Mild-moderate Degree Research Articles

Caracterización molecular y descripción fenotípica de dos casos con aberraciones cromosómicas recíprocas en la región de los síndromes de microdeleción/microduplicación 3q29

The 3q29 microdeletion and microduplication syndromes are characterised by a marked phenotypic heterogeneity, and delayed development and a mild-moderate degree of intellectual disability are the most frequent clinical manifestations. Two patients with reciprocal chromosomal aberrations in the 3q29 region. The patient with 3q29 microdeletion presented learning disabilities, borderline microcephaly, mild facial dysmorphism, attentional deficit and impulsiveness, and anxious and obsessive traits. The patient with reciprocal 3q29 microduplication presented learning disabilities, mild facial dysmorphism and a disruptive behavioural profile that was not previously associated with this duplication. The phenotypes of these patients are compared and the literature about paediatric patients with 3q29 microdeletions and microduplications is reviewed.

Effect of oleic acid-induced acute lung injury and conventional mechanical ventilation on renal function in piglets.

Animal models that demonstrate changes of renal function in response to acute lung injury (ALI) and mechanical ventilation (MV) are few. The present study was performed to examine the effect of ALI induced by oleic acid (OA) in combination with conventional MV strategy on renal function in piglets. Twelve Chinese mini-piglets were randomly divided into two groups: the OA group (n = 6), animals were ventilated with a conventional MV strategy of 12 ml/kg and suffered an ALI induced by administration of OA, and the control group (n = 6), animals were ventilated with a protective MV strategy of 6 ml/kg and received the same amount of sterile saline. Six hours after OA injection a severe lung injury and a mild-moderate degree of renal histopathological injury were seen, while no apparent histological abnormalities were observed in the control group. Although we observed an increase in the plasma concentrations of creatinine and urea after ALI, there was no significant difference compared with the control group. Plasma concentrations of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C increased (5.6 ± 1.3) and (7.4 ± 1.5) times in the OA group compared to baseline values, and were significantly higher than the values in the control group. OA injection in combination with conventional MV strategy resulted in a dramatic aggravation of hemodynamic and blood gas exchange parameters, while these parameters remained stable during the experiment in the control group. The plasma expression of TNF-α and IL-6 in the OA group were significantly higher than that in the control group. Compared with high expression in the lung and renal tissue in the OA group, TNF-α and IL-6 were too low to be detected in the lung and renal tissue in the control group. OA injection in combination with conventional MV strategy not only resulted in a severe lung injury but also an apparent renal injury. The potential mechanisms involved a cytokine response of TNF-α and IL-6 in plasma, lung and renal tissues.

Re-challenge with Etanercept in patients with Etanercept-induced Neutropenia

TNF blockers have rarely been associated with haematological complications; however, there are scattered case reports of marked neutropenia with their use and necessitating in their withdrawal. We would like to report a series of five patients who developed neutropenia with etanercept use; however, all these patients were re-challenged with etanercept with a mean follow up of 30months. These patients developed neutropenia within 2months of starting etanercept. Two patients were eventually taken off etanercept; one of them needed switching to a different form of TNF blockers, and the second patient is in clinical remission with low-dose corticosteroids. All our patients continued to have mild-moderate degree of neutropenia; however, they are being monitored very closely and they are enjoying complete disease remission. It was interesting to note that none of our patients had increased infections during the re-challenge phase, even though they had grade 2 to grade 4 neutropenia. We have re-challenged these patients without any clinical complications, revealing that patients with mild to moderate neutropenia can be safely exposed to TNF blockers as long as they are monitored with regular cell count checks. Although largely noted to be clinically insignificant in our patient series, the potential of drug-induced neutropenia in causing higher rate of infections do exist. Careful clinical and hematologic monitoring is the best way to recognize this adverse event.

