Differences In Clinical Parameters Research Articles

An approach for differentiating echovirus 30 and Japanese encephalitis virus infections in acute meningitis/encephalitis: a retrospective study of 103 cases in Vietnam

BackgroundIn recent decades, Echovirus 30 (E30) and Japanese encephalitis virus (JEV) have been reported to be the common causative agents of acute meningitis among patients in South East Asia. An E30 outbreak in Vietnam in 2001–2002 gained our interest because the initial clinical diagnosis of infected patients was due to JEV infection. There are few clinical insights regarding E30 cases, and there are no reports comparing E30 and JEV acute meningitis/encephalitis cases based on clinical symptoms and case histories. We therefore aimed to identify reliable clinical methods to differentiate E30 and JEV acute meningitis/encephalitis.MethodsA retrospective, cross-sectional study was conducted to compare E30 and JEV acute meningitis/encephalitis cases. We collected and analyzed the clinical records of 43 E30 confirmed cases (E30 group) and 60 JEV confirmed cases (JEV group). Clinical data were compared between the E30 and the JEV groups. Differences of clinical parameters were analyzed by certain statistical tests.ResultsFever, headache, and vomiting were the most common symptoms in both the E30 and the JEV groups. Combined symptoms of headache and vomiting and the triad of symptoms of fever, headache, and vomiting were observed in more patients in the E30 group (E30 vs. JEV: 19% vs. 0%, p < 0.001; 74% vs. 27%, p < 0.001, respectively). On the other hand, strong neurological symptoms such as seizure (5% vs. 73%, p < 0.001) and altered consciousness (12% vs. 97%, p < 0.001) were manifested primarily in the JEV group. CSF leukocytosis was observed predominantly in the E30 group (80 vs. 18 cells/μL, p = 0.003), whereas decreasing CSF sugar level was observed predominantly in the JEV group (58.7 vs. 46.9 mg/dL, p < 0.001).ConclusionFever, headache, vomiting, absence of neurological symptoms (seizure, altered consciousness), and presence of CSF leukocytosis are important parameters to consider in differentiating E30 from JEV cases during early infection. Then, proper measures can be adopted immediately to prevent the spread of the disease in the affected areas.

Detection of EGFR mutations in circulating free DNA by PNA-mediated PCR clamping

BackgroundEpidermal growth factor receptor (EGFR)-activating mutations are major determinants in predicting the tumor response to EGFR tyrosine kinase inhibitors in non-small cell lung cancer (NSCLC). Noninvasive test for the detection of EGFR mutations is required, especially in NSCLC patients from whom tissue is not available. In this study, we assessed the feasibility of detection of EGFR mutations in free DNA circulating in plasma.MethodsPlasma samples of 60 patients with partial response to gefitinib were analyzed to detect EGFR-activating mutations in exons 19 and 21. Forty (66.7%) of patients had tumor EGFR mutation results. EGFR mutations in plasma were detected using the peptide nucleic acid (PNA)-mediated polymerase chain reaction (PCR) clamping method. All clinical data and plasma samples were obtained from 11 centers of the Korean Molecular Lung Cancer Group (KMLCG).ResultsOf the 60 patients, 39 were female and the median age was 62.5 years. Forty-three patients never smoked, 53 had adenocarcinomas, and seven had other histologic types. EGFR-activating mutation was detected in plasma of 10 cases (exon 19 deletion in seven and exon 21 L858R point mutation in three). It could not be found in plasma after treatment for 2 months. When only patients with confirmed EGFR mutation in tumor were analyzed, 17% (6 of 35) of them showed positive plasma EGFR mutation and the mutation type was completely matched with that in tumor. There was no statistically significant difference in clinical parameters between patients with EGFR mutations in plasma and those without EGFR mutations.ConclusionsThe detection rate of EGFR mutations from plasma was not so high despite highly sensitive EGFR mutation test suggesting that more advances in detection methods and further exploration of characteristics of circulating free DNA are required.

SAT0141 Correlation of Serum Macrophage Migration Inhibitory Factor Levels With Response to Tocilizumab Therapy in Patients with Rheumatoid Arthritis

BackgroundCytokines, including chemokines are key mediators of the pathogenesis of rheumatoid arthritis (RA). Because tocilizumab, a humanized monoclonal antibody that is specific for the IL-6 receptor, induces rapid clinical improvement...

