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Background Parental education is one of the best predictors of child school achievement. Higher parental education is not only associated with higher child intelligence, but children from highly educated parents also perform better in school due to other family related factors. This study evaluates the relation between parental education, child non-verbal intelligence and parenting practices with child school achievement. Methods Longitudinal data from a large population-based, multi-ethnic cohort of children in the Netherlands (63% Dutch origin) followed from birth to age 13 years (3547 children; 52.3% girls) were analyzed. School achievement was measured at the end of primary school (12 years of age) with a national Dutch academic test score. Parental education was assessed at age 3 years. The non-verbal intelligence of the child was measured at age 6 years and a full intelligence was measured at age 13 years. Maternal and paternal family routines, harsh parenting and corporal punishment were assessed in early and mid-childhood. Mediation analysis was performed with the G-formula and Structural Equation Models. Results Child intelligence partially mediated [B indirect effect =0.54 95% CI (0.46, 0.62) P Conclusions Higher parental education was associated with better school achievement through two independent mechanisms, through higher intelligence of the child and parenting practices.

Between March 5 and July 25, 2020, the total number of SARS-CoV-2 confirmed cases in Bosnia and Herzegovina (BH) was 10 090 corresponding to a cumulative incidence rate of 285.7 per 100 000 population. Demographic and clinical information on all the cases along with exposure and contact information was collected using a standardized case report form. In suspected SARS-CoV-2 cases, respiratory specimens were collected and tested by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR) assay. The dynamic of the outbreak was summarized using epidemiological curves, instantaneous reproduction number Rt and interactive choropleth maps for geographical distribution and spread. The rate of hospitalization was 14.0 % (790/5646) in Federation of Bosnia and Herzegovina (FBH) and 6.2 % (267/4299) in Republic of Srpska (RS). The death rate was 2.2% (122/5646) in FBH and 3.6% in the RS (155/4299). After the authorities lifted mandatory quarantine restrictions, the basic reproduction number increased from 1.13 on May, the 20th to 1.72 on May the 31st. The outbreak concerns both entities, Federation of Bosnia and Herzegovina and Republika Srpska, and it is more pronounced in those aged 20-44 years. It is important to develop the communication and emergency plan for the SARS-CoV-2 outbreak in BH, including the mechanisms to allow the ongoing notification and updates at the national level.

BACKGROUND: Non-medical use of prescription drugs is a major public health concern in the United States. Prescription opioids and sedatives are among the most widely abused drugs and their combined use can be lethal. Increasingly rigid prescribing guidelines may contribute to the changing context of opioid use and increase drug diversion. OBJECTIVE: To examine gender differences in diversion of prescription opioids and sedatives among non-medical prescription opioid and sedative polysubstance users. We hypothesize that men will be more likely than women to engage in incoming diversion. METHODS: Data from the Prescription Drug Abuse, Misuse, and Dependence Study, a cross-sectional study focused on prescription drug users, were analyzed. Non-medical use was defined as use of a drug that was not prescribed or use in a way other than prescribed. Individuals who reported past 12-month non-medical opioid and sedative use were included; diversion was defined as incoming (obtaining drugs from a source other than a health professional) and outgoing (giving away/selling/trading prescription drugs). RESULTS: Among the 198 polysubstance users, 41.4% were female. Men were 2.85 times as likely as women to report incoming diversion (95% CI: 1.21–6.72). Women were more likely to obtain opioids from a healthcare professional; men were more likely to obtain sedatives from a roommate, coworker, or friend. Over half of men and women reported outgoing diversion opioids or sedatives. CONCLUSION: Drug diversion highlights an important point of intervention. Current prevention efforts that target prescribers should be expanded to include users and diversion activities; these interventions should be gender-specific.

Non-medical use (NMU) of prescription opioids is of concern due to the opioid epidemic in the United States. Objective: We examined sex differences in the effect of age of first use of prescription...

textabstractAlthough results of animal research show that interactions between stress and sex hormones are implicated in the development of affective disorders in women, translation of these findings to patients has been scarce. As a basic step toward advancing this field of research, we analyzed findings of studies which reported circulating cortisol levels in healthy women in the follicular vs. luteal phase of the menstrual cycle. We deemed this analysis critical not only to advance our understanding of basic physiology, but also as an important contrast to the findings of future studies evaluating stress and sex hormones in women with affective disorders. We hypothesized that cortisol levels would be lower in the follicular phase based on the proposition that changes in levels of potent GABAergic neurosteroids, including allopregnanolone, during the menstrual cycle dynamically change in the opposite direction relative to cortisol levels. Implementing strict inclusion criteria, we compiled results of high-quality studies involving 778 study participants to derive a standardized mean difference between circulating cortisol levels in the follicular vs. luteal phase of the menstrual cycle. In line with our hypothesis, our meta-analysis found that women in the follicular phase had higher cortisol levels than women in the luteal phase, with an overall Hedges’ g of 0.13 (p < 0.01) for the random effects model. No significant between-study difference was detected, with the level of heterogeneity in the small range. Furthermore, there was no evidence of publication bias. As cortisol regulation is a delicate process, we review some of the basic mechanisms by which progesterone, its potent metabolites, and estradiol regulate cortisol output and circulation to contribute to the net effect of higher cortisol in the follicular phase.

Introduction: The dietary supplements are defined as vitamins and minerals or herbal products and are typically given in the form of a capsule or tablet. The nonsmokers are more attempted to use dietary supplements than individuals who smoke. Aim: In our investigation, we examined associations between vitamin B, folic acid, multivitamin or mineral intake among the student population and their correlation with smoking prevalence and drinking coffee. Materials and methods: We used a questionnaire to examine the general characteristics of the subjects, age, sex, their lifestyle, cigarette smoking, coffee intake and their use of dietary supplements. Data were collected from participants of the University of Sarajevo and a longitudinal study of 960 men and women aged 18-24 years from 2017 to 2018 was conducted. Results: The results showed that 32% of students took vitamin B supplements and 10% folic acid. In opposite, more than half of students took multivitamins (59.5%) and minerals (60.4%) less than one year. About a quarter or less took multivitamins (23.9%) and minerals (24.3%) for years. Less than 20% of students took multivitamins and minerals within a period of one year. In student population smoking prevalence was estimated at 21.2% and coffee intake in 71.2%. The smoking and use of vitamin B supplements were independent of each other, p = 0.201. The use of folic acid did not depend on smoking p = 0.501. There were no observed correlations between multivitamin and mineral supplement consumption compared to smoking status or drinking coffee. Conclusion: Deficient dietary intake of folic acid and B vitamins from food and supplemental sources appear to be one of the atherosclerosis incidences. Further studies should examine associations between dietary supplements intake and lifestyle of students, as well as smoking status and coffee intake.

