Moderate Inverse Correlation Research Articles

Inability of single resting arterial blood gas to predict significant hypoxaemia in chronic obstructive pulmonary disease

While point measurement of resting arterial partial pressure of oxygen (P(a)O(2)) is the traditional gold-standard for assessment of oxygenation in chronic obstructive pulmonary disease (COPD), 24-h oximetry may identify further patients with clinically significant hypoxaemia. We aimed to describe the relationship between these two parameters and identify other correlated variables. All patients registered with the Barwon Health Hospital Admission Risk Program from 1 March to 31 October 2008 for the diagnosis of COPD were identified. The main inclusion criteria were obstructive spirometry, clinical stability and moderate resting hypoxaemia (P(a)O(2) 56-70 mmHg). All patients underwent 24-h oximetry, arterial blood gas, spirometry, anthropometry and telephone questionnaire, and 23 patients also completed polysomnography. Inclusion criteria were met in 35 of 287 patients. Mean recording time was 23.5 h, representing 97% of intended oximetry time. Nineteen patients (54%) spent greater than 30% of recorded oximetry time below 90%. There was a moderate inverse correlation between time below 90% saturations and P(a)O(2) (r=-0.40, P= 0.02), with body mass index (BMI) the only other independent predictor of the primary outcome identified (r= 0.39, P= 0.02). Correlations were similar for waking hours considered separately. However, for sleeping oximetry, BMI and age were the only independent predictors of time below 90%. Polysomnography demonstrated a high prevalence of rapid eye movement-related hypoventilation and obstructive sleep apnoea syndrome. Many patients with moderate hypoxaemia on resting P(a)O(2) desaturate significantly on ambulatory oximetry. The correlation between P(a)O(2) and proportion of saturations below 90% is moderate and similar to BMI, but this pattern does not hold during sleeping hours.

Reduction in Postoperative High-Density Lipoprotein Cholesterol Levels in Children Undergoing the Fontan Operation

Despite the emerging relevance of high-density lipoprotein (HDL) in the inflammatory cascade and vascular barrier integrity, HDL levels in children undergoing cardiac surgery are unexplored. As a measure of HDL levels, the HDL-cholesterol (HDL-C) in single-ventricle patients was quantified before and after the Fontan operation, and it was determined whether relationships existed between the duration and the type of postoperative pleural effusions. The study prospectively enrolled 12 children undergoing the Fontan operation. Plasma HDL-C levels were measured before and after cardiopulmonary bypass. The outcome variables of interest were the duration and type of chest tube drainage (chylous vs. nonchylous). The Kendall rank correlation coefficient and the Wilcoxon rank sum test were used. There were 11 complete observations. The median preoperative HDL-C level for all the subjects was 30 mg/dl (range, 24-53 mg/dl), and the median postcardiopulmonary bypass level was 21 mg/dl (range, 14-46 mg/dl) (p = 0.004). There was a tendency toward a moderate inverse correlation (-0.42) between the postcardiopulmonary bypass HDL-C level and the duration of chest tube drainage, but the result was not statistically significant (p = 0.07). In the chylous effusion group, the median postcardiopulmonary bypass HDL-C tended to be lower (16 vs. 23 mg/dl; p = 0.09). After the Fontan operation, the plasma HDL-C levels in children are significantly reduced. It is reasonable to conclude that the reduction in HDL-C reflects reduced plasma levels of HDL particles, which may have pertinent implications in postoperative pleural effusions given the antiinflammatory and endothelial barrier functions of HDL.

A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy

To compare intrascleral blebs characteristics after deep sclerectomy (DS) with three intrascleral implants using the Visante anterior segment optical coherence tomography. This is a cross-sectional study including 60 eyes of 51 patients that underwent DS with Sk-Gel, Esnoper, and Aquaflow implant. Intraocular pressure (IOP) measurement, slit-lamp examination, and Visante scans were performed the same day in all the patients. Visante scans were done through the intrascleral bleb at 45°, 90°, and 135° and the bleb height was measured. Sk-Gel was used in 19 eyes (31.66%), Esnoper in 22 eyes (36.66%), and Aquaflow in 19 eyes (31.66%). The median time lapsed from the surgery was 15.50 months 25th and 75th percentiles (p(25) 8.25; p(75) 20). The median IOP was 13 mm Hg (p(25) 10; p(75) 15), with no significant differences among implants (P = 0.232). Overall, the correlation between the scleral bleb height and the IOP was statistically significant at 45° (r=-0.359; P = 0.004), 90° (r = -0.410; P = 0.001), and 135° (r = -0.417; P = 0.001). However, Sk-Gel did not show any statistically significant correlation between the scleral height and IOP whereas the other two groups (Esnoper and Aquaflow) showed a significant correlation. There were no differences in the bleb height among implants. There was a moderate inverse correlation between the scleral bleb height and the IOP measurement after DS with Esnoper and Aquaflow implants. There were no differences in bleb height among the three implants.

