Function Of Disease Severity Research Articles

Tu1944 Efficacy and Safety of Standard vs Low Dose Adalimumab Maintenance Therapy As a Function of Disease Severity in Pediatric Patients With Crohn's Disease: Subanalysis of Imagine 1

Aim: Adalimumab (ADA) has been shown to be an effective treatment for inducing and maintaining clinical remission and/or response in children with moderate to severe Crohn's disease (CD)1. Although the standard adult dose (SD) ADA maintenance therapy exhibited generally greater efficacy than low dose (LD)1, the influence of baseline (BL) disease severity on outcomes has not been determined. Methods: In IMAgINE11, patients (pts) aged 6-17 years that had a PCDAI score .30 at BL, with CD resistant or intolerant to conventional therapy, including prior infliximab (IFX), received open-label induction ADA at weeks (wks) 0/2 according to bodyweight (≥40kg, 160/80mg;,40kg, 80/40mg). At wk4, 188 randomized pts (ITT population) received either double-blind SD ( ≥40kg, 40mg every other wk (eow); ,40kg, 20mg eow) or LD (≥40kg, 20mg eow; ,40kg, 10mg eow) maintenance therapy. After wk12, pts could move to blinded weekly (ew) dosing for disease flare or non-response. Clinical remission (PCDAI≤10) and response (PCDAI decrease ≥15 points from BL) were measured at wk52. Subgroup analyses by disease severity, based on the median BL PCDAI observed for the study population (less severe CD, PCDAI,40; more severe CD, PCDAI≥40), and also by prior IFX use were performed. Non-responder imputation was used for missing data or after switch to ew therapy. Treatment-emergent adverse events (AE) were reported as events/100pt-years (E/100PY) for any pt receiving at least one dose of ADA. Results: Greater clinical remission and response was achieved with SD ADA therapy compared to LD at wk52 in pts with more severe disease, with the greatest difference between doses occurring in IFX Naive pts. For pts with less severe CD, similar rates of remission and response were observed between SD and LD ADA (Table). Switch to ew dosing occurred most frequently in pts with more severe CD receiving LD ADA (55.6%) than in pts with less severe CD receiving the same dose (43.9%). For pts receiving SD ADA, escalation to ew dosing occurred in a similar percentage of pts, regardless of BL disease severity (35.9%, less severe; 38.9%, more severe). The overall rate of AEs was similar between dosing groups for either pt population. For pts with less severe CD, serious AEs (SAEs) were higher with SD (32.0 E/100PY) than LD ADA (17.6 E/100PY), whereas a similar rate of SAEs was observed between SD and LD ADA in pts with more severe disease (54.8 vs 64.5 E/ 100PY, respectively). No malignancies, TB, congestive heart failure or deaths were reported. Conclusion: At wk52, SD maintenance ADA was a more effective therapy than LD for children with more severe CD, whereas pts with less severe disease benefitted equally from both doses. The greatest remission and response rates were observed for IFX-Naive pts. The overall safety profile was similar for SD and LD ADA treatment. 1.Hyams 2012 Gastroenterology;143:365 Clinical outcomes in pediatric CD pts with eow SD vs eow LD ADA (ITT population)

Airway Somatosensory Deficits and Dysphagia in Parkinson's Disease

Individuals with Parkinson's disease (PD) often experience substantial impairment of swallow control, and are typically unaware of the presence or severity of their impairments suggesting that these individuals may also experience airway sensory deficits. However, the degree to which impaired swallow function in PD may relate to airway sensory deficits has yet to be formally tested. The purpose of this study was to examine whether airway sensory function is associated with swallow impairment in PD. Eighteen PD participants and 18 healthy controls participated in this study and underwent endoscopic assessment of airway somatosensory function, endoscopic assessment of swallow function, and clinical ratings of swallow and disease severity. PD participants exhibited abnormal airway somatosensory function and greater swallow impairment compared with healthy controls. Swallow and sensory deficits in PD were correlated with disease severity. Moreover, PD participants reported similar self-rated swallow function as healthy controls, and swallow deficits were correlated with sensory function suggesting an association between impaired sensory function and poor self-awareness of swallow deficits in PD. These results suggest that control of swallow is influenced by airway somatosensory function, that swallow-related deficits in PD are related to abnormal somatosensation, and that swallow and airway sensory function may degrade as a function of disease severity. Therefore, the basal ganglia and related neural networks may play an important role to integrate airway sensory input for swallow-related motor control. Furthermore, the airway deficits observed in PD suggest a disintegration of swallow-related sensory and motor control.