Children with Autism Spectrum Disorder (ASD) often exhibit problematic eating behaviors, an observation mostly based on male dominated, clinical ASD study samples. It is, however, important to evaluate both children with an ASD diagnosis and children with subclinical autistic traits as both often experience difficulties. Moreover, considering the suggestion of a possible girl-specific ASD phenotype, there is a need to determine whether autistic traits are related with problematic eating behaviors in girls as well. This study explores the sex-specific association between autism (both autistic traits and diagnosed ASD) and eating behavior in middle childhood in Generation R, a prospective population-based cohort from fetal life onwards. We collected parental reports of autistic traits at six years (Social Responsiveness Scale) and of eating behavior at ten years (Children's Eating Behaviour Questionnaire). In this cohort of 3559 children, autistic traits at six years were associated with more Picky Eating, Emotional Eating and Food Responsiveness in later childhood (e.g. adjusted B for Picky Eating = 0.07; 95% CI: 0.03, 0.11). Stratified analyses showed that in girls, autistic traits were associated with more Emotional Overeating and Emotional Undereating (e.g. adjusted B for Emotional Undereating= 0.12; 95% CI: 0.04, 0.20), while no associations were found for boys. Results comparing children with and without an ASD diagnosis in the cohort largely confirm these associations (e.g. in girls, adjusted B for Emotional Undereating = 0.72; 95% CI: 0.01, 1.42). Our results point to a sex-specific association between autism and eating behavior in middle childhood. Also, our study is the first study to show that autistic traits are associated with emotionally based eating problems in girls and possibly represent part of a girl-specific ASD phenotype.

Objective The current analysis examines whether opioid use is associated with insomnia in a community sample, as the consequences of the growing epidemic of prescription opioid use continue to cause public health concern. Study design A cross-sectional study including 8433 members in a community outreach program, HealthStreet, in Northeast Florida. Methods Community Health Workers (CHWs) assessed health information, including use of opioids (i.e., Vicodin®, Oxycodone, Codeine, Demerol®, Morphine, Percocet®, Darvon®, Hydrocodone) from community members during field outreach. Insomnia was determined based on self-report: “Have you ever been told you had, or have you ever had a problem with insomnia?” Summary descriptive statistics were calculated and logistic regression modeling was used to calculate adjusted odds ratios (ORs) with 95% confidence intervals for insomnia, by opioid use status, after adjustment for demographics and other covariates. Results Among 8433 community members recruited (41% male; 61% Black), 2115 (25%) reported insomnia, and 4200 (50.3%) reported use of opioids. After adjusting for covariates, opioid users were significantly more likely to report insomnia than non-users (adjusted OR, 1.42; 95% CI, 1.25–1.61). Conclusion Insomnia was 42% more likely among those who reported using prescription opioids compared to those who did not. With one half of the sample reporting prescription opioid use, and a fourth reporting insomnia, it is important to further investigate the relationship between the two. Findings provide useful preliminary information from which to conduct further analyses.

Parental separation is a major adverse childhood experience. Parental separation is generally preceded by conflict, which is itself a risk factor for child problem behavior. Whether parental separation independent of conflict has negative effects on child problem behavior is unclear. This study was embedded in Generation R, a population-based cohort followed from fetal life until age 9 years. Information on family conflict was obtained from 5,808 mothers and fathers. The 4-way decomposition method was used to apportion the effects of prenatal family conflict and parental separation on child problem behavior into 4 nonoverlapping components. Structural equation modeling was used to test bidirectional effects of child problem behavior and family conflict over time. Family conflict from pregnancy onward and parental separation each strongly predicted child problem behavior up to preadolescence according to maternal and paternal ratings. Using the 4-way decomposition method, we found evidence for a strong direct effect of prenatal family conflict on child problem behavior, for reference interaction, and for mediated interaction. The evidence for interaction implies that prenatal family conflict increased the children’s vulnerability to the harmful effect of parental separation. There was no evidence of a pure indirect effect of parental separation on child problem behavior. Overall, results indicated that if parental separation occurs in families with low levels of conflict, parental separation does not predict more child problem behavior. Moreover, the bidirectional pattern suggested that child problem behavior influences the persistence of family conflict

Background: Previous studies have shown that poor family environments are related to more sleep problems; however, little is known about how family irregularity in early life affects the development of sleep problems over childhood using objective sleep measures. The current study tests the hypothesis that early family irregularity contributes to the development of sleep problems. Methods: This population-based study comprises 5,443 children from the Generation R Study. Family irregularity was measured with seven maternal-reported questions on family routines when children were 2 and 4 years old. Mothers reported on sleep problems at child age 3, 6, and 10 years, whereas children completed questionnaires on sleep problems at age 10. Additionally, we used tri-axial wrist accelerometers for five nights in 851 children (mean age 11.7 years) to assess sleep objectively. Results: Family irregularity was associated with more mother- and child-reported sleep problems at ages 3, 6, and 10 years as well as with a shorter sleep duration and later objective sleep onset, but not with sleep efficiency or waking time. The association between family irregularity and multi-informant subjective sleep problems at age 10 years was mediated by mother-reported child psychopathology at age 6 years. Conclusions: Our findings show a long-term robust association of preschool family irregularity with more sleep problems during childhood as well as shorter sleep duration and later sleep onset as measured objectively with actigraphy. In part, these sleep problems were associated with family irregularity by way of child psychopathology. These findings suggest that interventions improving preschool family irregularity, which are targeted to reduce child psychopathology, may also impact the development of sleep problems beneficially.

Schizophrenia and bipolar disorder (BD) are heritable disorders with similarities in clinical symptoms and typical onset after puberty. While research shows that impaired motor coordination can have an associationwith schizophrenia, there are limited data on childhood development preceding BD. Murray et al proposed a developmental model for similarities and dissimilarities between schizophrenia and BD, but it remains unknown if dissimilarities exist in early infancy and if they covary with genetic liability for these disorders. Using polygenic risk scores (PRSs),we exploredwhether genetic risk for schizophrenia and genetic risk for BD are associated with neuromotor development in infancy.

Concurrent use of prescription medications and alcohol is prevalent among older adults and impacts women more than men, however little is known about characteristics of older women who use both. The current analysis aims to evaluate those characteristics. Participants were recruited through HealthStreet, an outreach program. Community health workers (CHWs) assess health needs and concerns among community members. CHWs collect demographic, substance use, and other health data from participants. Female participants (≥ 50 years) interviewed November 2011–November 2017 were included and stratified into four groups: neither prescription opioid nor hazardous alcohol use (three or more drinks in a single day), hazardous alcohol use only, prescription opioid use only, and both prescription opioid and hazardous alcohol use. Chi square and ANOVA tests were used to compare these groups. Among the 2370 women (53% black; mean age 61 years), 70% reported neither prescription opioid nor hazardous alcohol use, 12% reported hazardous alcohol use only, 15% reported prescription opioid use only, and 3% reported use of both in the past 30 days. Concurrent prescription opioid and hazardous alcohol use were significantly associated with comorbid depression and anxiety (p