Dynamic changes of high-sensitive C-reactive protein and visfatin in patients with acute traumatic injury of brain

Objective To observe the dynamic changes of high-sensitive C-reactive protein （hs-CRP） and visfatin in patients with acute traumatic injury of brain. Method A total of 120 patients with equal number in each gender （ n = 60） and with average age of （43.2 ± 6.2） years were admitted and treated by the neurosurgical department of ICU from August 2009 to June 2010. All patients were eligible to the diagnostic criteria of craniocerebreal injury. The clinical conditions of patients were assessed with Glasgow coma scale （C CS） at admission,and as per the scores of GCS, the patients were classified into mild degree （13- 15, n = 40）, moderate degree （9 - 12, n = 40） and severe degree （3 - 8, n = 40）. Another 60 subjects from those asking for health care by physical examination as control with equal number in each gender and their average age was （42.2±6.7） years.Blood samples were collected from fasted patients within 12 hours, 1d, 3d, 7d and 15 days after admission, and the levels of hs-CRP and visfatin in peripheral blood were detected. Results The levels of hs-CRP and visfatin were significantly higher in brain injury group than those in control group on the admission day （both P 〈 0.01 ）,and they both had positive relationships with severity of injury. The level of hs-CRP increased to peak on the first day of admission and visfatin increased to the peak on the 3rd day after admission. There was a correlation between levels of hs-CRP and visfatin （ r = 0.63, P 〈 0.01 ）. Conclusions hs-CRP and visfatin levels are related to the severity of acute traumatic injury of brain. Key words: Traumatic brain injury; High-sensitive C-reactive protein（hs-CRP） ; Visfatin

A third evaluation of tertiary cytoreduction

To evaluate the impact of tertiary cytoreductive surgery (TCS) on patient survival and to determine predictors of optimal TCS. Twenty patients with recurrent epithelial ovarian carcinoma who had TCS at Hacettepe University Hospital during 1992-2004 were retrospectively reviewed. Tertiary cytoreductive attempt was successful (optimal defined as <2 cm residual) in 12 patients and suboptimal in the remaining eight patients. Seven patients had no macroscopic residual, five patients had <2 cm gross residual and remaining 8 patients had >or=2 cm gross residual disease. Of these alive patients, 10 patients were alive with metastatic disease and only three patients were alive without any evidence of disease. Three patients had operative morbidity (15%), all of which were mild-moderate degree. Multivariate analysis could not differentiate a unique significant factor to have a possible predictor effect of optimal TCS. Multivariate survival analysis also could not differentiate any factor to have significant effect upon patient survival, neither the outcomes of primary, secondary or tertiary cytoreductive surgeries nor the usage of preoperative or postoperative chemotherapies. TCS may not be helpful for patient survival. Neither of the clinical factors predicted an optimal TCS. Further larger series are needed for a definite conclusion.

Hyperhomocysteinemia in Chronic Renal Insufficiency

Hyperhomocysteinemia in Chronic Renal Insufficiency Hyperhomocysteinemia is an independent risk factor for premature cardiovascular disease. Since the homocysteine level is elevated in patients with advanced chronic renal insufficiency, it has been presented as an important factor contributing to the development of cardiovascular complications in these patients. In this study we examined the level of homocysteine in patients with mild-moderate degree of glomerular filtration rate reduction (creatinine clearance &gt;40 mL/min and &lt;80 mL/min/1.73 m2). Thirty patients (f=15, m=15) were compared with healthy subjects (n=32, f=17, m=15). Blood samples were collected and subjected to assays for homocysteine, creatinine, creatinine clearance. The results show that homocysteine levels of patients were significantly higher than those of healthy subjects (12.75 ± 3.9 vs. 8.5 ± 1.75 μmol/L, p&lt;0.001). The obtained results also show a significant negative relationship between the level of homocysteine and creatinine clearance (r=-0.8). In conclusion, hyperhomocysteinemia is a common finding not only in advanced chronic renal insufficiency, but also in patients with mild-moderate reduction of glomerular filtration rate, and may significantly contribute to premature development of cardiovascular complications.

A Study on the Etiology of 912 Anemia Patients in General Hospital.

