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Prognostic factors and treatment effects on survival in erythroleukemia: a retrospective study of 134 cases.

A total of 134 cases of erythroleukemia (119 from the literature and 15 of the authors' patients) were reviewed in an attempt to correlate survival with age, sex, hepatomegaly, splenomegaly, lymphadenopathy, infection, or hemorrhagic complications at initial presentation; hemoglobin (Hgb), white blood cell (WBC) count, and platelet count; percent myeloblasts in the marrow at diagnosis; and treatment regimens employed. Statistical methods included single classification analysis of variance, nonparametric analysis of variance (Kruskal-Wallis method), contingency table analysis, and correlation coefficient determination for numerical data. No significant correlation between survival and age, sex, hepatomegaly, lymphadenopathy, infection, or hemorrhagic phenomena was found. Improved survival was noted in patients without splenomegaly, and in daunorubicin-treated cases in contrast to those treated with other chemotherapeutic agents. A positive correlation between survival and initial Hgb and WBC was also noted. Erythroleukemia complicating a chronic myeloproliferative disorder had a worse prognosis than de novo erythroleukemia.

Adult↗

Effect of processing method on the dimensional accuracy and water sorption of acrylic resin dentures.

STATEMENT OF PROBLEM: Acrylic resin complete dentures exhibit certain unavoidable dimensional changes. Processing shrinkage and expansion due to water uptake are 2 important aspects influencing dimensional accuracy. PURPOSE: This study investigated linear dimensional changes and water sorption of dentures processed by dry and wet heat with different rates of cooling. METHODS: Fine crosses marked on tinfoil inserts were placed at the incisive papilla and tuberosity regions of edentulous maxillary casts and incorporated into the dentures during polymerization by 3 processing techniques. A traveling microscope was used to measure the distances between the reference points to determine dimensional changes. Water uptake and content were determined by the mass changes of the dentures with an electronic balance. Data of linear dimensional change and water sorption were analyzed by multivariate analysis of variance and analysis of variance, respectively. Bonferroni simultaneous confidence intervals (95%) were applied for multiple comparison. RESULTS: Dry heat-processed and water bath-processed acrylic resin dentures did not exhibit significant differences in shrinkage (0.42% to 0.58%) at water saturation. Amounts of water sorption of dentures processed by dry and wet heat (0.50 and 0.48 mass%, respectively) were not significantly different, and their associated expansion did not entirely compensate for the processing shrinkage. The initial water content of dry heat-processed dentures (1.77 mass%) was unexpectedly slightly higher than that of wet heat-processed dentures (1.68 mass%). The rate at which the dentures cooled did not affect their initial water content and subsequent water uptake. CONCLUSIONS: Water uptake of dry and wet heat-processed acrylic resin dentures after deflasking was in both cases low, and the dentures did not reveal significant differences in shrinkage at water saturation. Air oven-processed and water bath-processed acrylic resin dentures show similar dimensional shrinkage at water saturation.

Acrylic Resins↗

Comparison and recovery of Escherichia coli and thermotolerant coliforms in water with a chromogenic medium incubated at 41 and 44.5 degrees C.

This study compared the performance of a commercial chromogenic medium, CHROMagarECC (CECC), and CECC supplemented with sodium pyruvate (CECCP) with the membrane filtration lauryl sulfate-based medium (mLSA) for enumeration of Escherichia coli and non-E. coli thermotolerant coliforms (KEC). To establish that we could recover the maximum KEC and E. coli population, we compared two incubation temperature regimens, 41 and 44.5 degrees C. Statistical analysis by the Fisher test of data did not demonstrate any statistically significant differences (P = 0.05) in the enumeration of E. coli for the different media (CECC and CECCP) and incubation temperatures. Variance analysis of data performed on KEC counts showed significant differences (P = 0.01) between KEC counts at 41 and 44.5 degrees C on both CECC and CECCP. Analysis of variance demonstrated statistically significant differences (P = 0.05) in the enumeration of total thermotolerant coliforms (TTCs) on CECC and CECCP compared with mLSA. Target colonies were confirmed to be E. coli at a rate of 91.5% and KEC of likely fecal origin at a rate of 77.4% when using CECCP incubated at 41 degrees C. The results of this study showed that CECCP agar incubated at 41 degrees C is efficient for the simultaneous enumeration of E. coli and KEC from river and marine waters.