To investigate the potential role of interleukin 4 (IL-4), interleukin 10 (IL-10) and high-sensitivity C-reactive protein (hs-CRP) as serum biomarkers of persistent/recurrent disease in papillary thyroid carcinoma (PTC) with/without Hashimoto's thyroiditis (HT).Eighty consecutive patients (64 F/16 M, 43.2 ± 12.7 years) with PTC and 40 (37 F/3 M, 40.6 ± 12.3 years) with papillary thyroid carcinoma associated with Hashimoto's thyroiditis (PTC + HT) were evaluated before radioiodine therapy. A control group of 20 patients with HT without thyroid cancer (18 F/2 M, 47.3 ± 2.8 years) was included in the study for the comparison of cytokine levels.No meaningful differences were found in clinical outcomes between PTC and PTC + HT groups (47.5% vs. 45% persistent/recurrent disease). Serum IL-4, IL-10 and hs-CRP levels were higher in patients with persistent/recurrent disease compared to those without recurrence (p0.001). IL-4, IL-10 and hs-CRP were also found in substantially higher concentrations in PTC + HT patients with persistent/recurrent disease than in patients with HT or PTC (with or without recurrence) (p0.01). Positive correlations were observed between IL-4, IL-10, hs-CRP and thyroglobulin (Tg) (r between 0.48 and 0.56, p0.005) or antithyroglobulin antibodies (TgAb) (r between 0.63 and 0.80, p0.002) in PTC and PTC + HT patients with persistent/recurrent disease.Increased levels of serum IL-4, IL-10 and hs-CRP are associated with persistent/recurrent disease in PTC and PTC + HT patients. Our results suggest that these biomarkers might be used to improve patient stratification according to the risk of recurrence, especially in patients with PTC + HT, where Tg levels are not reliable due to presence of TgAb.

Signaling pathways involved in electrical, structural and contractile remodeling processes behind development and progression of atrial fibrillation (AF) have not been completely elucidated, but it seems to be related to complex interactions among neurohormonal and cellular mediators. We aimed to investigate interleukin-6 (IL-6), transforming growth factor-beta1 (TGF-β1), matrix metalloproteinase-9 (MMP-9), tissue inhibitor of metalloproteinase-1 (TIMP-1), as biomarkers of atrial remodeling, in patients with paroxysmal and persistent AF, and their correlation with N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and left atrial (LA) diameter.Thirty-seven patients (22M/15F) with paroxysmal AF, 32 patients (22M/10F) with persistent AF and 30 healthy control subjects (18M/12F) were enrolled in the study. Serum levels of biomarkers were measured by ELISA. Cardiac function was assessed echocardiographically.IL-6 levels and MMP-9/TIMP-1 ratio were significantly higher in AF patients than in non-AF controls (P .001), and in persistent than in paroxysmal AF (P .001), in line with NT-proBNP and LA diameter. In contrast, TGF-β1levels declined with increasing AF duration (from 51.2 pg/mL, IQR: 38.9-87.9 pg/mL in paroxysmal to 23.9 pg/mL, IQR: 16.9-43.6 pg/mL in persistent AF). TGF-β1 was negatively correlated with NT-proBNP (r = -0.53, P = .001 in paroxysmal AF and r = -0.71, P .001 in persistent AF) and LA diameter (r = -0.44, P = .006 in paroxysmal AF and r = -0.51, P = .003 in persistent AF).Our results demonstrate that AF development and progression (from paroxysmal to persistent) is associated with a gradual increase in serum levels of NT-proBNP, IL-6 and MMP-9/TIMP-1 ratio. Moreover, this study suggests that the relationship between TGF-β1, NT-proBNP and LA diameter allows for the progression of atrial remodeling during AF, despite compensatory changes in the TGF-β1 signaling pathway.

Background Renal insufficiency is one of the most serious renal diseases. Early diagnosis plays an essential role. Serum creatinine as a marker has had priority so far. The use of cystatin C for estimation of glomerular filtration rate has been recommended recently. There is a set of formulae which consolidates serum values of both creatinine and cystatin C. The study focuses on different formulae and their estimation for the purpose of better, faster, and more accurate diagnosis of renal insufficiency. Methods The sample consists of 75 examinees which are divided into three groups. The first group is made of patients with the glomerular filtration rate (GFR) 90 - 120 mL/minute/1.73m². The second group consists of patients with GFR 60 - 89 mL/minute/1.73m² and the third with GFR 30 - 59 mL/minute/1.73m². The exclusion criteria are the following: children and adolescents under the age of 20, pregnant women, patients on corticosteroid therapy and blockers of the distal tubular creatinine secretion. The five equations (GFR1-5) used in this research are: a Cockcroft-Gault equation - GFR1; a MDRD equation - GFR2; CKD-EPI - an equation based on cystatin C - GFR3; CKD-EPI - an equation based on cystatin C, adjusted according to the gender and age - GFR4; and CKDEPI - a combined equation based on cystatin C and creatitine, adjusted according to the age, gender, and race - GFR5. Upon acquiring the results, it is followed up with the statistical data analysis followed by graphs and tables. Results After data analysis, it is established that data distribution does not show normal distribution in each case, which leads to the use of nonparametric statistics. Depending on the stage of kidney injury there are different results regarding the difference in statistics of the used formulae. The highest sensitivity is recorded with the formulae GFR4 and GFR5. Then the increase in cystatin C levels increases sensitivity with the formulae GFR3 and GFR4. Conclusions As a result of this study, it is to be established that the formula of choice is the GFR3 - CKD-EPI formula based on serum cystatin C values, without adjustments. Its sensitivity, specificity, price, and feasibility are to be observed as parameters. Besides that, the increase in serum cystatin levels leads to the increase of sensitivity of the GFR3 formula, which could be an additional factor in the selection of formulae.

Recent literature focused on prescription opioids has neglected sex differences in use. Here, we evaluated the recent literature (since 2015) examining sex differences in prescription opioid use.Between 2015 and 2016, our review found only eight articles addressing sex differences in prescription opioid use mostly opioid misuse in North America among individuals with chronic pain. Risk factors included depression, pain, and polydrug use. In addition to that review, we had the opportunity to further address sex differences in, and risk factors for, prescription opioid use through a community engagement program, HealthStreet. Among the sample (n = 8525, Mage = 43.7 years, 58.6% women), approximately half reported use of prescription opioids. Women were significantly more likely to report lifetime use (54.9 vs. 42.2%; P 0.0001) and report cancer compared with men, yet, women with cancer had a significantly reduced risk of using opioids compared with men with cancer (odds ratio: 0.46; 95% confidence interval, 0.36-0.59).Only a few recently published studies analyzed sex differences related to prescription opioid use. Findings from the literature and our data suggest women are more likely to use prescription opioids compared with men. There is limited information on sex differences in opioid use risk factors and outcomes and more research in this area is warranted.

