Symptom Severity In Groups Research Articles

Radiological Significance of Ligamentum Flavum Hypertrophy in the Occurrence of Redundant Nerve Roots of Central Lumbar Spinal Stenosis

ObjectiveThere were previous reports of redundant nerve roots (RNRs) focused on their clinical significance and pathogenesis. In this study, we investigated the significant radiologic findings that correlate with RNRs occurrence. These relations would provide an advanced clue for clinical significance and pathogenesis of RNRs.MethodsRetrospective research was performed with data from 126 patients who underwent surgery for central lumbar spinal stenosis (LSS). Finally, 106 patients with common denominators (inter-observer accuracy : 84%) were included on this study. We divided the patients into two groups by MRI, patients with RNRs and those with no RNRs (NRNRs). Comparative analyses were performed with clinical and radiologic parameters.ResultsRNRs were found in 45 patients (42%) with central LSS. There were no statistically significant differences between the two groups in severity of symptoms. On the other hand, we found statistically significant differences in duration of symptom and number of level included (p<0.05). In the maximal stenotic level, ligamentum flavum (LF) thickness, LF cross-sectional area (CSA), dural sac CSA, and segmental angulation are significantly different in RNRs group compared to NRNRs group (p<0.05).ConclusionRNRs patients showed clinically longer duration of symptoms and multiple levels included. We also confirmed that wide segmental angulation and LF hypertrophy play a major role of the development of RNRs in central LSS. Together, our results suggest that wide motion in long period contribute to LF hypertrophy, and it might be the key factor of RNRs formation in central LSS.

Co-occurrence of arseniasis and fluorosis due to indoor combustion of high fluorine and arsenic content coal in a rural township in northwest China: epidemiological and toxicological aspects

A large number of fluorosis and arseniasis cases appeared in a mountainous area in northwest China. The residents relied on local inferior coal ("bone coal") of high fluorine and arsenic content for domestic heating and cooking. For deep-inside information about this rare case of co-endemia of fluorosis and arseniasis in the population in this special exposure scenario, a field investigation in one of the hyperendemic townships was conducted. The resident population registered (n = 27,713) was enrolled in the investigation. All cases were diagnosed and assigned to three symptom severity groups, that is severe, medium, and mild according to Chinese National Standard Criteria GB 16396-96 and to the technical guideline WS/T208-01 or WS/T211-01 issued by the Chinese Ministry of Health. Gender difference was analyzed by standardized incidence ratio. Age trend and severity trend were tested by χ(2) analysis. Fluorosis was diagnosed in 56.7% of the residents. Over 95% of the diagnosed arseniasis cases were simultaneously diagnosed with fluorosis symptoms. Combined fluorosis-arseniasis represented 11.9% of the total fluorosis cases and 6.7% of the local population. No gender-related differences in the prevalence of skeletal, dental, or dermal symptoms inside all severity groups were detected. Symptom severity increased with age. The high frequency of superposition of arseniasis with fluorosis might be due to the fact that the local resident population has been exposed to very high levels of fluorine and arsenic via the same exposure route.

Identifying High Symptom Burden in Patients with Chronic Myeloid Leukemia on Tyrosine Kinase Inhibitor Therapy