Drug−disease interaction: Crohn's disease elevates verapamil plasma concentrations but reduces response to the drug proportional to disease activity

Inflammation is involved in the pathogenesis of cardiovascular diseases that includes reduced response to pharmacotherapy due to altered pharmacokinetics and pharmacodynamics. It is not known if these effects exist in general in all inflammatory conditions. It also remains unknown whether in a given population the effect is a function of disease severity. We investigated whether pharmacokinetics and pharmacodynamics of a typical calcium channel inhibitor are influenced by Crohn's disease (CD), a disease for which the disease severity can be readily ranked. We administered 80 mg verapamil orally to (i) healthy control subjects (n= 9), (ii) patients with clinically quiescent CD (n= 22) and (iii) patients with clinically active CD (n= 14). Serial analysis of verapamil enantiomers (total and plasma unbound), blood pressure and electrocardiograms were recorded over 8 h post dose. The severity of CD was measured using the Harvey-Bradshaw Index. CD substantially and significantly increased plasma verapamil concentration and in a stereoselective fashion (S, 9-fold; R, 2-fold). The elevated verapamil concentration, however, failed to result in an increased verapamil pharmacodynamic effect so that the patients with elevated verapamil concentration demonstrated no significant increase in response measured as PR interval and blood pressure. Instead, the greater the disease severity, the lower was the drug potency to prolong PR interval (r= 0.86, P < 0.0006), CD patients with severe disease may not respond to cardiovascular therapy with calcium channel blockers. Reducing the severity increases response despite reduced drug concentration. This observation may have therapeutic implication beyond the disease and the drug studies herein.

CSF xanthine, homovanillic acid, and their ratio as biomarkers of Parkinson's disease

Diminished nigrostriatal dopaminergic neurotransmission is a biochemical hallmark of Parkinson's disease. Despite this, a reliable trait biomarker of sporadic Parkinson's disease has not emerged from measurements of cerebrospinal fluid dopamine metabolites. Previous studies have highlighted strong neurochemical relationships between dopamine and various purine compounds. In this study, we analyzed cerebrospinal fluid concentrations of homovanillic acid (the major catabolite of dopamine) and the purine compound xanthine for a comparison of 217 unmedicated Parkinson's disease subjects and 26 healthy controls. These compounds were highly correlated for both the Parkinson's disease subjects (r=0.68) and for controls (r=0.73; both groups, p<0.001). While neither homovanillic acid nor xanthine concentrations differentiated Parkinson's disease from controls, their ratio did. For controls, the mean [xanthine]/[homovanillic acid] quotient was 13.1±5.5 as compared to the Parkinson's disease value of 17.4±6.7 at an initial lumbar CSF collection (p=0.0017), and 19.7±8.7 (p<0.001) at a second CSF collection up to 24months later. The [xanthine]/[homovanillic acid] ratio in the Parkinson's disease subjects differed as a function of disease severity, as measured by the sum of Unified Parkinson's Disease Rating Scale Activities of Daily Living and Motor Exam ratings. The [xanthine]/[homovanillic acid] ratio also increased between the first and second CSF collections, suggesting that this quotient provides both a state and trait biomarker of Parkinson's disease. These observations add to other neurochemical evidence that links purine metabolism to Parkinson's disease.

Yield loss caused by huanglongbing in different sweet orange cultivars in São Paulo, Brazil

Citrus huanglongbing (HLB) reduces an affected orchard’s economic life. This work aimed to characterize yield loss due to HLB for different sweet orange cultivars and determine the relationship between disease severity and yield. Disease severity and yield were assessed on 949 individual trees distributed in 11 different blocks from sweet orange cultivars Hamlin, Westin, Pera and Valencia. In each block, plants showing a range of HLB severity levels and asymptomatic plants were selected. Total yield (weight of harvested fruit), mean weight of asymptomatic and symptomatic fruit, relative yield (symptomatic tree yield/mean yield of asymptomatic trees from the same block) and relative number of fruits (fruit number from symptomatic tree/mean number of fruits from asymptomatic trees from the same block) were determined. The weight of symptomatic fruit was lower than the weight of asymptomatic fruit, but the weights of asymptomatic and symptomatic fruit were not correlated with disease severity, indicating that the effects of HLB were restricted to symptomatic branches. The relationship of the relative yield with HLB severity can be satisfactorily described by a negative exponential model. The rates of yield decrease as a function of disease severity were similar for all assessed cultivars. A relative yield (up to 19%) was observed even for trees where disease severity was 100%. The strong linear relationship between relative number of fruits per tree and the relative yield per tree suggested that the yield reduction was due primarily to early fruit drop or lack of fruit set on affected branches.

