Esophageal Mycobacterium avium-intracellulare infection in a bone marrow transplant patient: Case report and literature review.

Mycobacterium avium-intracellulare complex (MAC) is the most common cause of nontuberculous mycobacterial (NTM) disease in humans. We report a case of esophageal MAC disease in a patient who had allogeneic bone marrow transplant for acute lymphoblastic leukemia. Although pulmonary MAC in immunocompromised host is not uncommon, there are only a few cases of NTM-associated esophageal mass reported.

Behavioural assessment unit improves outcomes for patients with complex psychosocial needs.

Objective: We aimed to assess the impact of a new model of care for patients presenting to the ED with acute behavioural disturbance.

Methods: This pre-/post-intervention study involved creating a dedicated, highly resourced six bed unit, the behavioural assessment unit (BAU). Co-located with the ED at the Royal Melbourne Hospital, the unit was designed to fast-track the admission of patients affected by intoxication, mental illness or psychosocial crisis and provide front-loaded interventions.

Intracranial EEG evaluation of relationship within a resting state network.

Objective: We tested if a relationship between distant parts of the default mode network (DMN), a resting state network defined by fMRI studies, can be observed with intracranial EEG recorded from patients with localization-related epilepsy.

Methods: Magnitude squared coherence, mutual information, cross-approximate entropy, and the coherence of the gamma power time-series were estimated, for one hour intracranial EEG recordings of background activity from 9 patients, to evaluate the relationship between two test areas which were within the DMN (anterior cingulate and orbital frontal, denoted as T1 and posterior cingulate and mesial parietal, denoted as T2), and one control area (denoted as C), which was outside the DMN. We tested if the relationship between T1 and T2 was stronger than the relationship between each of these areas and C.

Modeling the Nonlinear Time Dynamics of Multidimensional Hormonal Systems.

In most hormonal systems (as well as many physiological systems more generally), the chemical signals from the brain, which drive much of the dynamics, can not be observed in humans. By the time the molecules reach peripheral blood, they have been so diluted so as to not be assayable. It is not possible to invasively (surgically) measure these agents in the brain.

Oscillations in joint synchrony of reproductive hormones in healthy men.

Negative-feedback (inhibitory) and positive-feedforward (stimulatory) processes regulate physiological systems. Whether such processes are themselves rhythmic is not known. Here, we apply cross-approximate entropy (cross-ApEn), a noninvasive measurement of joint (pairwise) signal synchrony, to inferentially assess hypothesized circadian and ultradian variations in feedback coupling.

H5N1 virus-like particle vaccine elicits cross-reactive neutralizing antibodies that preferentially bind to the oligomeric form of influenza virus hemagglutinin in humans.

Transmission of pathogenic avian influenza viruses (AIV) from wild birds to domestic poultry and humans is continuing in multiple countries around the world. In preparation for a potential AIV pandemic, multiple vaccine candidates are under development. In the case of H5N1 AIV, a clear shift in transmission from clade 1 to clade 2 viruses occurred in recent years.

Safety and immunogenicity of a virus-like particle pandemic influenza A (H1N1) 2009 vaccine in a blinded, randomized, placebo-controlled trial of adults in Mexico.

Virus-like particles (VLPs) can be rapidly developed from influenza virus genetic sequences in order to supply vaccine after the onset of a pandemic. The safety and immunogenicity of one or two doses of a recombinant A (H1N1) 2009 influenza VLP vaccine was evaluated in a two-stage, Phase 2, randomized, double-blind, placebo-controlled study conducted in 4563 healthy adults, 18-64 years of age, during the H1N1 2009 pandemic in Mexico. In Part A, 1013 subjects were randomized into four treatment groups (5 μg, 15 μg, or 45 μg hemagglutinin [HA] VLP vaccine or placebo) and vaccinated 21 days apart, with sera collected on Days 1, 14 and 36 for hemagglutination inhibition (HAI) testing.

Influenza virus-like particles as a new tool for vaccine immunogenicity testing: validation of a neuraminidase neutralizing antibody assay.

Detection of neutralizing antibody to viral neuraminidase (NA) by testing for enzyme inhibition has been recognized as an important part of the immunogenicity of influenza vaccines. However, the absence of a well characterized standard source of active NA and validated assays has significantly limited clinical studies of NA immunity. Influenza virus-like particles (VLPs) containing hemagglutinin (HA), NA, and M1 proteins were produced from insect cells infected with a recombinant baculovirus and used as the NA source for the NA inhibition (NAI) assay.

Gender, age, body mass index, and IGF-I individually and jointly determine distinct GH dynamics: analyses in one hundred healthy adults.

Background: GH secretion is quantifiable as mean, peak, and nadir GH concentrations; degree of irregularity (approximate entropy); and spikiness (brief staccato-like fluctuations).

Hypothesis: Distinct GH dynamics reflect relatively distinct (combinations of) subject variables, such as gender, age, body mass index (BMI), and IGF-I concentrations.

Location: The study took place at a clinical translational research unit.

Predicting response to leuprolide of women with premenstrual dysphoric disorder by daily mood rating dynamics.

Approximately 60-70 percent of women with premenstrual dysphoric disorder (PMDD) show symptomatic improvement in response to the GnRH agonist leuprolide acetate, which suppresses ovarian function. However, it has been very difficult to either predict or understand why some women respond, while others do not. We applied several complementary statistical methods to the dynamics of pre-treatment mood rating data to determine possible predictors of response for women with PMDD.

Regulation of complex pulsatile and rhythmic neuroendocrine systems: the male gonadal axis as a prototype.

Hormone-secreting glands communicate via intermittent (pulsatile or rhythmic) signal exchange. Signals act upon target glands via implicit (not directly observable) stimulatory and inhibitory dose-response functions. Time delays operate, since secreted hormones do not arrive at or act on responsive cells instantaneously.