Abstract 3138 Background:Patient report of symptom burden from Philadelphia chromosome-positive chronic myeloid leukemia (CML) and its treatment is scarce. Symptom burden is the combined impact of symptoms from disease and treatment on daily functioning. Lack of symptom recognition may result in failure to address symptoms and maximize patient functioning and treatment adherence. The purposes of this study are to develop a valid and reliable patient questionnaire for measuring CML symptom burden and to describe symptom burden over 1 year. This abstract reports intermediate results of the longitudinal symptom burden of CML. Methods:160 patients with CML rated the 20 symptom items (13 core cancer and 7 CML-specific symptom items) and 6 interference items of the M. D. Anderson Symptom Inventory for CML (MDASI-CML), on a 0-to-10 scale (0 = not present or no interference; 10 = as bad as can be imagined or complete interference) every 2 weeks using interactive voice response (IVR) telephone technology. Information on performance status, quality of life, disease history, and treatment was collected at study entry. The longitudinal symptom burden of CML and associated factors are reported using descriptive statistics, t-tests, and group-based trajectory and logistic regression modeling. Results:As of May 31, 2011, 160 patients had completed the MDASI-CML for 6 months; 35 patients (22%) had more that 50% data missing and were excluded from analysis. Of the remaining 125 patients, average age at study entry was 50.7 years (standard deviation [SD] = 13.2), 54% were female, 98% had chronic phase (CP) CML, 94% were receiving tyrosine kinase inhibitor (TKI) therapy, average time on current TKI therapy was 44.2 months (SD = 35.7), 2% began TKI therapy at study entry, and 99% had a clinician-rated ECOG performance status of 1 or less. The 5 most severe symptoms reported by the patients were fatigue (mean = 2.73, SD = 2.38), drowsiness (2.17, 2.26), muscle soreness and cramping (2.09, 2.36), disturbed sleep (2.03, 2.37), and difficulty remembering (1.68, 1.88). Trajectory analysis of a composite of the 5 most severe symptoms showed that patients could be divided into 2 groups reporting significantly more (48 patients, 38%) or less (77 patients, 62%) symptom severity across the 6 months of assessment (Figure 1). Average severity of all the individual symptom and interference items as well as the composite means of the top 5 symptoms, the 13 core symptoms, the 7 CML-specific symptoms, and the 6 interference items were significantly different between the groups (all p<0.01). Multivariate logistic regression modeling showed that being unmarried, higher severity of fatigue, difficulty sleeping, difficulty remembering, lack of appetite, easy bruising and bleeding, and lower severity of diarrhea at the time of study entry were independent factors significantly predicting membership in the high symptom severity group (Table 1). No other demographic or disease and treatment variables significantly predicted group membership. [Display omitted] Implications:A subset of patients (approximately one third) with CML primarily in CP receiving TKI therapy experiences more severe symptoms and needs special attention to symptom management. A single assessment (the MDASI-CML) can identify patients who experience chronically higher symptom burden and who need interventions to ameliorate symptoms, maintain daily functioning, and encourage treatment adherence. More analysis and research is needed to further delineate the symptom burden of CML and its treatment, understand the effects of symptom burden on treatment adherence, and develop effective interventions to relieve more-severe symptoms.TableFactors in CML patients predicting membership in high-symptom severity group.OR*P-Value#Lower CI TFU1-3Upper CI TFU1-3Unmarried13.744.0171.585119.154Fatigue1.616.0021.1842.204Disturbed Sleep1.676.0081.1462.451Difficulty Remembering1.543.0271.0492.268Lack of Appetite2.424.0251.1165.263Diarrhea.594.012.396.890Easy Bruising/Bleeding1.517.0151.0832.124*OR = odds ration;#P-value = probability value;##CI = confidence interval Disclosures:Williams:Novartis: Research Funding. Ault:Novartis: Speakers Bureau; Bristol-Myers Squibb: Speakers Bureau. Cortes:Novartis: Consultancy; Novartis: Research Funding; BMS: Consultancy, Research Funding; Ariad: Consultancy, Research Funding; Pfizer: Consultancy, Research Funding.

New classification for men with lower urinary tract symptoms: cluster analysis using the International Prostate Symptom Score

• Secondary analysis of anonymous data from 10,434 patients enrolled in a postmarketing surveillance study of tamsulosin in Japan was performed. Data were prospectively collected through the central register from men diagnosed with LUTS in 1100 medical institutions between October 2004 and March 2005. • Those who had received an α1-adrenoceptor antagonist within 1 week before the initial visit were excluded. • The survey items were International Prostate Symptom Score (IPSS), quality of life (QOL) score, and patient characteristics including age, bodyweight, body mass index, and LUTS-related comorbid conditions. • Data on IPSS items were used in a hierarchical cluster analysis (Ward's method). • Of 10,434 men with LUTS, 9910 were included in the analysis after 5% data trimming (524 patients). Five symptom clusters were identified and the symptom types of each cluster were examined. • The largest cluster (27%) consisted of patients with multiple severe symptoms, i.e. complaining of six or more symptoms with a mean score ≥2.8. In contrast, the second smallest cluster (13%) consisted of patients with minimal symptoms, i.e. complaining of essentially one or two symptom with a mean score ≤2.1. • The other three clusters were labelled based on their dominant symptoms. The clusters were weak stream (27%), storage symptoms (21%) and voiding symptoms (12%). • The storage symptoms group was older, and had more comorbidities. • The distribution of the QOL score was different among the clusters, and the percentage of patients who were very dissatisfied was highest in the multiple severe symptoms group and lowest in the minimal symptoms group. • Cluster analysis using the IPSS showed that men with LUTS can be classified into five characteristic symptom groups. • A new approach to symptom-based classification may be useful to elucidate the pathology of male LUTS and individualize the therapeutic strategy for affected patients, but further studies are needed.

