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PubMed2006

The first Italian trauma registry of national relevance: methodology and initial results.

OBJECTIVE: To describe and discuss the ongoing endeavor to establish a multiregional trauma registry in Italy. METHODS DESIGN: Prospective observational analysis by description and cohort comparison. SETTING: Three Italian hospitals, referral centers for severely traumatized patients. PATIENTS: trauma victims admitted between 1 July 2004 and 28 February 2005 with an Injury Severity Score >15 or requiring early admission to intensive care. INTERVENTIONS: None. MEASURES: Compilation rates for some 'sentry' variables. Total number of patients and Injury Severity Score. Ten widely used descriptive variables (type of trauma, mechanism of injury, age, gender, Injury Severity Score, Revised Trauma Score, Prognostic Severity Index, 'call-to-hospital' and 'admission-to-ward' intervals, and outcome at 30 days) measured in the subgroup with Injury Severity Score>15, in general and by hospital. RESULTS: A trauma registry has been established that fit the present organization of trauma care in Italy. It seems to compare well with the references available in the literature. Five hundred and forty-nine patients have been enrolled so far. The compilation rate has been well above 70% for all variables in all hospitals, except pre-hospital times in two hospitals. A substantial homogeneity exists among the hospitals in the general characteristics of the patients with Injury Severity Score>15. CONCLUSIONS: The project has achieved its goals so far. The previous estimates on the number of cases (about 300/year/hospital) are confirmed and major shortcomings in methodology seem unlikely. Therefore, positive future developments are possible: usage for quality improvement and research, linkage to other European registries and participation of other hospitals.

Adult↗
PubMed2002

Pairwise difference analysis in modern human origins research.

Pairwise difference analysis is a phenetic method that groups taxa on the basis of the number of differences they exhibit. Recently, pairwise difference analysis has been used to investigate the phylogenetic relationships of hominid fossils at the centre of the modern human origins debate. It has been argued that the results of these analyses disprove the African replacement model of modern human origins, and support instead its competitor, the multiregional evolution model. However, this inference is problematic because the ability of pairwise difference analysis to recover phylogenetic information from morphological data has not been demonstrated. With this in mind, we conducted pairwise difference analyses of craniodental and soft tissue evidence from a group of extant primates for which a reliable molecular phylogeny is available, the hominoids. We found that the phylogenies yielded by the pairwise difference analyses were incompatible with the molecular phylogeny for the group. Given the robustness of the molecular phylogeny, these results suggest that pairwise difference analysis cannot be relied on to generate reliable estimates of primate phylogeny from morphological data. The corollary of this is that the results of published pairwise difference analyses of hominid fossils are not informative regarding the origin of modern humans.

Africa↗
PubMed2005

Prevalence of rheumatoid arthritis in France: 2001.

BACKGROUND: Prevalence estimates of rheumatoid arthritis (RA) vary across Europe. Recent estimates in southern European countries showed a lower prevalence than in northern countries. OBJECTIVES: To estimate the prevalence of RA in France in a multiregional representative sample in the year 2001. METHODS: A two stage random sample was constituted in seven areas (20 counties) from the national telephone directory of households and by the next birthday method in each household. Patient-interviewers, member of self help groups, were trained to administer telephone surveys using a validated questionnaire for case detection of inflammatory rheumatism, and conducted the survey under quality control. All suspected cases of RA were confirmed by their rheumatologist or by clinical examination. Prevalence estimates after probability sampling correction were standardised for age and sex (national census 1999). RESULTS: An average response rate of 64.7% (two stages combined) led to a total of 9395 respondents. Standardised prevalence was 0.31% (95% confidence interval 0.18 to 0.48) for RA, 0.51% in women and 0.09% in men, with a higher age-specific prevalence in the 65-74 year age band. A geographical analysis of county clustering showed significant variation across the country. CONCLUSION: This national multiregional cooperative study demonstrates the usefulness of working in association with patients of self help groups. It showed a similar prevalence of RA to that of the spondyloarthropathies estimated concomitantly during the survey. It provides a reliable basis for definition of population targets for healthcare delivery and drug treatments.

