Total Clinical Score Research Articles

Effects of Exercise Interventions in Graft-Versus-Host Disease Models

Graft-versus-host-disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), which is associated with high morbimortality and decreased patients' physical capacity. We evaluated the effects of an 11-week moderate-intensity exercise (treadmill) training program performed after allo-HSCT in a murine acute (aGVHD) and chronic GVHD model (cGVHD). Female mice (aged 8-12 weeks) were randomly assigned to the exercise or the control group. They completed a maximal treadmill test before allo-HSCT (with donor bone marrow cells and splenocytes) and after the 11-week period, during which we evaluated clinical severity scores and survival (Kaplan-Meier method). Before allo-HSCT and at days +21, +52 and +83 (upon sacrifice), we collected blood samples for immune cell reconstitution and cytokine analysis. The main results were that (i) in aGVHD, exercise improved maximal physical capacity over the 11-week period compared with pre-allo-HSCT conditions (p < 0.001 for the between-group comparison) and benefited total clinical score evolution (p = 0.05 for the group × time interaction effect), without altering immune reconstitution; (ii) in cGVHD, exercise training resulted in a lesser deterioration of physical capacity after 11 weeks (p = 0.023). Our results highlight the potential beneficial effects of exercise as coadjuvant intervention against GVHD, especially in the acute form of the disease.

Exercise Benefits in Chronic Graft versus Host Disease

Chronic graft versus host disease (cGVHD) is a life-threatening complication of allogeneic hematopoietic stem cell transplantation that generates considerable morbidity and compromises the physical capacity of patients. We determined the effects of an exercise training program performed after allogeneic hematopoietic stem cell transplantation on clinical and biological variables in a minor histocompatibility antigen-driven murine model of cGVHD treated with cyclosporine A. Recipient BALB/C female mice (age 8 wk) received bone marrow cells and splenocytes from donor B10.D2 male mice and were randomly assigned to an exercise (n = 11) or control group (n = 12). For approximately 11 wk after transplant, the exercise group completed a moderate-intensity treadmill program. Variables assessed were clinical severity scores, survival, physical fitness, cytokine profile, immune cell reconstitution, molecular markers of muscle exercise adaptations, and histological scores in affected tissues. Exercise training increased survival (P = 0.011), diminished total clinical severity scores (P = 0.002), improved physical fitness (P = 0.030), and reduced blood IL-4 and tumor necrosis factor α levels (P = 0.03), while increasing circulating B220 (P = 0.008) and CD4 lymphocytes (P = 0.043). A moderate-intensity exercise program that mimics widely accepted public health recommendations for physical activity in human adults was well tolerated and positive effects on survival as well as on clinical and biological indicators of cGVHD.

문제중심학습 연계 시뮬레이션 기반 통합간호교육과정을 이수한 신졸업간호사의 간호수행능력과 자신감

본 연구의 목적은 PBL 연계 시뮬레이션 기반 통합간호교육과정을 이수한 신졸업간호사와 교과목 중심의 전통적 간호교육과정을 이수한 신졸업간호사간의 간호수행능력정도와 간호수행능력 자신감의 차이를 표준화환자 기반 간호수행평가를 활용하여 비교분석하는 것이다. 연구대상자는 전통적 간호교육과정을 이수한 신졸업간호사 39명과 통합간호교육과정을 이수한 신졸업간호사 35명, 총 74명이었다. 연구방법은 두 대상자 그룹간에 표준화환자 기반 간호실무능력 평가 시험에서 간호수행능력 평가점수와 간호수행능력 자신감을 비교하기 위한 비동등성 대조군 사후 시차설계를 적용한 유사 실험 연구로 수집된 자료는 SPSS 19.0 프로그램을 사용하여, Fisher's exact test, t-test, Pearson's correlation coefficient, ANCOVA를 이용하여 분석하였다. 표준화환자를 활용한 간호실무수행능력 평가시험을 실시한 결과 통합간호교육과정 이수 신졸업간호사와 교과목 중심의 전통적 간호교육과정 이수 신졸업간호사 간에 표준화 환자가 채점한 간호수행능력 점수는 차이가 없었으나, 통합간호교육과정 이수 신졸업간호사의 교수자가 평가한 기술적 술기 점수, 비기술적 술기 점수와 간호수행능력에 대한 자신감이 대조군에 비해 유의하게 높았다. 본 연구의 결과를 바탕으로 간호교육과정에 PBL 연계 시뮬레이션 기반 교과를 적용할 것을 제언하며, 통합간호교육과정을 이수한 신졸업간호사의 임상간호 현장에서의 실무능력과 환자 성과 변화를 장기추적 관찰하는 추후 연구가 필요하다. The purpose of this study was to verify the effectiveness of an integrated nursing curriculum based on simulation with problem-based learning (PBL) by comparing the clinical competence and the self-confidence of newly graduated nurses. A non-equivalent control group post-test design was employed to compare the clinical competence and the self-confidence in the clinical performance examination using standardized patients between 39 newly graduated nurses with the traditional nursing curriculum and 35 with the integrated nursing curriculum. Data analysis involved Fisher's exact test, t-test, Pearson's correlation coefficient, and ANCOVA with the SPSS 19.0 program. The total clinical competence mean score graded by the standardized patients was not different between the two groups. However, the total clinical competence mean score graded by faculty was significantly higher in the integrated curriculum group than the traditional curriculum group. The mean self-confidence score was significantly higher in the integrated curriculum group than the traditional curriculum group. Active teaching-learning strategies including simulation or PBL in the nursing curriculum could benefit for nursing students by inducing favorable clinical competence and self-confidence. Longitudinal follow-up studies based on observation are needed to explore the patient outcomes in addition to the learner outcomes in clinical settings.