Estimation of health care costs as a function of disease severity in people with psoriatic arthritis in the UK

The primary aim of this study was to estimate annual health care costs for biologic-naïve patients with PsA in the UK. The relationship between disease severity, defined by physical limitations, and costs was also explored. This study utilized data from the British Society of Rheumatology Biologics Register (BSRBR) to develop a multivariate model estimating disease severity from parameters available in routine primary care data. The HAQ Disability Index was used to determine disease severity. This algorithm was then applied to routine data from The Health Improvement Network (THIN). Annual costs were estimated for drugs, contacts with a general practitioner and other health care professionals, tests, hospital outpatient attendances and inpatient admissions from a National Health Service perspective using official tariffs. The relationship between disease severity and health care costs was estimated using a generalized linear model. Three hundred and fifty-six cases with PsA were identified in the BSRBR and 4492 in THIN. Total mean annual health care costs ranged from £11 to £20 782 with a mean of £1446 (s.d. £1756). When costs were sub-grouped by the predicted HAQ score, the mean annual observed costs ranged from £548 per person for the least severely affected (HAQ ≤ 1.2) to £4832 for the most severely affected (HAQ > 2.6). Prescription costs and secondary care episodes accounted for more than a third of total care costs each (38 and 34%, respectively). When the relationship between disease severity and costs was examined, estimated HAQ was found to be a significant predictor of total health care costs. Treatment of people with PsA resulted in considerable financial costs and these costs varied markedly by disease severity.

Elevated response of human amygdala to neutral stimuli in mild post traumatic stress disorder: neural correlates of generalized emotional response

Previous evidence from functional magnetic resonance imaging (fMRI) studies has shown that amygdala responses to emotionally neutral pictures are exaggerated at a group level in patients with severe post-traumatic stress disorder (PTSD) [ Hendler T, Rotshtein P, Yeshurun Y, Weizmann T, Kahn I, Ben-Bashat D, Malach R, Bleich A (2003) Neuroimage 19(3):587–600]. The present fMRI study tested the hypothesis that amygdala responses are elevated not only in response to negative pictures but also to neutral pictures as a function of disease severity in patients with mild symptoms and in subjects who did not develop symptoms. To this end, fMRI scans were performed in 10 patients with mild PTSD and 10 healthy controls (both victims of a bank robbery), during the execution of a visuo-attentional task in which they were asked to observe emotionally negative or neutral pictures. Control subjects showed enhanced amygdala responses to emotionally negative stimuli compared to neutral stimuli. On the contrary, PTSD patients were characterized by high amygdala responses to both neutral and emotional pictures, with no statistically significant difference between the two classes of stimuli. In the entire group, we found correlations among the severity of the PTSD symptoms, task performance, and amygdala activation during the processing of neutral stimuli. Results of this study suggest that amygdala responses and the selectivity of the emotional response to neutral stimuli are elevated as a function of disease severity in PTSD patients with mild symptoms.

Laryngeal somatosensory deficits in Parkinson's disease: implications for speech respiratory and phonatory control.

Parkinson's disease (PD) is often associated with substantial impairment of speech respiratory and phonatory control. However, the degree to which these impairments are related to abnormal laryngeal sensory function is unknown. This study examined whether individuals with PD exhibited abnormal and more asymmetric laryngeal somatosensory function compared with healthy controls, and whether these deficits were associated with disease and voice severity. Nineteen PD participants were tested and compared with 18 healthy controls. Testing included endoscopic assessment of laryngeal somatosensory function, with aerodynamic and acoustic assessment of respiratory and phonatory control, and clinical ratings of voice and disease severity. PD participants exhibited significantly abnormal and asymmetric laryngeal somatosensory function compared with healthy controls. Sensory deficits were significantly associated with timing of phonatory onset, voice intensity, respiratory driving pressure, laryngeal resistance, lung volume expended per syllable, disease severity, and voice severity. These results suggest that respiratory and phonatory control are influenced by laryngeal somatosensory function, that speech-related deficits in PD are related to abnormal laryngeal somatosensory function, and that this function may degrade as a function of disease severity. Thus, PD may represent a model of airway sensorimotor disintegration, highlighting the important role of the basal ganglia and related neural networks in the integration of laryngeal sensory input for speech-related motor control.