Introduction Symptomatic and etiopathologic heterogeneity of schizophrenia (SCH) and bipolar disorder (BD) can be adequately addressed using a dimensional approach to psychopathology, as well as interpreting physiological properties and markers as predictors of disease onset and relapse. Risk factors, genetic and environmental, are likely to modify the neurobiological processes characteristic of certain physiological processes that manifest to a greater degree of overlapping symptoms. One of the most common laboratory tests in psychiatric patients is a standard laboratory blood test. It gives us an insight into the general somatic condition of the patient. It assesses the ability to transport oxygen to tissues and carbon dioxide back to the lungs via erythrocytes (RBC) and hemoglobin (HGB) as their most important constituents, and is also an indicator of iron status and blood oxygenation. Aim Schizophrenia (SCH) and bipolar disorder (BD) are psychiatric disorders whose complex etiology and pathogenesis are still far from known. A correlation between red blood cell abnormalities and these diseases has been recognized in some studies. One of the most common laboratory tests in psychiatric patients is a standard laboratory blood test. However, so far there is a small number of published papers that relate to the relationship between laboratory parameters of blood and the aim of this paper is to reveal more light in this subject. Methods The research was done as an observational prospective clinical study that has evaluated different physiological and pathological parameters in patients with BD and SCH over a two-year period. A total of 159 patients with schizophrenia, 61 patients diagnosed with bipolar disorder and 82 healthy subjects participated in this study. Results At baseline, BD compared to SCH patients had higher mean lymphocyte count (2,6±0,7 vs. 2,0±0,6x109; p=0,006) and haemoglobin concentration (146,8±12,2 vs. 140,2±14,7 g/L; p=0,03), and significantly lower red cell distribution width (13,6±2,2 vs. 14,7±1,8%; p=0,008). In both BD and SCH patients there was a significant number of patients with low red blood cells count and low haemoglobin concentration, and high MCH and MCHC at baseline and at 3 and 6 months of follow up. Conclusions The finding that SCH as well as BD differed from controls with respect to red blood cells, hemoglobin, lymphocytes, and average platelet count was consistent with previous findings and could be understood as a qualitative measure in the evaluation of this sample. The fact that no association with other parameters was found, as well as an association with the diagnosis, does not exclude that these associations can be found in larger samples.

Background Morbidity and mortality attributed to prescription opioids are a crisis in the US and spreading globally. Sex differences related to these conditions have not been adequately assessed. Methods Through our community engagement program, data on demographics, health status, and substance use, including prescription opioids (e.g., Vicodin®, Oxycodone), were collected from community members in Florida (primarily North Central Florida) during a health needs assessment. Participants over 18 years of age were classified by opioid use: past 30-day, lifetime but not past 30-day, or no lifetime prescription opioid use. Descriptive statistics and chi-square tests were calculated, and multinomial logistic regression was used to calculate adjusted odds ratios (aOR; CI). Analyses were conducted for men and women separately to examine sex specific effects. Results Among 9221 community members assessed, the mean age was 45 years, 60% were female, and 58% were black. Respondents who endorsed past 30-day use and lifetime use were more likely to be female. Prescription sedative use was the strongest risk factor for past 30-day (aOR = 3.96; 95% CI, 3.35–4.68) and lifetime (aOR = 2.67; 95% CI, 2.34–3.04) prescription opioid use, regardless of sex. Other factors including marijuana use and history of cancer were significantly associated with prescription opioid use; they varied by sex. Conclusions The risk factors identified in this community sample provide additional information not accounted for by national studies. Future examinations of the consequences of concomitant opioid and sedative use, especially among women, are needed.

Non-medical use (NMU) of prescription opioids in youth is of concern since they may continue this pattern into adulthood and become addicted or divert medications to others. Research into risk factors for NMU can help target interventions to prevent non-medical use of opioids in youth.The National Monitoring of Adolescent Prescription Stimulants Study (N-MAPSS) was conducted from 2008 to 2011. Participants 10-18years of age were recruited from entertainment venues in urban, rural and suburban areas of 10 US cities. Participants completed a survey including questions on their use of prescription opioids. NMU was defined as a non-labeled route of administration or using someone else's prescription. Information on age, gender, alcohol, marijuana and tobacco use was also collected. Summary descriptive, chi-square statistics and logistic regression were conducted using SAS 9.4.Of the 10,965 youth who provided information about past 30day prescription opioid use, prevalence of reported opioid use was 4.8% with 3.2% reported as NMU (n=345) and 1.6% as medical use (MU) only (n=180). More males than females (55.7% vs. 44.4%) reported opioid NMU (p0.0001). Logistic regression revealed that among males (comparing NMU to MU only), current smokers were 4.4 times more likely to report opioid NMU than non-smokers (95% CI: 1.8, 10.7). Among females (comparing NMU to MU only), current smokers and alcohol users were more likely to report opioid NMU than those who had never smoked or used alcohol (OR=3.2, 95% CI: 1.4, 7.0 and OR=4.1, 95% CI: 1.7, 10.4, respectively).These results suggest that further research on gender differences in opioid NMU is needed; interventions for opioid NMU may need to be gender specific to obtain the best results.

BACKGROUND: Research of adults and school-aged children suggest a neurodevelopmental basis for psychiatric disorders. We examined whether infant neuromotor development predicted internalizing and externalizing problems in young children. METHODS: In Generation R, a population-based cohort in the Netherlands (2002–2006), trained research assistants evaluated the neuromotor development of 4006 infants aged 2 to 5 months by using an adapted version of Touwen’s Neurodevelopmental Examination (tone, responses, and senses and other observations). We defined nonoptimal neuromotor development as scores in the highest tertile. Mothers and fathers rated their children’s behavior at ages 1.5, 3, 6, and 10 years with the Child Behavior Checklist (n = 3474, response: 86.7%). The associations were tested with generalized linear mixed models. RESULTS: Overall, neuromotor development predicted internalizing scores, but no association was observed with externalizing scores. Nonoptimal muscle tone was associated with higher internalizing scores (mothers’ report: β = .07; 95% confidence interval [CI]: 0.01 to 0.13; fathers’ report: β = .09, 95% CI: 0.00 to 0.16). In particular, nonoptimal low muscle tone was associated with higher internalizing scores (mothers’ report: β = .11; 95% CI: 0.05 to 0.18; fathers’ report: β = .13; 95% CI: 0.04 to 0.22). We also observed an association between senses and other observations with internalizing scores. There was no relationship between high muscle tone or reflexes and internalizing scores. CONCLUSIONS: Common emotional problems in childhood have a neurodevelopmental basis in infancy. Neuromotor assessment in infancy may help identify vulnerability to early internalizing symptoms and offer the opportunity for targeted interventions.