To what extent does the Health Professions Admission Test-Ireland predict performance in early undergraduate tests of communication and clinical skills? An observational cohort study.

BackgroundInternationally, tests of general mental ability are used in the selection of medical students. Examples include the Medical College Admission Test, Undergraduate Medicine and Health Sciences Admission Test and the UK Clinical Aptitude Test. The most widely used measure of their efficacy is predictive validity.A new tool, the Health Professions Admission Test- Ireland (HPAT-Ireland), was introduced in 2009. Traditionally, selection to Irish undergraduate medical schools relied on academic achievement. Since 2009, Irish and EU applicants are selected on a combination of their secondary school academic record (measured predominately by the Leaving Certificate Examination) and HPAT-Ireland score. This is the first study to report on the predictive validity of the HPAT-Ireland for early undergraduate assessments of communication and clinical skills.MethodStudents enrolled at two Irish medical schools in 2009 were followed up for two years. Data collected were gender, HPAT-Ireland total and subsection scores; Leaving Certificate Examination plus HPAT-Ireland combined score, Year 1 Objective Structured Clinical Examination (OSCE) scores (Total score, communication and clinical subtest scores), Year 1 Multiple Choice Questions and Year 2 OSCE and subset scores. We report descriptive statistics, Pearson correlation coefficients and Multiple linear regression models.ResultsData were available for 312 students. In Year 1 none of the selection criteria were significantly related to student OSCE performance. The Leaving Certificate Examination and Leaving Certificate plus HPAT-Ireland combined scores correlated with MCQ marks.In Year 2 a series of significant correlations emerged between the HPAT-Ireland and subsections thereof with OSCE Communication Z-scores; OSCE Clinical Z-scores; and Total OSCE Z-scores. However on multiple regression only the relationship between Total OSCE Score and the Total HPAT-Ireland score remained significant; albeit the predictive power was modest.ConclusionWe found that none of our selection criteria strongly predict clinical and communication skills. The HPAT- Ireland appears to measures ability in domains different to those assessed by the Leaving Certificate Examination. While some significant associations did emerge in Year 2 between HPAT Ireland and total OSCE scores further evaluation is required to establish if this pattern continues during the senior years of the medical course.

Abstract 1375: Benefits of adding an exercise intervention to conventional immunosuppression in chronic graft versus host disease: insights from a murine model.