Bacteriological Techniques↗

Medical students' perceptions of unethical conduct at one medical school.

PURPOSE: To assess medical students' perceptions of the ethical environment across four years of medical school. METHOD: In the spring of 1996, the authors distributed a questionnaire to all four classes at the Wake Forest University School of Medicine. The students provided demographic information and information about their exposures to or participation in unethical situations. Results were analyzed using multiple analysis of variance, univariate analysis of variance, Pearson correlation, and cross-tabulations. RESULTS: The response rate was 71%. The students reported that exposures to unethical behavior started early and continued to increase with each year in school. For example, 35% of the first-year students reported observing unethical conduct by residents or attending physicians. This percentage rose to 90% of the fourth-year students. The authors found no significant relationship between demographic variables other than the year in school and the ethical dilemma variables. CONCLUSION: Medical students face perceived ethical dilemmas beginning as early as the first year of medical school. Thus ethics instruction must begin in the freshman year. In addition, there must be changes to the environment in which clinical education is conducted to enhance the positive enculturation of students into the medical profession.

Adult↗

Silence analysis of AMPA receptor mutated at the CaM-kinase II phosphorylation site.

Direct phosphorylation of the GluR1 subunit of postsynaptic AMPA receptors by Ca(2+)/calmodulin-dependent protein kinase II (CaM-KII) is believed to be one of the major contributors to the enhanced strength of glutamatergic synapses in CA1 area of hippocampus during long-term potentiation. The molecular mechanism of AMPA receptor regulation by CaM-KII is examined here by a novel approach, silence analysis, which is independent of previously used variance analysis. I show that three fundamental channel properties-single-channel conductance, channel open probability, and the number of functional channels-can be measured in an alternative way, by analyzing the probability of channels to be simultaneously closed (silent). Validity of the approach was confirmed by modeling, and silence analysis was applied then to the GluR1 AMPA receptor mutated at S831, the site phosphorylated by CaM-KII during long-term potentiation. Silence analysis indicates that a negative charge at S831 is a critical determinant for the enhanced channel function as a charge carrier. Silence and variance analyses, when applied to the same sets of data, were in agreement on the receptor regulation upon mutations. These results provide independent evidences for the mechanism of AMPA receptor regulation by CaM-KII and further strengthens the idea how calcium-dependent phosphorylation of AMPA receptors can contribute to the plasticity at central glutamatergic synapses.

Calcium-Calmodulin-Dependent Protein Kinase Type 2↗

[Reliability and validity of Burnout Questionnaire in occupational population].

OBJECTIVE: To evaluate the reliability and validity of simple Burnout Questionnaire in occupational population. METHODS: A self-administered Burnout Questionnaire comprising 19 items was developed in light of Maslash Burnout Questionnaire and used for investigating 458 employees. RESULTS: Cronbach's alpha between total items of Burnout Questionnaire and each factor fell in between 0.82 and 0.85 through the consistency test. All 19 items of Burnout Questionnaire were subjected to factor analysis, and three latent factors were identified, wherein 56.3% of total variance could be explained. According to the contents described in the items and Maslash burnout theory, they were emotional exhaustion, depersonalization, and personal accomplishment. According to the covariance and the variance analysis, there was significant difference in the integral of the type of work among the three subitems (P < 0.01); there was significant difference in the integral of depersonalization between two sexes (P < 0.01); There were significant difference in the integral of the personal achievement among different level of education (P < 0.01). CONCLUSION: The reliability and validity of Burnout Questionnaire is acceptable and can be used for assessing burnout in occupational population.

Adult↗

[The serum beta-2-microglobulin values in drug addicts with persistent generalized lymphadenopathy].

Serum beta 2-microglobulin levels (beta-2-M) were studied in 150 drug addicts, 50 of them asymptomatic carriers of anti HIV-1 antibodies, 50 symptomatic carriers with persistent generalized lymphadenopathy (P.G.L.) and 50 serum negative patients who had been living in a closed community for at least 2 years. The results showed increased beta-2-M in 24 P.G.L. patients (48%), in 6 of the asymptomatic serum positive cases (12%) and in 3 of the serum negative subjects (6%). No such increase was found in the selected control group. Statistical analysis using the chi-square test and one-way variance analysis gave a significant result. The data suggest that increased serum beta-2-M is essentially linked to the presence of P.G.L.