Role of buccal corridor in smile esthetics and its correlation with underlying skeletal and dental structures

This study was designed to evaluate the buccal corridor in smile esthetics and to correlate it with underlying hard tissues. Posed smiling frontal photographs, digital posterior-anterior (PA) cephalograms, and study models of 25 males and 25 females in age range of 18-25 years were taken. Photographs were evaluated for smile esthetics by eight orthodontists, eight plastic surgeons, eight beauticians and eight lay people to group them into three groups with least attractive, average and attractive smile and buccal corridor width was measured. Digital PA cephalograms were transferred on Nemo-tech software for frontal facial analysis. Intercanine and intermolar widths were measured on upper study model with the help of a digital calliper. The buccal corridor width was least in attractive smile group and maximum in least attractive smile group. The buccal corridor width had a negligible correlation with hard tissues and a mild to moderate inverse correlation with intercanine and intermolar widths within the groups. As the amount of buccal corridor display was increased, smiling images were scored less attractive by the evaluators. The buccal corridor is not influenced by underlying skeletal hard tissues but have mild to moderate inverse correlation with the intercanine and intermolar width.

Assessment of a prototype computer colour matching system to reproduce natural tooth colour on ceramic restorations

ObjectivesThe aim of this study was to assess the accuracy of a prototype computer colour matching (CCM) system for dental ceramics targeting the colour of natural maxillary central incisors employing a dental spectrophotometer and the Kubelka–Munk theory. MethodsSeventeen human volunteers with natural intact maxillary central incisors were selected to participate in this study. One central incisor from each subject was measured in the body region by a spectrophotometer and the reflectance values were used by the CCM system in order to generate a prescription for a ceramic mixture to reproduce the target tooth's colour. Ceramic discs were fabricated based on these prescriptions and layered on a zirconia ceramic core material of a specified colour. The colour match of each two-layered specimen to the target natural tooth was assessed by CIELAB colour coordinates (ΔE*, ΔL*, Δa* and Δb*). ResultsThe average colour difference ΔE* value was 2.58±84 for the ceramic specimen–natural tooth (CS–NT) pairs. ΔL* values ranged from 0.17 to 2.71, Δa* values ranged from −1.70 to 0.61, and Δb* values ranged from −1.48 to 3.81. There was a moderate inverse correlation (R=−0.44, p-value=0.0721) between L* values for natural target teeth and ΔE* values; no such correlation was found for a* and b* values. ConclusionThe newly developed prototype CCM system has the potential to be used as an efficient tool in the reproduction of natural tooth colour.

Circulating Endothelial Cells as a Marker of Vascular Dysfunction in Patients With Systemic Lupus Erythematosus by Real-Time Polymerase Chain Reaction

Systemic lupus erythematosus (SLE) is associated with an increased risk of atherosclerosis; endothelial dysfunction represents the first step in its pathogenesis. To assess endothelial dysfunction in SLE by circulating endothelial cells (CECs) and to characterize SLE-specific factors that contribute to its appearance. Case-control study was conducted on 60 subjects, divided into 2 groups: group A (30 patients with SLE) and group B (30 healthy sex- and age-matched controls). Total cholesterol, triglycerides, antinuclear antibodies, anti-double-stranded DNA antibodies, and C3 were determined in all patients. Systemic lupus erythematosus activity was assessed using the SLE Disease Activity Index. Endothelial function was assessed by means of flow-mediated dilation of the brachial artery using B-mode ultrasonography and relative quantification of CD 146 mRNA by real-time polymerase chain reaction. The group of SLE patients was formed of 20 females and 10 males, with a mean age of 31.16 ± 9.69 years. The values of SLE-specific tests and SLE Disease Activity Index were represented by anti-double-stranded DNA antibodies 160 ± 40.5, C3 68.91 ± 11.91 mg/dL, total cholesterol 188.66 ± 49.63 mg/dL, triglycerides 143.41 ± 46.26 mg/dL, and SLE Disease Activity Index 12.66 ± 3.70. Values for flow-mediated dilation were 8.85% ± 2.02% (group A) and 20.33% ± 6.19% (group B), P < .001, and CECs were 300 ± 40.5 μL⁻¹ blood (group A) and 10 ± 2.5 μL⁻¹ blood (group B). The statistical analysis showed a strong inverse correlation between CECs and SLE Disease Activity Index, a strong correlation between CECs and C3, a strong correlation between CECs and anti-double-stranded DNA antibodies, and a moderate inverse correlation between CECs and total cholesterol. Endothelial dysfunction is present in SLE patients even in the absence of traditional cardiovascular risk factors due to disease activity.