In a longitudinal population-based study of 2,905 children, we investigated if infants' neuromotor development was associated with autistic traits in childhood. Overall motor development and muscle tone were examined by trained research assistants with an adapted version of Touwen's Neurodevelopmental Examination between ages 2 and 5 months. Tone was assessed in several positions and items were scored as normal, low, or high tone. Parents rated their children's autistic traits with the Social Responsiveness Scale (SRS) and the Pervasive Developmental Problems (PDP) subscale of the Child Behavior Checklist at 6 years. We defined clinical PDP if scores were98th percentile of the norm population. Diagnosis of autism spectrum disorder (ASD) was clinically confirmed in 30 children. We observed a modest association between overall neuromotor development in infants and autistic traits. Low muscle tone in infancy predicted autistic traits measured by SRS (adjusted beta = 0.05, 95% CI for B: 0.00-0.02, P = 0.01), and PDP (adjusted beta = 0.08, 95% CI for B: 0.04-0.10, P 0.001). Similar results emerged for the association of low muscle tone and clinical PDP (adjusted OR = 1.36, 95% CI: 1.08-1.72, P = 0.01) at age 6 years. Results remained unchanged if adjusted for child intelligence. There was no association between high muscle tone and SRS or PDP. Exclusion of children with ASD diagnosis did not change the association. This large study showed a prospective association of infant muscle tone with autistic traits in childhood. Our findings suggest that early detection of low muscle tone might be a gateway to improve early diagnosis of ASD. Autism Res 2017, 10: 757-768. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

SUMMARYWe report an outbreak associated with a dinner cruise on Lake Michigan. This took place on the same day as heavy rainfall, which resulted in 42·4 billion liters of rainwater and storm runoff containing highly diluted sewage being released into the lake. Of 72 cruise participants, 41 (57%) reported gastroenteritis. Stool specimens were positive for Shigella sonnei (n=3), Giardia (n=3), and Cryptosporidium (n=2). Ice consumption was associated with illness (risk ratio 2·2, P=0·011). S. sonnei was isolated from a swab obtained from the one of the boat's ice bins. Environmental inspection revealed conditions and equipment that could have contributed to lake water contaminating the hose used to load potable water onto the boat. Knowledge of water holding and distribution systems on boats, and of potential risks associated with flooding and the release of diluted sewage into large bodies of water, is crucial for public health guidance regarding recreational cruises.

In April 2009, following the first school closure due to 2009 pandemic influenza A (H1N1) (pH1N1) in Chicago, Illinois, area hospitals were inundated with patients presenting with influenza-like illness (ILI). The extent of disease spread into the surrounding community was unclear. We performed a household survey to estimate the ILI attack rate among community residents and compared reported ILI with confirmed pH1N1 cases and ILI surveillance data (ie, hospital ILI visits, influenza testing, and school absenteeism). The estimated ILI attack rate was 4.6% (95% confidence interval, 2.8%-7.4%), with cases distributed throughout the 5-week study period. In contrast, 36 (84%) of 43 confirmed pH1N1 cases were identified the week of the school closure. Trends in surveillance data peaked during the same week and rapidly decreased to near baseline. Public awareness and health care practices impact standard ILI surveillance data. Community-based surveys are a valuable tool to help assess the burden of ILI in a community.

Adenoid cystic carcinoma of the breast is a rare subtype of breast cancer with basal-like features. Published studies on breast adenoid cystic carcinoma are limited, resulting in relatively scarce information on the value of predictive tumor markers. We studied 20 primary cases of adenoid cystic carcinoma of the breast for expression of estrogen receptor, progesterone receptor, androgen receptor, epidermal growth factor receptor, HER-2/neu, and topoisomerase IIα using immunohistochemistry and fluorescent in situ hybridization methods. Estrogen and progesterone receptor expression were detected in 1 case each. All tumors were uniformly negative for Her-2/neu expression. Androgen receptor and topoisomerase IIα expression were weakly positive in three cases and 7 cases, respectively. Epidermal growth factor receptor overexpression was detected in 13 cases (65% of all cases). Amplification of TOP2A or HER- 2/neu gene was not detected in any of the cases. Our study shows that the majority of adenoid cystic carcinomas of the breast do not overexpress Her-2/neu, topoisomerase IIα, or estrogen receptor, and thus, they are unlikely to respond to therapies targeting these proteins. However, these tumors frequently over-express epidermal growth factor receptor, indicating a potential benefit from anti-epidermal growth factor receptor therapy for patients with advanced adenoid cystic carcinomas of the breast.

BACKGROUND: In pulmonary arterial hypertension (PAH), adding oral sildenafil to intravenous epoprostenol improved 6-minute walk distance (6MWD) and hemodynamics and delayed time to clinical worsening in a 16-week randomized, placebo-controlled trial (Pulmonary Arterial Hypertension Combination Study of Epoprostenol and Sildenafil [PACES-1]). METHODS: Patients completing PACES-1 could receive sildenafil (titrated to 80 mg, three times daily, as tolerated) in an open-label extension study (PACES-2) for ≥ 3 years; additional therapy was added according to investigator judgment. Survival and changes from PACES-1 baseline in World Health Organization Functional Class and 6MWD were captured. RESULTS: In an open-label setting, 6MWD, an effort-dependent outcome measure, was known to have improved or to have been maintained in 59%, 44%, and 33% of patients at 1, 2, and 3 years, respectively; functional class was known to have improved or to have been maintained in 73%, 59%, and 46%. At 3 years, 66% of patients were known to be alive, 24% were known to have died, and 10% were lost to follow-up. Patients with PACES-1 baseline 6MWD < 325 meters without 6MWD improvement during the first 20 weeks of sildenafil treatment subsequently had poorer survival. CONCLUSIONS: Although reliable assessments of safety and efficacy require a long-term randomized trial, the addition of sildenafil to background intravenous epoprostenol therapy appeared generally to be well tolerated in PAH patients.

Retrospective study was conducted in surgical intensive care unit (ICU) in Clinical Hospital Center Zagreb in 2005. The aim of study was to create guidelines for empirical antibiotic therapy of sepsis in ICU for unknown causative agent based on antimicrobial susceptibility of causative bacteria.Thirty-two patients with severe sepsis were included in study and from medical records their clinical and microbiological data were analyzed. Antimicrobial susceptibility of the strains isolated from the blood-culture was tested by disk diffusion method according to CLSI (Clinical Laboratory Standard Institution). We used APACHE II score to predict the severity of illness. Mann-Whitney test and χ2 test were used to test statistical significance difference between results.Acinetobacter baumannii and Pseudomonas aeruginosa were the predominant causative agent. Acinetobacter baumannii was displaying excellent susceptibility to ampicillin+sulbactam and carbapenems, whereas Pseudomonas aeruginosa was showed good susceptibility on ceftazidim and carbapenems. Methicillin-resistant Staphylococcus aureus (MRSA), third predominant causative agent exhibiting good susceptibility to vancomycin and linezolide.The recommended therapy is empirical antibiotic therapy and should cover all important pathogens.

