The microbiota and immune-mediated diseases: Opportunities for therapeutic intervention.

A multitude of diverse microorganisms, termed the microbiota, reside in the gut, respiratory tract, skin, and genital tract of humans and other animals. Recent advances in metagenomic sequencing and bioinformatics have enabled detailed characterization of these vital microbial communities. Studies in animal models have uncovered vital previously unrecognized roles for the microbiota in normal function of the immune responses, and when perturbed, in the pathogenesis of diseases of the gastrointestinal tract and lungs, but also at distant sites in the body including the brain.

A novel 800 kb microduplication of chromosome 16q22.1 resulting in learning disability and epilepsy may explain phenotypic variability in a family with 15q13 microdeletion.

The phenotype of 15q13.3 microdeletion is variable and can be non-penetrant. Recently, "second-hit hypothesis" has been proposed as a possible explanation for some variability in recurrent microdeletion syndromes.

Haploinsufficiency of the nerve growth factor beta gene in a 1p13 deleted female child with an insensitivity to pain.

Pain insensitivity is mediated at the genetic level by the disruption of specific genes associated with neuronal development. Mammalian in vivo and in vitro studies have shown the nerve growth factor (NGF) gene to play an integral role in nerve maintenance and function. Pain insensitivity in humans can be attributed to hereditary sensory and autonomic neuropathies (HSAN) of which there are five classes (HSAN I - HSAN V).

Array comparative genomic hybridisation-based identification of two imbalances of chromosome 1p in a 9-year-old girl with a monosomy 1p36 related phenotype and a family history of learning difficulties: a case report.

Introduction: Monosomy 1p36 is one of the most common terminal deletion syndromes, with an approximate incidence of 1 in every 5000 live births. This syndrome is associated with several pronounced clinical features including characteristic facial features, cardiac abnormalities, seizures and mental retardation, all of which are believed to be due to haploinsufficiency of genes within the 1p36 region. The deletion size varies from approximately 1.

Comparing neuropsychological function before and during haemodialysis: a habituating selective deficit for prose recall.

This study was based on the clinical observation that patients receiving haemodialysis(HD) showed poor retention for complex verbal information. To investigate this hypothesis, 45 patients with endstage renal disease were administered a neuropsychological (NP) test battery, including a test of prose recall on two occasions, 7 days apart (pre-dialysis and whilst dialysing). A range of demographic, biochemical and mood variables were also assessed.

Genetic analysis of the TOR pathway in Aspergillus nidulans.

We identified five genes encoding components of the TOR signaling pathway within Aspergillus nidulans. Unlike the situation in Saccharomyces cerevisiae, there is only a single Tor kinase, as in plant and animal systems, and mutant phenotypes suggest that the TOR pathway plays only a minor role in regulating nitrogen metabolism.

Medicaid behavioral health care plan satisfaction and children's service utilization.

This study examines associations between caregivers' satisfaction with children's Medicaid-funded behavioral health care plans and the likelihood that children with severe emotional disturbance receive mental health services. Data are from a multisite study of managed care versus fee-for-service (FFS) settings. In multivariate logistic regression analyses controlling for demographic, environmental, site, and clinical characteristics, plan satisfaction was associated with greater likelihood of subsequent service use regardless of managed care versus FFS setting.

Effects of alcohol and drug use on inpatient and residential treatment among youth with severe emotional disturbance in Medicaid-funded behavioral health care plans.

This study examined the use of alcohol and recreational drugs among 875 youth with severe emotional disturbance (SED) enrolled in Medicaid-funded behavioral health care plans, and whether co-occurring SED and substance use affected the subsequent likelihood of receiving inpatient and/or residential treatment. Youth at five sites nationwide were interviewed about their use of drugs and alcohol, while interviews with their caregivers elicited information about youths' service utilization, degree of functional impairment, and a series of demographic and environmental variables. Results indicated that half of the youth (52%) reported lifetime use of alcohol, street drugs, or over-the-counter medications for recreational purposes, while 18% reported use in the past 30 days.

A multi-site study of Medicaid-funded managed care versus fee-for-service plans' effects on mental health service utilization of children with severe emotional disturbance.

Although Medicaid-funded managed care arrangements are commonly used in the delivery of mental health and substance abuse services to low-income children and youth, little is known about the effectiveness of such efforts. This article examines differences in mental health services utilization between children and youth with severe emotional disturbance covered by Medicaid-funded managed care behavioral health plans and those covered by fee-for-service plans. Data are from a federally funded multi-site study.

Training for state-funded providers of assertive community treatment.

This chapter describes a training program for state-funded providers of assertive community treatment services in Illinois and presents results of the evaluation of the didactic education component.