What Has Transcranial Magnetic Stimulation Taught Us About Neural Adaptations To Strength Training? A Brief Review

The evidence for neural mechanisms underpinning rapid strength increases has been investigated and discussed for over 30 years using indirect methods, such as surface electromyography, with inferences made toward the nervous system. Alternatively, electrical stimulation techniques such as the Hoffman reflex, volitional wave, and maximal wave have provided evidence of central nervous system changes at the spinal level. For 25 years, the technique of transcranial magnetic stimulation (TMS) has allowed for noninvasive supraspinal measurement of the human nervous system in a number of areas such as fatigue, skill acquisition, clinical neurophysiology, and neurology. However, it has only been within the last decade that this technique has been used to assess neural changes after strength training. The aim of this brief review is to provide an overview of TMS, discuss specific strength training studies that have investigated changes, after short-term strength training in healthy populations in upper and lower limbs, and conclude with further research suggestions and the application of this knowledge for the strength and conditioning coach.

Evaluation of Normal Appearing White Matter in Multiple Sclerosis

The aim of this study was to determine diffusion magnetic resonance imaging (MRI), magnetization transfer (MT) imaging and multivoxel MR spectroscopy findings in plaques, periplaque white matter and normal appearing white matter (NAWM) regions in multiple sclerosis (MS) and to correlate the findings with the expanded disability status scale (EDSS). A total of 30 patients with MS and 30 healthy control subjects were studied and apparent diffusion coefficient (ADC) values, MT ratio (MTR), N-acetyl-aspartate/creatine (NAA/Cr) and choline/creatine (Cho/Cr) ratios were measured in plaques, periplaques and NAWM regions and compared with the control subjects. The MTR and NAA/Cr ratio were decreased more in plaques than periplaques and NAWM, in contrast ADC values and Cho/Cr ratios were highest in plaques and higher in periplaques than in NAWM. Decreased MTR and NAA/Cr in NAWM demonstrated moderate inverse correlations (r = - 0.604, p < 0.001 and r = - 0.494, p < 0.001, respectively) while Cho/Cr ratios and ADC of NAWM demonstrated weak linear correlations (r = 0.370, p = 0.004, r = 0.297, p = 0.021 respectively) with EDSS. The MS, MTR and MR spectroscopy findings were found to be useful for detecting subtle abnormalities in NAWM. Although ADC values were significantly altered in plaque and periplaque regions a significance difference was not found in NAWM.

Nanoleakage related to bond strength in RM-GIC and adhesive restorations

This was to investigate the nanoleakage of Resin Modified Glass Ionomer Cement (RMGIC) and composite resin (CR) restorations in sound and caries-affected primary dentine, submitted to load cycling and cariogenic challenge in vitro. Occlusal cavities were prepared in 60 sound exfoliated primary second molars and 30 specimens were subjected to chemical induction of artificial caries lesions and the others were restored without caries induction. All prepared teeth were divided into 2 groups according to restorative materials. From each dentine condition 5 restored teeth and restorative material were subjected to microtensile bond strength and nanoleakage tests immediately or after load-cycling or submitted to the pH-cycling procedure before testing. The adhesive presented bigger areas of silver leakage at the interfaces on caries-affected dentine (2.46±0.47)mm2 than sound dentine (0.90±0.19)mm2. RMGIC nanoleakage was not influenced by the sound (1.75±0.11)mm2 or caries-affected (2.08±0.39) condition of the substrate. A significant moderate inverse correlation was revealed between the bond strength and silver leakage area at the interface, (r= -0.55, p<0.001). Nanoleakage is greater in caries-affected primary teeth dentine than sound dentine in adhesive restorations although at the interfaces of RMGIC does not differ. As nanoleakage increases, bond strength decreases significantly.