AIDS-Related Complex↗

The interaction between soft tissues and the sagittal development of the dentition and the face.

The purpose of this study was to investigate whether there are relationships between the cross-sectional surface area (CSSA) of the lips and the sagittal structure of the skeletal parts of the face and the dentition in the midsagittal plane and whether the sagittal structure of the face and the dentition is related to the class of malocclusion. The CSSA of the upper and lower lip was measured with a planimeter on the lateral cephalograms of 156 patients before their orthodontic treatment with a closed lip relation in rest. They were divided into 18 groups according to their age, sex, and Angle classification. The Quick Ceph program (Orthodontic Processing, Chula Vista, Calif.) was used to digitize and analyze 23 dental and skeletal parameters. The parameters were tested by an analysis variance to show differences between the three classes of malocclusion. The regression analysis was used to look for relations between the CSSA and the skeletal or dental parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

[Myopia: frequency of lattice degeneration and axial length].

OBJECTIVE: To evaluate the relationship between lattice retinal degeneration and axial length of the eye in different grades of myopia. MATERIAL AND METHODS: A sample of 200 eyes from 124 myopic patients was collected by chance. The average age was 34.8 years (20-50 years) and the myopia was between 0.5 and 20 diopters (D). The eyes were grouped according to the degree of refraction defect, the mean axial length of each group (Scan A) and the frequency of lattice retinal degeneration and the relationship between these variables was studied. The possible influence of age on our results was also considered. For the statistical analysis, the SAS 6.07 program with the variance analysis for quantitative variables, and chi(2) test for qualitative variables with a 5% significance were used. A multivariable linear regression model was also adjusted. RESULTS: The highest frequency of lattice retinal degeneration occurred in those myopia patients having more than 15 D, and also in the group of myopia patients between 3 and 6 D, but this did not show statistical significance when compared with the other myopic groups. If the axial length is assessed, a greater frequency of lattice retinal degeneration is also found when the axial length is 25-27 mm and 29-30 mm, which correspond, respectively, to myopias between 3-10 D and more than 15 D. When the multivariable linear regression model was adjusted, the axial length showed the existence of lattice retinal degeneration (beta 0.41 mm; p=0.08) adjusted by the number of diopters (beta 0.38 mm; p<0.001). The determination coefficient (r(2)) was also 0.86. CONCLUSIONS: The highest number of cases of lattice retinal degeneration was found for myopias with axial eye length between 29-30 mm (more than 15 D), and 25-27 mm (between 3-10 D).

Adult↗

[Survival analysis in cirrhotic patients].

BACKGROUND: Hepatic cirrhosis (HC) is a chronic and progressive disease that, independently of its etiology, favors the presence of some complications that impair the survival of patients. AIMS: To determine the frequency, etiology, and main decompensation factors, as well as analyse survival curves in HC of a population of Durango, México. METHODS: Cirrhotic patients of both sexes from the Hospital General del IMSS in Durango were included. The etiology of cirrhosis, the factors of decompensation and the grade of portal hypertension (PHT) were determined. A 39 month follow-up was done, registering complications and cause of death. STATISTICAL ANALYSIS: Fisher's exact test, Friedman's variance analysis, Mantel-Haenzsel chi-square test and Kaplan-Meier methods were used. RESULTS: Fifty patients were studied, 30 female and 20 male. The mean age was 54.3 years old (range 32-74 years). The more frequent etiology was alcoholic in 42% patients (19 male and 2 female). Forty three patients (86%) had decompensation by ascitis; 19 (38%) had variceal bleeding, 18(36%) had encephalopathy and 16(32%) were icteric. Twenty six patients (52%) had PHT III, and 30 (60%) were Child-Pugh class B. CONCLUSIONS: Survival in the decompensated group at 19.8 months follow-up was 62% and 73% in the total group, 20% died. Statistical significance (p < 0.05) was found between PHT grade and Child-Pugh functional class; hepatic reserve correlated inversely with bleeding (p < 0.05) and encephalopathy (p < 0.05) probability. The advanced grade of PHT directly correlated with bleeding encephalopathy and mortality (p < 0.05). We did not find any association between the etiology of cirrhosis and the incidence of complications.