Objectives To investigate incidence rate and the etiological factors of anemia in general hospital.Methods We selected 912 patients with anemia from 4198 inpatients in our hospital from Jan.to Feb.2004,and analyzed their clinical data retrospectively. All inpatients had been detected Hb,RBC,MCV and MCHC. We collected 2ml venous blood in anticoagulant EDTA-k2 tube and measured them with Gen.STM System2 blood cell radiomete in 2 hours. some patients had been punctured bone marrow examination. According to diagnostic standard of anemia(male adult Hb<120g/L, female adult Hb<110g/L, gravida Hb<100g/L) and anemia degree(Mild degree anemia: Hb 90~120 g/L, Moderate degree anemia: Hb 60~90 g/L, Severe degree anemia: Hb30~60 g/L, Profound degree anemia: Hb<30g/L), we classified anemia according to clinical types and cell morphology. according to clinical types, anemia was resulted from primary hematologic disease and secondary anemia. Main causes of secondary anemia were chronic disease, blood loss and chronic systemic disease. According to red blood cell morphology, anemia was classified: microcytic hypochromic anemia (MCV<80fl,MCHC<32%), pure microcytic anemia(MCV<80fl,MCHC32%~36%),normocytic normochromic anemia (MCV80fl~100fl,MCHC32%~36%) and macrocytic anemia( MCV>100fl).Results The incidence of anemia in inpatients in general hospital was 21.72%. 96.71% of patients were mild-moderate degree anemia and only 13.71% anemia patients showed symptom of anemia such as dizzying,drumming. But only 1.10% of patients had been diagnosed by doctors. 6.36% of patients were caused by hematologic disease and 89.74% of patients coexisted primary disease.53.62% of patient were secondary to chronic disease such as tumor,chronic infection, rheumatic disease. 27.85% of patients were secondary to blood loss. Then 8.00% of patients was caused by chronic systemic disease.Conclusions Anemia existed in various clinical diseases. Misdiagnosis rate of anemia was high. Appropriate treatment of secondary anemia was beneficial for prognosis of primary diseases. All doctors should pay more attention to anemia in general hospital.

Modulation of early angiogenesis by nitric oxide

undergone surgical placement of bone anchorage devices for orthodontic treatment. A total of 37 devices have been placed to date. In three cases, maxillary IMF screws were placed bilaterally in order to provide orthodontic anchorage. In the remaining 16 patients, specialized bone anchorage devices were used. Data collection was carried out during a retrospective review of each patient’s record, preoperative and postoperative radiographs, and patient and surgeon questionnaires completed during the perioperative period. Results: All participating surgeons rated the surgical procedure as very easy to moderately easy. The most challenging aspect of the surgical procedure was related to retraction during the placement of devices through small vertical incisions. Postoperative morbidity was characterized by minimal to mild pain and moderate degree of swelling. Postoperative complications included mucosal inflammation around the device (2 implants), fracture of one device, and failure of the monocortical screws securing the device (2 implants). Conclusion: The use of skeletal fixation devices for anchorage appears to be a promising adjunctive treatment for specific orthodontic indications. Our preliminary surgical experience has revealed easy surgical placement, minor postoperative morbidity, and a low rate of postoperative complications related to the implants.

Prevalence of mental disorders in an urban sample examined at 70, 75 and 79 years of age.

The prevalence of mental disorders in a representative sample of old people in Gothenburg, Sweden, was studied at 70, 75 and 79. The study comprised 392 subjects at 70, 302 subjects at 75 and 203 at 79. A case was defined by cut-off points on symptom and sign rating scales, and diagnoses were defined operationally as closely as possible to the ICD-classification. The total psychiatric morbidity was 21.9, 24.2 and 31.0% in the three age groups. The prevalence of schizophrenic and paranoid syndromes was 0.5, 1.7 and 2.5% and of affective disorders 1.0, 2.3 and 0.5%. The prevalence of dementias of psychotic degree was 1.3, 2.3 and 6.9% and of asthenic neuroses corresponding to dementias of mild-moderate degree 2.3, 4.0 and 9.4%. The prevalence of anxiety, depressive and obsessive-compulsive neuroses of moderate-severe degree was 6.6, 4.6 and 3.9% and of mild degree 7.9, 6.0 and 5.9%. The prevalence of active alcoholism in men was 4.2, 3.4 and 3.0% and in women 0.0% in all age groups. Current treatment was reported by 67-85% of subjects with psychoses, about one half of them in psychiatric services, and by 35-65% of subjects with neuroses, about one fifth of them in psychiatric services.