Spatial inhibition and the visual cortex: A magnetic resonance spectroscopy imaging study

IntroductionDeficits in processing spatial information have been observed in clinical populations who have abnormalities within the dopamine (DA) system. As psychostimulants such as methamphetamine (MA) are particularly neurotoxic to the dopaminergic system it was of interest to examine the performance of MA-dependent individuals on a task of spatial attention. Method51 MA-dependent subjects and 22 age-matched non-substance abusing control subjects were tested on a Spatial Stroop attention test. MR Spectroscopy (MRS) imaging data were analyzed from 32 MA abusers and 13 controls. ResultsNo group differences in response time or accuracy emerged on the behavioral task with both groups exhibiting equivalent slowing when the word meaning and the spatial location of the word were in conflict. MRS imaging data from the MA abusers revealed a strong inverse correlation between NAA/Cr ratios in the Primary Visual Cortex (PVC) and spatial interference (p=0.0001). Moderate inverse correlations were also seen in the Anterior Cingulate Cortex (ACC) (p=0.02). No significant correlations were observed in the controls, perhaps due to the small sample of imaging data available (n=13). DiscussionThe strong correlation between spatial conflict suppression and NAA/Cr levels within the PVC in the MA-dependent individuals suggests that preserved neuronal integrity within the PVC of stimulant abusers may modulate cognitive mechanisms that process implicit spatial information.

Serum levels of angiopoietin-1 in patients with pulmonary hypertension due to mitral stenosis

The molecular basis and pathophysiology of pulmonary hypertension (PH) are rapidly evolving areas. Recently discovered angiopoietins (Ang) constitute a family of growth factors, and whether they play a causal or protective role in pulmonary hypertension has not been fully elucidated. Since left heart disease probably represents the most frequent cause of PH, we sought to determine whether there was a relationship between serum Ang-1 levels and pulmonary hypertension caused by mitral stenosis (MS). The study population was composed of 49 patients with isolated MS. These patients were then divided into group 1 [31 patients with severe MS: mitral valve area (MVA) ≤1.1cm(2)] and group 2 (18 patients with mild-moderate MS: MVA 1.2-2.0cm(2)). Twenty-one healthy volunteers comprised the control group (group 3). All of the subjects underwent complete transthoracic echocardiography with determination of systolic pulmonary artery pressure (PAPs). Ang-1 levels were determined in serum. Serum levels of Ang-1 were significantly higher in the control group compared to patients with severe (group 1) and mild-moderate (group 2) MS (p<0.001). Ang-1 levels were found to have moderate inverse correlation with PAPs and left atrial (LA) diameter (r: -0.620, p<0.001 and r: -0.489, p<0.001, respectively). The AUC for the ROC curve for predicting PAPs <50mmHg by serum Ang-1 level was 0.824 (95% CI 0.722-0.926, p<0.001). A serum level of Ang-1 above 34,656pg/ml has 74% sensitivity and 80% specificity for predicting that PH is not severe (PAPs <50mmHg). In conclusion, the findings of this study are distinctive in the sense that they clearly demonstrate a negative correlation between serum Ang-1 levels and the degree of PH.

Six-minute walk distance predicts mortality in liver transplant candidates

The 6-minute walk distance (6MWD) is a simple test measuring global physical function. It is commonly used to predict mortality in patients with cardiac and pulmonary diseases, but it is also useful in assessing the functional status of patients with a variety of other medical conditions. We sought to determine (1) the characteristics of the 6MWD in patients listed for liver transplantation (LT), (2) the existence of a relationship between the 6MWD and the quality of life, and (3) the relationship between the 6MWD and survival in LT candidates. The 6MWD was prospectively measured in all patients listed for LT. The 6MWD was determined when the listed Model for End-Stage Liver Disease (MELD) score was ≥ 15. Patients were followed until LT, death, removal from the wait list, or the end of the study period. Quality of life was assessed with the Short Form 36 (SF-36). In 121 patients, the mean 6MWD was 369 ± 122 m; it was not related to age, height, weight, body mass index, albumin level, or etiology of liver disease and showed a moderate correlation with the physical component score (PCS) on the SF-36 (r = 0.4) and a moderate inverse correlation with the native MELD score (r = -0.61). In an unadjusted analysis, a high native MELD score, a low 6MWD, and a low PCS were associated with mortality, with only the 6MWD retaining significance after adjustment for covariates. Each 100-m increase in the 6MWD was significantly associated with increased survival (hazard ratio = 0.48, P = 0.0001), with 6MWD < 250 m being associated with an increased risk of death (P = 0.0001). In conclusion, the 6MWD is significantly reduced in patients awaiting LT and is inversely correlated with the native MELD score. A pretransplant 6MWD < 250 m is a risk for death on the wait list.