Treatment of Intrabony Defects with Anorganic Bone Matrix/P-15 or Guided Tissue Regeneration in Patients with Aggressive Periodontitis

Intrabony periodontal defects present a particular treatment problem, especially in patients with generalized aggressive periodontitis (G-AgP). Regenerative procedures have been indicated for this clinical situation. The aim of this study was to compare treatment outcomes of intrabony periodontal defects with either anorganic bone matrix/cell binding peptide (ABM/P-15) or guided tissue regeneration (GTR) in patients with G-AgP. Fifteen patients, with two intrabony defects ≥3 mm deep, were selected. Patients were randomly allocated to be treated with ABM/P-15 or GTR. At baseline and at 3 and 6 months after surgery, clinical and radiographic parameters and IL-1β and IL-6 gingival fluid concentrations were recorded. There was a significant probing pocket depth reduction (p<0.001) for both groups (2.27 ± 0.96 mm for ABM/P-15 group and 2.57 ± 1.06 mm for GTR group). Clinical attachment level gain (1.87 ± 0.94 mm for ABM/P-15 group and 2.09 ± 0.88 mm for GTR group) was also observed. There were no statistically significant differences in clinical parameters between the groups. The radiographic bone fill was more expressive in ABM/P-15 group (2.49 mm) than in GTR group (0.73 mm). In subtraction radiographs, the areas representing gain in density were 93.16% of the baseline defect for ABM/P-15 group versus 62.03% in GRT group. There were no statistically significant differences in inter-group and intra-group comparisons with regards to IL-1β and IL-6 quantification. Treatment of intrabony periodontal defects in patients with G-AgP with ABM/P-15 and GTR improved significantly the clinical outcomes. The use of ABM/P-15 promoted a better radiographic bone fill.

FRI0119 The predictive value of cardiovascular risk factors on carotid intima media thickness in rheumatoid arthritis

BackgroundRheumatoid arthritis (RA) is recognized as an independent cardiovascular risk factor. The ongoing inflammatory state in RA is believed to be the main cause of this increased cardiovascular risk since...

Thrombospondin‐1 and L‐selectin are associated with silent cerebral infarct in children with sickle cell anaemia

Thrombospondin‐1 and <scp>L</scp>‐selectin are associated with silent cerebral infarct in children with sickle cell anaemia

Impairment of health-related quality of life in patients with chronic hepatitis C is associated with insulin resistance

Although it has been reported that hepatitis C virus (HCV) infection is associated with a significant decline in health-related quality of life (HRQOL), the underlying causes and mechanisms are still unknown. Insulin resistance (IR) is recognized as a distinct aspect of chronic HCV infection. Therefore, we attempted to identify the factors including IR indices that are related to the HRQOL of patients with chronic hepatitis C (CHC). One hundred and seventy-five CHC patients (91 female, 84 male, mean age, 56.4years) not using antidiabetic agents were included and underwent a 75-g oral glucose tolerance test (OGTT) and completed a self-administered HRQOL questionnaire, the Short Form 36 (SF-36), which is a well-validated questionnaire for assessing general QOL. Scale scores were standardized and summarized into physical and mental component summary (PCS and MCS). We investigated which clinical parameters, including homeostasis model assessment of insulin resistance (HOMA-IR), were associated with decline in PCS and MCS scores in CHC patients. There were no significant differences in clinical parameters between high and low MCS, but there were significant differences in age, sex, hemoglobin, liver fibrosis, OGTT pattern, and HOMA-IR between high and low PCS. Multivariate analysis showed that HOMA-IR >2 was independently associated with lower PCS (OR 2.92, p<0.01). Our results suggest that impairment of HRQOL, especially physical domains, in CHC patients is associated with IR.

