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Background: Clinicians and researchers commonly use global cognitive assessments to screen for impairment. Currently there are no published studies directly comparing the sensitivity and specificity of the Montreal Cognitive Assessment and Mattis Dementia Rating Scale-2 in PD. The objective of this study was to identify the relative sensitivity and specificity of the Montreal Cognitive Assessment and Mattis Dementia Rating Scale-2 in PD.Methods: The Montreal Cognitive Assessment and Mattis Dementia Rating Scale-2 were administered to training and validation cohorts. Cutoff scores were determined within the training cohort (n = 85) to optimize sensitivity and specificity for cognitive impairment and were applied to an independent validation cohort (n = 521).Results: The Montreal Cognitive Assessment was consistently sensitive across training and validation cohorts (90.0% and 80.3%, respectively), whereas the Mattis Dementia Rating Scale-2 was not (87.5% and 60.3%, respectively). In individual domains, the Montreal Cognitive Assessment remained sensitive to memory and visuospatial impairments (91.9% and 87.8%, respectively), whereas the Mattis Dementia Rating Scale-2 was sensitive to executive impairments (86.2%).Conclusion: The Montreal Cognitive Assessment and Mattis Dementia Rating Scale-2 demonstrated individual strengths. Future work should focus on developing domain-specific cognitive screening tools for PD. © 2018 International Parkinson and Movement Disorder Society. [ABSTRACT FROM AUTHOR]

Purpose: The safety of combined immunotherapy and thoracic radiation therapy (iRT) has been understudied. We evaluated toxicities in patients receiving iRT from 3 single-institutional phase 1/2 trials.Methods and Materials: Clinical/treatment characteristics and toxicities (per the Common Toxicity Criteria for Adverse Events, version 4.0) were extracted. For purposes of this analysis, groupings were made into (1) patients receiving immunotherapy plus stereotactic body radiation therapy (50 Gy/4 fractions or 60 Gy/10 fractions), (2) immunotherapy plus 45 Gy/15 fractions, and (3) twice-daily chemoimmunoradiotherapy (45 Gy in twice-daily fractions).Results: None of the 60 patients undergoing immunotherapy plus stereotactic body radiation therapy (50 Gy, n = 49; 60 Gy, n = 11) experienced grade ≥4 events. There were 34 instances of any grade 3 event (in 15 total patients), with 9 pulmonary specific grade 3 events (in 4 patients). In the patients receiving 45 Gy/15 fractions (small cell lung cancers, n = 26; non-small cell lung cancers, n = 27), there were 2 grade 4 events (in the same patient), along with 17 grade 3 toxicities experienced by 10 total patients (2 pulmonary specific). Lastly, in the twice-daily cohort (n = 22), there were 5 grade 4 events (3 of which occurred in 1 patient) and 16 grade 3 toxicities occurring in 8 total patients (half of which were hematologic).Conclusions: Administration of combined iRT is safe in the short term. Toxicities did not appreciably associate with demographics or dosimetry. [ABSTRACT FROM AUTHOR]

Mitochondrial DNA (mtDNA) is the only autonomously replicating source of DNA outside the nucleus. The mitochondrial genome encodes thirteen essential polypeptides of the mitochondrial respiratory chain. Defects of the mitochondrial genome can cause severe neurological and multi-systemic disorders. In many patients there is a mixture of mutated and wild-type mtDNA in the same cell (a situation termed heteroplasmy). In these patients the ratio of mutated to wild-type mtDNA is crucial and a biochemical defect only occurs with relatively high levels of mutated mtDNA within an individual cell. This threshold also seems to be critical in the development of mtDNA disease. Since the genetic defect causes a dysfunction in the terminal stage of oxidative metabolism, there is little potential for pharmacological intervention. Molecular techniques must be developed to reverse the ratio of mutated and wild-type mtDNA. In this paper we summarise our approach using both antigenomic peptide nucleic acids and cell necrosis. [ABSTRACT FROM AUTHOR]