The aim of this study was to investigate expression of cyclin D1, bcl-2, p53, Ki-67 and HER-2 proteins in 14 cases of non-small cell lung cancer and to establish their correlation to classical clinico-pathological findings, and alleged prognostic value to estimate biological potential of tumor. Retrospective pilot study of the surgically treated non-small cell lung cancer biopsy specimen, paraffin embedded, used immu-nohistochemical method to demonstrate expression of cyclin D1, bcl-2, p53, Ki-67 and HER-2. Protein quantification was performed by the semi-quantitative method. Achieved results were correlated with classical clinico-pathological parameters, like tumor size, histological type, differentiation level, presence ofvascular invasion and metastasis in regional lymph nodes. Out of 14 cases of non-small cell lung cancer, squamous cell carcinoma was found in 7 patients, giant cell carcinoma in 3, adenocarcinoma in 2, and 1 case of pleomorphic and mucoepidermoid carcinoma. Expression of cyclin D1 was not found, while expression of HER-2 and bcl-2 protein was established in one cases each. p53 expression was noted in 8 cases (57,1%). Statistically positive significant correlation (p

In primary care, collecting information about patient health behaviors between appointments can be advantageous. Physicians and researchers who embrace phone-based technology may find valuable ways to monitor patient-reported outcome measures of health (PROM). However, the level of phone technology sophistication should be tailored to the phone use of the population of interest. Despite the growing use of telephones as a means to gather PROM, little is known about phone use among primary care patients. As part of an ongoing study, the authors recruited primary care patients (N = 9126) for a health behavior screening study by calling them on the primary contact number listed in their medical record. The current study evaluated the frequency with which individuals were reached on landlines, basic cell phones, and smartphones, and examined participant characteristics. The majority of participants (63%) used landlines as their primary contact. Of the 37% using cell phones on the recruitment call, most (71%) were using smartphones. Landline users were significantly older than cell phone users (61.4 vs. 46.2 years; P = .001). Cell phone use did not differ significantly between participants with a college education and those without (37% vs. 38%; P = .82); however, smartphone use did differ (61% vs. 77%; P = .01). The majority of participants sampled used landlines as their primary telephone contact. Researchers designing phone-based PROM studies for primary care may have the broadest intervention reach using interactive voice response telephone technology, as patients could report health outcomes from any type of phone, including landlines. (Population Health Management 2016;19:212-215).

Background: The long-term safety and tolerability of sildenafil treatment of pulmonary arterial hypertension (PAH) were assessed. Methods: Two hundred fifty-nine of 277 randomized and treated patients completed a 12-week, double-blind, placebo-controlled trial (SUPER-1 [Sildenafil Use in Pulmonary Arterial Hypertension]) of oral sildenafil in treatment-naive patients with PAH (96% functional class II/III) and entered an open-label uncontrolled extension study (SUPER-2) that continued until the last patient completed 3 years of sildenafil treatment. Patients titrated to sildenafil 80 mg tid; one dose reduction for tolerability was allowed during the titration phase. Results: The median duration of sildenafil treatment across SUPER-1 and SUPER-2 was 1,242 days (range, 1-1,523 days); 170 patients (61%) completed both studies, and 89 patients discontinued from SUPER-2. After 3 years, 87% of 183 patients on treatment were receiving sildenafil 80 mg tid. Of patients remaining under follow-up, 3%, 10%, and 18% were receiving a second approved PAH therapy at 1, 2, and 3 years, respectively. At 3 years post-SUPER-1 baseline, 127 patients had an increased 6-min walk distance (6MWD); 81 improved and 86 maintained functional class. Most adverse events were of mild or moderate severity. At 3 years, 53 patients had died (censored, n 5 37). Three-year estimated survival rate was 79%; if all censored patients were assumed to have died, 3-year survival rate was 68%. No deaths were considered to be treatment related. Conclusions: Long-term treatment of PAH initiated as sildenafil monotherapy was generally well tolerated. After 3 years, the majority of patients (60%) who entered the SUPER-1 trial improved or maintained their functional status, and 46% maintained or improved 6MWD.

Within a population-based study of 3356 children, we investigated whether infant neuromotor development was associated with cognition in early childhood. Neuromotor development was examined with an adapted version of Touwen's Neurodevelopmental Examination between 9 and 20 weeks. Parents rated their children's executive functioning at 4 years. At age 6 years, children performed intelligence and language comprehension tests, using Dutch test batteries. At age 6-9 years, neuropsychological functioning was assessed in 486 children using the validated NEPSY-II-NL test battery. We showed that less optimal neurodevelopment in infancy may predict poor mental rotation, immediate memory, shifting, and planning; but not nonverbal intelligence or language comprehension.

BACKGROUND: SCC (squamous cell carcinoma) antigen (SSCA), a tumor marker, is already used for the diagnosis and follow-up of carcinoma of the cervix and lungs. The aim of our study was the determination of SCCA concentration in 96 serum samples using CMIA (chemiluminesecent microparticle immnoassay) on an Architect i2000 (Abbott Diagnostics) and MEIA (microparticle enzyme immnoassay) on an IMx Chemistry Analyzer (Abbott Diagnostics). METHODS: In our investigation we used a CMIA (chemiluminesecent microparticle immnoassay) Architect i2000 and MEIA (microparticle enzyme immnoassay) Imx Chemistry Analyzer for SCCA determination. RESULTS: All patients were hospitalized at the Department of Gynecologic Oncology and Department for Oncology at the University Clinics Center of Sarajevo. The normal serum range of SCCA should be < 0.1 microg/L. The quality control, precision and accuracy of the Architect i2000 were assessed. The quality control was done using quality control serums for low (X = 2.17 microg/L), medium (X = 10.23 microg/L), and high (X = 48.99 microg/L) range. The precision for the Architect i2000 has a CV of 3.44% to 4.44%. We established that the main difference between Architect i2000 and IMx was statistically significant at p < 0.05 according to Student's t-test. The correlation coefficient was r = 0.990. The some samples have higher concentrations on the Architect than on the IMx because the sensitivity of the Architect assay is high (< 0.1 microg/L). CONCLUSIONS: The CMIA Architect technology is an applicable method significant in diagnostic of SCCA.

Many authors have written about the participation of women in WW2 in Bosnia and Herzegovina, mostly in health care. Participation of Bosnian and Herzegovinian women in the 1992-1995 war was also significant. According to Army of Bosnia and Herzegovina data, there were 5360 recruited women. Some were engaged in logistics and some were fighters. This review presents the characters of the brave women who have inspired current generations.