Trauma at the Hands of Another

Survivors of traumatic events of an interpersonal nature typically have higher rates of posttraumatic stress disorder (PTSD) than survivors of noninterpersonal traumatic events. Little is known about potential differences in the nature or trajectory of PTSD symptoms in survivors of these different types of traumatic events. The current study aimed to identify the specific symptom profile of survivors of interpersonal and noninterpersonal trauma, and to examine changes in differences in the symptom profile over time. The study examined PTSD symptom data from 715 traumatic injury survivors admitted to the hospital between April 2004 and February 2006, who were assessed 3, 12, and 24 months after injury using the Clinician-Administered PTSD Scale (primary outcome measure). Multivariate analyses of variance were used to investigate differences in PTSD symptom profile over time between interpersonal and noninterpersonal trauma. Multivariate analyses of variance revealed significant differences between the 2 groups in overall severity of PTSD symptoms at each of the 3 time points: 3 months, F(17,696) = 5.86, P < .001; 12 months, F(17,696) = 3.62, P < .001; 24 months, F(17,696) = 3.09, P < .001. Survivors of interpersonal trauma demonstrated significantly (P < .01) higher scores on 14 PTSD symptoms at 3 months after injury but on only 6 symptoms by 24 months. Symptoms on which differences persisted were the PTSD unique symptoms more associated with fear and threat. Interpersonal trauma results in more severe PTSD symptoms in the early aftermath of trauma. Over the course of time, the distinctive persisting symptoms following interpersonal trauma involve fear-based symptoms, which suggest fear conditioning may be instrumental in persistent interpersonal PTSD.

Validation of an Instrument to Measure Quality of Life in British Children With Inflammatory Bowel Disease

To validate IMPACT-III (UK), a health-related quality of life (HRQoL) instrument, in British children with inflammatory bowel disease (IBD). One hundred six children and parents were invited to participate. IMPACT-III (UK) was validated by inspection by health professionals and children to assess face and content validity, factor analysis to determine optimum domain structure, use of Cronbach alpha coefficients to test internal reliability, ANOVA to assess discriminant validity, correlation with the Child Health Questionnaire to assess concurrent validity, and use of intraclass correlation coefficients to assess test-retest reliability. The independent samples t test was used to measure differences between sexes and age groups, and between paper and computerised versions of IMPACT-III (UK). IMPACT-III (UK) had good face and content validity. The most robust factor solution was a 5-domain structure: body image, embarrassment, energy, IBD symptoms, and worries/concerns about IBD, all of which demonstrated good internal reliability (α = 0.74-0.88). Discriminant validity was demonstrated by significant (P < 0.05, P < 0.01) differences in HRQoL scores between the severe, moderate, and inactive/mild symptom severity groups for the embarrassment scale (63.7 vs 81.0 vs 81.2), IBD symptom scale (45.0 vs 64.2 vs 80.6), and the energy scale (46.4 vs 62.1 vs 77.7). Concurrent validity of IMPACT-III (UK) with comparable domains of the Child Health Questionnaire was confirmed. Test-retest reliability was confirmed with good intraclass correlation coefficients of 0.66 to 0.84. Paper and computer versions of IMPACT-III (UK) collected comparable scores, and there were no differences between the sexes and age groups. IMPACT-III (UK) appears to be a useful tool to measure HRQoL in British children with IBD.