Driving Behaviors Among Community-Dwelling Persons With Multiple Sclerosis

Schultheis MT, Weisser V, Manning K, Blasco A, Ang J. Driving behaviors among community-dwelling persons with multiple sclerosis. Objective The current study examined driver behaviors and patterns among drivers with multiple sclerosis (MS) as a function of disease severity and in comparison to drivers without MS. Design Between-group comparisons of participants with and without MS and cohorts of MS groups at varying levels of severity. Setting All data were collected in an outpatient research setting. Participants Community-dwelling persons (n=66) with clinically definite MS who were active drivers and healthy controls (n=30) were included. Interventions Not applicable. Main Outcome Measures Driving characteristics' measures included (1) driving frequency defined in days and miles driven per week, (2) self-reports of voluntarily limited driving behaviors, (3) changes in driving since MS diagnosis, and (4) self-rating as a driver. Driving performance was also assessed by using pass/borderline performance on a clinical behind-the-wheel evaluation. Results Mann-Whitney U tests showed a significant difference in driving frequency ( P=.021) with MS participants reporting they drove fewer days per week than healthy control group. This was also seen between cohorts of MS drivers ( P=.014), with high Expanded Disability Status Scale (EDSS) participants driving less frequently than the low EDSS group. Descriptive observations suggested that participants with moderate EDSS scores drove less and engaged in more self-limiting behaviors. Chi-square tests showed that participants with high EDSS scores were more likely to report changing their driving behavior after diagnosis ( P=.01) and were more likely to not pass the behind-the-wheel evaluation ( P<.001). Conclusions The current findings suggest that as disease severity progresses, differences in frequency of driving (days per week) and the use of self-limiting driving behaviors may vary. Furthermore, the findings also raise questions regarding the overall sensitivity of the most commonly used clinical driving assessment method (the behind-the-wheel evaluation) to accurately capture driving capacity in the milder stages of the disease process. The results indicate the need to consider issues related to driving as MS severity progresses, and, given the progressive nature of MS and the concerns of the validity of the most common clinical driving assessment measures (the behind-the-wheel evaluation), repeated assessment of driving ability may be the most effective approach for identifying driving difficulties among persons with MS.

Lung Insufflation Capacity in Neuromuscular Disease

To compare maximal passive lung insufflation capacity (LIC) with lung inflation by air stacking (to maximum insufflation capacity [MIC]) and with vital capacity (VC); to explore relationships between these variables that correlate with glottic function and cough peak flows (CPF); to demonstrate the effect of routine inflation therapy on LIC and MIC; and to determine the relative importance of lung inflation therapy as a function of disease severity. Case series of 282 consecutive neuromuscular disease (NMD) clinic patients 7 yrs and older with VC <70% of the predicted normal value. All cooperative patients meeting these criteria were prescribed thrice-daily air stacking and/or maximal passive lung insufflation to pressures of 40-80 cm H2O, and they underwent measurements of VC, MIC, LIC, and unassisted and assisted CPF on every visit. Means +/- standard deviations for VC, MIC, and LIC were 1131 +/- 744, 1712 +/- 926, and 2069 +/- 867 ml, respectively, and, for unassisted and assisted CPF, they were 2.5 +/- 2.0 and 4.3 +/- 2.2 liters/sec, respectively, with all differences statistically significant (P < 0.001). MIC minus VC correlated inversely with LIC minus MIC (P = 0.01) and, therefore, with glottic function. Both MIC and LIC increased with practice (P < 0.001). Increases in LIC but not MIC over VC were greatest for patients with the lowest VC (P < 0.05). There were no complications of lung mobilization therapy. Passive lung insufflation can distend the lungs of patients with NMD significantly greater than air stacking, particularly when glottic and bulbar-innervated muscle dysfunction is severe. LIC, MIC, and VC measurements permit quantifiable assessment of glottic integrity and, therefore, bulbar-innervated muscle function for patients with NMD. The patients who benefit the most from insufflation therapy are those who have the lowest VC.