Incarcerated inguinal hernias in infants are commonly encountered. Reduction with intravenous sedation using morphine and related drugs carries risks of apnoea and/or respiratory arrest, especially in small, ex-premature babies who have an increased incidence of incarceration and thus opiate use is best avoided. Caudal epidural anaesthesia is widely used as pre- and post-operative analgesia in elective inguinal herniotomy in infants. In this study we sought to determine if caudal epidural anaesthesia would allow reduction of an incarcerated inguinal hernia in the acute setting, thereby obviating the need for intravenous sedation. A retrospective review of 12 male infants, with irreducible, incarcerated inguinal hernias was done. Each hernia was successfully reduced with the help of caudal epidural anaesthesia. This group of babies was treated at The Royal Belfast Hospital for Sick Children. Twelve male infants were identified with an incarcerated inguinal hernia in whom attempted reduction, without sedation had failed. Using Bupivacaine (1 ml/kg 0.25%), placed into the caudal space, these hernias were successfully reduced non-operatively. Ages at presentation ranged from 2 to 17 weeks with a median gestational age of 36 weeks (range 29-39 weeks). Caudal epidural anaesthesia is a safe, feasible and effective method of achieving reduction of irreducible, incarcerated inguinal hernias. It is especially useful in low-birth weight, premature infants where intravenous opiate sedation is best avoided. [ABSTRACT FROM AUTHOR]

103 patients with acute airflow obstruction (56 asthma, 47 chronic obstructive pulmonary disease [COPD]) completed a double-blind trial of nebulised bronchodilator treatment in a hospital accident and emergency department. Each patient was randomised to receive either 10 mg of salbutamol nebuliser solution in 2 ml of saline or 10 mg of salbutamol in 2 ml (0.5 mg) of preservative-free ipratropium bromide. Peak flow rate (PFR) was recorded before treatment and 1 hour after beginning nebulised treatment. In 23 asthmatic patients given salbutamol alone PFR rose by a mean 31% 1 hour after treatment whereas in 33 such patients given combined treatment it rose by a mean 77% (95% confidence interval for the difference 8-84%). Patients whose PFR was below 140 l/min at entry gained maximum benefit from the combined treatment. For COPD patients the PFR rise was almost identical for both treatments. In acute asthma the immediate PFR response to a mixture of salbutamol and ipratropium bromide was better than the response to nebulised salbutamol alone. For COPD patients, the two treatments were of equal benefit. [ABSTRACT FROM AUTHOR]

The purpose of this study was to compare the efficacy of thoracoscopic drainage with open drainage of empyema in children. A retrospective case history audit was done of children presenting to a single major paediatric centre who underwent thoracoscopy drainage and decortication or open decortication and drainage (thoracotomy) between January 2000 and September 2002. Time to resolution of infection, duration of intercostal catheter (ICC) drainage, postoperative morphine requirements, and length of hospital admission were compared as primary measures of outcome. Thirty-three patients, 17 male and 16 female, aged between 1 month and 21 years were included in the study. Median age at surgery was 2.6 years. The location of the empyema was right-sided in 17 patients and left-sided in 16 patients. The empyema was drained by thoracoscopy in 11 patients, and 22 patients underwent thoracotomy. Two patients had thoracoscopy converted to thoracotomy for late-stage disease requiring greater surgical access. There were no differences between treatment groups with respect to duration of ICC drainage (p=0.6), duration of fever (p=0.6), length of stay (p=0.9), or postoperative morphine use (p=0.2). However, overall pain scores were lower in the thoracoscopy group, particularly on days 2 and 3; this approached statistical significance (p=0.07). This study has demonstrated that thoracoscopic drainage is an effective procedure for treating empyema in children. It is less invasive than open thoracotomy and is associated with less patient discomfort and less severe pain as measured by objective pain scores. We advocate thoracoscopic drainage for the majority of patients with empyema, except for those with advanced disease. [ABSTRACT FROM AUTHOR]