Adolescent↗
PubMed1997

The selection of internal migration models for European regions.

"A full multiregional projection model requires migration data that are simultaneously classified by age and gender and region of origin and region of destination. Except for a very small number of regions, these data requirements are so high that aggregation of the data (which is equivalent to simplification of the model) is called for. This paper investigates the extent to which the full internal migration matrix can be simplified without seriously affecting the performance of the resulting multiregional model. Using IPF (iterative proportional fitting) methods, a log-linear analysis of alternative model specifications is made, using data for Italy, the Netherlands and the UK....A reasonable balance between goodness-of-fit and parsimony is found for the model in which time interacts with the main effects only (i.e. with age/sex, with origin and with destination)."

Age Factors↗
PubMed1999

Pain intensity processing within the human brain: a bilateral, distributed mechanism.

Functional imaging studies of human subjects have identified a diverse assortment of brain areas that are engaged in the processing of pain. Although many of these brain areas are highly interconnected and are engaged in multiple processing roles, each area has been typically considered in isolation. Accordingly, little attention has been given to the global functional organization of brain mechanisms mediating pain processing. In the present investigation, we have combined positron emission tomography with psychophysical assessment of graded painful stimuli to better characterize the multiregional organization of supraspinal pain processing mechanisms and to identify a brain mechanism subserving the processing of pain intensity. Multiple regression analysis revealed statistically reliable relationships between perceived pain intensity and activation of a functionally diverse group of brain regions, including those important in sensation, motor control, affect, and attention. Pain intensity-related activation occurred bilaterally in the cerebellum, putamen, thalamus, insula, anterior cingulate cortex, and secondary somatosensory cortex, contralaterally in the primary somatosensory cortex and supplementary motor area, and ipsilaterally in the ventral premotor area. These results confirm the existence of a highly distributed, bilateral supraspinal mechanism engaged in the processing of pain intensity. The conservation of pain intensity information across multiple, functionally distinct brain areas contrasts sharply with traditional views that sensory-discriminative processing of pain is confined within the somatosensory cortex and can account for the preservation of conscious awareness of pain intensity after extensive cerebral cortical lesions.

Adult↗
PubMed2000

Molecular analysis of Neanderthal DNA from the northern Caucasus.

The expansion of premodern humans into western and eastern Europe approximately 40,000 years before the present led to the eventual replacement of the Neanderthals by modern humans approximately 28,000 years ago. Here we report the second mitochondrial DNA (mtDNA) analysis of a Neanderthal, and the first such analysis on clearly dated Neanderthal remains. The specimen is from one of the eastern-most Neanderthal populations, recovered from Mezmaiskaya Cave in the northern Caucasus. Radiocarbon dating estimated the specimen to be approximately 29,000 years old and therefore from one of the latest living Neanderthals. The sequence shows 3.48% divergence from the Feldhofer Neanderthal. Phylogenetic analysis places the two Neanderthals from the Caucasus and western Germany together in a clade that is distinct from modern humans, suggesting that their mtDNA types have not contributed to the modern human mtDNA pool. Comparison with modern populations provides no evidence for the multiregional hypothesis of modern human evolution.

Animals↗
PubMed1993

The MEG in evaluation of generalized epilepsy.

This review looks at the magnetoencephalogram (MEG) studies on generalized epilepsy starting from the first cases investigated up to the most recent contributions regarding the photoconvulsive response and the results obtained applying the template analysis. As far as the spike-and-wave complex is concerned, in the cases both of photoconvulsive response and of non-generalized epilepsy, a primary multiregional participation of the cerebral cortex is shown, which, variable in time and often with a side prevalence, is alternated by bisynchronous epileptiform activity starting from midline structures.

Epilepsy, Generalized↗
PubMed2006

Higher HIV-1 incidence and genetic complexity along main roads in Rakai District, Uganda.