Effects of rhythmic sensory stimulation (auditory, visual) on gait in Parkinson’s disease patients

This study has focused on how sensory stimulation affects gait in Parkinson's disease (PD). The kinematic parameters of gait [cadence, step amplitude, velocity, coefficient of variation of stride time (CV(stride-time)), and the coefficient of variation of the step amplitude (CV(step-amplitude))] were analysed in 25 PD patients and 10 control subjects. Step amplitude, velocity and CV(stride-time) were altered in the patients with PD. However, when kinematic parameters were analysed as a function of disease severity, none of the parameters differed between early PD (I-II Hoehn and Yahr) and the controls. Nevertheless, more severely affected PD patients (III-IV Hoehn and Yahr) walked with a reduced step amplitude, lower velocity, higher CV(stride-time), and higher CV(step-amplitude) than the controls. The administration of auditory stimulation at a frequency matching the preferred walking cadence led to a decrease in the CV(stride-time) in PD(III-IV) patients, and to an increase in step amplitude in PD(III-IV )and controls. Visual stimulation at the same frequency did not modify any of the altered kinematic parameters in PD(III-IV )patients. When different stimulation frequencies were utilised, auditory stimulation significantly changed some of the altered walking parameters in Parkinson patients. Frequencies matching preferred walking cadence or above this, up to the fastest walking, were those that seem to interact most effectively with the abnormal kinematic parameters in PD(III-IV )patients. Visual stimulation negatively modulated cadence in PD(III-IV) in the frequency range used. Sensory stimulation facilitates gait in PD. Studies using sensory stimulation as a tool to facilitate walking should take into account the grade of disability of the patients.

Cone- and Rod-Mediated Dark Adaptation Impairment in Age-Related Maculopathy

To examine impairment in cone- versus rod-mediated dark adaptation in the parafovea of persons with age-related maculopathy (ARM). Cross-sectional. Older adults with ARM at various severity levels from early to advanced (n = 83) and in good retinal health (n = 43), as determined by stereo fundus photographs evaluated with the Age-Related Eye Disease Study severity scale. Dark adaptation, both cone- and rod-mediated components, was measured with a modified Humphrey Field Analyzer using a target located 12 degrees in the inferior visual field on the vertical meridian, after exposure to a 98% bleach. Information was collected on self-reported problems for activities at night or under dim illumination (Low Luminance Questionnaire [LLQ]) and for activities during daytime conditions (modified National Eye Institute Visual Function Questionnaire [NEI VFQ]). Cone- and rod-mediated parameters of dark adaptation. Compared with older adults in normal retinal health, ARM patients had significant impairments in rod-mediated parameters of dark adaptation (rod-cone break, rod slope, rod sensitivity) (P<0.0001), which were increasingly abnormal as disease severity increased. Cone-mediated parameters (cone time constant and cone sensitivity) were not impaired. Low Luminance Questionnaire scores and NEI VFQ scores decreased with increased ARM severity (P = 0.0004 and P = 0.0005, respectively); the percent decrease in LLQ scores as a function of disease severity was larger in magnitude than the percent decrease in NEI VFQ scores. Disturbances in rod-mediated but not cone-mediated dark adaptation in the parafovea at 12 degrees in the inferior field on the vertical meridian are characteristic of ARM even in its early phases.

Atteinte cardiaque de l'hémochromatose

Cardiac involvement in hemochromatosis affects mainly the myocardium: iron overload of the myocytes reduces left ventricular distensibility. Heart failure is the most frequent manifestation of cardiac involvement. Diagnosis of cardiac involvement depends essentially on Doppler echocardiography showing abnormal left ventricular filling and, later, ventricular dilatation with left ventricular systolic dysfunction. Magnetic resonance imaging can quantify intrahepatic and intramyocardial iron levels. Age at onset of symptoms and specific organ involvement in hemochromatosis depend on the type of mutation. The two principal means of treatment by iron depletion are phlebotomy in primary hemochromatosis and excretion of iron by chemical chelation in secondary hemochromatosis. Early diagnosis and iron depletion improve survival by reducing organ iron overload, especially in the liver and the myocardium. Recent guidelines issued by Anaes (national agency for health evaluation) make it possible to identify risk factors for complications early, to determine disease stage, and to provide appropriate management as a function of disease severity.