Background intracranial EEG spectral changes with anti-epileptic drug taper.

Objective: Previous studies have revealed a surprising decrease in spike counts and Teager energy between on- and off-AEDs states during intracranial EEG (icEEG) monitoring. Here, we expand the measures evaluated to icEEG power and frequency band power.

Methods: Two icEEG epochs, on- and off-AEDs, each 1h in duration, were studied for each of 21 unselected adult patients.

Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures.

Objective: We developed and implemented clinical practice guideline (CPG) using computerized tomography (CT) as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work.

Methods: This observational study evaluated implementation of our CPG, which incorporated early wrist CT in patients with "clinical scaphoid fracture": a mechanism of injury consistent with scaphoid fracture, anatomical snuff box tenderness, and normal initial plain x-rays.

The effects of temperature, age and sex on presentations of renal colic in Melbourne, Australia.

Objective: To determine whether renal colic incidence in the temperate environment of Melbourne, Australia, varies with ambient temperature and season.

Methods: This was a retrospective analysis of patients with renal colic who presented, between 1999 and 2005 inclusive, to a Victorian inner city emergency department. The emergency department database was interrogated to identify patients with an International Classification of Diseases 10th revision diagnostic code of renal colic.

Basal, pulsatile, entropic (patterned), and spiky (staccato-like) properties of ACTH secretion: impact of age, gender, and body mass index.

Background: Age, gender, and BMI determine ultradian modes of LH and GH secretion, viz., pulsatile, basal, pattern-defined regularity [approximate entropy (ApEn)] and spikiness (sharp, brief excursions). Whether the same determinants apply to ACTH secretion is not known.

A decrease in EEG energy accompanies anti-epileptic drug taper during intracranial monitoring.

Objective: During intracranial EEG (icEEG) monitoring the likelihood of observing a seizure is increased by tapering anti-epileptic drugs (AEDs). Presumably AED taper results in an increase in cortical excitation which in turn promotes seizure emergence. We measured change in signal energy of icEEGs in response to AED taper to quantify changes in excitation which accompany the increased propensity for seizures.

Localization-related epilepsy exhibits significant connectivity away from the seizure-onset area.

In localization-related epilepsy, seizures are presumed to arise from a discrete cortical area. The control of seizures by epilepsy surgery can be poor, however, even when there has been complete resection of the area identified by standard clinical procedures to give rise to seizures. We used a coherence-based measure of functional connectivity to test for network effects within and outside the seizure-onset area.

Motivations and methods for analyzing pulsatile hormone secretion.

Endocrine glands communicate with remote target cells via a mixture of continuous and intermittent signal exchange. Continuous signaling allows slowly varying control, whereas intermittency permits large rapid adjustments. The control systems that mediate such homeostatic corrections operate in a species-, gender-, age-, and context-selective fashion.

A noninvasive measure of negative-feedback strength, approximate entropy, unmasks strong diurnal variations in the regularity of LH secretion.

The secretion of anterior-pituitary hormones is subject to negative feedback. Whether negative feedback evolves dynamically over 24 h is not known. Conventional experimental paradigms to test this concept may induce artifacts due to nonphysiological feedback.

Early computerized tomography accurately determines the presence or absence of scaphoid and other fractures.

Objective: To validate the use of early CT in predicting scaphoid fracture and other fractures in patients with suspected scaphoid fracture.

Method: A prospective observational study of adult patients with a diagnosis of clinical scaphoid fracture presenting to a regional ED. Patients were immobilized in a scaphoid plaster and had a CT (wrist and carpals) same or next day.

Differentiation of women with premenstrual dysphoric disorder, recurrent brief depression, and healthy controls by daily mood rating dynamics.

Enhanced statistical characterization of mood-rating data holds the potential to more precisely classify and sub-classify recurrent mood disorders like premenstrual dysphoric disorder (PMDD) and recurrent brief depressive disorder (RBD). We applied several complementary statistical methods to differentiate mood rating dynamics among women with PMDD, RBD, and normal controls (NC). We compared three subgroups of women: NC (n=8); PMDD (n=15); and RBD (n=9) on the basis of daily self-ratings of sadness, study lengths between 50 and 120 days.

Approximate entropy as a measure of irregularity for psychiatric serial metrics.

Objectives: The quantification of subtle patterns in sequential data, and their changes, has considerable potential utility throughout psychiatry, including the analyses of mood ratings, heart rate, respiratory, and electroencephalographic recordings.

Methods: Approximate entropy (ApEn), a relatively recently developed statistic quantifying serial irregularity, has been applied in numerous studies throughout mathematics and other fields of study, especially biology.

Results: We discussed applications of ApEn, both extant and potential, of most relevance to psychiatrists.

The length of perimenopausal menstrual cycles increases later and to a greater degree than previously reported.

Objective: To demonstrate that the perimenopausal increase in menstrual cycle length presented by Treloar et al. was biased by misidentified menopause dates, mean values classified by calendar year, and exclusion of menstrual cycles straddling two calendar years; and to use the revised data to investigate women's experiences of longer perimenopausal cycles.

Design: Secondary analysis of prospectively collected menstrual cycle data.

Human complement receptor type 1-directed loading of tissue plasminogen activator on circulating erythrocytes for prophylactic fibrinolysis.

Plasminogen activators (PAs) are not used for thromboprophylaxis due to rapid clearance, bleeding, and extravascular toxicity. We describe a novel strategy that overcomes these limitations. We conjugated tissue-type PA (tPA) to a monoclonal antibody (mAb) against complement receptor type 1 (CR1) expressed primarily on human RBCs.