Adult↗

[L-arginine and immunity. Study of pediatric subjects].

BACKGROUND: Nitric oxide (NO) play a pivotal role in many biological processes, as in the vessel tone control, the atherogenesis, the platelets aggregation and the immune system modulation. The physiologic precursor of NO is the L-arginine. Evidence exists that the L-arginine administration can stimulate immune system in children with recurrent infections. This clinical trial was designed to evaluate the effects of oral administration of L-arginine on the number of infective events and on the lymphocytes subsets in children suffering from airways recurrent infections. METHODS: Forty outpatients, 21 male and 19 female, aging from 2 to 13 yrs. Two balanced groups, treated for 60 days with L-arginine or a placebo. Evaluation criteria: number of septic episodes; number of circulating white blood cells, % of the lymphocytes; lymphocytes subsets. STATISTICAL ANALYSIS: Descriptive analysis; inference tests: chi 2; "t" test; variance analysis. Statistical significance: p = 0.05. RESULTS: Fifteen patients treated with L-arginine and five treated with placebo (p < 0.01) were free from infections. The percentage of CD3 and CD4 subsets significantly (p < 0.05) increased in the L-arginine group than in the placebo group, while the CD8 subset significantly decreased. The CD4/CD8 ratio raised from 1.05 +/- 0.29 to 1.51 +/- 0.46 (p < 0.01) in the L-arginine group, from 1.12 +/- 0.16 to 1.27 +/- 0.24 in the placebo group. There were no side effects in both groups. CONCLUSIONS: L-arginine seems able to increase the immune system defences and to protect against the airway infections.

Adolescent↗

[Postoperative proliferative vitreoretinopathy in rhegmatogenous retinal detachment associated with stage B preoperative proliferative vitreoretinopathy: comparative results of trans-scleral retinopexy with diode laser or trans-pupillary retinopexy with argon laser].

PURPOSE: To compare the rate of severe postoperative PVR in primary rhegmatogenous retinal detachments (RD) associated with preoperative grade B PVR and managed either with transpupillary Argon laser photocoagulation or transscleral Diode laser photocoagulation. MATERIAL AND METHODS: We evaluated 72 primary rhegmatogenous retinal detachment associated with preoperative grade B PVR (retinal tears with curled posterior edges), referred before any failed attempt to reattach the retina. Eleven RD were due to giant tear. The retinopexy was performed using transpupillary Argon laser. photocoagulation in 46 eyes, and transscleral Diode laser photocoagulation in 26 eyes. Follow up was 6 to 30 months. Statistical analysis used Chi-square test, and variance analysis. RESULTS: The overall rate of postoperative PVR was 6.9% (5/72 eyes). The rate of postoperative PVR was 6.5% (3/46) in eyes managed with Argon laser photocoagulation and 7.7% (2/26) in eyes managed with Diode laser photocoagulation (p > 0.05). The rate of postoperative PVR in RD due to horseshoe tears was 5.4% (2/37) in eyes managed with Argon laser and 8.3% (2/24) in eyes treated with Diode laser (p > 0.05). The rate of postoperative PVR in giant tear was 11.1% (1/9) in eyes managed with Argon laser photocoagulation and 0% (0/2) in eyes managed with Diode laser photocoagulation (p > 0.05). CONCLUSION: In the present series the rate of postoperative PVR was not influenced by the method of photocoagulation (transpupillary Argon laser or transscleral Diode laser). Therefore each technique can be used as the retinopexy method in primary rhegmatogenous retinal detachment associated with preoperative grade B PVR.

Adolescent↗

Observer perception of skin color in a study of malignant melanoma.

