Variability in the interpretation of thorax radiography in a primary care medical community and its reference radiologists

OBJECTIVE: To know the variability in the interpretation (normal/pathological) of posteroanterior view chest radiograph and the associated factors between a medical primary care community and a Gold Standard (GS) from 3 reference radiologists. DESIGN: Crossover study. SETTING: Primary care. Teaching health centers of Elche. METHODS: Interobserver percentage agreement (IPA) and Kappa statistic (K) were used to analyse the interobserver agreement (IA) between the GS and every of the participants in interpretation of 100 radiographs. Intraobserver variability was assessed with a second review. Using uni and multivariant analysis some possibly associated factors were studied. RESULTS: Overall IPA and K were 71.3% (CI 95%: 69.2-73.3) and 0.41 (CI 95%: 0.36-0.46) respectively. Time employed in radiographs reading and time passed after medicine studies finished were independently and significantly associated to higher and lower interobserver agreement results respectively, whereas recent professional experience, permanent job and age were not associated. Professional training is the variable that most explain the inter and intraobserver variability. CONCLUSIONS: Overall IA is acceptable. The IA showed by the participants trained under the MIR system is good but the IA achieved by the rest of participants is not acceptable. It is necessary a training which increase the clinical competence, as it does MIR training.     

Interpretation of chemically created periapical lesions using direct digital imaging

Perchloric acid (70%) was used to create simulated periapical lesions in tooth sockets of 15 dentate cadaver jaw specimens. Using the Trophy USA direct digital radiographic system, linear images were captured at selected time intervals after initial acid application and altered by contrast reversal, pseudocolor enhancement, and two forms of histogram equalization. The 525 total images were randomized for display on a computer monitor for evaluation by five endodontists. Images were evaluated twice by each rater, with viewings 1 to 2 wk apart. Statistical analysis determined interrater variability, intrarater reproducibility, and the relative merits of each enhancement technique. At 8, 12, 16, and 24 h after acid application, both techniques of histogram equalization yielded a statistically significant improvement over reverse contrast in perception of periapical patholais. Linear and pseudocolor-enhanced images were also significantly more diagnostic than reverse contrast at 12, 16, and 24 h. Intrarater reproducibility showed moderate agreement, but analysis showed only a fair level of interrater agreement.     

Teaching severely self-abusive and aggressive autistic residents to exit to fire alarms

Fifty-two case-hardened, severely self-abusive and aggressive autistic and retarded students, living in six different community residences, were trained to exit their residences, without the presence or assistance of staff, when a fire alarm sounded at night. On a pretest, prior to an 11-week period of intensive environmental and behavioral interventions, only 25% of the students exited within 2 1/2 minutes and independent of staff assistance. At posttest, 100% exited successfully, in a mean evacuation time of 60 seconds. The study was conducted at the Behavior Research Institute (BRI).     

Active site structure and stability of the thiol protease papain studied by electron paramagnetic resonance employing a methanethiosulfonate spin label

The benzodiazepine receptor antagonist flumazenil (2.5-20 mg/kg i.p.) increased acetylcholine (ACh) release by up to 85% in the hippocampus of freely moving rats. In contrast, the benzodiazepine receptor full agonist diazepam (2.5-10 mg/kg i.p.) decreased ACh release up to a maximum of 45% in the same brain area. Injection of flumazenil (10 pmol) or diazepam (10 pmol) into the medial septum increased (95%) or reduced (50%), respectively, ACh release in the hippocampus. The maximum effect produced by those drugs was of the same magnitude as that observed after systemic injection. The changes in hippocampal cholinergic function elicited by activation and blockade of benzodiazepine receptors in the medial septum may thus play a crucial role in the alterations of the cognitive processes elicited by benzodiazepine receptor ligands.     

Reversible parotid enlargement and pseudo-Sj?gren's syndrome secondary to hypertriglyceridemia

We describe 2 patients with a Sj?gren-like syndrome apparently secondary to hypertriglyceridemia. Both had bilateral parotitis in addition to musculoskeletal and sicca symptoms. Parotid gland histology revealed fatty infiltration with no inflammation. Therapy with dietary modification and triglyceride lowering drugs resulted in resolution of symptoms and parotid swelling in one patient. In the 2nd patient, hypertriglyceridemia was resistant to triglyceride lowering drugs, and parotid symptoms and swelling continued unabated. Our findings suggest aggressive treatment of hyperlipidemia in pseudo-Sj?gren's syndrome may result in amelioration of musculoskeletal and parotid symptoms.     

Dual recognition of lipid A and DNA by human antibodies encoded by the VH4-21 gene: a possible link between infection and lupus

The VH4-21 (V4-34) gene segment, a member of the VH4 family, is expressed early in B-cell maturation and is utilized by approximately 6% of normal adult B lymphocytes. This prevalence indicates an importance of VH4-21 in the B-cell repertoire. The gene also encodes certain autoantibodies being mandatory for pathological IgM anti-red cell antibodies directed against the I/i antigen, and also capable of encoding anti-DNA antibodies. Recognition of I/i antigen or DNA appears to be via two distinct sites on VH, with I/i binding mediated by sequences in the framework region, and DNA binding correlating with the presence of positively charged amino acids in complementarity-determining region 3. However, these positively charged residues appear to suppress the ability of the framework region to interact with I/i, rendering a single sequence monospecific for I/i or DNA. The IgM anti-DNA antibodies also recognize bacterial lipid A, whereas the anti-I/i antibodies do not, indicating that CDR3 may be involved in binding the negatively charged lipid A. Structural similarities between the DNA backbone and lipid A provide a possible explanation for this cross-reactivity. This dual recognition of bacterial antigen and autoantigen provides a potential link between infection and autoimmunity.     

Selective extraction of pyrethroid pesticide residues from milk by solid-matrix dispersion

Fifty human temporal bones from necropsies were used to study the frequency of canal dehiscences in detail along the course of the facial nerve. Specifically, the study focused on bony dehiscences in the fallopian canal and vascular communications between the facial nerve and the surrounding bone. High frequency of dehiscences at the oval window (60%) and in the pyramidal segment (54%) were found. These dehiscence rates are in agreement with published reports. A 20% rate of dehiscences at the most anterior segment of the tympanic segment was noted and a non-reported high rate (20%) of multiple dehiscences along the course of the fallopian canal in the same temporal bone in specimens of newborns and young children. The significance of these findings in terms of clinical implications is discussed.