Obesity and Extracorporeal Membrane Oxygenation.

Obesity is increasing in prevalence worldwide and carries a theoretical increased risk of morbidity and mortality in critical illness, including hypercoagulability, thrombosis, and renal dysfunction. Obesity has historically been considered a relative contraindication to candidacy for extracorporeal membrane oxygenation (ECMO); however, recent research has suggested that obesity may be associated with improved outcomes in ECMO. This review was conducted to assess and synthesize the existing literature on ECMO outcomes in the obese population.

CD4 T-cell cytokine correlates of diagnostic tests for latent tuberculous infection in HIV-1-infected subjects.

Setting: Public human immunodeficiency virus (HIV) clinic and tuberculosis (TB) clinics in Kampala, Uganda.

Objective: To examine TB-specific CD4 T-cell single and polyfunctional cytokine correlates of clinical diagnostic tests for latent tuberculous infection (LTBI) in HIV-1-infected subjects.

Design: Thirty antiretroviral therapy-naïve HIV-1-infected adults without active TB disease underwent clinical tuberculin skin test (TST), interferon-gamma release assay (IGRA), and in vitro flow cytometry analysis on cells stimulated with purified protein derivative (PPD) and TB antigens early secreted antigenic target 6 + culture filtrate protein 10 (EC) for frequencies of interleukin (IL) 2, IL-17, interferon-gamma (IFN-γ) and tumor necrosis factor alpha (TNF-α) expressing cells.

CD4+ T cell polyfunctional profile in HIV-TB coinfection are similar between individuals with latent and active TB infection.

CD4+ T cell counts of HIV-infected individuals with pulmonary TB (PTB) are higher than with other opportunistic infections suggesting that progression to PTB is not merely due to T cell depletion but also dysfunction. There are limited data examining T cell functional signatures in human HIV-TB co-infection particularly in PTB which accounts for about 80% of active TB disease overall. We examined a cohort of HIV-infected anti-retroviral naïve individuals in Kampala, Uganda, a TB endemic area using multiparametric flow cytometry analysis to determine IFN-γ, IL-2, IL-17, and TNF-α production in CD4+ memory T cell subsets.

Microcystic/reticular Schwannoma: morphological features causing diagnostic dilemma on fine-needle aspiration cytology.

Background: Schwannoma is a common, benign, peripheral nerve sheath tumor. Fine-needle aspiration (FNA) has been very useful for diagnosing classic Schwannoma. Recently, a new morphological variant, the so-called microcystic/reticular Schwannoma, has been recognized.

A proposed method to estimate premorbid full scale intelligence quotient (FSIQ) for the Canadian Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) using demographic and combined estimation procedures.

Establishing a comparison standard in neuropsychological assessment is crucial to determining change in function. There is no available method to estimate premorbid intellectual functioning for the Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV). The WISC-IV provided normative data for both American and Canadian children aged 6 to 16 years old.

Synergistic value of single-photon emission computed tomography/computed tomography fusion to radioimmunoscintigraphic imaging of prostate cancer.

The rationale on which positron emission tomography/computed tomography (PET/CT) imaging is based, combining the functional features of PET with the anatomic detail of CT, provides many advantages that are easily transferable to single-photon emission computed tomography (SPECT)/CT imaging. Our efforts have focused on applying fused SPECT/CT imaging to identify prostate cancer and its metastasis and recurrence through radioimmunoscintigraphy (RIS). This application of RIS to imaging prostate cancer requires 2 key components: (1) a well-defined target associated with the cancer and (2) a "magic bullet" to seek that target.

Clinical validation of the General Ability Index--Estimate (GAI-E): estimating premorbid GAI.

The clinical utility of the General Ability Index--Estimate (GAI-E; Lange, Schoenberg, Chelune, Scott, & Adams, 2005) for estimating premorbid GAI scores was investigated using the WAIS-III standardization clinical trials sample (The Psychological Corporation, 1997). The GAI-E algorithms combine Vocabulary, Information, Matrix Reasoning, and Picture Completion subtest raw scores with demographic variables to predict GAI. Ten GAI-E algorithms were developed combining demographic variables with single subtest scaled scores and with two subtests.