Observer perceptions of skin color with a 15-step skin tone panel were evaluated during an as yet unpublished case-control study of malignant melanoma. Skin color is a risk factor for melanoma, and the skin tone panel was introduced in an effort to reduce its misclassification. Reflectances of the 15 artificial skin tones were measured at four wavelengths with a reflectance spectrophotometer. Six observers each evaluated the skin color of eight study subjects twice under three lighting conditions, and the results were transformed to reflectance values. Components of variance analysis demonstrated that between-subject variability contributed 63% or more of the variance at wave-lengths of 400-600 nm, while observers, light source, observation time, and error contributed 30% or less. At 700 nm, only 25.5% of the variance was due to subjects, indicating lower levels of reliability. Similarly, the correlation of visual and spectrophotometric assessment of skin reflectance was higher at 400-600 nm (r = 0.63-0.71) than at 700 nm (r = 0.41). Thus, the value of the skin tone panel-based assessments depends upon knowledge of which wavelengths most closely relate to the physiologic risk factor. For instance, reflectance at 650-700 nm is a better measure of skin melanin content than reflectance at lower wavelengths. Since the role of melanin as a risk factor remains in doubt, the utility of this technique has yet to be demonstrated. However, data from the case-control study and from this validity and reliability study will allow us to develop an analytic approach that minimizes misclassification of skin color as a confounder.

Analysis of Variance↗

The integumental profile: a reflection of the underlying skeletal configuration?

The aim of this study was twofold: (1) to evaluate the importance of the level of training in orthodontics when estimating skeletal configuration by visual inspection of the soft tissue profile, and (2) to evaluate a possible discrepancy between integumental profile (IP) and skeletal class (SC). Four test groups comprising 10 orthodontists (O), 10 senior assistants (S), 10 junior assistants (J), and 10 dentists (D) assessed horizontal and vertical skeletal pattern from a series of slides of 100 patients. The assessments were repeated after a 1-month interval. Cephalometric analysis was also carried out by using a number of conventional analyses. Analysis of the results with Levene's test, two factor mixed-design variance analysis, and Newman-Keuls' Multiple-Range test showed that (1) orthodontists, independent of their level of training, are more consistent in assessing an IP than dentists; (2) assessments were more consistent for sagittal profile than for vertical profile; (3) sagittally the Wits' appraisal corresponds best with IP, and (4) vertically the Steiner analysis corresponds best with IP.

Adolescent↗

Expression of glucocorticoid and progesterone nuclear receptor genes in archival breast cancer tissue.

BACKGROUND: Previous studies in our laboratory have shown associations of specific nuclear receptor gene variants with sporadic breast cancer. In order to investigate these findings further, we conducted the present study to determine whether expression levels of the progesterone and glucocorticoid nuclear receptor genes vary in different breast cancer grades. METHODS: RNA was extracted from paraffin-embedded archival breast tumour tissue and converted into cDNA. Sample cDNA underwent PCR using labelled primers to enable quantitation of mRNA expression. Expression data were normalized against the 18S ribosomal gene multiplex and analyzed using analysis of variance. RESULTS: Analysis of variance indicated a variable level of expression of both genes with regard to breast cancer grade (P = 0.00033 for glucocorticoid receptor and P = 0.023 for progesterone receptor). CONCLUSION: Statistical analysis indicated that expression of the progesterone nuclear receptor is elevated in late grade breast cancer tissue.

Breast Neoplasms↗

Validation of the Dutch Eating Behaviour Questionnaire parent version (DEBQ-P) in the Italian population: a screening tool to detect differences in eating behaviour among obese, overweight and normal-weight preadolescents.

OBJECTIVE: To validate the Dutch Eating Behaviour Questionnaire Parent version (DEBQ-P) in the Italian population and investigate the differences in eating behaviour among Italian normal-weight, overweight and obese preadolescents. DESIGN: A cross-sectional validation study. Participants were measured and the approved translation of the questionnaire was administered to their parents. SETTING: : Three school communities in the province of Bergamo, Northern Italy. SUBJECTS: A total of 312 preadolescents (mean age 12.9 y; s.d. 0.8, both sexes) from three secondary schools of the province of Bergamo, Northern Italy, and their parents were invited to participate to the study. Informed written consent was obtained from each subject and their parents. Students were measured and their parents filled in the approved translation of the DEBQ-P. Recruitment was opportunistic and school based. RESULTS: Factor and internal consistency analysis confirmed the factor structure of the DEBQ-P and the high internal consistency of its three scales. Variance analysis showed that eating behaviour of Italian normal-weight, overweight and obese preadolescents differs significantly only in regards to the 'restrained eating' scale (F 19.29, P < 0.001), with overweight and obese scoring higher. CONCLUSIONS: The DEBQ-P can be used for screening projects regarding eating behaviour in the Italian population. The association between restrained eating and weight status was confirmed for both sexes, but the relationship between external eating and emotional overeating and overweight requires further exploration.

