accurate and reproducible record keeping was introduced into the orthopedic practice of one author at Rush--Presbyterian--St. Luke's Medical Center (RPSLMC) in 1976 and has been used in the evaluation of each new patient with a lumbar spine problem since that time. In order to demonstrate the usefulness and effectiveness of this form, a small subset of these patients (i.e., those with "spinal stenosis") who had had decompressive surgical treatment were recalled, reexamined, and the form redone completely. The format of the form then was changed (without changing the content) in order to give a numeric score to the various clinical subcategories covered in the history and physical examination. Within the parameters studied, significant changes were found in both of the major categories of pain and objective physical findings. This suggested that patients with "spinal stenosis" obtained definite, measurable benefit from surgical decompression during the period of 1-3 years following their surgery.

Pupil size in psychoneurotic patients. A psychophysiological and psychometric investigation.

A significant relationship has previously been demonstrated [Liakos, 1969] between pupil size (corrected for iris size) and ‘neuroticism’ as measured by the EPI. A subsequent attempt has been made in a pilot study to examine the above pupil sizes in relation to standardized measures of clinical subcategories of psychoneurotic disorders (MHQ). Twenty-four patients with psychoneurotic disorders and 13 ‘normal’ subjects comparable in age and sex were examined in this. ‘Static’ pupil size was found to correlate highly with ‘anxiety’ scores in ‘normal’ subjects but not at all in ‘neurotic’ subjects. Correlations between ‘static’ pupil size and phobic, obsessional, psychosomatic and depressive scores were wide ranging and not significant with the small numbers studied. These findings must be regarded with caution and require further testing on larger numbers of subjects. It is suggested that the MHQ may provide a useful psychometric tool in psychophysiological and psychosomatic research.

Types of Diabetes Mellitus

Editorials1 August 1962Types of Diabetes MellitusT. S. DANOWSKI, M.D., F.A.C.P.T. S. DANOWSKI, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-57-2-321 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptThe two reports of undue hyperglycemia in uremic patients, presented elsewhere in this number of the ANNALS, add another category of diabetes mellitus to the many already extant. These categories of diabetes mellitus, many of them overlapping, include juvenile (prematurity), adult (post-maturity), obese, lipoatrophic, insulin dependent (ketosis prone), insulin non-dependent (ketosis resistant), insulin sensitive, insulin resistant, brittle, post-pancreatectomy, and pancreatic diabetes mellitus. The list can be extended further by citing clinical sub-categories of diabetes mellitus like those associated with acromegaly, Cushing's syndrome or disease, adrenal rest tumors of the ovaries, pheochromocytoma, islet cell tumor of the pancreas, exophthalmic and non-exophthalmic... This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Department of Medicine University of Pittsburgh School of Medicine Pittsburgh, Pennsylvania PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTherapies of Diabetes MellitusDrug Therapy of Diabetes Mellitus 1 August 1962Volume 57, Issue 2_Part_1Page: 321-323KeywordsAcromegalyAdrenal tumorsDiabetes mellitusHyperglycemiaInsulinOvariesOverweightPancreasPheochromocytoma Issue Published: 1 August 1962 PDF downloadLoading ...