Clinical profile of Spondarthritis in females as compared to male patients with reference to HLAB27: A single center study from Nepal

Background and Aims-To study the differences in clinical parameters between male and female patients with spondarthritis (SpA) in Nepalese population; to study the prevalence of HLA B27 phenotype in Nepalese patients with SpA and to study the differences in clinical parameters in relation to HLA B27 phenotype. Methods- This is cross sectional observational study of 102 patients diagnosed with SpA attending rheumatology clinic at Alka Hospital, Nepal from September 2011 to February 2012. Electronic clinical registry was maintained and HLA B27 was performed by flowcytometry. Results- A total of 102 patients with SpA were enrolled in the study with male to female ratio of 1.8:1 . The mean age of male patients was 6±3 years lower than that of female patients (p=0.05). There were no other statistically significant differences in clinical parameters or prevalence of HLA B27 in both the genders. Of the total patients, 52.9% were HLA B27 positive. Presence of HLA B27 was associated with early presentation by 7.1±2.8 years and the occurrence of inflammatory spinal pain P &lt;0.001. Statistically significant association of HLA B27 with other clinical manifestations of SpA were not seen. Conclusions- HLA B27 was present in 52.9% of patients with diagnosed SpA. The presence of HLA B27 was associated with earlier presentation of disease and occurrence of inflammatory spinal pain. However, there was no gender difference in clinical manifestation of SpA or prevalence of HLAB27 in our patients except for early age at presentation in male patients. Journal of Advances in Internal Medicine 2013;02(01):3-5 DOI: http://dx.doi.org/10.3126/jaim.v2i1.7628

Vaccination of feedlot cattle with extracts and membrane fractions from two Mycoplasma bovis isolates results in strong humoral immune responses but does not protect against an experimental challenge

Mycoplasma bovis is one of the most significant contributors to the bovine respiratory syndrome (BRD) that causes major losses in feedlot and dairy farms. Current experimental vaccines against M. bovis are ineffective and in some cases seem to enhance disease. Experimental infection with M. bovis induces a predominantly Th2 response and high levels of IgG1, which is an inferior opsonin and hence lacks protective capacity. In an attempt to induce a balanced (Th1/Th2) immune response, we have used CpG ODN 2007 as an adjuvant in a trial involving vaccination of cattle with M. bovis total extracts and/or membrane fractions and subsequent intranasal inoculation with an infective dose of M. bovis prepared from two different clinical isolates. Significant IgG1 serum responses were observed against both, extracts and fractions while IgG2 responses were significant against the extracts only. Proliferation of peripheral blood mononuclear cells (PBMC) after incubation with M. bovis cells was only observed in post-challenge samples of cattle vaccinated with both extracts and fractions but not in samples of cattle immunized with the membrane fractions alone. All groups showed transient weight losses and increased temperatures however, there were no significant differences in clinical parameters and survival rates between the groups.

Remote Epidural Hemorrhage after Unilateral Decompressive Hemicraniectomy in Brain-Injured Patients

Epidural hemorrhage (EDH) that develops remote from the decompressed hemisphere can be associated with devastating morbidity after hemicraniectomy for traumatic brain injury (TBI). In this study, we investigated the incidence, risk factors, and outcome influence of post-craniectomy remote EDH. For this retrospective study, we enrolled 139 patients undergoing unilateral hemicraniectomy for TBI. The patients were subdivided into two groups based on whether EDH remote from the site of bone decompression was present (n=11) or not (n=128). We identified the intergroup differences in clinical parameters and outcomes. Multivariate odds regression was used to adjust for independent risk factors of the development of EDH. The incidence of remote EDH following decompressive hemicraniectomy for TBI was 7.9%. There were two independent risk factors for remote EDH, including absence of contusional hemorrhage (odds ratio, 95% confidence interval=6.158, 1.090-34.802; p=0.040) and presence of remote skull fracture (odds ratio, 95% confidence interval=19.770, 2.194-178.152; p=0.008) in preoperative computed tomography scans. The mean Glasgow Outcome Scale did not differ between the patients with and without EDH. In conclusion, remote EDH in patients undergoing unilateral decompressive hemicraniectomy for TBI is not uncommon. The absence of contusional hemorrhage and presence of remote skull fracture are independent risk factors. Although postcraniectomy remote EDH is devastating, timely computed tomography scanning and immediate hematoma evacuation are efficient and crucial for patient outcomes.