Adolescent↗

A comparative in vitro study of the strength of directly bonded brackets using different curing techniques.

The aim of this study was to compare, by shear testing, the bond strengths after 1 and 24 hours of a light-cured resin (Enlight) and a light-cured glass ionomer cement GIC (Fuji Ortho LC) using various polymerization lamps (halogen, high performance halogen, xenon, and diode) for the direct bonding of brackets. The self-curing resin (Concise) was used as the control. The analysis was carried out using the SPSS program. For group comparison purposes, the single factor variance analysis (ANOVA) and the post-hoc test (Tukey's HSD) were used. The level of significance was established at P < 0.05. When comparing two mean values the t-test for independent random samples was employed. All polymerization lamps achieved the minimum bond strength of 5-8 MPa. With Enlight LV, bond strength was dependent on curing time (the halogen lamp achieved the highest bond strength of 10.0 MPa, P < 0.001, with a curing time of 40 seconds. The other lamps showed similar results) and on the mode of cure (the highest bond strength values were achieved by four-sided curing, P= 0.04). Fuji Ortho LC, on the other hand, was independent of the duration of light curing and the type of lamp used. The bond strengths of the resin-modified glass ionomer cement (RMGIC) were similar to or somewhat higher than those achieved with light-cured composite resin (P = 0.039) when lamps with short polymerization times were used, but were significantly lower (P< 0.001) when compared with the self-curing composite adhesive. After 24 hours, the bond strengths of all adhesives showed a significant increase: Enlight 19 per cent, Fuji Ortho LC 6.6 per cent, Concise 16 per cent. Bond failure occurred for Enlight at the bracket-composite resin adhesive interface in 90 per cent and with Concise in 57 per cent. However, Fuji Ortho LC showed far more cohesive and mixed failures, indicating an improved bond between bracket and cement.

Adhesives↗

Quality of life improves within 30 days of surgery for Crohn's disease.

BACKGROUND: The effect of surgery on quality of life (QOL) in the early postoperative period is important in Crohn's disease because of the multiple surgical procedures that patients undergo and the acute QOL benefits that might occur as a result of modifications of medical treatment. Earlier studies of the effect of surgery on QOL have been retrospective and assessed changes 3 to 24 months after surgery. This study prospectively assesses the effect of surgery on QOL in the early postoperative period. STUDY DESIGN: Patients requiring surgical management of sequelae of Crohn's disease were obtained from a prospectively entered database including data on QOL. Preoperative and 30-day postoperative QOL were determined in 82 patients using Cleveland Global Quality of Life (CGQL) scores (range from 0 [worst] to 10 [best possible] QOL). Preoperative and postoperative scores were compared using a paired t-test to determine the significance of any change in QOL after surgery. The effect of other variables on change in QOL after surgery was assessed using the t-test or analysis of variance. Multifactor analysis of variance was used to assess the effect of several independent variables. RESULTS: Eighty-two patients (41 women) of 142 patients who had had surgery (58%) had complete preoperative and 30-day postoperative scores. The incidence of complications was 23% (11% were major). There was a significant improvement in QOL 30 days after surgery as measured by CGQL (0.6 +/- 0.2 preoperative to 0.7 +/- 0.2 postoperative; mean +/- SD; p < 0.001). The mean preoperative CGQL was 0.56 +/- 0.24 and the mean improvement was 0.11 +/- 0.20 toward a better QOL. Female patients (p < 0.05) and those who did not develop complications within 30 days of surgery (p < 0.05) had a significantly greater improvement in CGQL after surgery than other groups. No other factor was predictive of improved outcomes. CONCLUSIONS: QOL as measured by CGQL improves early after surgery (30 days postoperatively). Improvement in CGQL is greater in female patients and patients who do not develop complications in the postoperative period. It is not affected by other patient characteristics, nature of disease, indication, or procedure performed. Most patients who undergo surgery for Crohn's disease feel that surgery has helped them and would undergo surgery again.

Adult↗