The diagnostic value of scoring models for organic and non-organic gastrointestinal disease, including the irritable-bowel syndrome

Scoring models based on history and physical examination have been developed to discriminate patients with non-organic gastrointestinal disease from those who have organic disease. The application of these models may lead to more efficient diagnosis and prevent somatization. Although the models have high diagnostic accuracy in the population in which they have been developed, their value in other populations has not been established. In this study previously developed models were tested in validation populations defined by the original selection criteria from the studies in which the models were developed and in unselected general practice and outpatient populations. The diagnostic performance of the models are expressed in terms of odds ratio and sensitivity and specificity for the classification of patients as having organic and non-organic disease. The diagnostic performance of all the models were rather low in the validation populations. Relatively few elements of the models had independent diagnostic value. In addition, the correlation between the scoring models, expressed in Cohen's kappa, was extremely low. The diagnostic values of the scoring models were not reproduced in comparable and unselected populations. Therefore, it is concluded that the diagnostic value of such a model has little external validity.     

The use of meditation--relaxation techniques for the management of stress in a working population

The efficacy of meditation-relaxation techniques has been widely researched in the laboratory, but their effectiveness for management of stress in organizational settings is still relatively unexplored. The present study compared relaxation and control conditions as part of a program of stress-reduction in industry. A total of 154 New York Telephone employees self-selected for stress learned one of three techniques--clinically standardized meditation (CSM), respiratory one method meditation (ROM) or progressive relaxation (PMR)--or served as waiting list controls. At 5.5 months, the treatment groups showed clinical improvement in self-reported symptoms of stress, but only the meditation groups (not the PMR group) showed significantly more symptom reduction than the controls. The meditation groups had a 78% compliance rate at 5.5 months with treatment effect seen whether subjects practiced their techniques frequently or occasionally. The safe and inexpensive semi-automated meditation training has considerable value for stress-management programs in organizational settings.     

Bovine leukocyte adhesion deficiency--clinical course and laboratory findings in eight affected animals

To compare multiple and singleton pregnancies in the treatment of threatened preterm delivery with prolonged intravenous ritodrine, 32 women with multiple pregnancy (26 twins, 6 triplets, 70 fetuses, 30.3 +/- 3.5 weeks) and 51 women with singleton pregnancy (31.3 +/- 2.6 weeks) admitted for threatened preterm delivery without rupture of the membranes were the subjects of a retrospective study of obstetric data, perinatal outcome and maternal adverse effects. Significance was assessed by chi 2 test and Student's t test. Multiple pregnancies were associated with a marked increase in the duration of tocolysis (17.2 +/- 17.3 vs. 7.6 +/- 8.1 days, P < 0.01), incidence of delivery before 37 weeks (87.5 vs. 35.3%, P < 0.01) and incidence of maternal cardiovascular complications (34.4 vs. 4.0%, P < 0.01), including three cases of pulmonary edema. The incidences of delivery before 32 weeks (12.5 vs. 7.8%) and of neonatal death (2.9 vs. 0%) were not significantly different in the two groups. Multiple pregnancies dramatically increased the incidence of maternal adverse effects of prolonged intravenous ritodrine therapy. Neonatal benefit is questionable and was difficult to establish since it was not a randomized study.     

Association of TAP1 and TAP2 with systemic sclerosis in Japanese

Paroxysmal nocturnal haemoglobinuria (PNH) is an acquired clonal stem cell disorder resulting in insufficient and defective haematopoesis associated frequently with aplastic anaemia (AA). A deficiency of the glycosyl phosphatidylinositol (GPI)-anchored complement activation regulatory proteins CD55 and CD59 is responsible for an increased sensitivity of erythrocytes to complement attack leading to chronic intravascular haemolysis with haemoglobinuria. In this study we investigated the effects of complement activation caused by anti-thymocyte globulin (ATG) treatment on the PNH clone in a patient affected with the PNH/AA-syndrome. Fluid phase complement components C3, C4, C6 and terminal complement complex (TCC) were assayed by ELISA. CD55, CD59 and cell-associated TCC were monitored by flow cytometry. ATG treatment resulted in profound systemic complement activation which led to a decrease in the levels of native C3 and C4 to 65% and 40%, respectively, of the original levels on day 5 and of C6 and TCC to 61% and 23%, respectively, on day 10. A return to pre-treatment levels was observed for C3 by day 15, for C6 by day 30 and for C4 by day 90. Flow cytometry revealed that the deficiency in the GPI-anchored protein was restricted to granulocytes, while lymphocytes remained unaffected. Cell-bound TCC increased by 1.67-fold and 2.37-fold on day 5 and day 10, respectively, decreasing to 1.40-fold and 1.30-fold on day 15 and day 30, respectively. The percentage of PNH granulocytes as identified by the absence of the CD55- and CD59-antigens exhibited a temporary decrease from 72% on day 0 to 65% on day 5 and 59% on day 10 and returned thereafter to the original percentage of 70% by day 15 and exceeding this level to 76% on day 30 and 79% on day 90. We report profound activation of the classical pathway of the complement cascade and the terminal complement complex by the globulin leading to a transient decrease of the PNH clone, presumably due to subsequent lysis of the PNH cells devoid of complement regulatory proteins.     