Quality of life assessment of patients with chronic liver disease in eastern India using a Bengali translation chronic liver disease questionnaire

The aim of this study was to translate and validate chronic liver disease questionnaire (CLDQ) into Bengali using a standard protocol and use it to assess the impact of socioeconomic factors, etiology, disease severity and complications on the quality of life of patients. Formal translation of CLDQ to Bengali was done. Cronbach's alpha and test-retest was performed for reliability analysis. Patients with clinically stable chronic liver disease (CLD) without significant associated co-morbid states were administered Bengali CLDQ in the Liver Clinic. The clinical, biochemical and disease parameters were recorded for analysis. Bengali CLDQ was administered to 100 patients with CLD. Cronbach's alpha of overall scores was 0.90 and test-retest correlation coefficient of average CLDQ was 0.86 (P<0.001). Patients with history of decompensation (96.51 vs. 109.61; P=0.039) and Child's C status (92.24 vs. 105.71; P=0.028) had significantly lower CLDQ scores. CLDQ scores showed a moderate inverse correlation with Child's status (r= -0.35) and a poor correlation with MELD score (r= -0.09). Bengali translation of CLDQ was found to be reliable. History of decompensation, Child's C status was associated with worse CLDQ scores. Child's status may have some role in predicting quality of life of patients with CLD. MELD score had poor predictability of quality of life.

PET Assessment of Myocardial Perfusion Reserve Inversely Correlates with Intravascular Ultrasound Findings in Angiographically Normal Cardiac Transplant Recipients

Cardiac allograft vasculopathy (CAV) is the major determinant of long-term survival after heart transplantation. We aimed to evaluate the efficacy of PET as a noninvasive way to assess the early stages of CAV. Twenty-seven consecutive patients (20 men and 7 women; mean age +/- SD, 46 +/- 12 y) who had normal results on coronary angiography and normal left ventricular systolic function (ejection fraction >or= 60%) were enrolled at 2.5 +/- 2.1 y after transplantation. Myocardial blood flow (MBF) was assessed using dynamic (13)N-ammonia PET at rest and during adenosine-induced hyperemia, and myocardial perfusion reserve (MPR) was calculated as the ratio of hyperemic MBF to resting MBF. Regional (13)N-ammonia PET was assessed using a 5-point scoring system. The intravascular ultrasound (IVUS) measurements for the extent of intimal hyperplasia, including plaque volume index (calculated as [total plaque volume/total vessel volume] x 100%) and maximum area of stenosis, were compared with MPR by linear regression analysis. In 27 angiographically normal cardiac transplant recipients, MBF at rest and during adenosine stress and MPR of the left anterior descending artery distribution correlated strongly with the other 2 coronary artery distribution territories (r >or= 0.97, P < 0.0001). Summed stress score and summed difference score showed a moderate inverse correlation with MPR (r = -0.41 and -0.49, respectively; P < 0.05) but not with IVUS measurements. MPR correlated inversely with plaque volume index (r = -0.40, P < 0.05) but not with maximal luminal stenosis as assessed by IVUS. In addition, MPR and IVUS measurements gradually inversely changed after heart transplantation (all P < 0.05). This study confirms that CAV is a progressive process, diffusely involving the epicardial and microvascular coronary system. Plaque burden as determined by IVUS agrees well with MPR as assessed by PET in recipients with normal coronary angiography results. This finding suggests that dynamic (13)N-ammonia PET is clinically feasible for the early detection of CAV and can be used as a reliable marker of disease progression.