Relationships between serum vitamin D levels and clinical characteristics of drug reaction with eosinophilia and systemic symptoms syndrome

Purpose: Vitamin D deficiency (VDD) is widely spread and on the increase throughout the world. Although vitamin D is essential for skeletal mineralization, VDD or vitamin D insufficiency (VDI) has been associated with nonskeletal disorders including cardiovascular disease, cancer, allergic disease and skin disease. However, a few reports showed the association of vitamin D and drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome. Thereafter, we evaluated the association between vitamin D and DRESS syndrome. Methods: We conducted a retrospective study on 45 patients with DRESS syndrome. Four hundred and ninty-eight healthy people who visited the health screening center were enrolled in the study as a control group. We investigated the clinical characteristics, the causative drugs and treatments in the patients with DRESS syndrome, and also analyzed the associations with serum 25-hydroxyvitamin D (25(OH)D3). Results: Forty-four patients (97.8%) had low serum vitamin D levels; 21 patients were VDD (serum 25(OH)D3 <10 ng/mL), and 23 patients were VDI (serum 25(OH)D3 10 to 30 ng/mL). There were no significant differences in clinical parameters between two groups. Serum 25(OH)D3 level of the study patients was significantly lower that of the controls (12.3±9.6 ng/mL vs. 17.3±5.5 ng/mL, P<0.001). Serum 25(OH)D3 level showed a significant negative correlation with admission days (r=-0.377, P=0.011). Conclusion: The majority of the patients with DRESS syndrome showed low vitamin D levels. Serum 25(OH)D3 was inversely correlated with admission days. (Allergy Asthma Respir Dis 2013;1:144-150)

Treatment of severe falciparum malaria: quinine versus artesunate

Background: Malaria is the most important disease of human being. More than 40% of the world’s population is considered to be at risk of exposure of this disease. Malaria infection has been increasing over recent years due to combination of factors including increasing resistance of malarial parasite. Most of the strains of P. falciparum are now resistance to conventional drugs like chloroquine in many areas. The objective of this study was to compare the efficacy and safety of quinine and artesunate in treatment of P. falciparum malaria. Methods: This is hospital based prospective study, conducted amongst 35 randomly selected patients of severe P. falciparum malaria. Patients with any contraindications of either drug were excluded to avoid bias. Standard statistical tests were applied for qualitative as well as quantitative data. Results: As per the study end point results of difference of mortality in patients receiving either drug was not significant ( p &gt; 0.75), but difference in clinical parameters like fever clearance time ( p &lt;0.01), parasite clearance time ( p &lt; 0.001) and coma resolution time (p &lt; 0.001) were significant among patients receiving artesunate. There were no any significant differences in adverse effects of both the drugs. Mortality was same in both arms taking either drug. Conclusions: Artesunate is as good as quinine in mortality aspect but artesunate is superior in fever clearance time (FCT) &amp; parasite clearance time (PCT). Coma resolution time is faster with quinine as compared to artesunate. There are no significant adverse effects of either drug. So artesunate is equivalent or superior for treatment for severe falciparum malaria.

Impact of single‐session motivational interviewing on clinical outcomes following periodontal maintenance therapy

Patient engagement in effective oral hygiene following periodontal therapy is essential to long-term success. Motivational interviewing (MI) is a behavioural counselling approach documented to positively influence behaviour change related to smoking, diabetes control and medication adherence. Emerging evidence suggests utility of MI to improve oral health. The objective of this study was to evaluate whether the use of brief motivational interviewing (BMI) is effective in improving internal motivation for oral hygiene behaviour. A convenience sample of fifty-six previously treated periodontal patients who were in maintenance yet presented with signs of clinical inflammation were recruited to participate in this single blind, randomized controlled trial. Patients were randomly assigned to receive either BMI in conjunction with traditional oral health education (TOHE), (n = 29) or TOHE alone (n = 27). Bleeding on probing scores (BOP), plaque index (PI), pocket depths (PD), motivation (M), autonomous regulation (AR) controlled regulation (CR) and oral health knowledge (K) were assessed at baseline, 6 weeks and 12 weeks. Statistically significant decreases were found over time for BOP (P = 0.001), PI (P = 0.001) and PD 4-6 mm (P = 0.001) for both groups. Differences in clinical parameters between groups were not evident at either 6 or 12 weeks. Results show that a one-time MI session is insufficient for improving oral hygiene in long-standing maintenance patients.

