Pediatric case of the day. Hinman syndrome (nonneurogenic bladder [NNNB], detrusor-sphincter dyssynergia)

Two cases of spontaneous left main coronary artery dissection are reported. This condition is rare and may present as an urgent surgical dilemma. The presentation, diagnosis, and management of primary left main coronary artery dissection are reviewed. Causative factors and underlying pathology are clarified. Prompt diagnosis and surgical intervention with temporary ventricular support is safe and effective.     

Models of integration given multiple sources of information.

Several models of information integration are developed and analyzed within the context of a prototypical pattern-recognition task. The central concerns are whether the models prescribe maximally efficient (optimal) integration and to what extent the models are psychologically valid. Evaluation, integration, and decision processes are specified for each model. Important features are whether evaluation is noisy, whether integration follows Bayes's theorem (S. M. Stigler, 1986), and whether decision consists of a criterion rule or a relative goodness rule. Simulations of the models and predictions of the results by the same models are carried out to provide a measure of identifiability or the extent to which the models can be distinguished from one another. The models are also contrasted against empirical results from tasks with 2 and 4 response alternatives and with graded responses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Estrogen, serotonin, and mood disturbance: where is the therapeutic bridge?

A growing body of literature describes the effects of estrogen and other gonadal steroids on the central nervous system. The ability of estrogen to modulate serotonergic function, in particular, raises the possibility that sex steroids may play a role in the mechanisms associated with depression and its treatment. This review will focus on those aspects of the estrogen-serotonin interaction that relate to possible increased vulnerability to affective disorders and on hormonal treatments that may be clinically applicable to women. After a discussion of the potential relationship between estrogen and mood disorders across the female life cycle, a model is proposed in which differential sensitivity to mood disorders explains the differential response by some women to periods of normal hormonal changes. Possible serotonin receptor-mediated and intracellular mechanisms by which estrogen may exert its effects on mood are also reviewed. These are compared to putative mechanisms of standard antidepressant effect. Lastly, treatment studies in which estrogen has been used as 1) monotherapy for depression, 2) an augmentation strategy, or 3) a prophylactic intervention against recurrence of depression are reviewed.     

Adult Dirofilaria repens in a subcutaneous granuloma on the chest of a dog

A 10-year-old, 9 kg, intact male crossbred dog was treated for nasal mites with milbemycin oxime using a dose of 1 mg/kg bodyweight orally, three times at 10-day intervals. One month after the initiation of this treatment a subcutaneous nodule developed on the sternum of the dog. The nodule was removed and found to contain a single, 82 mm long, thread-like nematode. Several exotic parasites were suspected as possibilities because the dog had been imported to Norway from South Africa. Microfilariae were not detected in the blood and heartworm antigen tests were negative. The worm was identified morphologically as an adult, female Dirofilaria repens. This is the first report of D repens from Norway. The case is of interest because of the differential diagnostic problem it posed and because infestation was recognised following treatment of another parasitic condition with a broad-spectrum, antiparasitic drug. In addition, the case provides a reminder of the necessity to be aware of geographical differences in disease occurrence which can produce unexpected disease in non-endemic areas as a consequence of increased international travel with pets.     

Method for segmenting chest CT image data using an anatomical model: preliminary results

We present an automated, knowledge-based method for segmenting chest computed tomography (CT) datasets. Anatomical knowledge including expected volume, shape, relative position, and X-ray attenuation of organs provides feature constraints that guide the segmentation process. Knowledge is represented at a high level using an explicit anatomical model. The model is stored in a frame-based semantic network and anatomical variability is incorporated using fuzzy sets. A blackboard architecture permits the data representation and processing algorithms in the model domain to be independent of those in the image domain. Knowledge-constrained segmentation routines extract contiguous three-dimensional (3-D) sets of voxels, and their feature-space representations are posted on the blackboard. An inference engine uses fuzzy logic to match image to model objects based on the feature constraints. Strict separation of model and image domains allows for systematic extension of the knowledge base. In preliminary experiments, the method has been applied to a small number of thoracic CT datasets. Based on subjective visual assessment by experienced thoracic radiologists, basic anatomic structures such as the lungs, central tracheobronchial tree, chest wall, and mediastinum were successfully segmented. To demonstrate the extensibility of the system, knowledge was added to represent the more complex anatomy of lung lesions in contact with vessels or the chest wall. Visual inspection of these segmented lesions was also favorable. These preliminary results suggest that use of expert knowledge provides an increased level of automation compared with low-level segmentation techniques. Moreover, the knowledge-based approach may better discriminate between structures of similar attenuation and anatomic contiguity. Further validation is required.     

Two novel plasmid-mediated cefotaxime-hydrolyzing beta-lactamases (CTX-M-5 and CTX-M-6) from Salmonella typhimurium

The effect of substitution of asparagine for arginine at position 276 (Ambler's numbering) on the properties of the extended-spectrum beta-lactamase CTX-M-4 was studied. Compared with CTX-M-4, the mutant beta-lactamase CTX-M-4(R276N) conferred lower levels of resistance to cefotaxime, ceftriaxone and aztreonam while the levels of resistance to penicillins and penicillin-inhibitor combinations were similar. Arg-276-->Asn substitution rendered CTX-M-4 slightly less susceptible to inhibition by clavulanate and tazobactam. It also caused a three-fold reduction in the relative rate of hydrolysis of cefotaxime. These results indicate that Arg-276 in CTX-M-type beta-lactamases may be implicated in hydrolysis of oxyimino-beta-lactams; they do not, however, support the hypothesis that Arg-276 is the functional equivalent of Arg-244 found in other class A beta-lactamases.     

Conditional logistic regression with sandwich estimators: application to a meta-analysis

Motivated by a meta-analysis of animal experiments on the effect of dietary fat and total caloric intake on mammary tumorigenesis, we explore the use of sandwich estimators of variance with conditional logistic regression. Classical conditional logistic regression assumes that the parameters are fixed effects across all clusters, while the sandwich estimator gives appropriate inferences for either fixed effects or random effects. However, inference using the standard Wald test with the sandwich estimator requires that each parameter is estimated using information from a large number of clusters. Since our example violates this condition, we introduce two modifications to the standard Wald test. First, we reduce the bias of the empirical variance estimator (the middle of the sandwich) by using standardized residuals. Second, we approximately account for the variance of these estimators by using the t-distribution instead of the normal distribution, where the degrees of freedom are estimated using Satterthwaite's approximation. Through simulations, we show that these sandwich estimators perform almost as well as classical estimators when the true effects are fixed and much better than the classical estimators when the true effects are random. We achieve simulated nominal coverage for these sandwich estimators even when some parameters are estimated from a small number of clusters.