Abstract Purpose.- Graft-versus-host-disease (GVHD) is a major complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT), and it is associated with high morbimortality and decreased patients’ physical capacity. We determined the effects of an exercise training program performed after allo-HSCT on survival, clinical evolution and physical capacity, using a murine model of chronic GVHD treated with cyclosporine A. Methods.- BALB/C female mice (aged 8 weeks) were randomly assigned to an exercise (n=11) or control group (n=12). Allo-HSCT was performed with donor bone marrow cells and splenocytes from B10.D2 female mice. Mice of the exercise group performed a moderate-intensity treadmill running program, and both groups received Cyclosporine A (15 mg/kg/day) during ∼11wks after transplant. We analyzed survival and total clinical severity score (which is the sum of five individual scores). We measured mice basal heart rate as an indicator of physical fitness status before and after allo-HSCT. We collected blood and serum samples for immune cell reconstitution at days +21 and +82, and for cytokine analysis (IL2, IL4, IL6, IL10, IL17a, IFNγ and TNFα) at days -10 and +82. On sacrifice day, we removed target tissues (liver, intestine, skin) and spleen, for analyzing the GVHD damage and the immune cell reconstitution respectively, and skeletal muscles evaluating the muscle adaptations. Results.- Exercise training resulted in an increased survival (p=0.011) and lesser deterioration of physical capacity after ∼11 weeks (p=0.03 for the between-group comparison) in the exercise group. Regarding disease clinical course/severity, the exercise intervention induced a significant group x interaction effect for total severity score (p=0.002), reflecting a better disease evolution in the exercise group. We found a beneficial effect in three individual scores: weight (a reliable indicator of the severity of the disease, p=0.02), spontaneous activity (p=0.001) and posture (p=0.002). Exercise training reduced blood IL4 and TNFα (p=0.025 and p=0.031, respectively) while increasing circulating B220 (p=0.008) and CD4 lymphocytes (p=0.043). We found no between-group difference in citrate synthase activity (p=0.322), and a trend towards higher muscle anabolism (as determined by the ratio of phospho-p70 S6 kinase / p70 S6 kinase) in the exercise compared with the control group (p=0.083). Conclusion.- A moderate-intensity exercise program mimicking the widely accepted public health recommendations for physical activity in humans (≥ 30min/day) was well tolerated and had significant positive effects on clinical and biological indicators of chronic GVHD, and resulted in better survival. Citation Format: Carmen Fiuza-Luces, Luisa Soares-Miranda, África González-Murillo, Jesús Martínez Palacio, Isabel Colmenero, Fernando Casco, Gustavo Melén, María Morán, Manuel Ramírez, Alejandro Lucía. Benefits of adding an exercise intervention to conventional immunosuppression in chronic graft versus host disease: insights from a murine model. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1375. doi:10.1158/1538-7445.AM2013-1375

Does filaggrin expression correlate with severity of clinical signs in dogs with atopic dermatitis?

Filaggrin expression is decreased in subsets of humans and dogs with atopic dermatitis (AD). Filaggrin expression is modulated by inflammation, but it is unknown whether expression is inversely correlated with clinical signs. To investigate the correlation between filaggrin expression and the severity of clinical signs in an experimental model of canine AD. Eighteen atopic research beagle dogs sensitized to house dust mite allergens. Dogs were challenged with house dust mites for 3days consecutively (days1-3) and skin biopsies collected on days1 (before allergen challenge), 3 (peak of challenge) and 10 (at resolution of lesions). Clinical signs were scored using a modified version of CADESI-03, the Canine Atopic Dermatitis Extent and Severity Index. Immunohistochemical staining was measured subjectively by three investigators who graded filaggrin staining for continuity, granularity and intensity. For objective evaluation of staining, the stratum granulosum and epidermis were traced, and the percentage of filaggrin per unit stratum granulosum and epidermal area were calculated. Correlations were investigated using Pearson's product-moment correlation (for linear correlations) and Spearman's rank correlation (for nonlinear correlations), pooling all days together and then separately on each day, using total clinical scores and either subjective or objective filaggrin scores. The only significant correlation was found between the subjective filaggrin scores and total clinical scores on day1. No inverse correlation exists between the severity of clinical signs and filaggrin expression; the clinical relevance of filaggrin in canine AD is unknown.

Efficacy of Intravitreal Levofloxacin 0.5% Ophthalmic Solution in Treating Pseudomonas Aeruginosa Endophthalmitis on a Rabbit Model.