Evaluation of the degree of satisfaction in oocyte donors using sustained-release FSH corifollitropin α

Ovarian stimulation treatment is recognized as placing a physical and psychological burden on patients and oocyte donors. The introduction of sustained follicle stimulants will reduce the number of injections and may improve the overall patient experience. This study aimed to evaluate the degree of satisfaction in oocyte donors undergoing treatment with corifollitropin α, a synthetic recombinant rFSH which replaces daily FSH injections for the first week of ovarian stimulation. The results showed no significant differences in clinical parameters between the two protocols (recombinant FSH versus corifollitropin α). Implantation rates for the corifollitropin α and daily FSH protocol groups were 39.1% and 38.4%, respectively, while ongoing pregnancy rates were 45.9% and 44.4%. There were no statistical between-group differences in the responses to the questionnaires. However, donors treated with corifollitropin α who had undergone a previous cycle with daily FSH reported greater satisfaction with the corifollitropin α protocol. In conclusion, no significant differences were found in any analysed parameters between treatments. However, when donors who had undergone both treatments chose which treatment they preferred, the results clearly showed a positive trend towards choosing corifollitropin α, confirming that this protocol may reduce treatment burden and increase donor compliance.Infertility is a stressful situation for couples trying to conceive and has both societal and personal consequences. IVF treatment offers a hopeful solution to many infertile couples; however, the stress of infertility can be increased by IVF treatment, which is a complex process that is both physically and emotionally demanding. There is a clear need for simplified treatment approaches to lessen the treatment burden of IVF. One of the improvements to shorten treatment duration and decrease the number of injections has been the introduction of corifollitropin α, a long-acting recombinant FSH. A single injection of this drug can replace daily gonadotrophin injections for 7days and can further decrease the number of injections in an ovarian stimulation cycle. In this study, we report an evaluation of the degree of satisfaction in oocyte donors undergoing treatment with corifollitropin α, compared with patients being treated with daily follitropin β. Through some questionnaires being offered to donors after oocyte retrieval, we tried to establish if there were any links between this novel treatment and a lower degree of discomfort suffered during the whole treatment.

The early diagnosis of acute kidney injury after liver transplantation by urine lactate dehydrogenase, cystatin C and neutrophil gelatinase-associated lipocalin

Objective To investigate the value of urinary lactate dehydrogenase(LDH),Cystatin C (Cys-C) and neutrophil gelatinase-associated lipocalin (NGAL) in early diagnosis of acute kidney injury after liver transplantation. Methods From January 2011 to October 2011,45 patients were recruited.Blood and urinary samples were collected before operation and the end of the operation,and used to determine serum creatinine (SCr),Cys-C,LDH,and total bilirubin,as well as urinary LDH,Cys-C and NGAL.All the patients were divided into AKI and non-AKI groups,according to the Acute Kidney Injury Network (AKIN) criteria of AKI.The statistics were used along ROC analysis to evaluate the diagnose value of selected biomarkers. Results There were no significant differences in clinical parameters between AKI and non-AKI groups while 20 of the 45 patients suffered AKI [ ( 140±54)vs (81±20),P＜0.05].Urine LDH,Cys-C and NGAL raised in all the samples,and the level of the 3 enzymes in AKI group increased significantly [ (6.50±2.86)vs (3.21±1.63),P＜0.05 ],[ ( 1.55±0.54)vs (0.86±0.31),P＜0.05 ],[ ( 107±59)vs (43±11 ),P＜0.05 ].ROC analysis revealed that (AUC 0.853,0.833,0.880) the 3 enzymes are capable of early diagnosis of AKI. Conclusions Urinary LDH,Cys-C and NGAL appear to be sensitive and specific biomarkers of AKI in liver transplant recipients,but further research are needed in the future for the clinical diagnosis. Key words: Liver transplantation; Acute kidney injury ; Lactate dehydrogenase ; Cystatin C; Neutrophil gelatinaseassociated lipocalin

Comparison of treatment effect between periodontal subgingival scaling with the special series of ultrasonic inserts and Gracey curette