Item Response Theory Analysis of Binge Drinking and Its Relationship to Lifetime Alcohol Use Disorder Symptom Severity in an American Indian Community Sample

Item response theory (IRT) has been used to examine alcohol use disorder (AUD) symptoms and their psychometric properties but has not been previously applied to AUD symptoms from an American Indian sample. Lifetime DSM-IV AUD symptoms and binge drinking (5+ drinks men/4+ drinks women) at ≥1, ≥4, ≥8, and ≥15 days per month during the period of heaviest lifetime drinking criteria were assessed in 530 American Indian participants. Exploratory factor analysis was used to examine the factor structure of the 10 AUD symptoms and each alcohol consumption criterion. Two-parameter IRT models generated marginal maximum likelihood estimates for discrimination (a) and threshold (b) parameters for 10 DSM-IV AUD symptoms and each consumption criterion. Differential item functioning (DIF) analysis was used to assess AUD symptom severity in groups defined by gender and age at interview. The AUD symptoms of "Withdrawal" and "Activities Given Up" were the most severe symptoms. "Tolerance" and "Social/Interpersonal Problems" were the least severe. All AUD symptoms fell on the moderate portion of the severity continuum, except "Withdrawal," which fell at the lower end of the severe portion. The consumption criterion of 5+/4+ (male/female) at ≥8 times per month demarcated the portion of the severity continuum where AUD symptoms began to occur at a probability of 50%. DIF analysis showed significant gender and age at interview differences for "Hazardous Use,""Tolerance," and "Activities Given Up," but not for the other AUD symptoms. In this American Indian community sample, alcohol abuse and dependence did not represent distinct disorders. Only one AUD symptom was found outside the moderate portion of the underlying AUD severity continuum. Drinking 5+/4+ (male/female) drinks at a frequency of ≥8 times per month during the period of heaviest lifetime drinking was found to function well as both a risk and a diagnostic criterion for lifetime DSM-IV AUD. DSM-IV AUD symptom criteria, as currently assessed, may be limited in their ability to capture the full range of symptom severity of AUDs, at least in this high-risk population.

Who Benefits the Most from Psychiatric Day Hospitals? A Comparison of Three Clinical Groups

Comparison of the effects of psychiatric day hospital programs between homogenous clinical groups is an important issue that requires more attention. One group of day hospital patients who have not been included in most studies are people with cluster B personality disorders. The purpose of this study was to compare clinical and social participation outcomes in three groups of individuals treated in a psychiatric day hospital: patients with psychotic disorders, patients with mood and anxiety disorders, and patients with cluster B personality disorders. A pre-experimental, pre-test post-test design was used. During the first and last week of treatment, as well as 6 months after discharge, 20 participants in each group completed questionnaires on severity of symptoms, distress, accomplishment, satisfaction with social participation, and self-esteem. During the intervention, there was significant improvement in all groups on all variables, except for self-esteem in people with psychotic disorders, which remained stable. The patients with psychotic disorders showed significantly less improvement than the two other groups in severity of symptoms, distress, and self-esteem. Following discharge, the degree of change was comparable in the three groups on all variables based on between-groups analyses. However, based on within-group analyses, patients in the mood and anxiety disorders group continued to show significant improvement over time after discharge on self-esteem, accomplishment, and satisfaction with social participation, while no significant changes were seen in the other two groups. Although all three clinical groups made significant gains during their participation at the day hospital and maintained these gains after discharge, those with mood and anxiety disorders benefited the most from their day hospital experience.

Does adenoid hypertrophy really have effect on tympanometry?

Objective The goal of this study is to determine the correlation between the radiographic measurements of adenoid size and tympanometric findings. Study design Prospective study. Setting Haydarpasa Numune Research and Education Hospital, Istanbul, Turkey. Subjects and methods Nine five consecutive children complaining of one or more of the symptoms of upper airway obstruction (UAO) (presence of snoring, mouth breathing or difficulty in breathing during sleep, obstructive breathing or apnea during sleep) were included in the study. Symptom severity was assessed by a standardized questionnaire. All patients underwent digital lateral soft tissue radiographs. Assessment of nasopharyngeal obstruction in radiographs was done according to four different methods. Tympanometry was used to evaluate the middle ear. Results Of 190 ears, 79 were type A, 49 were type B and 62 were type C tympanograms. The symptom severity of 14 patients was graded as mild, 56 patients as moderate and 25 patients as severe. There was no statistically significant difference between UAO symptom severity groups and tympanogram types ( p > 0,05). Each one of the four methods of radiologic measurements of the adenoid enlargement showed no statistically significant difference between the tympanogram types ( p > 0,05). Conclusion The adenoid hypertrophy in both means of radiologic measurements and symptom severity does not correlate with the changes in tympanograms. These findings do not support the hypothesis that adenoidal size plays a major role in the etiopathogenesis of middle ear effusion (MEE).