Subjective preference for lamotrigine or topiramate in healthy volunteers: relationship to cognitive and behavioral functioning.

Objective: Outcomes research emphasizes patient self-assessment and preferences in optimizing treatment. We previously showed that lamotrigine produces significantly less cognitive and behavioral impairment compared with topiramate. In the current study we extend these observations to subject self-report of preference for lamotrigine or topiramate independent of potentially confounding effects of seizures or seizure control.

Differential estimation of verbal intelligence and performance intelligence scores from combined performance and demographic variables: the OPIE-3 verbal and performance algorithms.

Data from the WAIS-III standardization sample (The Psychological Corporation, 1997) was used to generate VIQ and PIQ estimation formulae using demographic variables and current WAIS-III subtest performances. The sample (n = 2450) was randomly divided into two groups; the first was used to develop formulas and the second to validate the regression equations. Age, education, ethnicity, gender, region of the country as well as Vocabulary, Matrix Reasoning, and Picture Completion subtests raw scores were used as predictor variables.

Leucoencephalopathy with neuroaxonal spheroids (LENAS) presenting as the cerebellar subtype of multiple system atrophy.

Leucoencephalopathy with neuroaxonal spheroids (LENAS) is a rare disease of cerebral and cerebellar white matter. LENAS usually presents as a disorder of cognition and behaviour, or with gait dysfunction and ataxia. This report describes a patient who had a 14 year course of progressive neurological decline consistent with a clinical diagnosis of probable multiple system atrophy, with prominent cerebellar dysfunction and dysautonomia.

Bcl-2 and calcium: controversy beneath the surface.

The function of Bcl-2 family members on the endoplasmic reticulum has received increasing attention in recent years. The endoplasmic reticulum is the major organelle involved in intracellular calcium homeostasis and calcium signaling, including calcium signals that mediate apoptosis induction by anticancer drugs. But currently a controversy exists regarding reported effects of Bcl-2 on the calcium concentration within the lumen of the endoplasmic reticulum.

Myeloablation is not required to select and maintain expression of the drug-resistance gene, mutant MGMT, in primary and secondary recipients.

Gene transduction of hematopoietic progenitors capable of reconstituting both primary and secondary recipients is an important milestone in preclinical development of gene therapy. Myeloablation conditioning prior to infusion of transduced stem cells causes significant host morbidity. In contrast, drug-resistance gene transfer utilizes judicious in vivo selection of transduced stem cells over time, reaching only the level of transduction and expression required.

DNA mismatch repair (MMR) mediates 6-thioguanine genotoxicity by introducing single-strand breaks to signal a G2-M arrest in MMR-proficient RKO cells.

Purpose: The DNA mismatch repair (MMR) system plays an important role in mediating cell death after treatment with various types of chemotherapeutic agents, although the molecular mechanisms are not well understood. In this study, we sought to determine what signal is introduced by MMR after 6-thioguanine (6-TG) treatment to signal a G(2)-M arrest leading to cell death.

Experimental Design: A comparison study was carried out using an isogenic MMR(+) and MMR(-) human colorectal cancer RKO cell system, which we established for this study.

Autonomic nervous system testing may not distinguish multiple system atrophy from Parkinson's disease.

Background: Formal laboratory testing of autonomic function is reported to distinguish between patients with Parkinson's disease and those with multiple system atrophy (MSA), but such studies segregate patients according to clinical criteria that select those with autonomic dysfunction for the MSA category.

Objective: To characterise the profiles of autonomic disturbances in patients in whom the diagnosis of Parkinson's disease or MSA used criteria other than autonomic dysfunction.

Methods: 47 patients with parkinsonism and autonomic symptoms who had undergone autonomic laboratory testing were identified and their case records reviewed for non-autonomic features.

Unexpected advanced generation cephalosporinase activity of the M69F variant of SHV beta-lactamase.