The lithium ions concentration in human serum and saliva was determined using dry-slide technology Vitros 250 Analyser (Ortho Clinical Diagnostic) and atomic absorption spectrometry Perkin Elmer 403 (AAS). We analyzed lithium ions in 100 serum and saliva specimens of patients after oral administration of lithium carbonate (3 x 300 mg) Jadran, Galen Laboratory Rijeka. Saliva and blood were taken 2 and 12 hours after the last dose. At the same time lithium ions at samples of blood and saliva were determined with both methods which showed high level of correlation. The mean difference of lithium ions between saliva and serum was statistically significant for p

Inhaled human insulin (Exubera; EXU) has shown encouraging tolerability in short-term trials. We evaluated the safety profile of EXU after long-term exposure.In two, open-label, 2-year studies patients poorly controlled on a sulphonylurea were randomised to adjunctive EXU or metformin (study 1) and patients poorly controlled on metformin were randomised to adjunctive EXU or the sulphonylurea, glibenclamide (study 2).The studies included 446 (study 1) and 476 (study 2) patients with type 2 diabetes, no clinically significant respiratory disease and glycosylated haemoglobin (HbA(1c)) levels of 8-12%.Main outcome measures were pulmonary function tests and insulin antibody assays.A total of 109 patients (study 1) and 195 patients (study 2) completed 104 weeks treatment. In both studies, small treatment group differences in change from baseline forced expiratory volume in 1 s were greatest at 6 months (first time-point measured) and less at later visits, and reversed on treatment discontinuation. At 2 years, differences in mean changes were -0.10 and -0.01 l in studies 1 and 2, respectively, and -0.04 l for the pooled studies. There was no discernable effect of long-term EXU therapy on pulmonary gas exchange. Insulin antibody binding reached a plateau at 6 months and did not correlate with HbA(1c) or lung function changes. Glycaemic control was maintained over 2 years.Exubera was well tolerated during long-term use. Pulmonary function changes compared with comparator groups were small, non-progressive and reversed upon treatment discontinuation. Importantly, rates of lung function change were indistinguishable between EXU and comparator after 6 months of therapy.

The lithium ions concentration in human serum was determined using Dry-slide technology Vitros 250 Analyser (Ortho Clinical Diagnostic), atomic absorption spectrometry (AAS) method Perkin Elmer 403 and ion-selective electrode (ISE) potentiometry AVL 9181. We compared lithium ions results in sample sera between these methods. Our reference method was AAS. We analyzed lithium ions concentration in 23 sera samples of patients after oral administration of lithium carbonate (3x 300mg) Jadran, Galen Laboratory Rijeka, by dry-slide technology, AAS and ISE methods. The quality control, precision, reproducibility and accuracy for Vitros dry slide technology were assessed. We established that the main difference between AAS method and dry slide technology was not statistically significant at p< 0.05 according to Student t-test. Therefore, the dry slide technology may be a useful alternative or it may even replace other methods, such as AAS. The main difference between dry slide technology and ISE methods was statistically significant at p

To compare the effects of propiverine and oxybutynin on ambulatory urodynamic monitoring (AUM) parameters, safety, and tolerability in patients with overactive bladder.This was a randomized, double-blind, placebo-controlled, multicentre, crossover study. Patients (n = 77) received two of the following treatments during two 2-week periods: propiverine 20 mg once daily, propiverine 15 mg three times daily, oxybutynin 5 mg three times daily, and placebo. AUM parameters, salivary flow, visual near point, and heart rate were assessed.A consistent order in the efficacy between active treatment groups was observed for the reduction in mean involuntary detrusor contractions (IDCs; oxybutynin 15 mg/= propiverine 45 mg/= propiverine 20 mg). Differences between the oxybutynin and propiverine 20 mg groups were statistically significant for several AUM endpoints. Statistically significant differences between the oxybutynin and both propiverine groups were also noted in salivary flow rate and heart rate (oxybutynin 15 mgboth propiverine regimens) and in heart rate variability (both propiverine regimensoxybutynin 15 mg). All active treatments lengthened visual near point. The incidence of dry mouth was significantly more pronounced in the oxybutynin group than in either propiverine group. Treatment with propiverine 45 mg resulted in the highest rates of constipation, lengthening of the visual near point, and effects on heart rate.Oxybutynin 15 mg was more effective than propiverine 20 mg in reducing symptomatic and asymptomatic IDCs in ambulatory patients. The primary differences between the two drugs were the incidence and type of adverse events, which varied with the antimuscarinic receptor specificity of each agent.

To compare the efficacy and safety profile of adding inhaled human insulin (INH; Exubera) or metformin to sulfonylurea monotherapy in patients with poorly controlled type 2 diabetes.We performed an open-label, parallel, 24-week, multicenter trial. At week -1, patients uncontrolled on sulfonylurea monotherapy were divided into two HbA(1c) (A1C) arms:or =8 toor =9.5% (moderately high) and9.5 toor =12% (very high). Patients were randomized to adjunctive premeal INH (n = 225) or metformin (n = 202). The primary efficacy end point was change in A1C from baseline.In the A1C9.5% arm, INH demonstrated a significantly greater reduction in A1C than metformin. Mean adjusted changes from baseline were -2.17 and -1.79%, respectively; between-treatment difference was -0.38% (95% CI -0.63 to -0.14, P = 0.002). In the A1Cor =9.5% arm, mean adjusted A1C changes were -1.94 and -1.87%, respectively (-0.07% [-0.33 to 0.19], P = 0.610), consistent with the noninferiority criterion. Hypoglycemia (events/subject-month) was greater in the INH (0.33) than in the metformin (0.15) group (risk ratio 2.16 [95% CI 1.67-2.78]), but there were no associated discontinuations. Other adverse events, except increased cough in the INH group, were similar. At week 24, changes in pulmonary function parameters were small and comparable between groups. Insulin antibody binding increased more with INH but did not have any associated clinical manifestations.In patients with type 2 diabetes poorly controlled on a sulfonylurea (A1C9.5%), the addition of premeal INH significantly improves glycemic control compared with adjunctive metformin and is well tolerated.

This systematic review considers the most recent attitudes and news regarding the influence of the stroma on tumor initiation and progression. It is now widely accepted that tumor stroma plays an active role in carcinogenesis. Many different signaling molecules, ligands and signaling pathways recently have been discovered. This review considers the complexity of interactions between malignant cells and its stroma (cross-talk). The recent advances and better understanding of the tumor-stroma interactions will have important impact on the new and combined therapeutic approaches and modalities.

INTRODUCTION Accommodative Convergence/Accommodation (AC/A) ratio is constant at one and the same person in the course of life, i.e. the same ratio accommodative convergence monitor any change in accommodation measured in diopters. Such a perfect relationship is possible if there are no refractive anomalies in both eyes and oculomotor imbalance of eye muscles. MATERIAL AND METHODS We are examined 50 patients with close brain injury, and patients which had problems with near vision, accommodation and convergency were reducted, with loss motor fussion, and preserved stereoscopis vision, and showed us, that disturbances are clear motor and folowed with incapable of patient to hold of superposition view to watching object. RESULTS The difference in average proximity distance vision and reading time with no fatigue after 6 months a statistically significant, the value of t-test, t = 1873 for p