OBJECTIVE: To determine the association between the incidence of HIV-1 infection and the genetic complexity of HIV-1 strains in 2 geographic strata within Rakai District, Uganda. METHODS: Study volunteers with recent HIV-1 infections during the period 1997 through 2003 were recruited from 10 communities that were geographically stratified as a main road trading center (n = 5) or a secondary road trading village (n = 5). Cryopreserved plasma was available from 384 volunteers and was the source of viral RNA for genotyping by the multiregion hybridization assay. Hazard ratios (HRs) for a single HIV subtype, a recombinant form, or dual infection for gender and geographic strata were obtained using Cox proportional hazards analysis. RESULTS: The HIV-1 incidence rate during the period 1999 through 2002 was 1.3 per 100 person-years (PYs) in the trading centers and 1.1 per 100 PYs in the trading villages. The HR for infection with an HIV-1 recombinant strain in trading centers relative to trading villages was 2.3 (95% confidence interval [CI]: 1.0 to 6.7). Among those who changed residence between village strata, the HR for a recombinant HIV-1 infection was 8.1 (95% CI: 0.4 to 47.7). CONCLUSIONS: HIV-1 incidence and genetic complexity are associated with geographic strata and population mobility in Rakai District and are important variables to be considered in planning and recruitment for vaccine trials.

Adolescent↗
PubMed2005

Regional distribution and extent of perfusion abnormalities, and the lung to heart uptake ratios during exercise thallium-201 SPECT imaging in patients with cardiac syndrome X.

BACKGROUND: Cardiac syndrome X is defined as angina-like chest pain with transient ischemic ST-segment changes during exercise and angiographically normal epicardial coronary arteries. Studies with myocardial perfusion imaging in this syndrome have indicated that some patients, but not all, have an abnormality on perfusion scan. However, the impact of these perfusion abnormalities on pulmonary thallium uptake is not clear in this group of patients. OBJECTIVE: To evaluate the regional distribution and extent of perfusion abnormalities, and the lung to heart (L:H) uptake ratios using exercise thallium-201 single-photon emission computed tomography (TI-201 SPECT) in patients with cardiac syndrome X. METHODS: The study group consisted of 31 selected cardiac syndrome X patients with regional perfusion abnormalities during exercise TI-201 SPECT imaging. A control group included 26 healthy subjects with normal coronary angiograms, exercise testing and exercise TI-201 SPECT imaging. Exercise TI-201 SPECT results were analyzed with further estimation of the L:H ratios, number and localization of regional perfusion defects, and their mean extent scores expressed in pixels and in per cent of the left ventricular wall. Twenty-two patients with known coronary artery disease were also included in the analysis of the L:H ratios. RESULTS: Multiple perfusion defects were detected in 13 (42%) patients and perfusion defects of single localization were detected 18 (58%) patients. All patients had reversible perfusion abnormalities: 21 (67.7%) had anterior, 14 (45.2%) had inferior and 12 (38.7%) had lateral localization of perfusion defects. The analysis of the extent of the perfusion defects revealed that the mean scores of the extent of the single regional defects were 38.61+/-43.8 pixels and those of multiregional defects were 106.1+/-55.2 pixels, which corresponded to 6.05+/-1.8% and 16.6+/-5.4% of the left ventricular wall defects, respectively. Patients with cardiac syndrome X had a significantly higher L:H ratio during exercise than the healthy subjects (0.46+/-0.02 versus 0.34+/-0.03, P<0.01). In addition, L:H ratios were found to be higher in patients with multiple perfusion defects (0.50+/-0.02) than in patients who had only anterior (0.45+/-0.08) or inferior (0.43+/-0.02) perfusion defects (P<0.05 for both). There were no statistically significant differences in the rest L:H ratios between the study and control groups. Also, no significant differences were observed in exercise L:H ratios between the cardiac syndrome X patients and the patients with coronary artery disease (0.46+/-0.02 versus 0.49+/-0.03, P>0.05). CONCLUSIONS: The results suggest that multiple perfusion defects in multiple vascular regions are relatively common in cardiac syndrome X patients, with the majority of these patients having at least one abnormal perfusion bed. Patients with this syndrome who have perfusion abnormalities also had significantly higher L:H ratios during exercise than did the control patients. Increased exercise L:H ratios were more prominent in patients with multiple perfusion defects.