To evaluate the efficacy of intravitreal levofloxacin 0.5% ophthalmic solution as treatment of Pseudomonas aeruginosa endophthalmitis in a rabbit model. This is a parallel randomized experimental study. Twenty-six New Zealand white rabbits were enrolled. P. aeruginosa was inoculated intravitreally on the right eyes of all rabbits, which were further categorized into 2 groups, the treatment group (Group A) receiving 0.1 mL intravitreal injection levofloxacin 0.5% 24 hours after inoculation and the control group (Group B), which had 0.1 mL intravitreal aqua destilata (placebo). Clinical observation of the eyes in each group was performed on the first until the sixth day after the inoculation using clinical grading scale. On the sixth day, the eyes were examined for microbiological and histopathologic evaluations. The total clinical grading scores of each group were similar 24 hours after P. aeruginosa inoculation (P > 0.05). The total clinical grading scores of Group A on the sixth day and the difference in total clinical scores on the first and the sixth day were shown to be significantly lower than that of Group B (P < 0.05). Microbiological analysis revealed that there was a lower bacterial count in Group A (mean = 1.18 ± 0.93 logCFU/0.1 mL) compared with Group B (mean = 4.09 ± 1.51 logCFU/0.1 mL), and the histopathologic scores of both groups were also significantly different (P < 0.05). Intravitreal levofloxacin 0.5% ophthalmic solution at 0.1 mL dose appeared to be effective in treating P. aeruginosa endophthalmitis in rabbits.

The influence of dexamethasone treatment and successive road transport stress on the occurrence of caprine pneumonia in a hot humid tropical environment

Aim: The information on the effect of multiple stress and caprine pneumonia especially in a hot humid environment is limited in literature. Materials and Methods: Sixteen goats were divided into 4 groups. All goats were observed for respiratory signs while temperature was monitored daily. Dead ones were necropsied while the s The clinical, gross, histopathological, immunohistochemical scores were according to standard methods. Results: The mean total clinical score was higher in group B than group A, C and D. T The dead goats in groups A, B, C had lung lesions typical of pneumonic pasteurellosis. An average of the lung consolidation of dead animals in group A was 15%, in group B, 8.5% and group C, 6.5% mostly involving the anterior and ventral part of the lung. The immunostaining results was also similar with all the lung samples positive for both Pasteurella multocida and haemolytica especially in the groups A, B, C with enhanced severity in A > B > C. Conclusion: This further buttress the need to reduce stress in farm animals and the emergence of P. multocida over M. haemolytica in the epidemiology of bacterial caprine pneumonia in stressed goats in Malaysia.

Comparison of the Antipsoriatic Effect and Tolerability of Calcipotriol-Containing Products in the Treatment of Psoriasis Vulgaris Using a Modified Psoriasis Plaque Test

In 1972, Dumas and Scholtz developed the psoriasis plaque test to evaluate the potency of local corticosteroids. Through further modification of this method, the efficacy between antipsoriatic products can be differentiated. This method allowed for the simultaneous application of several products to different test sites in the same psoriasis patient. The objective of this current study was to compare the antipsoriatic effect of six topical products using a modified version of the original psoriasis plaque test with emphasis on the predictive capacity of this model. Validation of the use of immunohistochemical and histological scoring of biopsy material, in conjunction with clinical scoring, in the prediction of antipsoriatic effects was an additional objective. This study was a single-centre, investigator-blinded, within-subject randomized, active- and vehicle-controlled, intraindividual comparison of six topical products in patients with psoriasis vulgaris. The products evaluated were calcipotriol ointment (50 μg/g); calcipotriol cream (50 μg/g); two-compound ointment (calcipotriol 50 μg/g; betamethasone dipropionate 0.5 mg/g); two-compound gel (calcipotriol 50 μg/g; betamethasone dipropionate 0.5 mg/g) [all in their marketed formulations]; an investigational ointment (calcipotriol 25 μg/g; hydrocortisone 10 mg/g); and a vehicle control. Psoriasis patients (≥18 years of age; n = 24) received simultaneous topical application of each of the products 6 days a week for a period of 21 days, at different test sites located on psoriasis plaques. Clinical assessment of the test sites was completed twice a week. Test site biopsies were taken at the final visit for histological analysis. The primary endpoint was the absolute change in total clinical score (TCS; erythema, scaling and infiltration) from baseline. For all products, the change in TCS correlated well with changes in histological and immunohistochemical values. The two-compound ointment and the two-compound gel both resulted in a large and significant reduction in TCS. Calcipotriol ointment and the calcipotriol/hydrocortisone ointment were less effective, although they were still more effective than the calcipotriol cream and the ointment vehicle. This study has demonstrated that the modified psoriasis plaque test can provide a relatively quick and effective method to evaluate the antipsoriatic effect of several topical treatments in small cohorts and that, by combining clinical scoring and histological assessment, a more accurate prediction of the antipsoriatic effect can be made. The two-compound formulations (ointment and gel) had a comparable antipsoriatic effect, which was superior to the other products tested. Furthermore, these data indicate that the gel formulation could provide an alternative effective treatment option to the well established two-compound ointment for psoriasis patients. Registered as EudraCT no: 2007-005463-10.