To compare the special series of ultrasonic inserts with Gracey curettes in the effectiveness and efficiency for non-surgical periodontal treatment. A total of 30 patients with moderate to advanced chronic periodontal disease were treated with both ultrasonic inserts (ultrasonic group) and Gracey curettes (Gracey group) according to a prospective, randomized, controlled, one-blind, "split-mouth" design. Twenty-six cases were available for the whole follow-up period. Plaque index (PLI), bleeding index(BI), probing depth (PD), attachment loss (AL) were evaluated before and 6 weeks after treatment. Treatment time was recorded. The severity of pain during treatment and teeth sensitivity after treatment were evaluated by the visual analogue scale (VAS). Differences in clinical parameters were analyzed with the Wilcoxon signed ranks test and Mann and Whitney U-test. No significant differences in any of the clinical parameters were observed at baseline between the two groups. The mean value of PD, BI, PLI, AL decreased in both ultrasonic group and Gracey group. At moderately deep site (initial PD between 4 mm and 5 mm), PD [M(Q(25), Q(75))] changed in the ultrasonic group from 4.0 (4.0, 4.5) mm to 3.0 (3.0, 3.0) mm (P < 0.001) and in the Gracey group from 4.0 (4.0, 5.0) mm to 3.0(3.0, 3.0) mm (P < 0.001). At deep sites (initial PD ≥ 6 mm) PD [M(Q(25), Q(75))] changed in the ultrasonic group from 7.0(6.0, 7.0) mm to 5.0(4.0, 7.0) mm (P < 0.001) and in the Gracey group from 7.0 (6.0, 7.0) mm to 5.0(4.0, 6.0) mm(P < 0.001). In the furcation area, PD [M(Q(25), Q(75))] changed from 5.0(4.0, 7.0) mm to 3.0(3.0, 5.0) mm (P < 0.001) in both Gracey group and ultrasonic group. However, the average time of active instrumentation was (2.41 ± 0.61) min/tooth in the ultrasonic scaling and (2.71 ± 0.61) min/tooth in the Gracey curette (P < 0.001). VAS scores [M(Q(25), Q(75))] of pain during treatment was 5.0(3.0, 6.7) in the ultrasonic group and 5.9 (4.9, 8.0) in the Gracey group (P = 0.001). VAS scores [M(Q(25), Q(75))] of sensitivity after treatment was 4.0 (1.8, 6.0) in the ultrasonic group and 4.9 (2.0, 8.0) in the Gracey group (P = 0.043). Treatment with the special series of ultrasonic inserts was as effective as the Gracey curette during initial therapy period in all clinical parameters measured and has the advantage of being quicker.

Impact of Multiparametric Endorectal Coil Prostate Magnetic Resonance Imaging on Disease Reclassification Among Active Surveillance Candidates: A Prospective Cohort Study

We report magnetic resonance imaging findings among unselected men with low risk prostate cancer before active surveillance. We prospectively enrolled men with low grade, low risk, localized prostate cancer. All patients underwent multiparametric endorectal coil magnetic resonance imaging and were offered confirmatory biopsy within 1 year of imaging. The primary outcome was the impact of magnetic resonance imaging on identifying patients who were reclassified by confirmatory biopsy as no longer fulfilling active surveillance criteria. We further identified clinical parameters associated with reclassification. The cohort was stratified as patients with 1) normal magnetic resonance imaging, 2) cancer on magnetic resonance imaging concordant with initial biopsy (less than 1 cm) and 3) cancer on magnetic resonance imaging larger than 1 cm. We performed univariate analysis to assess differences in clinical parameters among the groups. Magnetic resonance imaging did not detect cancer in 23 cases (38%) while magnetic resonance imaging and initial biopsy were concordant in 24 (40%). Magnetic resonance imaging detected a 1 cm or larger lesion in 13 patients (22%). Of the cases 18 (32.14%) were reclassified. When no cancer was identified on magnetic resonance imaging, only 2 cases (3.5%) were reclassified. The positive and negative predictive values for magnetic resonance imaging predicting reclassification were 83% (95% CI 73-93) and 81% (95% CI 71-91), respectively. Prostate specific antigen density was increased in patients with lesions larger than 1 cm on magnetic resonance imaging compared to those with no cancer on imaging (median 0.15 vs 0.07 ng/ml/cc, p=0.016). Magnetic resonance imaging appears to have a high yield for predicting reclassification among men who elect active surveillance. Upon confirmation of our results magnetic resonance imaging may be used to better select and guide patients before active surveillance.

Impact of multiparametric endorectal coil prostate MRI on disease reclassification among active surveillance candidates: A prospective cohort study.