Infections with bacteria that contain hydrolytic beta-lactamase enzymes are becoming a serious problem in the United States. Mutations at Met-69, an amino acid proximal to the active site Ser-70 in the TEM-1 and SHV-1 beta-lactamases, have emerged as a puzzling cause of bacterial resistance to inhibitors of beta-lactamases. Site-saturation mutagenesis of the 69 position in SHV beta-lactamase was performed to determine how mutations of this non-catalytic residue play a role in increasing 50% inhibitory concentrations (IC(50) concentrations) for clinically important beta-lactamase enzyme inhibitors.

Severe perinatal liver disease associated with fetal thrombotic vasculopathy.

Three neonates with fetal thrombotic vasculopathy in the placenta and severe neonatal liver disease are described. Symptoms included a bleeding disorder on the first day of life, followed by direct hyperbilirubinemia and elevated liver transaminases. All patients also had evidence of thrombosis outside the placenta, including cerebral infarct in two infants and thrombosis of the inferior vena cava in one infant.

Evaluation of a rapid urine amylase test using post-ERCP hyperamylasemia as a model.

Objective: The initial diagnosis of acute pancreatitis is often based on clinical criteria together with elevations of serum amylase and lipase. A reliable bedside urine test could facilitate the early diagnosis of pancreatitis. We evaluated a rapid urine amylase test (Rapignost) by using post-ERCP hyperamylasemia as a human model of acute development of hyperamylasemia suggestive of pancreatitis.

Bipolar rapid cycling: focus on depression as its hallmark.

The phenomenon of frequent cycling in bipolar disorder was first recognized by Emil Kraepelin in 1913. More recently, rapid cycling has been reported to be a predictor of nonresponse to treatment. At the time of presentation, most patients with DSM-IV-defined rapid cycling appear to be in the depressed phase of their illness.

A 13-year-old boy with cognitive impairment, retinoblastoma, and Wilson disease.

A developmentally delayed child manifested retinoblastoma at age 4 years and Wilson disease at age 11, a previously unreported association. Cytogenetic and molecular analysis showed an interstitial deletion in the long arm of the paternally derived homologue of chromosome 13 (13q14.2-13q22.

Effect of cross-sectional imaging on negative appendectomy and perforation rates in children.

Purpose: To compare negative appendectomy and perforation rates in children who underwent ultrasonography (US), computed tomography (CT), or no imaging before urgent appendectomy.

Materials And Methods: All children who underwent urgent appendectomy during a 4(1/2)-year period were identified in a surgical billing database. Pathology reports were coded as negative or as showing acute inflammation or perforation.

Role of the human V1 vasopressin receptor COOH terminus in internalization and mitogenic signal transduction.

We studied the role played by the intracellular COOH-terminal region of the human arginine vasopressin (AVP) V1-vascular receptor (V1R) in ligand binding, trafficking, and mitogenic signal transduction in Chinese hamster ovary cells stably transfected with the human AVP receptor cDNA clones that we had isolated previously. Truncations, mutations, or chimeric alterations of the V1R COOH terminus did not alter ligand binding, but agonist-induced V1R internalization and recycling were reduced in the absence of the proximal region of the V(1)R COOH terminus. Coupling to phospholipase C was altered as a function of the COOH-terminal length.

DNA replication precedes neuronal cell death in Alzheimer's disease.

Alzheimer's disease (AD) is a devastating dementia of late life that is correlated with a region-specific neuronal cell loss. Despite progress in uncovering many of the factors that contribute to the etiology of the disease, the cause of the nerve cell death remains unknown. One promising theory is that the neurons degenerate because they reenter a lethal cell cycle.

Impact of a guideline-based disease management team on outcomes of hospitalized patients with congestive heart failure.

Background: Congestive heart failure is the most common reason for hospitalization in the United States, and guidelines to improve the quality of care for patients with congestive heart failure have been developed. However, adherence is typically low. We hypothesized that a guideline-based care management team would result in greater quality and efficiency of care than guidelines alone.