Adult↗
PubMed1991

MACOP-B for advanced stage large cell lymphoma (DLCL). More is better? Italian Multiregional Cooperative Study Group (IMCSGL).

A study of the predictive value for CR, DFS and OS of the presenting features was carried out on 180 patients with advanced stage DLCL treated with MACOP-B between June 1986 and March 1989. A multivariate regression analysis identified LDH level, bone marrow involvement and tumor burden as independent risk factors with a 4 year survival rate of 79%, 58% and 28% respectively. Therefore MACOP-B proved to be an adequate treatment for the first two groups of patients but not for the third which requires a more aggressive treatment. A sequential single drug high dose chemotherapy with collection of peripheral blood stem cell program followed by bone marrow harvesting, super-intensive radio-chemotherapy and bone marrow transplant has been activated. Seven patients have been so far enrolled: preliminary results demonstrated the feasibility of the program. A larger number of cases and a longer follow-up is required for assessing the efficacy of this approach.

Adolescent↗
PubMed1997

Multiregional introgressions inferred from the mitochondrial DNA phylogeny of a hybridizing species complex of gobiid fishes, genus Tridentiger.

Partial sequences of the cytochrome b gene (402 bp) in mtDNA were determined for brackishwater gobiid fishes, genus Tridentiger, collected from geographically distant locations in the Japanese Archipelago, and their interspecific and geographic variations were analyzed and compared. Contrary to the results of a previous allozyme analysis which revealed the existence of considerable genetic divergence (Nei's genetic distance > 0.5) between T. obscurus and T. brevispinis, the mtDNA haplotypes (mitotypes) of these two species were very similar and could not be distinguished by any of the neighbor-joining, maximum-likelihood or parsimony analyses. Hybrid individuals between the two species were also found, with several mitotypes being shared by both species and their hybrids. The phylogenetic relationships of mitotypes were divided into three subgroups, the geographical distributions of the latter being allied to geographical features of the Archipelago. These results suggested the occurrence of multiregional introgression between the two species, with mitotypes transferring from one species to the other.

Animals↗
PubMed2005

The effects of duration of caregiving on institutionalization.

PURPOSE: Our objective in this analysis was to determine how the duration of caregiving interacts with key care demands (i.e., severity of problem behaviors) to influence the institutionalization of individuals suffering from dementia. METHODS: We utilized multiregional data from 4,761 caregivers of individuals with dementia over a 3-year period. We conducted multinomial logistic and Cox proportional hazards analyses to determine the moderating effects of duration on behavior problems when institutionalization was predicted. Baseline covariates included the context of care, primary objective stressors, primary subjective stressors, resources, and global outcomes. RESULTS: The Duration of care x Behavior problems interaction term was not significant in the multinomial regression or Cox hazards models. However, main effects models demonstrated that more recent caregivers were more likely to institutionalize individuals with dementia than respondents in different stages of the caregiving career. IMPLICATIONS: The results emphasize the need to (a) broaden scientific conceptualizations to consider duration of care as integral; (b) refine targeting when interventions are administered early in the dementia caregiving process; and (c) understand patterns of attrition when caregiver adaptation is modeled over time.

Dementia↗
PubMedDate not supplied

A new perspective of human origin and dispersals derived from the microevolution of teeth.

Recent genetic studies have heightened the expectation that the origin of modern humans will be defined, but one clear vision has yet to be developed. The study of teeth has historically been an informative means to help define human dispersals. Quantitative tooth data is presented encompassing worldwide human populations. A null hypothesis phylogeny developed from the multivariate analysis of the microevolution of the dental phenotype was interpreted to be broadly in accord with the dominant interpretation of genetic, archaeological, and other dental data by showing that the first division in the dispersion of extant humanity was within sub-Sahara Africans; i.e., San, and Western Africans and Bantu. This "out-of-Africa" interpretation of the graphical results suggests that the first modern human African emigrants not to go extinct were Southeast Asian Negritos. All Eurasians then emerged and expanded through a series of extinct antecedent populations branching from the short lineage extending from Negritos to Australian aborigines. Caucasoids were the first group to fission from this stock. Under this hypothesis, the next to have emerged were antecedent Southeast Asians, from which present Southeast Asians and then antecedent east Central Asians then diverged. Independently, people from the region of Mongolia and all Native Americans arose as daughter populations from antecedent east Central Asians. The broad outline of humanity studied here cannot disprove the equally explanatory protean multiregional hypotheses, but with the inclusion of hominids and further modern human populations either parts of the multiregional hypothesis or the outlined more linear evolutionary scenario likely can be refuted.