Purpose: To evaluate whether determining graft-host trephine disparity on the basis of videokeratoscopic data of keratoconus patients having penetrating keratoplasty (PKP) reduces ametropia and to correlate preoperative videokeratoscopic values, posterior axial length (PAL), and trephine disparity with postoperative refractive outcomes. Setting: Hotel-Dieu, University of Paris, France. Methods: This randomized clinical trial comprised 18 keratoconus patients who had PKP. After computerized videokeratoscopic analysis, patients were randomly assigned to a test or control group with matching for midperipheral corneal keratoscopic criteria. One surgeon performed all grafts using the same technique (except for donor button punching with an 8.00 or 8.25 mm blade, depending on preoperative keratoscopy) with suction trephination (8.00) and a running 10-0 nylon suture. The PAL (total axial length minus the distance from the anterior corneal surface to the anterior lens surface) was measured by applanation ultrasonography. Refraction and videokeratoscopic analysis were done 18 months postoperatively (6 months after suture removal). Results: The mean deviation from emmetropia corrected for PAL in test group patients who had trephine sizing based on the hypothesis that preoperative videokeratoscopy is a useful determining factor was 1.12 diopters (D) ± 0.74 (SD), which was significantly smaller (P = .005) than that in the control group (2.19 ± 0.85 D). The test group had uncorrected visual acuities of 20/50 or better. Postoperative spherical equivalent was affected by PAL (P = .0001), preoperative keratoscopy (P = .0001), and trephine disparity (P = .01). Central corneal power after grafting was influenced by keratoscopy (P = .0001) and trephine disparity (P = .002). Uncorrected visual acuity was affected by PAL (P = .001) and keratoscopic data (P = .01). Conclusions: Parameters for reducing ametropia after grafting of keratoconus patients can be developed for each surgeon based on trephine disparity dependent on preoperative keratoscopic values of the recipient midperipheral cornea and PAL. If the PAL is between 19.0 and 21.0 mm, preoperative midperipheral corneal videokeratoscopy to choose same-size or 0.25 mm different donor and recipient trephine blades is useful to achieve refractive results approximating emmetropia with the described technique.

Purpose: The authors performed a prospective, randomized clinical trial to compare postoperative astigmatism and visual rehabilitation after penetrating keratoplasty with and without intraoperative suture adjustment. Methods: Twenty-five patients undergoing penetrating keratoplasty for avascular corneal pathology randomly were assigned to two groups. All surgery was performed by one surgeon (ONS) using the same technique (except for intraoperative suture adjustment) with Hanna trephination (8 mm) and a running 10-0 nylon suture. Postoperative suture adjustment was done during the first postoperative month in all patients who had more than 3.5 diopters of astigmatism. Refraction and computerized topographic analysis were performed at 1 and 6 months postoperatively. Results: Intraoperative suture adjustment significantly decreased postkeratoplasty topographic ( P = 0.0001) and refractive ( P = 0.0001) astigmatism and improved best spectacle-corrected visual acuity ( P = 0.0019) during the first postoperative month. Seventy-seven percent of control patients (mean topographic astigmatism, 4.89 ± 1.99 D at 1 month), but no patients who underwent intraoperative suture adjustment (mean topographic astigmatism, 1.50 ± 0.74 D at 1 month), required at least one postoperative suture adjustment that delayed optical stability and increased postoperative complications. At 6 months postoperatively, mean topographic ( P = 0.06) and refractive ( P = 0.0001) astigmatism were smaller in the intraoperatively adjusted group than in the control group with postoperative suture adjustments. After intraoperative adjustment, best spectacle-corrected visual acuity was better ( P = 0.0168, P = 0.0434) and corneal topography was more regular ( P = 0.02, P = 0.07, NS) at 1 and 6 months, respectively, than after postoperative adjustment. Conclusion: Visual rehabilitation with decreased postkeratoplasty astigmatism and more regular corneal topography was attained more rapidly and safely with intraoperative suture adjustment.

There recently have been several reports of microsporidial keratoconjunctivitis caused by the organism Encephalitozoon hellem. However, treatment of this infection has been largely ineffective. We report a case of a 35-year-old Hispanic woman with AIDS and E. hellem keratoconjunctivitis confirmed with light, electron, and immunofluorescence microscopy that resolved promptly with topical fumagillin, a crystalline antibiotic with proven efficacy against Encephalitozoon species. No corneal or systemic toxicities were noted using the dosage and preparation employed (10 mg/ml suspension in balanced salt solution). An easily prepared, topical fumagillin suspension appears to be a safe, effective treatment for E. hellem keratoconjunctivitis.

We studied the clinicopathologic features of seven patients with acquired immunodeficiency syndrome (AIDS) and ocular microsporidiosis. All patients had decreased levels of CD4-positive cells (mean, 26/ml 3 ) and ocular symptoms; five had bilateral punctate epithelial keratopathy, one had intermittent red eyes with conjunctivitis, and one had red eyes only. Light and electron microscopy of corneal and conjunctival biopsy and cytologic specimens and intact globes disclosed microsporidia belonging to the genus Encephalitozoon. Because E. cuniculi and E. hellem , the two species of the Encephalitozoon genus, are morphologically identical, an immunofluorescent antibody technique was used for species identification. In all seven patients, the agent was identified as E. hellem. Pathologic examination of globes obtained after autopsy disclosed E. hellem infection to be restricted to the corneal and conjunctival epithelium. We studied methods for the routine diagnosis of ocular microsporidiosis in patients with AIDS, including the role of immunofluorescent antibody staining.

Conventional röntgenologic examinations of fifty patients with posttraumatic pelvic bone injuries were compared with computertomographic examinations. The major advantage of computertomography of the pelvis is in our view the more precise evaluation of injuries of the dorsal pelvic ring. Almost fifty percent of the fractures of the sacrum and two thirds of the injuries of the iliosacral joint in our series could not be diagnosed on conventional examinations. Computertomography of fractures of the sacrum and fractures of the acetabulum give us important informations about the extension of the fracture, its dislocation, its degree of instability and accompanying soft tissue injuries. So planning of operative treatment becomes much easier.

A case of sarcoidosis is reported, which began 25 years ago. As a late complication the patient developed compression syndrome of the superior caval vein, which was caused by swelling of the lymph nodes. After surgical treatment, which was carried out by removing the regional lymph nodes and implantation of a dacron prosthesis, stenosis occurred within the proximal part of the prosthesis, which was treated by the PTA technique according to the Dotter method.

An extremely rare manifestation of atherosclerosis is described. Two women, aged 57 and 55, presented with upper extremity hypertension and diminished femoral pulses. Plain radiography and total angiographic visualization of the aorta demonstrated focal highly obstructing intraluminal masses containing heavy flocculent calcification in the upper descending thoracic (case 1) and the thoracoabdominal aorta (case 2) producing a significant pressure gradient. The acquired coarctation due to calcified thrombus was relieved by resection and graft replacement in one and placement of a thoracoabdominal bypass graft in the second patient.

The so-called superior-Cava Syndrome is caused by obstructions by centrally localized tumors by thrombosis or by inflammations of the mediastinum. In cases of tumorous infiltration a graft can be inserted. The different phenomena of thrombosis caused by nutritial catheters and pace makers are of clinical importance. Acute thrombosis of the brachio-cervical veins and the Vena Cava can be treated successfully by means of thrombolysis. Besides CT bilateral brachial phlebography communicates optimal information concerning localization of vascular obstruction and collateral circuits.