The Comparison of Fluoroquinolones to Nonfluoroquinolone Antibacterial Agents for the Prevention of Endophthalmitis in a Rabbit Model

Topical antibacterial agents, used as an off-label indication, are frequently administered pre- and postoperatively to prevent endophthalmitis. We compared topical treatment with fluoroquinolone (FQ) anti-infectives to non-FQ antibacterial agents to prevent Staphylococcus aureus endophthalmitis. We hypothesize that FQ anti-infectives are more effective than non-FQ antibacterial agents for preventing endophthalmitis. Moxifloxacin 0.5%, ofloxacin 0.3%, gentamicin 0.3%, chloramphenicol 0.5%, polymyxin B/trimethoprim (10,000 units/mL/0.1%), povidone-iodine 5%, and saline were tested for topical treatment to prevent endophthalmitis. Topical treatment was applied every 15 min for 1 h (5 drops) to the left eye of 14 rabbits for each antibacterial agent and saline. After appropriate anesthesia, the anterior chambers were injected with 1×10(5) colony-forming units of a clinical endophthalmitis isolate of a S. aureus that was susceptible to all tested antibacterials. One drop was administered immediately and another 4 drops of topical treatment were applied over 24 h after injection. At 24 h postinjection, the eyes were graded for clinical signs of endophthalmitis (ocular discharge, conjunctivitis/scleral injection, limbal injection, hypopyon*, iritis*, anterior chamber cells*, anterior chamber flare*, corneal infiltration, and fibrin production*) using a severity scale (0-3). The indication of clinical endophthalmitis was a total score of >3.0 for the presentations marked with an asterisk. The data were analyzed using Fisher's Exact Randomization or Mann-Whitney nonparametric testing. Topical ofloxacin (14/14, 100% without endophthalmitis) and moxifloxacin (13/14, 93%) prevented the clinical presentation of endophthalmitis significantly more frequently (P=0.03, Fisher's Exact Test (FE)) than topical gentamicin (7/14, 50%), povidone iodine (4/14, 29%), chloramphenicol (0/14, 0%), polymyxin B/trimethoprim (0/14, 0%), and saline (0/14, 0%). The median total clinical scores for the ofloxacin (0.5) and moxifloxacin (0.8) groups were significantly (P=0.008, Mann-Whitney Test (MW)) lower than gentamicin (5.7), chloramphenicol (17.5), polymyxin B/trimethoprim (21.2), povidone-iodine (15.5), and saline (18.7). The FQs, ofloxacin and moxifloxacin, were more effective in preventing endophthalmitis than the non-FQ antibacterial agents in a rabbit S. aureus endophthalmitis model. The observed results are consistent with the hypothesis that FQs penetrate into the anterior chamber at more effective levels than many of the common non-FQ antibacterial agents.

Two 6-Week, Randomized, Double-Blind, Placebo-Controlled Studies of Ziprasidone in Outpatients With Bipolar I Depression