Item Response Theory Analysis of Lifetime Cannabis-Use Disorder Symptom Severity in an American Indian Community Sample

The aim of this study was to use Item Response Theory to assess Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R), lifetime cannabis-use disorder (CUD) symptom severity and its relationship to first cannabis use before age 15 years, male gender, and childhood conduct disorder in an American Indian community sample. The Semi-Structured Assessment for the Genetics of Alcoholism was used to determine demographic information, age at first use, and DSM-III-R childhood conduct disorder and lifetime CUD symptoms in a community sample of 349 American Indian participants who had used cannabis at least 21 times in a single year. Two-parameter Item Response Theory models generated marginal maximum likelihood estimates for discrimination (a) and threshold (b) parameters for nine DSM-III-R CUD symptoms along an underlying latent CUD severity continuum. Differential Item Functioning (DIF) analysis was used to assess for differences in symptom severity in groups defined by presence versus absence of age at first use before 15 years, male gender, and childhood conduct disorder. CUD symptoms of "use in larger amounts or over longer periods of time," "activities given up," and "role failure" were the most severe symptoms. All CUD symptoms fell on the moderate portion of the severity continuum. "Time spent" was more severe in individuals who first used cannabis after age 15 years, "hazardous use" was more severe in females, and "use in larger amounts or over longer periods of time" was more severe in individuals with co-morbid childhood conduct disorder. Specific risk factors for the development of lifetime CUD are associated with increased severity of several CUD symptoms in this high-risk group.

Time to Relapse After Short- or Long-term Treatment of Severe Premenstrual Syndrome With Sertraline

The duration of treatment after achieving a satisfactory response is unknown in the treatment of premenstrual syndrome. This information is needed in view of the improvement provided by medication vs the adverse effects and costs of drugs. To compare rates of relapse and time to relapse between short- and long-term treatment with sertraline hydrochloride administered in the luteal phase of the menstrual cycle. Eighteen-month survival study with a randomized double-blind switch to placebo after 4 or 12 months of sertraline treatment. Academic medical center. One hundred seventy-four patients with premenstrual syndrome or premenstrual dysphoric disorder. Relapse, defined as symptoms returning to the entry criterion level as assessed with daily ratings. The relapse rate was 41% during long-term treatment compared with 60% after short-term sertraline therapy, with a median time to relapse of 8 months vs 4 months (hazard ratio, 0.58; 95% confidence interval, 0.34-0.98; P = .04). Patients with severe symptoms at baseline were more likely to experience relapse compared with patients in the lower symptom severity group (hazard ratio, 2.02; 95% confidence interval, 1.18-3.41; P = .01) and were more likely to experience relapse with short-term treatment (P = .03). Duration of treatment did not affect relapse in patients in the lower symptom severity group (P = .50). Patients who demonstrated remission were least likely to experience relapse (hazard ratio, 0.22; 95% confidence interval, 0.10-0.45; P < .001). Further analysis comparing relapse in the first 6 months of placebo treatment in each group yielded similar results. The relapse rate was significantly greater after short-term treatment compared with long-term treatment. The relapse rate was also high during extended drug treatment. Subjects with severe symptoms at baseline were most likely to experience relapse, and relapse occurred more swiftly regardless of treatment duration. These findings suggest that the severity of symptoms at baseline and symptom remission with treatment should be considered in determining the duration of treatment. clinicaltrials.gov Identifier: NCT00318773.