30 Background: One troubling aspect of active surveillance (AS) is that a subset of patients diagnosed as very-low risk prostate cancer (PCa) appear to be under sampled and, in fact, harbour larger often higher grade cancers.The aim of this study is to report MRI findings among unselected men with low-risk PCa prior to AS. Methods: We prospectively enrolled men with low-grade, low-risk, localized PCa. All patients underwent multiparametric endorectal coil MRI scanning and offered a confirmatory biopsy within one year of MRI. The primary outcome was the impact of MRI in identifying patients reclassified as no longer fulfilling AS criteria by a confirmatory biopsy. We further aimed to identify clinical parameters associated with reclassification. Cohort was stratified as follows: normal MRI; cancer on MRI concordant with initial biopsy (less than 1 cm); cancer on MRI larger than 1cm. We performed a univariate analysis to assess differences in clinical parameters between groups. Results: MRI did not detect cancer in 23 (38%) while MRI and initial biopsy were concordant in 24 patients (40%). MRI detected a 1cm or larger lesion in 13 patients (22%). Eighteen patients (32.14%) reclassified. When no cancerous lesion was identified on MRI only 2 patients (3.5%) reclassified. The positive and negative predictive values for MRI predicating reclassification were 83% (95% CI, 73%-93%) and 81% (95% CI, 71%-91%), respectively. PSA density was elevated among patients with larger than 1 cm MRI lesions compared to those with no cancer on MRI (medians of 0.15 vs 0.07 ng/ml/cc, respectively p=0.016). Conclusions: MRI appears to have a high yield in predicting reclassification among men choosing AS. Upon confirmation of our results MRI may be used to better select and guide patients before AS.

Identification of sepsis subtypes in critically ill adults using gene expression profiling

IntroductionSepsis is a syndromic illness that has traditionally been defined by a set of broad, highly sensitive clinical parameters. As a result, numerous distinct pathophysiologic states may meet diagnostic criteria for sepsis, leading to syndrome heterogeneity. The existence of biologically distinct sepsis subtypes may in part explain the lack of actionable evidence from clinical trials of sepsis therapies. We used microarray-based gene expression data from adult patients with sepsis in order to identify molecularly distinct sepsis subtypes.MethodsWe used partitioning around medoids (PAM) and hierarchical clustering of gene expression profiles from neutrophils taken from a cohort of septic patients in order to identify distinct subtypes. Using the medoids learned from this cohort, we then clustered a second independent cohort of septic patients, and used the resulting class labels to evaluate differences in clinical parameters, as well as the expression of relevant pharmacogenes.ResultsWe identified two sepsis subtypes based on gene expression patterns. Subtype 1 was characterized by increased expression of genes involved in inflammatory and Toll receptor mediated signaling pathways, as well as a higher prevalence of severe sepsis. There were differences between subtypes in the expression of pharmacogenes related to hydrocortisone, vasopressin, norepinephrine, and drotrecogin alpha.ConclusionsSepsis subtypes can be identified based on different gene expression patterns. These patterns may generate hypotheses about the underlying pathophysiology of sepsis and suggest new ways of classifying septic patients both in clinical practice, and in the design of clinical trials.

Etiology of Hypokalemic Paralysis in Korea: Data from a Single Center

Recognizing the underlying causes of hypokalemic paralysis seems to be essential for the appropriate management of affected patients and their prevention of recurrent attacks. There is, however, a paucity of documented reports on the etiology of hypokalemic paralysis in Korea. We retrospectively analyzed 34 patients with acute flaccid weakness due to hypokalaemia who were admitted during the 5-year study period in order to determine the spectrum of hypokalemic paralysis in Korea and to identify the differences in clinical parameters all across the causes of hypokalemic paralysis. We divided those 34 patients into 3 groups; the 1st group, idiopathic hypokalemic periodic paralysis (HPP), the 2nd, thyrotoxic periodic paralysis (TPP), and the 3rd group, secondary hypokalemic paralysis (HP) without TPP. Seven of the patients (20.6%) were diagnosed as idiopathic HPP considered the sporadic form, and 27 patients (79.4%) as secondary HP. Among the patients diagnosed as secondary HP, 16 patients (47.1%) had TPP. Patients of secondary hypokalemic paralysis without TPP required a longer recovery time compared with those who had either idiopathic HPP or TPP. This is due to the fact that patients of secondary HP had a significantly negative total body potassium balance, whereas idiopathic HPP and TPP were only associated with intracellular shift of potassium. Most of the TPP patients included in our study had overt thyrotoxicosis while 3 patients had subclinical thyrotoxicosis. This study shows that TPP is the most common cause of hypokalemic paralysis in Korea. And we suggest that doctors should consider the presence of TPP in patients of hypokalemic paralysis even if they clinically appear to be euthyroid state.