Inflammation within Carotid Atherosclerotic Plaque: Assessment with Late-Phase Contrast-enhanced US

To determine if the number of nontargeted microbubbles retained in human carotid plaque is sufficient to be detected with ultrasonography (US). The study protocol was approved by the local research ethics committee. Informed consent was obtained. A total of 37 subjects with carotid atherosclerosis (mean age, 69.9 years; age range, 49-86 years), of whom 27 (73%) were men (mean age, 69.7 years; age range, 58-86 years) and 10 (27%) were women (mean age, 70.3 years; age range, 49-86 years), were studied between December 2008 and May 2009 with late-phase (LP) contrast material-enhanced US by using flash imaging with a nonlinear mode at an intermediate mechanical index of 0.34 6 minutes after bolus contrast agent injection. Plaques were defined as symptomatic if symptoms consistent with stroke, transient ischemic attack, or amaurosis fugax had occurred in the neurovascular territory of the plaque studied within 12 months prior to entry into the study. Plaques were defined as asymptomatic if no such events had ever occurred within the neurovascular territory. Raw linear data were used to quantify echogenicity of the plaque, which was normalized to lumen echogenicity. Gray-scale median score was also calculated. Of the 37 subjects, 16 (43%) had symptomatic plaques and 21 (57%) had asymptomatic plaques. All examinations yielded evaluable LP contrast-enhanced US data. Normalized LP plaque echogenicity was greater in the symptomatic group (0.39; 95% confidence interval: -0.11, 0.89) than in the asymptomatic group (0.69; 95% confidence interval: -1.04, -0.34) (P = .0005). There was a moderate (rho = -0.44, P = .016) inverse correlation between normalized LP plaque echogenicity and gray-scale median score. By quantifying microbubble retention within the carotid plaque, LP contrast-enhanced US depicts clear differences between groups of subjects with plaque ipsilateral to symptoms and asymptomatic plaques. This technique has promise as a tissue-specific marker of inflammation and a potential role in the risk stratification of atherosclerotic carotid stenosis.

Experience with Early Enteral Feeding in a Patient with Venoarterial Extracorporeal Membrane Oxygenation

The study deals with the pathogenesis and early diagnosis of renal dysfunction in low and extremely low birth weight (ELBW) premature neonates. Objective: to study the specific features of the mechanisms responsible for the development of acute renal failure (ARF) in low and ELBW neonates and to use an analysis of oxygen status parameters as a method for early diagnosis of neonatal ARF. Subjects and methods. The study included 172 neonatal infants with a birth body weight of 800 to 1500 g. The values of blood gas composition and base-acid balance, and oxygen status were daily studied in all the children, by analyzing all the indices reflecting tissue hypoxia. Results. Analysis of oxygen status parameters in relation to a baby&#8217;s body weight revealed no considerable differences. The development of renal dysfunction and ARF in low and ELBW neonates was demonstrated to be most frequently caused by the progression of respiratory failure and tissue hypoxia, which suggests secondary renal lesion in the pattern of multiple organ dysfunction. It was ascertained that edema had a direct correlation with a physiological shunt fraction and oxygenation index and a moderate inverse correlation with blood oxygen tension and respiration index. In addition, an inverse correlation was found between the serum concentration of lactate and the daily volume of diuresis. The rate of hourly diuresis had a direct correlation with respiratory index and an inverse correlation with oxygenation index. Conclusion. Dysfunction of the kidneys and acute renal failure in neonatal infants in the pattern of multiple organ syndrome are secondary and closely related to the progres&#8211; sion of respiratory failure, as suggested by the oxygen status parameters that may be used for the prediction and early diagnosis or Key words: acute renal failure, renal dysfunction, neonaQtal infants, low and extremely low birth weight, hypoxia, oxygen status, multiple organ dysfunction. neonates. Key words: acute renal failure, renal dysfunction, neonatal infants, low and extremely low birth weight, hypoxia, oxygen status, multiple organ dysfunction.

Motor and functional evaluation of patients with spastic paraplegia, optic atrophy, and neuropathy (SPOAN)

Spastic paraplegia, optic atrophy, and neuropathy (SPOAN) is an autosomal recessive complicated form of hereditary spastic paraplegia, which is clinically defined by congenital optic atrophy, infancy-onset progressive spastic paraplegia and peripheral neuropathy. In this study, which included 61 individuals (age 5-72 years, 42 females) affected by SPOAN, a comprehensive motor and functional evaluation was performed, using modified Barthel index, modified Ashworth scale, hand grip strength measured with a hydraulic dynamometer and two hereditary spastic paraplegia scales. Modified Barthel index, which evaluate several functional aspects, was more sensitive to disclose disease progression than the spastic paraplegia scales. Spasticity showed a bimodal distribution, with both grades 1 (minimum) and 4 (maximum). Hand grip strength showed a moderate inverse correlation with age. Combination of early onset spastic paraplegia and progressive polyneuropathy make SPOAN disability overwhelming.