Further Validation and Responsiveness Assessment of the Herpes Outbreak Impact Questionnaire and Herpes Symptom Checklist

Objective The Herpes Outbreak Impact Questionnaire (HOIQ) and Herpes Symptom Checklist (HSC) are patient-completed questionnaires for assessing genital herpes outbreaks. This report describes the validation of paper-and-pencil versions of the scales and responsiveness assessments in an Australian clinical trial. Methods Acceptability of the language of the original UK versions was tested with Australians. The HOIQ and HSC were then field-tested with patients. The new versions were validated using patients' daily responses to the questionnaires in a famciclovir study. Results The HOIQ and HSC were readily adapted into Australian English and were acceptable to patients. Psychometric sample: N = 151; 81 (54%) male; mean age 39.9 ± 11.6 years; mean outbreaks 5.1 ± 3.0 per year. Internal consistency was good (alphas at outbreak 1 ranged 0.84–0.90 HOIQ and 0.73–0.87 HSC). Rasch analysis showed item stability over time. Correlations between HOIQ and HSC ranged from 0.46 to 0.60. Both scales distinguished outbreak healing presence or absence at day 6 ( P = 0.001), and the HOIQ scale distinguished between symptom severity groups ( P < 0.001). Scale scores declined significantly over study duration, exhibiting large effect sizes. Conclusions The paper-and-pencil HOIQ and HSC were reliable, valid, and responsive in a clinical trial setting. These instruments are recommended for use in clinical studies.

Leaf Chlorophyll Fluorescence Parameters and Huanglongbing

Chlorophyll fluorescence and photochemical and nonphotochemical quenching parameters were measured in 20 genotypes of Citrus spp. or relatives grown in the greenhouse and commercial ‘Valencia’ sweet orange (Citrus sinensis) trees at two Florida locations. The purpose was to determine the utility of measurements for early huanglongbing [HLB (Candidatus Liberibacter asiaticus)] detection in asymptomatic trees and to examine the leaf response to HLB infection. Polymerase chain reaction (PCR)-negative healthy and PCR-positive symptomatic, asymptomatic, and distant asymptomatic leaves were used for fluorescence analysis using a portable chlorophyll fluorometer. Greenhouse-grown genotypes were separated into mild, moderate, and severe symptom groups based on leaf mottling, color, and size. In general, mild symptom genotypes were characterized by increased photosystem II (PSII) excitation pressure and unregulated heat dissipation and decreased regulated heat dissipation, whereas moderate and severe symptom genotypes increased loss of photosynthetic efficiency and increased unregulated and regulated heat dissipation. Distant asymptomatic leaves could be distinguished from healthy ones in moderate and severe symptom genotypes by increased total and regulated heat dissipation measurements. In the field, overall photosynthetic efficiency and total regulated heat dissipation measurements could distinguish between healthy and asymptomatic ‘Valencia’ sweet orange leaves at the location with slow or more recent infection, but not at the location where infection appeared to progress faster or was of longer duration. Starch content followed a similar pattern. The results indicate that no single measurement uniquely described the relationship between HLB and the host in asymptomatic and healthy leaves, but accuracy of field-based detection could be strengthened by a combination of total nonphotochemical quenching, overall photosynthetic efficiency, starch content, and PCR analyses. Chlorophyll fluorescence and quenching measurements suggest a PSII-based explanation for, and temperature dependency of, leaf symptom development.

Associations between neurohormonal and inflammatory activation and heart failure in children

Adult heart failure (HF) has been shown to be associated with neuroendocrine and inflammatory activation. We hypothesize that neuroendocrine and inflammatory activation also associate with symptom severity and echocardiographic measurements in pediatric HF. Nineteen children with HF were divided into 3 symptom severity groups. Measurements were made of left ventricular (LV) ejection fraction, LV shortening fraction (LVSF), LV shortening fraction Z score (LVSFz), and LV end-systolic (LVSDz) and diastolic diameter Z scores. Blood levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor alpha, and soluble tumor necrosis factor receptor II were measured. NT-proBNP and hsCRP were significantly elevated with more severe symptoms (P < or = .003) and discriminated between clinical severity groups (volume under the receiver operating characteristic surface = 0.58 and 0.62, P = .007 and P = .002, respectively). NT-proBNP was negatively associated with LV ejection fraction, LVSF, and LVSFz (P < or = .05) and positively associated with LVSDz (P < .001). High-sensitivity C-reactive protein was negatively associated with LVSF (P = .02) and positively associated with NT-proBNP (P = .03). Tumor necrosis factor alpha was negatively associated with LVSF and LVSFz (P < or = .03) and positively associated with LVSDz and NT-proBNP (P < or = .02). Soluble tumor necrosis factor receptor II was negatively associated with LVSFz (P = .03). Neuroendocrine and inflammatory activation are associated with more severe symptoms and worse cardiac characteristics in pediatric HF. Blood levels of these biomarkers could be used to better assess the severity of HF in children.