Risk Factors For Rate of Decline in Forced Expiratory Volume in One Second in Children and Adolescents with Cystic Fibrosis

To characterize the rate of decline of forced expiratory volume in 1 second (FEV(1)) in children and adolescents with cystic fibrosis and to identify and compare risk factors associated with FEV(1) decline. The rate of decline in FEV(1)% predicted over 3 to 6 years in 3 different age groups was determined. Risk factors for decline were identified and compared among and within age groups as a function of disease severity with repeated-measures, mixed-model regression. Mean (+/-SD) baseline FEV(1)% predicted was 88.4% +/- 20.5% for 6- to 8-year-olds (n = 1811), 85.3% +/- 20.8% for 9- to 12-year-olds (n = 1696), and 78.4% +/- 22.0% for 13- to 17-year-olds (n = 1359). Decline in FEV(1)% predicted/year was -1.12, -2.39, and -2.34, respectively. High baseline FEV(1) and persistent crackles were significant independent risk factors for decline across all age groups. Female sex, Pseudomonas aeruginosa infection, low weight-for-age, sputum, wheezing, sinusitis, pulmonary exacerbations treated with intravenous antibiotics, elevated liver test results, and pancreatic insufficiency were also identified as independent risk factors in some age groups. This study identifies risk factors for FEV(1) decline in children and adolescents with cystic fibrosis. Clinicians should not be reassured by high lung function, particularly in young children, because this factor, among others, is independently associated with steeper decline in FEV(1).

Fimbrial lectins influence the chemokine repertoire in the urinary tract mucosa

The defense against mucosal infections relies on chemokines that recruit inflammatory cells to the mucosa. This study examined if the chemokine response to uro-pathogenic Escherichia coli is influenced by fimbrial expression. The CXC (CXCL1, CXCL5, CXCL8, CXCL9, CXCL10) and CC chemokines (CCL2, CCL3, CCL5) were quantified after in vitro infection of uro-epithelial cells with a fimbriated E. coli pyelonephritis isolate, or with P or type 1 fimbriated transformants of an avirulent E. coli K-12 strain. The response profile was shown to vary with the fimbrial type. Type 1 fimbriated E. coli elicited mainly CXCL1 and CXCL8, whereas P fimbriated E. coli stimulated CCL2 and CCL5 and class II were more potent chemokine inducers than class III P fimbriae. Chemokines were also quantified in urine samples from 73 patients with febrile urinary tract infection, and analyzed as a function of disease severity and fimbrial expression by the strain infecting each patient. A complex CXC and CC chemokine response was detected in patient urine, with a significant influence of the fimbrial type. The results show that virulence factors like fimbriae may modify the mucosal chemokine response. This mechanism may allow the host to adjust the inflammatory cell infiltrate to fit the infecting strain.

Pulmonary Function Changes Associated With Cardiomegaly in Chronic Heart Failure

This study examined the influence of increased cardiac size on maximal lung volumes, forced expiratory airflows, and the diffusing capacity of the lungs in heart failure (HF) patients compared with controls. Forty-one HF patients of New York Heart Association (NYHA) class: Group A = class I/II (n = 26) and Group B = class III/IV (n = 15) and an equal number matched controls (CTL) were recruited. Participants underwent echocardiography, spirometry, and posteroanterior and lateral chest radiographic evaluation (RAD) for volumetric estimation of the total thoracic cavity (TTC), diaphragm, heart, and lungs. Analysis of variance demonstrated no difference between groups for TTC volume (P = .63). RAD cardiac volumes (% TTC volume) were significantly different among all groups (P < .001). Echocardiograms determined left ventricular mass was elevated in the HF groups compared with the CTL group (P < .001) with no difference between HF groups. Lung volume (% TTC volume) was reduced as a function of disease severity (P < .001). RAD measures of cardiac volume demonstrated the strongest relationship with restrictive lung alterations (t-statistic = -5.627, P < .001 and t-statistic = -4.378, P < .001 for forced vital capacity and forced expiratory volume in 1 second, respectively). These results suggest cardiac size may pose significant constraints on the lungs and likely plays a major role in the restrictive breathing patterns often reported in HF patients.