Usefulness of factor II and factor X as therapeutic markers in patients under chronic warfarin therapy

Oral anticoagulation with warfarin is a widely used form of treatment for an increasing number of medical conditions. Nevertheless, appropriate therapeutic monitoring and dosage readjustments should be carried out in order to ensure its safety and efficacy. Although prothrombin time (usually expressed as International normalized ratio [INR]) is the most common warfarin response marker, clotting factors (namely factors II and X) are also indicated as alternative anticoagulant effect markers. In this paper, we examine the relationship between these warfarin response markers using information obtained from eighty 80 patients undergoing long-term warfarin therapy. Within the usual INR therapeutic range (2.0–3.5), a moderate inverse correlation between INR and both clotting factors II and X was observed. However, for INR values above 3.5, a non-proportional relationship were found between INR and both response markers. Therefore, it can be concluded that below critical clotting factor concentrations (20.6% and 15.6% of factors II and X activity, respectively), time required for clot formation becomes non-proportional and haemostasis will be jeopardised.

Regional differences in lumbar spinal posture and the influence of low back pain

BackgroundSpinal posture is commonly a focus in the assessment and clinical management of low back pain (LBP) patients. However, the link between spinal posture and LBP is not fully understood. Recent evidence suggests that considering regional, rather than total lumbar spine posture is important. The purpose of this study was to determine; if there are regional differences in habitual lumbar spine posture and movement, and if these findings are influenced by LBP.MethodsOne hundred and seventy female undergraduate nursing students, with and without LBP, participated in this cross-sectional study. Lower lumbar (LLx), Upper lumbar (ULx) and total lumbar (TLx) spine angles were measured using an electromagnetic tracking system in static postures and across a range of functional tasks.ResultsRegional differences in lumbar posture and movement were found. Mean LLx posture did not correlate with ULx posture in sitting (r = 0.036, p = 0.638), but showed a moderate inverse correlation with ULx posture in usual standing (r = -0.505, p < 0.001). Regional differences in range of motion from reference postures in sitting and standing were evident. BMI accounted for regional differences found in all sitting and some standing measures. LBP was not associated with differences in regional lumbar spine angles or range of motion, with the exception of maximal backward bending range of motion (F = 5.18, p = 0.007).ConclusionThis study supports the concept of regional differences within the lumbar spine during common postures and movements. Global lumbar spine kinematics do not reflect regional lumbar spine kinematics, which has implications for interpretation of measures of spinal posture, motion and loading. BMI influenced regional lumbar posture and movement, possibly representing adaptation due to load.

Arterial Blood Supply of Hepatocellular Carcinoma and Histologic Grading: Radiologic-Pathologic Correlation

The objective of our study was to clarify the sequential changes of arterial blood supply during the development of hepatocellular carcinoma (HCC) with an emphasis on its late stage. Sixty HCC nodules were confirmed at pathology in 59 patients who had undergone CT hepatic arteriography and CT during arterioportography (CTAP). Lesions were classified into one of the four groups: group 1, nodules that appeared to show preserved portal perfusion on CTAP and showed hypo- or isoattenuation on CT hepatic arteriography; group 2, very hyperattenuating on CT hepatic arteriography; group 3, hyperattenuating on CT hepatic arteriography; and group 4, hypo- or isoattenuating on CT hepatic arteriography. Groups 2, 3, and 4 showed the portal perfusion defect on CTAP. These hemodynamic patterns were compared among different histologic grades. We also examined the number of unpaired arteries and the Ki-67 labeling index of the tumor pathologically. The numbers of lesions in each group were as follows for groups 1, 2, 3, and 4, respectively: 17, one, two, and 0 well-differentiated HCCs; 0, 10, nine, and one moderately differentiated HCC; and 0, three, 12, and five poorly differentiated HCCs. The lesions showed significantly different hemodynamic patterns among different histologic grades (Cramer's V = 0.6919, p < 0.0001). The number of unpaired arteries showed a strong correlation with Ki-67 labeling index in well-differentiated HCC and moderately differentiated HCC (rho = 0.673, p < 0.0001) and a moderate inverse correlation with Ki-67 labeling index in poorly differentiated HCC (rho = -0.540, p = 0.0185). In the late stage of HCC development, the arterial blood supply significantly decreases as the histologic grade progresses.