Biological Evolution↗
PubMed2000

An Australasian test of the recent African origin theory using the WLH-50 calvarium.

This analysis investigates the ancestry of a single modern human specimen from Australia, WLH-50 (Thorne et al., in preparation; Webb, 1989). Evaluating its ancestry is important to our understanding of modern human origins in Australasia because the prevailing models of human origins make different predictions for the ancestry of this specimen, and others like it. Some authors believe in the validity of a complete replacement theory and propose that modern humans in Australasia descended solely from earlier modern human populations found in Late Pleistocene Africa and the Levant. These ancestral modern populations are believed to have completely replaced other archaic human populations, including the Ngandong hominids of Indonesia. According to this recent African origin theory, the archaic humans from Indonesia are classified as Homo erectus, a different evolutionary species that could not have contributed to the ancestry of modern Australasians. Therefore this theory of complete replacement makes clear predictions concerning the ancestry of the specimen WLH-50. We tested these predictions using two methods: a discriminant analysis of metric data for three samples that are potential ancestors of WLH-50 (Ngandong, Late Pleistocene Africans, Levant hominids from Skhul and Qafzeh) and a pairwise difference analysis of nonmetric data for individuals within these samples. The results of these procedures provide an unambiguous refutation of a model of complete replacement within this region, and indicate that the Ngandong hominids or a population like them may have contributed significantly to the ancestry of WLH-50. We therefore contend that Ngandong hominids should be classified within the evolutionary species, Homo sapiens. The Multiregional model of human evolution has the expectation that Australasian ancestry is in all three of the potentially ancestral groups and best explains modern Australasian origins.

Animals↗
PubMed2002

Focal retrograde amnesia documented with matching anterograde and retrograde procedures.

Focal retrograde amnesia is an unusual and theoretically challenging form of memory disorder. The case of a 65-year-old woman presenting with focal retrograde amnesia is reported. Following a cardiac arrest and subsequent hypoxia she remained in a coma for 24 h with evidence of epileptiform activity during the early recovery period. MR scans, 4 and 7 months post-onset, showed mild bifrontal atrophic changes mainly affecting white matter areas. An [18F]fluorodeoxyglucose resting PET scan 1-year post-onset demonstrated right occipito-temporo-parietal hypometabolism. We were able to document the patient's performance on an extensive range of anterograde and retrograde tests and to monitor her recovery of function by assessing her performance at 4, 12 and 24 months post-onset. Spared anterograde memory was observed on a range of verbal and non-verbal tests, including matched tasks that compared pre-illness and post-illness onset recollections. In contrast, her performance on retrograde memory tests, using detailed autobiographical and public events verbal and photographic tasks, showed a temporally-graded retrograde amnesia, more particularly affecting memory for autobiographical episodes. Possible mechanisms underlying CH's focal retrograde amnesia are discussed in terms of Damasio's time-locked multiregional retroactivation model.

Aged↗
PubMedDate not supplied

[Analysis of factors influencing the prediction of surgical treatment for symptomatic temporal lobe epilepsy].

The results of treatment were analyzed in 37 patients with drug-resistant symptomatic temporal lobe epilepsy among whom there were 22 patients with low-grade intracellular tumors, 2 with cavernomas; 6 with cortical malformations, and 9 with residual organic lesions. Double pathology was noted in 4 patients. Mono- and multiregional lesions were observed in 30 cases. Removal of the site of lesion, extended medial resections, and temporal lobectomy were performed in 7, 5, and 25 cases, respectively. There was an association of the quality of outcomes with the scope of an intervention: the best results were achieved when the affected area with adjacent cortical portions was completely removed within the eliptogenic area. Resections for multiregional lesions are low effective.

Adolescent↗