Relationship Between Prereferral Periodontal Care and Periodontal Status at Time of Referral

According to a recent study, the severity of periodontal disease of individuals referred for periodontal care is greater now than in 1980. Variability in the standard of periodontal care in general dental practices may result in less than desirable outcomes and consequences of poorer periodontal health. A sample of 100 newly referred dental patients from three separate periodontal practices in the greater Kansas City, Missouri area participated in this study. Data were collected from three sources: 1) a clinical chart audit, 2) current periodontal disease status as determined by clinical examination, and 3) a patient response questionnaire on past professional care and personal oral care habits. Bivariate analyses were performed using a statistical package. Of the 100 subjects, 74 were diagnosed as periodontal case type IV at the point of referral, of which 29.8% were treatment planned by the periodontist for two or more extractions. Teeth treatment planned for extraction were significant as a function of disease severity (P = 0.0001). Periodontal treatment provided in general dental practices did not vary because of disease severity. The incidence of deep cleanings (scaling and root planing) was reported slightly higher (32.4%) for case type IV than for case type III (26.9%), but this difference was not statistically significant. The average number of cleanings received in the general dental office was less than the standard of care according to the severity of the disease. If one assumes that the data obtained in the Kansas City practices are representative of a larger geographic area, it indicates that dentistry may be failing to address issues of the timely diagnosis of periodontal disease, appropriate treatment, and/or timely referral for treatment.

Competition for Intrathoracic Space Reduces Lung Capacity in Patients With Chronic Heart Failure: A Radiographic Study

The purpose of this study was to determine the influence of changes in cardiac size on total lung volume in patients with chronic heart failure compared to control subjects.Forty-four patients and age-, gender-, and height-matched control participants were recruited. All participants underwent posteroanterior and lateral chest radiography for volumetric estimations of the total thoracic cavity (TTC), diaphragm, heart, and lungs. To assess the relationship between chronic heart failure severity and cardiac enlargement, patients with chronic heart failure were classified into groups based on New York Heart Association class, as follows: class I and II, n = 26 (group A); class III and IV, n = 18 (group B).There was no difference between the groups for TTC volume (TTCV) [p = 0.56]. Cardiac volumes were significantly different between all groups for both the absolute volumes (p < 0.001) were calculated as a percentage of TTCV (p < 0.001), with the largest cardiac volumes in group B (twice the volume of healthy control subjects). When expressed as a percentage of TTCV, there also was a clear reduction in lung volumes as a function of disease severity (p < 0.001).The present study demonstrates a close relationship between the severity of heart failure and cardiac size. These changes in cardiac size within a closed thoracic cavity may pose significant constraints on the lungs, resulting in reductions in lung volumes that likely play a major role in the restrictive breathing patterns often reported in patients with chronic heart failure.

Impact of Zernike-fit error on simulated high- and low-contrast acuity in keratoconus: implications for using Zernike-based corrections

This study examines the extent to which a Zernike-based optical correction can restore acuity in keratoconus as a function of disease severity and contrast level. Increasingly complete Zernike corrections in the presence of Zernike-fit error were simulated. Acuity for keratoconic eyes with <60 D maximum corneal power reached 20/13 with a fifth-order Zernike correction under high-contrast conditions and exhibited a loss of 0.1 logMAR (minimum angle of resolution) (from 20/32 to 20/40) for low-contrast conditions. Acuity for keratoconic eyes with >60 D maximum corneal power approached 20/13 with sixth-tenth-order corrections under high-contrast conditions but did not return to similar levels with a tenth-order correction for low-contrast conditions. The results suggest that fit error affects visual performance for more difficult tasks and that restoring high-contrast acuity (20/16 or better) using a fifth-order Zernike correction is not limited by Zernike=fit error for over 88% of keratoconus cases.

Remembering Words Never Presented: False Memory Effects in Dementia of the Alzheimer Type

Thirty-five young adults, 35 older adults and 29 individuals with dementia of the Alzheimer’s type studied lists of semantically related words (e.g., thread, pin, sewing) that converged on a non-presented lure (needle). Compared to the young adults, older adults remembered (recall and recognition tests) fewer studied items but falsely remembered more non-presented lures. Memory for studied items was lower in the DAT group compared to normal elders. The DAT group did recall some non-presented lures, although unlike the older adults, recall of non-presented lures was not elevated compared to veridical memory. Similar to the normal elders, the DAT group showed increased susceptibility to false recognition of non-presented lures. Susceptibility to false recognition did not vary as a function of disease severity.