Reported discrepancies in the effects of tumor necrosis factor (TNF)-alpha in modulating insulin sensitivity of cultured cells may relate both to cell types studied and to the time course of exposure to the cytokine. Additionally, the relationship of effects on glucose metabolism to changes in the insulin signaling pathway cannot be assumed. For in vitro study, the cell type most relevant to insulin resistance in humans is the cultured human muscle cell. In the present study, TNF brought about no change in the rate of glycogen synthesis in cultured human muscle cells unless present during differentiation. The presence of TNF (5 ng/ml) during the process of differentiation of myoblasts into mature myotubes diminished the response of glycogen synthesis to acute insulin stimulation. This finding was associated with an impairment of differentiation-dependent increases in total cellular glycogen synthase (GS) activity. Under the same conditions of TNF exposure, there was no effect on the response to acute insulin stimulation of the fractional activity of GS. Similarly, there was no effect on the insulin stimulation of protein kinase B (PKB) and inhibition of glycogen synthase kinase 3 (GSK-3). Acute insulin stimulation brought about a 4.08 +/- 0.44-fold stimulation of activity of PKB in the absence of TNF, with 4.81 +/- 0.70-fold stimulation in cells exposed to TNF. GSK-3 activity decreased to 74.0 +/- 5.8% of basal after insulin stimulation without TNF and 78.3 +/- 5.0% after TNF exposure. However, differentiation of myocytes, as defined by an increase in the acetylcholine receptor, myogenin, and mature creatine kinase isoform expression, was impaired in TNF-treated cells. These studies demonstrate that TNF, if present during differentiation, decreases insulin-stimulated rates of storage of glucose as glycogen and total GS activity but does not downregulate the insulin-signaling system to GS. More generally, TNF also inhibits differentiation of human muscle cells in culture. [ABSTRACT FROM AUTHOR]

The present study focused on the content and practice of racial socialization by black parents. Sociodemographic correlates of patterns of racial socialization were examined using data from a national probability sample of 2,107 respondents (National Study of Black Americans). Multivariate analysis revealed that gender, age, marital status, region, and racial composition of neighborhood predicted whether or not black parents imparted racial socialization messages to their children. Black parents envision racial socialization as involving several components, including messages regarding their experience as minority group members, themes emphasizing individual character and goals, and information related to black cultural heritage. The findings highlighted the critical importance of sociodemographic and environmental influences on the socialization process. Implications for future research on racial socialization are discussed. [ABSTRACT FROM AUTHOR]

We conducted a pilot study of potential sources of incorrect laboratory reports of human immunodeficiency virus type 1 testing using blind proficiency testing. Sets of three serum samples, including one serum sample with negative reactions in antibody tests, one serum sample with positive reactions, and one that gave false-positive results with certain testing kits, were sent as routine patient specimens to testing laboratories. Half the laboratories reported the serum sample positive for human immunodeficiency virus antibodies as "indeterminate"; one laboratory rendered a final positive report without supplemental testing. On the report forms, the actual laboratory results were often obscured and intermingled with information, sometimes incorrect, such as identifying the agent as "HTLV-III" (human T-cell lymphotropic virus type III) and advising that a test with positive results is evidence of exposure to the virus. Many of these reports have the potential to confuse, rather than to enlighten, the requesting physician. [ABSTRACT FROM AUTHOR]

This ecological study examines trends in socioeconomic differentials in mortality in New South Wales, Australia, over a 20-year period (1970–89). The proportion unskilled was used as the indicator of socioeconomic status and its selection justified. Using census data aggregated by Local Government Area, the relationship between mortality and socioeconomic status was examined using quintiles based on the proportion unskilled in the population. Local Government Areas were also sorted into quintiles using mortality rates (0–74 years) to describe change in mortality differentials over time. Socioeconomic differentials were more evident in the relatively homogeneous Local Government Areas within the Sydney Statistical Division than in the remaining NSW Statistical Divisions which are more heterogeneous and predominantly rural. Although there has been an overall decline in mortality for males and females, and for high and low status groups, over this period the relative socioeconomic differentials have not declined. For the most recent period (1985–89) there appears to be some widening of differentials for males. The NSW state trends are generally similar to those reported for Britain and for other industrialised countries, suggesting that this is a common trend and that policies to reduce inequalities have not been effective. [ABSTRACT FROM PUBLISHER]

Effects of stress on driving performance can depend on the nature of driver's stress reactions and on the traffic environment. In an experimental study, we assessed multiple dimensions of vulnerability to driver stress by a questionnaire that was validated in previous field studies and related those dimensions to performance on a driving simulator. Results were broadly consistent with prediction. A dimension of habitual dislike of driving was associated with reduced control skills, greater caution, and disturbance of moods. A measure of aggressive driving predicted more frequent and more error-prone overtaking, which are effects attributed to the use of confrontive coping strategies in interaction with other vehicles. An alertness measure predicted speed of reaction to pedestrian hazards. This research has practical applications for system design, automated monitoring of driver performance, selection and assessment of drivers, and training. [ABSTRACT FROM AUTHOR]