Two randomized, double-blind, placebo-controlled, 6-week studies comparing ziprasidone versus placebo for treatment of bipolar depression (BPD) failed to meet their primary study objectives, indicating that either ziprasidone is ineffective in the treatment of BPD or the study failed. Adult outpatients with bipolar I depression with 17-item Hamilton Rating Scale for Depression total score more than 20 at screening and baseline received either ziprasidone 40 to 80 mg/d, 120 to 160 mg/d, or placebo (study 1), or ziprasidone 40 to 160 mg/d or placebo (study 2). Primary efficacy measure in both studies was change from baseline in Montgomery-Åsberg Depression Rating Scale total scores at week 6 (end of the study). Mixed-model repeated-measures methodology was used to analyze the primary efficacy measure in both studies. Secondary efficacy measures in both studies included Hamilton Rating Scale for Depression total score and Clinical Global Impression-Improvement score. Post hoc analyses were conducted for both studies to examine potential reasons for study failure. In both, ziprasidone treatment groups failed to separate statistically from placebo for change from baseline Montgomery-Åsberg Depression Rating Scale score at week 6. Response rates were 49%, 53%, and 46% for placebo, ziprasidone 40 to 80 mg/d, and ziprasidone 120 to 160 mg/d, respectively (study 1), and 51% and 53% for placebo and ziprasidone 40 to 160 mg/d, respectively (study 2). Ziprasidone 40 to 160 mg/d did not show superiority over placebo at week 6 in the treatment of BPD. Post hoc analyses revealed serious inconsistencies in subject rating that may have limited the ability to detect a difference between drug and placebo response. Rating reliability warrants further investigation to improve clinical trial methodology in psychiatry.

Dose-response investigation of oral ketoprofen in pigs challenged with Escherichia coli endotoxin

In order to determine the effective dose, the effects of orally administered ketoprofen were evaluated in pigs following intravenous challenge with Escherichia coli endotoxin. One hour after the challenge, five...

Effect of Chrysanthemi borealis flos on atopic dermatitis induced by 1-chloro 2,4-dinitrobenzene in NC/Nga mouse

The flower of Chrysanthemum boreale has traditionally been used for treatment of various inflammatory disease including atopic dermatitis (AD). However, its action on AD is unclear. Therefore, we investigated the effect of CB on AD using NC/Nga mice as an AD model. The effect of CB on 1-Chloro-2,4-dinitrobenzene (DNCB) induced NC/Nga mice was evaluated by examining skin symptom severity, itching behavior, ear thickness, levels of serum Immunoglobulin E (IgE), tumor necrosis factor-α (TNF-α), and interleukin-4 (IL-4), skin histology. The CB significantly reduced the total clinical severity score, itching behavior, ear thickness and the level of serum IgE in AD mouse model. CB not only decreased TNF-α but also IL-4. These results suggest that CB may be a potential therapeutic modality for AD.

Bridge Program: An Alternative Curricular Model

With the motivation for career advancement, many adult learners have chosen to return to graduate education or professional programs. The bridge program is one relatively new alternative curricular model available for adult learners who wish to build on their education within their chosen profession. Evidence on the effectiveness of such programs for physical therapy is nonexistent. Thus, clinical performance outcomes between a bridge and a traditional physical therapy program were described and compared. The sample consisted of 157 students who completed either physical therapy program from The University of Findlay over a period of four years. Clinical Performance Instrument scores were analyzed to compare the differences between the two groups. While controlling the demographic variables, a significant difference was found with total Clinical Performance Instrument scores between the groups through analysis of covariance (alpha level was set at .05 for all procedures). After grouping the values of the Clinical Performance Instrument scores, the majority of the individual skills were found to have differences between the two groups. The higher Clinical Performance Instrument scores (total and individual), the increased number of total with distinction marks, and the greater attention to the consultation skill demonstrated positive outcomes through the bridge program. This alternative curricular model could be applied to other disciplines that have a large population of adult learners who are seeking advancement in their professions.

Pulse Transit Time and Assessment of Childhood Sleep Disordered Breathing&lt;alt-title&gt;Pulse Transit Time in Sleep Disordered Breathing&lt;/alt-title&gt;

To compare nocturnal polysomnography (PSG) with pulse transit time (PTT) recordings and structured clinical assessments and assess the reliability of these methods as a surrogate for the apnea-hypopnea index (AHI; calculated as the number of apneas/hypopneas per hour of total sleep time) and to test the associations between the clinical assessments and sleep disordered breathing (SDB). Prospective observational study. The parents of 51 children and adolescents filled out a questionnaire on SDB and the participants underwent examination. Scores from questionnaire and examination items were weighted according to their association with SDB. A total clinical score was assigned combining questionnaire and examination scores. Hospital pediatrics department. Children and adolescents aged 5 to 17 years undergoing standard PSG with the addition of PTT as part of a clinical investigation for SDB. The AHI and associations between the AHI and PTT arousal index (PTT-AI) and questionnaire, examination, and total clinical scores. We found a significant correlation between the AHI and PTT-AI (r=0.55; P<.001). The relationship between the AHI and PTT-AI was stronger when the AHI was greater than 3. We also found significant correlations between the PTT-AI and the total clinical score (r=0.38; P=.008) and the examination score (r=0.44; P=.002) but not the questionnaire score (r=0.23; P=.12). There was an association between the AHI and examination score in particular when the AHI was greater than 3. Pulse transit time shows promise as a screening test for SDB associated with an AHI greater than 3. For less severe SDB, the validity of using the PTT to separate these conditions from primary snoring has not been demonstrated in a clinical setting.

