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BackgroundIn recent years, numerous studies have highlighted the overlap between autism spectrum disorder (ASD) and catatonia, both from a clinical and pathophysiological perspective. This study aimed to investigate the relationship between the autism spectrum (autistic traits and ASD signs, symptoms, and behavioral manifestation) and Catatonia Spectrum (CS).MethodsA total sample of 376 subjects was distributed in four diagnostic groups. Subjects were assessed with the Structured Clinical Interview for DSM-5, Research Version, the Adult Autism Subthreshold Spectrum (AdAS Spectrum), and CS. In the statistical analyses, the total sample was also divided into three groups according to the degree of autism severity, based on the AdAS Spectrum total score.ResultsA statistically significant positive correlation was found between AdAS Spectrum and CS total score within the total sample, the gender subgroups, and the diagnostic categories. The AdAS Spectrum domains found to be significantly and strongly correlated with the total CS score were hyper–hypo reactivity to sensory input, verbal communication, nonverbal communication, restricted interests and rumination, and inflexibility and adherence to routine. The three groups of different autistic severity were found to be distributed across all diagnostic groups and the CS score increased significantly from the group without autistic traits to the group with ASD.ConclusionsOur study reports a strong correlation between autism spectrum and CS.

Recent publications have proposed revisions to disease classification criteria, new definitions of remission, and guidelines for implementing treat-to-target strategies for the management of patients with rheumatoid arthritis (RA). Despite developments leading to this practice-changing approach, the concept of treat to target has not yet been widely accepted or implemented in managed care. At the 24th Annual Meeting Expo of the Academy of Managed Care Pharmacy (AMCP), held in San Francisco on April 18, 2012, a 4-hour activity titled Incorporating New Treat-to-Target Guidance and Strategies in RA: What Managed Care Needs to Know was conducted in association with AMCP's Continuing Professional Education Partner Program. The practicum featured didactic presentations, a roundtable session, and an expert panel discussion detailing research evidence, ideas, and discussion topics central to the treat-to target concept in RA and its applications to managed care.To (a) discuss recent advances in RA management, (b) evaluate strategies to optimize the use of disease-modifying antirheumatic drugs(DMARDs), and (c) explain how to incorporate the treat-to-target paradigm in contemporary clinical practice and clinical care models in order to improve outcomes for patients.The past decade has seen a tremendous amount of change in the field of rheumatology. The early and aggressive treatment of RA, including the use of novel biologic agents, has been shown to have favorable patient outcomes in reducing synovial inflammation, delaying joint damage,and maintaining functional status, leading to the recently published revisions in classification criteria and updated recommendations for the utilization of conventional DMARDs and biologic agents in the treatment of RA. The revised classification criteria can be used to diagnose RA patients at an earlier point in the disease course by placing greater emphasis on clinical features that manifest early in the disease process. The concept of achieving tight control of RA and treating to target has been well established and utilizes early diagnosis, aggressive treatment, and regular monitoring,leading to positive outcomes in a significant number of patients with RA who achieve current treatment goals of low levels of disease activity or clinical remission.

We report the outcomes of 45 patients with relapsed or refractory aggressive non-Hodgkin's lymphoma (NHL) treated with a combination of ifosfamide, carboplatinum and etoposide (ICE) and 28 patients treated with a combination of ifosfamide, methotrexate and etoposide (IMVP) during two 5-year periods. The response rate (RR) to ICE was 47%, 2-year overall survival (OS) 31% and 2-year event-free survival (EFS) 22%. These results were similar to those obtained with IMVP (RR 39%, 2-year OS 23%, 2-year EFS 13%; p=0.355 for RR, 0.275 for OS, 0.668 for EFS). Higher IPI scores and refractoriness to treatment were negative prognostic factors, immunophenotype (B vs. T) had no influence on prognosis. Changing from IMVP to ICE does not substantially improve the outcome of patients with relapsed or refractory aggressive NHL. Patients with relapsed/refractory aggressive B-NHL do not have a superior out-come in comparison to those with T-NHL if treated with chemotherapy alone.

Objectives Most cases of granulosa cell tumors (GCT) of the ovary are characterized by a relatively good outcome. However, some tumors behave aggressively and some tend to recur many years after the initial diagnosis. Tumor growth depends on cell proliferation and angiogenesis. Thus, proliferative indices and microvessel density were studied to determine possible valuable methods to assess the GCT patient's outcome. Methods and study design Paraffin-embedded tissue blocks were available for 60 patients with primary GCT and were investigated by immunostaining with monoclonal antibodies against PCNA, Ki-67 and factor VIII-related antigen. The follow-up was available for 51 patients and ranged from 25 to 206 months. A clinical follow-up distribution of patients was made: 8 patients with recurrence (group I); 6 patients who lived with no evidence of recurrence for 100 months or more (group II), and 37 patients alive with no evidence of recurrence in the follow-up period of less than 100 months (group III). Results There was a statistical correlation between PCNA and Ki-67 proliferative indices. A significant increase (P «0.05) of mean PCNA and Ki-67 proliferative indices and mean tumor size was seen in patients of Group I compared to those of Group II. The mean PCNA proliferative index positively correlated with the mean Ki-67 proliferative index for Groups I and II. Mean microvessel density showed a positive correlation with mean PCNA and Ki-67 proliferative indices and with mean tumor size for Group I, whereas it was negatively correlated with PCNA proliferative index and tumor size for Group II. A positive correlation was found between mean mitotic count and both proliferative indices only for Group II. The following features were indicative of a relatively poor prognosis: GCT measuring >9 cm in diameter, PCNA >4.0%, Ki-67 >1.2%, and diffuse, insular and sarcomatoid histologic patterns. Conclusions The findings support the importance of proliferative factors, tumor size and histologic patterns as possible prognostic indicators for estimating the biologic behavior of patients with GCT. Unfortunately, angiogenesis did not seem to be a useful determinant parameter of a possible aggressive behavior. However, a longer follow-up period with larger series may be required to assess the value of the parameters in prediction of patient survival.