The role of androgen receptor gene mutations in male breast carcinoma

Certain germline mutations (607Arg-Gln, 608Arg-Lys) in the androgen receptor gene have been associated with the occurrence of breast cancer in males suffering from partial androgen insensitivity. To assess whether somatic mutations in this gene could be detected in breast carcinoma, archival tumor tissue of males without clinical evidence of androgen insensitivity was screened for point mutations in the androgen receptor gene. DNA was retrieved by chloroform-phenol extraction from formalin-fixed, paraffin-embedded tissues. Exons 2-8 of the androgen receptor gene, encoding the DNA- and hormone-binding regions of the receptor, were amplified by polymerase chain reaction and subjected to nonisotopic single strand conformation assay (SSCA) to screen for point mutations. In the tumor DNA, no variations suggestive of mutations were encountered on SSCA. However, in a control patient with partial androgen insensitivity and predominantly female phenotype, the germline mutation 607Arg-Gln was identified in blood leukocyte DNA. Our results indicate that somatic mutations of the androgen receptor are not required for the development of male breast cancer. This, however, does not exclude an increased risk of breast carcinoma in patients with androgen insensitivity.     

Tensile dislodgment evaluation of two experimental prefabricated post systems

This study tested the tensile dislodgment forces of two experimental post designs that are threaded 7 mm into the most coronal aspect of the root. Experimental post systems ParaPost XT-7 (XT-7), and ParaPost XT-10 (XT-10) were compared to the Flexi-Post (FP) and to the Standard ParaPost (SP). The XT-7 prototype post measured 7 mm in length, while all other post systems were 10 mm. The XT-7 and the FP are active post systems that are threaded throughout their entire length. The SP is a passive serrated post system, and the XT-10 is a combination active/passive design that has a 7 mm coronal thread with a passive serrated apical end. All systems tested were titanium alloy except the SP system, which was stainless steel. The purpose of this study was to compare an active and a passive post design to the experimental designs of the XT-7 active post and the combined active/passive design of the XT-10. This study clearly demonstrated highest retention for the active post system, least retention for the passive post, with an intermediate retentiveness for the combined design.     

Synergy between T cell Receptor and Fas (CD95/APO-1) signaling in mouse thymocyte death

Both extracellular and intracellular calcium (Ca2+) play important roles in hypoxic pulmonary vasoconstriction (HPV) and the vasoconstrictor responses to endogenous pulmonary vasoconstrictor substances, as evidenced by the effect of calcium-channel blockers on these vasoconstrictor responses and the measurement of changes in Ca2+ flux or intracellular Ca2+ concentrations in isolated cells. The more vasoselective the calcium-channel blocker, the greater its effect on pulmonary vasoconstriction. However, these drugs are not selective for the pulmonary vascular bed and are not as potent as pulmonary vasodilators when compared with other vasodilator drugs, including prostaglandin E1, isoproterenol, prostacyclin, or nitroglycerin. Moreover, the primary effect of vasoselective calcium-channel blockers on pulmonary vascular resistance is secondary to the effects of these agents on systemic vascular resistance and cardiac output. Although there is improvement in oxygen delivery, exercise tolerance, and survival in patients with primary pulmonary hypertension who respond to calcium-channel blockers, the response of individual patients to these drugs is difficult to predict because the extent of reversible versus irreversible changes in the pulmonary vasculature is not known. The use of these drugs in patients with chronic hypoxia-induced pulmonary vasoconstriction may be associated with a worsening of ventilation-perfusion mismatching secondary to inhibition of HPV.