Evaluation of the effectiveness of intrauterine treatment with formosulphathiazole of clinical endometritis in postpartum dairy cows

In cattle, elimination of bacterial contamination from the uterine lumen after parturition is often delayed or compromised, and pathogenic bacteria can persist, causing uterine disease and infertility. The aim of this study was to compare the clinical and bacteriologic recovery following a single intrauterine administration of formosulphatiazole, cephapirin or placebo in cows with clinical endometritis. Cows (n = 80), no less than 28 days postpartum, with clinical endometritis were enrolled in the study. Endometritis was diagnosed by a complete reproductive examination, including rectal palpation, ultrasonography, vaginoscopy and uterine swab. All cows were randomly assigned to receive one of three intrauterine treatments (T0): 2500 mg of formosulphatiazole (Group A); 500 mg of cephapirin (Group B); placebo (4250 mg of propylene glycol; Group C). Cows were examined at the first estrus after treatment or no more than 30 days after (T1). Bacteria isolated were E. coli, A. pyogenes, Pasteurella spp. and Streptococcus spp. After treatment, in Group A and B only 6/30 (20.0%) and 6/24 (25.0%) cows showed a positive bacteriologic culture (P > 0.05), while in Group C the number of positive animals was significantly higher (19/26; 73.1%; P < 0.05). At T0, total clinical scores were similar between the three groups (Group A: 5.84 ± 1.07; Group B: 5.91 ± 1.0; Group C: 5.62 ± 1.17; P > 0.05) and indicative of clinical endometritis. At T1, endometritis scores were significantly lower than those reported before uterine infusion (P < 0.05); however, Group A and B score, 0.4 ± 0.9 and 1.0 ± 2.1, respectively, correspond to no and slight endometritis, while animals in Group C reported a total endometritis score significantly higher (4.6 ± 3.5; P < 0.05) corresponding to endometritis. In the present study, a commercial formosulphatiazole preparation was as effective as cephapirin and more effective than placebo for the treatment of clinical endometritis.

Comparison of clinical efficacy and safety subcutaneous and sublingual immunotherapy in Kuwaiti schoolchildren with seasonal allergic rhinitis

Objective – To compare the clinical efficacy and safety of sublingual immunotherapy (SLIT) vs. subcutaneous immunotherapy (SCIT) in Kuwaiti schoolchildren with seasonal allergic rhinitis (SAR), sensitive to pollens of Salsola kali and Bermuda grass. Patients and methods – The study was single blinded. Patients and Methods: Eight-two schoolchildren, 9-14 years old, diagnosed with SAR due to sensitization to local pollen allergens (Salsola kali, Bermuda grass or both), who fulfilled the inclusion criteria, were randomly selected (1:1) to receive either SLIT (n=38), Staloral; Stallergenes SA, Antony France, or SCIT (n= 44), Alustal, from the same manufacturer, as a 3 year treatment course. Twenty-five patients from the SLIT and 34 from the SCIT group completed the treatment. Clinical efficacy was evaluated on a yearly basis, during the pollination period, by total clinical symptom scores (TCSS) and reduction in medication consumption. Adherence to the treatment, as well as safety profile of both modes of immunotherapy was compared. Results – There was no difference in adherence to the treatment between the 2 groups. Our study demonstrated that SCIT had a tendency for faster clinical improvement than SLIT, but at the end both were equally effective. Significant reduction in drug use (>50%) in the 1st treatment year was seen only in the SCIT group (p <0.02). In the end, there was no significant difference between the two groups (p <0.4). A mild systemic reaction (grade 2) was seen in 1 patient in the SCIT group, while local reactions were seen in both groups. Conclusion – Our study demonstrates that SLIT is a valid alternative to SCIT in terms of clinical efficacy and safety, and can be safely used in schoolchildren sensitive to pollen allergens.