To review the experience gained in transferring USA computer-based teaching system of medical school pathology to Croatia.Computer-based teaching program of pathology developed at the University of Kansas School of Medicine, Kansas City, Kansas, USA, was transferred to the University of Zagreb School of Medicine, Zagreb, Croatia. The experimental group of 49 students was enrolled into this computer-based program. Their performance was compared with that of 195 classmates enrolled in the standard course. Objective (performance on the examinations) and subjective data (students' interviews and written evaluations of the course) were analyzed.The computer program was operational 5 months from the inception of the transfer. It was well received by the students, even though many initially complained that it required more effort and a continuous commitment. The major problems concerned scheduling, reflecting various requirements i mposed on students by other departments teaching in parallel with the Pathology course. Objective data gathered so far indicate that the students enrolled in the computer-based program took the first midterm examination at a significantly higher rate than the rest of the class (p0.001), and passed the examination with significantly better grades (p0.001).Computer-based teaching programs can be readily transferred to other countries. Full implementation of the program, however, may require significant changes in the existing curriculum in the medical school to which such a program has been transferred or considerable modifications in the program adopted for transfer. It appears that the students enrolled in the computer-based program perform better than students in the standard pathology course.

Traditional treatment of interstitial pregnancy includes cornual resection or hysterectomy by laparotomy, but advanced minimally invasive surgery allows successful endoscopic management. We report a case where interstitial pregnancy was successfully diagnosed by ultrasound and treated by laparoscopy. Patient had an unremarkable postoperative course. This case demonstrates that a laparoscopic approach toward cornual pregnancy is possible.

The drinking water supply in Yaounde, Cameroon, often fails to meet demand and this leads many people to seek water from springs and wells the microbiological quality of which is unknown. We carried out a microbiological survey of five spring water points and ten wells. The fifteen study sites were located in various residential districts and were selected according to geographical location and number of users. Microorganisms were isolated on specific culture media using the membrane filter technique. We found that these water supplies contained many types of bacteria including Pseudomonas aeruginosa, Aeromonas hydrophila and indicators of fecal contamination. Maximum annual concentrations differed at the various sites and over time, from 750 to 98,000 CFU/l for P. aeruginosa, 40 to 78,000 CFU/l for A. hydrophila and 300 to 58,000 CFU/l for fecal indicator bacteria. The density of fecal bacteria was strongly correlated (p0.01) with those of P. aeruginosa in spring water and A. hydrophila in well water. The degree of correlation between microbial concentrations differed between sites. The source of fecal contamination differed between sites and was animal, human or both. The densities of bacteria recorded were high. Therefore, consumers of water drawn from these sources are at short-term risk of contracting waterborne diseases.

The aim was to analyze the histopathologic changes of placentas and to compare them to the results of arcuate artery color Doppler velocimetry. Fifty four placentas were from pregnancies complicated with pre-eclampsia that ranged from mild forms to convulsions (group 1), 42 from pregnancies complicated with intrauterine growth retardation (IUGR) (group 2) and 40 from uncomplicated pregnancies (group 3). The arcuate artery resistance index (AARI) was increased in 66.66% in group 1 and 59.52% in group 2 (NS). In all uncomplicated pregnancies (group 3) AARI was normal. In group 2, increased AARI was significantly more frequently associated with minimal hypoxic damage (MHD) of placental tissue than in group 1 (p0.005), whereas multiple infarcts were more common in group 1 than in group 2 (p0.005). At normal AARI multiple infarcts were significantly more frequently found in group 1 than in groups 2 and 3 (p0.005), whereas normal placental findings were significantly more common in group 3 than in groups 1 and 2 (p0.001). Hypoxic lesions were significantly more often associated with increased AARI (p0.01). The positive predictive value of arcuate artery color Doppler velocimetry for hypoxic placental lesions was 93%, and negative predictive value was 10%. Sensitivity and specificity of the method in the prediction of hypoxic placental lesions was 62% and 91%, respectively.

In 169 patients with all stages of endometrial cancer peritoneal cytology was performed and the finding correlated to the stage of disease, histologic grade, depth of myometrial invasion, tumor site in the uterine cavity, menstrual status, frequency of recurrence and 5-year survival. In 23 (11.6%) patients malignant cells were found in the peritoneal washing. In patients with Stage I endometrial cancer 6.5%, Stage II 9.1%, and in those in whom disease had spread outside the uterus (Stage III and IV) in 68.0% (p0.001). Positive peritoneal cytology was found significantly more frequently in patients with maintained menstrual cycle (p0.01), patients with tumor localized in uterine horns and in those patients with low values of steroid receptors. With regard to the histologic grade no difference was found in peritoneal cytology regardless of the stage of the disease. With regard to the myometrial invasion difference in the finding of malignant cells was found only in those patients in whom the tumor had spread outside the uterus (p0.05). Regardless of the stage of the disease, the frequency of recurrence and 5-year survival did not correlate with the finding of malignant cells in peritoneal lavage. According to our results the finding of peritoneal cytology, as an isolated prognostic factor, or in correlation with other prognostic factors, does not play an important role in the prognosis of patients with endometrial cancer, particularly those in whom the tumor is localized only in the uterus.