Associations between neurohormonal and inflammatory activation and heart failure in children

Background Adult heart failure (HF) has been shown to be associated with neuroendocrine and inflammatory activation. We hypothesize that neuroendocrine and inflammatory activation also associate with symptom severity and echocardiographic measurements in pediatric HF. Methods Nineteen children with HF were divided into 3 symptom severity groups. Measurements were made of left ventricular (LV) ejection fraction, LV shortening fraction (LVSF), LV shortening fraction Z score (LVSFz), and LV end-systolic (LVSDz) and diastolic diameter Z scores. Blood levels of N-terminal prohormone brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), tumor necrosis factor α, and soluble tumor necrosis factor receptor II were measured. Results NT-proBNP and hsCRP were significantly elevated with more severe symptoms ( P ≤ .003) and discriminated between clinical severity groups (volume under the receiver operating characteristic surface = 0.58 and 0.62, P = .007 and P = .002, respectively). NT-proBNP was negatively associated with LV ejection fraction, LVSF, and LVSFz ( P ≤ .05) and positively associated with LVSDz ( P P = .02) and positively associated with NT-proBNP ( P = .03). Tumor necrosis factor α was negatively associated with LVSF and LVSFz (P ≤ .03) and positively associated with LVSDz and NT-proBNP ( P ≤ .02). Soluble tumor necrosis factor receptor II was negatively associated with LVSFz ( P = .03). Conclusions Neuroendocrine and inflammatory activation are associated with more severe symptoms and worse cardiac characteristics in pediatric HF. Blood levels of these biomarkers could be used to better assess the severity of HF in children.

Atrioventricular Nodal Reentrant Tachycardia in Children

The purpose of this study was to identify the clinical and electrophysiological characteristics of children with atrioventricular reentry tachycardia (AVNRT) and to define the prognosis and the treatment strategy. Sixty-two children (28 males and 34 females mean age, 10.2 +/- 3.2 years) with AVNRT ("slow-fast" type) were included in the study. Patients were divided into two groups: 47 patients with severe symptoms (group A) and 15 with mild symptoms (group B). The severity of the symptoms was not related to the electrophysiological parameters. Females were more symptomatic than males. Patients in group B did not receive any treatment (except 1 because of parents' choice) nor did they develop symptoms, and 5 patients had resolution of palpitations. Forty-one of 46 patients in group A were successfully treated with medical therapy as initial treatment. Thirty-one patients in group A underwent slow pathway ablation. There were late recurrences of AVNRT in 6 patients. Typical AVNRT in young patients does not appear to be life threatening. Patients with mild or no symptoms do well without therapy. Medical therapy and slow pathway ablation appear to be effective in the more symptomatic patients. Age and electrophysiological variables are not related to the symptoms or response to treatment. Females with AVNRT are more symptomatic and more likely to present with syncope.

A cognitive behavioral workshop for subclinical obsessions and compulsions

The present study investigates the effectiveness of a 3-h cognitive behavioral workshop for individuals, ages 18–22, with subclinical obsessions and compulsions. It was hypothesized that, compared to individuals in an assessment-only waitlist group ( n = 4 2 ), individuals assigned to the workshop group ( n = 4 3 ) would experience a significant decrease in obsessive–compulsive (OC) symptomatology, comorbidity, and thought action fusion endorsement at 1-month and 5-month follow-up assessments. An additional outcome of interest was the number of incident cases of obsessive–compulsive disorder (OCD) over the course of the study. The results indicated that the workshop group reported a significantly fewer number of OC symptoms at 5-month follow-up and endorsed significantly less thought action fusion at both follow-up points. However, there were no differences between groups in severity of OC symptoms and number of comorbid diagnoses endorsed. Only one incident case of OCD was observed during the study, from a participant in the waitlist group. These results are discussed in reference to treatment of subclinical anxiety symptoms.