Adaptation to coronary artery disease: first pilot study in the military.

To determine how a group of 29 male military patients with coronary artery disease (CAD-MIL group) have adapted physically and psychosocially, we compared results from standard questionnaires with those from 39 healthy military men (WELL-MIL group) and 27 male civilian patients with coronary artery disease (CAD-CIV group). There was no difference in the degree of severity of coronary artery disease between the two groups with the disease. The WELL-MIL group reported a higher activity level than the CAD-MIL group, which reported a higher activity level than the CAD-CIV group.

Minimally invasive coronary artery bypass: a series with early qualitative angiographic follow-up.

Background: Notwithstanding the advantages offered by minimally invasive coronary bypass, valid concerns have been raised about the technical accuracy of the distal anastomoses that can be fashioned on a beating heart. The main objective of our study was to undertake early and complete qualitative angiographic graft analysis in all patients undergoing this procedure.

Methods: All enrolled patients (25) from January to October 1996 who had bypass done by one surgeon via left minithoracotomy (19) or median sternotomy (6) on a beating heart underwent postoperative angiography within 4 to 6 hours.

Psychosocial aspects of coronary artery disease related to military patients.

Objective: Coronary artery disease (CAD) is a major cause of nontraumatic morbidity and mortality in military personnel. Most studies of the psychosocial impact of CAD have dealt with civilian populations. The purpose of this paper is to highlight differences between military and civilian populations with CAD in 4 areas: depression and anxiety, social support, return to work, and stress.

Interventions for coronary stenosis--a Canadian experience of 30 revolutionary years.

Objective: To report 2324 coronary stenosis interventions (Vineberg procedures [VbP], coronary artery bypass graft operations [CABG] and percutaneous transluminal coronary angioplasties [PTCA]), in 1711 patients of a Canadian military hospital between 1965 and 1995 and to report their evolution and interaction in a historical context.

Design: Retrospective examination of clinical and angiographic findings in hard records, collected from the beginning for long term follow-up and later embedded in a custom-designed computer database.

Patients: Most were male, mean ages 43.

Coronary bypass graft fate and patient outcome: angiographic follow-up of 5,065 grafts related to survival and reoperation in 1,388 patients during 25 years.

Objectives: We sought to examine, angiographically, the longterm fate of a large number of mainly venous coronary bypass grafts and to correlate graft patency and disease with patient survival and reoperation.

Background: Much is known about bypass graft patency and disease, but the precise relation between graft fate and patient outcome has not been substantiated and documented.

Methods: A total of 1,388 patients underwent a first coronary artery bypass graft procedure at a mean age of 48.

Coronary-pulmonary steal syndrome.

The development of an internal thoracic artery-pulmonary artery fistula after operation is a rare entity of no clear etiology. We report a patient who underwent coronary bypass reoperation, presented 3 years later with angina on exertion, and upon investigation was found to have an internal thoracic artery-pulmonary artery fistula. This patient was managed conservatively.

Traumatic tricuspid insufficiency: a case followed for 32 years, with a note on early sources.

A healthy young man suffered nonpenetrating chest trauma in an automobile accident in August 1962, sustaining tricuspid valve disruption and insufficiency, a rare event. Clinical diagnosis was confirmed by cardiac catherization, but valve replacement did not take place for 10 years. Since initial valve replacement he has had two further operations to deal with valve malfunction resulting in recurrent tricuspid stenosis.

Shared care for open heart surgery: 21 years' experience.

Objectives: To determine whether patients undergoing open heart surgery, the majority coronary artery bypass grafting (CABG), can safely be returned early to the smaller nonspecialized hospital that referred them for postoperative care by a cardiological team. Another objective is to determine what benefits might accrue from this practice and to whose credit.

Design: All 1696 patients, 1512 having coronary bypass alone or with ventricular aneurysm repair in 6%, referred from a military hospital with investigative facilities from November 1971 to November 1992 were studied with attention to length of postoperative stay in both hospitals, perioperative mortality and major complications mandating return to the surgical centre (which was almost always for reoperation).

Coronary subclavian steal: a recurrent case with notes on detecting the threat potential.

A 43-year-old military patient with silent myocardial ischemia due to proximal anterior descending coronary artery and major diagonal branch stenoses had left and right internal mammary artery grafts in 1973, with excellent angiographic results. In 1984, silent ischemia recurred, due to proximal subclavian occlusion with collateral subclavian steal from the left internal mammary artery. A carotid-subclavian artery graft required replacement in 1987 and in 1989 for steal recurrence from graft stenosis due to thrombosis/atherosclerosis.