Is radiology a determinant of pain, stiffness, and functional disability in knee osteoarthritis? A cross-sectional study

Background and purposesDiscordance between clinical and radiological profiles in knee osteoarthritis has been reported. We hypothesized that the discordance could be due to limited radiological variables studied. This study essentially analyzed many more radiological features than previous studies in order to seek an association between clinical and radiographic features. MethodsOne hundred and eighty patients with knee osteoarthritis were enrolled as per the American College of Rheumatology (ACR) guidelines. Visual analog scale (VAS) for knee pain and the knee-specific Western Ontario Mac University (WOMAC) index for pain, stiffness, and disability were recorded. Five additional radiological features apart from those in the Kellgren-Lawrence (KL) classification grading system were recorded by two authors who were blinded to the clinical diagnosis. The variables significantly associated were analyzed by linear regression model. ResultsPain was significantly associated with increasing KL grades; physical function was nearly significant and stiffness was not. On analysis of individual radiological features, WOMAC pain was significant with subchondral sclerosis, joint space width, and tibiofemoral alignment although the correlation was week. VAS pain was significant with the latter two and with articular incongruity. Functional disability was associated with medial joint-space narrowing, tibiofemoral alignment, loose bodies, and juxta-articular osteopenia. However, in the linear regression model, pain and stiffness were significantly associated with articular incongruity and functional disability and total clinical scores with juxta-articular osteopenia. ConclusionWhen the radiological features were extended beyond those included in KL grades, pain, stiffness, and disability correlated well with radiography; articular incongruity with pain and stiffness; and juxta-articular osteopenia with physical disability and clinical severity.

Inhibitory effects of Chelidonium majus extract on atopic dermatitis-like skin lesions in NC/Nga mice

Aim of the studyChelidonium majus (CM) has traditionally been used for treatment of various inflammatory diseases including atopic dermatitis (AD). However its action on atopic dermatitis (AD) is unclear. Therefore, we investigated the effect of CM on AD using NC/Nga mice as an AD model. Materials and methodsThe effect of CM on 1-chloro-2,4-dinitrobenzene (DNCB) induced NC/Nga mice was evaluated by examining skin symptom severity, itching behavior, ear thickness, levels of serum immunoglobulin E (IgE), tumor necrosis factor-α (TNF-α), and interlukin-4 (IL-4), skin histology. ResultsThe CM significantly reduced the total clinical severity score, itching behavior, ear thickness and the level of serum IgE in AD mouse model. CM not only decreased TNF-α but also IL-4. ConclusionThese results suggest that CM may be a potential therapeutic modality for AD.

Randomised clinical trial: the effects of amitriptyline on drinking capacity and symptoms in patients with functional dyspepsia, a double-blind placebo-controlled study

Functional dyspepsia is one of the most prevalent (15-40%) functional gastrointestinal disorders. Antidepressants such as amitriptyline are often used in these patients, but clinical studies are currently lacking. To evaluate the effect of 8 weeks of treatment with amitriptyline on drinking capacity, symptoms evoked by a standardised drink test (primary endpoint) and clinical symptoms (secondary endpoint). Patients meeting the Rome III criteria for functional dyspepsia (FD) were invited to participate in a double blind, randomised, placebo-controlled trial and were treated with either amitriptyline (12.5-50 mg) or placebo during 8 weeks. All included patients underwent a nutrient drink test before and after treatment. Drinking capacity and evoked symptoms were recorded. In addition, dyspeptic symptoms were weekly assessed using PAGI SYM (patient assessment of upper gastrointestinal symptom severity index) questionnaire. Thirty-eight patients (amitriptyline n=18, placebo n=20; age 41±2year, 61% F) completed the study. The drinking capacity of liquid meal was not affected by either amitriptyline or placebo treatment. Postprandial symptoms were not significantly different between amitriptyline and placebo. During the entire treatment, total symptom score (0.47 points, P=0.02) and nausea (0.86 points, P=0.004) on PAGI SYM were significantly reduced by amitriptyline compared with placebo. Amitriptyline did not affect drinking capacity and postprandial symptoms evoked by the drink test in FD patients. However, total clinical symptom score and nausea were reduced during 8 weeks of treatment. Our data suggest that amitriptyline particularly improves nausea in functional dyspepsia, but larger clinical trials are needed to further confirm our findings.