Early-onset social anxiety disorder in adults: clinical and therapeutic features

To investigate possible differences in clinical and treatment response in patients suffering from early-onset (< 18 years) and late-onset (> or =18 years) social anxiety disorder. Patients diagnosed with social anxiety disorder of early-onset (n = 47; 75.8%) were compared to those diagnosed with late-onset social anxiety disorder (n = 15; 24.2%) in terms of age, mode of onset, subtype, psychiatric comorbidities (according to the Structured Clinical Interview for DSM-IV), symptom severity and response (assessed according to the Clinical Global Impression scale) after at least ten weeks of drug treatment. The statistical analyses included chi2 tests with Yates correction or Fisher's exact test, as well as Student's t-test or Mann-Whitney test. The level of statistic significance adopted was 5%. Patients presenting early-onset phobic symptoms more frequently: were inactive (chi2 = 4.28; df = 1; p = 0.04); suffered from the generalized subtype of social phobia (chi2 = 6.53; df = 1; p = 0.01); and presented psychiatric comorbidity (chi2 = 6.71; df = 1; p = 0.01). No differences were observed between the groups in severity of symptoms and therapeutic response. The findings suggest the existence of a possible social anxiety disorder subtype characterized by early onset of symptoms, higher rates of absenteeism, a wider range of social phobia symptoms and psychiatric complications.

Factors influencing outcome in Guillain–Barré Syndrome: comparison of plasma adsorption against other treatments

Objective: This study was performed to evaluate which factors influence the outcome of Guillain–Barré Syndrome (GBS), focusing on the choice of treatments. Methods: Sixty-three GBS patients were retrospectively studied and the following factors were evaluated: sex, age, days from onset of disease to the start of treatment, severity of symptoms, prior infection, autonomic dysfunction, bulbar palsy, anti-ganglioside antibody, and disease form, as well as the choice of treatment. Plasma adsorption (PA, n = 39), plasma exchange (PE, n = 14), or immunoglobulin treatment (IVIg, n = 10) were performed in this study. Outcomes were evaluated using the functional grading scale (FGS) of Hughes. Results: The number of days needed for one functional grade improvement was significantly longer in the elderly, the severe symptom group, and patients with acute motor axonal form, and days needed for two functional grade improvement was significantly longer in the elderly, patients with autonomic dysfunction, and acute motor axonal form. The choice of treatments (PA, PE, or IVIg) did not significantly influence the outcome as determined by both univariate and multivariate analysis. Conclusion: Although patient age, symptoms, and disease form influenced the outcome, treatment methods did not significantly influence the outcome. Since PA does not result in a risk of unknown infection, choosing a PA treatment may be justified, especially for patients (or doctors) who may be anxious about a possibility of unknown infection.

Longitudinal study of men with mild symptoms of bladder outlet obstruction treated with watchful waiting for four years

Objectives To determine the risk of clinical progressions in men with mild lower urinary tract symptoms of bladder outlet obstruction and identify the predictors for progression in this group of men. Methods A total of 397 men who presented to the urology clinics with mild symptoms of bladder outlet obstruction (International Prostate Symptom Score less than 8) were analyzed in this longitudinal study conducted during a 4-year period. They began with the watchful waiting protocol and were followed up every 3 months for 48 months. Age, International Prostate Symptom Score (IPSS), divided into obstructive symptom score and irritative symptom score, serum prostate-specific antigen level, total prostate volume, transitional zone volume, urinary flow rates, and postvoid residual urine volume were documented. Results The cumulative incidence of clinical progression, defined as worsening of the IPSS with migration to the moderate symptom group (IPSS 8 to 18) or severe symptom group (IPSS 19 to 35) and an increase in IPSS of more than 2 points, was 6%, 13%, 15%, 24%, 28%, and 31% at 6, 12, 18, 24, 36, and 48 months, respectively. Nineteen patients (4.9%) developed acute urinary retention within the 48-month follow-up period. Of these 19 patients, only 2 (0.6%) required transurethral resection of the prostate. The variables of importance for disease progression in the artificial neural network analysis were, in order of statistical significance, prostate-specific antigen level, obstructive symptom score, and transitional zone volume. Conclusions The risk for men with mild symptoms of bladder outlet obstruction to progress clinically and develop complications such as acute retention of urine is moderate. Prostate-specific antigen, obstructive symptom score, and transitional zone volume were identified as important risk factors.