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Inflammatory myofibroblastic tumor (IMT) is a benign lesion composed of myofibroblasts accompanied by varying numbers of inflammatory cells. Various pathogenetic factors have been proposed, but the etiology of most IMTs remains unknown. This article presents a case of IMT occurring in the left maxillary sinus. A 24-year-old man complained of throbbing pain in the maxillary left molars and swelling of the left cheek. His maxillary left second molar was diagnosed as pulp necrosis and root canal treatment performed. After that, his symptoms continued and he was referred to the Department of Otolaryngology. Computerized tomography disclosed compact soft tissue masses in the left maxillary sinus with obstruction of maxillary ostium. Under general anesthesia, the lesions were fully excised. Histopathologically, the lesions were composed of plump or spindled myofibroblasts. Cells were immunoreactive for smooth muscle actin and [beta]-catenin, and were negative for ALK1, CD34, and EMA. The diagnosis was IMT of left maxillary sinus. Although it is very rare, IMT should be included as a differential diagnosis in patients with compact masses in maxillary sinus. [ABSTRACT FROM AUTHOR]

Purpose: We retrospectively analyzed the computed tomography (CT) findings of H1N1 virus infection in 17 patients with relatively mild illness.Materials and Methods: From September 2009 to January 2010, a total of 17 patients with confirmed H1N1 infection were included in the study (mean age 30.7 years). All patients were managed as outpatients or required short hospitalization without ventilation assistance. The CT scans were assessed for the presence of nodules, ground glass opacity (GGO), consolidation, bronchial wall thickening, reticulation, effusion, and lymph node enlargement. Location and distribution were evaluated.Results: The most frequent manifestation was a mixture of nodules, consolidation, and GGO (5/17, 29.4%). In one case there was a focal area of bronchiolitis (centrilobular nodules with tree-in-bud appearance), and 10 of 17 cases (58.8%) showed bronchial wall thickening (findings of bronchitis/peribronchitis) and/or other abnormalities. In 16 of the 17 cases (94.1%) there were CT abnormalities with bilateral and random distribution without zonal predominance. Pleural effusions were seen in eight cases (47.1%).Conclusion: In contrast to several reports so far, CT findings of H1N1 virus infection in patients with mild illness are variable, including suggestive findings of inflammation involving large and/or small airways. This study showed various CT findings overlapping with other viral, atypical, or bacterial pneumonia and even cryptogenic organizing pneumonia. [ABSTRACT FROM AUTHOR]

We evaluated the clinical utility of combined [(18)F]fluorodeoxyglucose (FDG) positron emission tomography (PET) and computed tomography (CT), as well as CT and magnetic resonance imaging (MRI) in identifying nodal metastases in the contralateral neck in patients with head and neck squamous cell carcinoma (HNSCC). A total of 114 patients were preoperatively evaluated with PET/CT and CT/MRI. Histopathologic analysis from bilateral neck dissection tissues was used as the gold standard in assessing these imaging techniques. Of the 114 patients, 63 (55%) had neck metastases and 26 (23%) had contralateral neck metastases. On a per-level basis, FDG PET/CT was significantly more sensitive and accurate than CT/MRI in the ipsilateral (88% vs. 70%, P<0.01 and 93% vs. 89%, P<0.01, respectively) and contralateral (52% vs. 36%, P<0.01 and 91% vs. 90%, P=0.039, respectively) neck. PET/CT and CT/MRI were less sensitive in detecting contralateral than ipsilateral neck metastases due to the lower incidence of metastases and smaller nodes on the contralateral side. Combined PET/CT is superior to CT/MRI in detecting metastatic neck nodes in HNSCC patients. However, PET/CT may not abrogate the need for contralateral neck surgery or radiotherapy in these patients. [ABSTRACT FROM AUTHOR]

Acute hemorrhagic leukoencephalitis (AHL) is a rare and usually fatal disease characterized by an acute onset of neurological abnormalities. We describe the case of a 37-year-old man with biphasic AHL with a focus on the rare involvement of the brain stem and cerebellum. Initial computed tomography (CT) and magnetic resonance imaging revealed two hemorrhagic foci in the left middle cerebellar peduncle. After 15 days multifocal hematomas in the contralateral cerebellar hemisphere were imaged using CT. The pathological diagnosis was AHL. Following high-dose steroid treatment, the patient recovered with minor neurological sequelae. [ABSTRACT FROM AUTHOR]

Propylthiouracil (PTU) is a drug used to treat hyperthyroidism. A number of adverse effects have been reported with this drug, including fever, agranulocytosis, skin rash, and vasculitis. PTU-induced interstitial pneumonia is rare--only three cases have been reported--and PTU-induced nonspecific interstitial pneumonia (NSIP) has not been reported. We report a patient who developed NSIP after taking PTU for 1 year. She developed dyspnea, cough, and mild fever lasting 1 month, and a chest CT scan showed multifocal patchy consolidation in both lungs. She underwent a surgical lung biopsy, and NSIP was confirmed pathologically. The symptoms and abnormalities seen in the chest radiograph improved after withdrawal of PTU. To our knowledge, this is the first documented case of pathologically proven PTU-induced NSIP. [ABSTRACT FROM AUTHOR]

Objective: To determine whether the amount of tagged stool and fluid significantly affects the radiation exposure in low-dose screening CT colonography performed with an automatic tube-current modulation technique.Methods: The study included 311 patients. The tagging agent was barium (n = 271) or iodine (n = 40). Correlation was measured between mean volume CT dose index (CTDI (vol)) and the estimated x-ray attenuation of the tagged stool and fluid (ATT). Multiple linear regression analyses were performed to determine the effect of ATT on CTDI (vol ) and the effect of ATT on image noise while adjusting for other variables including abdominal circumference.Results: CTDI (vol) varied from 0.88 to 2.54 mGy. There was no significant correlation between CTDI (vol) and ATT (p = 0.61). ATT did not significantly affect CTDI (vol) (p = 0.93), while abdominal circumference was the only factor significantly affecting CTDI (vol) (p < 0.001). Image noise ranged from 59.5 to 64.1 HU. The p value for the regression model explaining the noise was 0.38.Conclusion: The amount of stool and fluid tagging does not significantly affect radiation exposure. [ABSTRACT FROM AUTHOR]

Bone marrow stem cells (BMSCs) can be obtained from the vertebral body (VB) and iliac crest (IC) for augmenting spinal arthrodesis. However, it is still not evaluated, which of the two sites would have a better BMSCs potential on Proliferation and osteoblastic differentiation is still not evaluated. Fourteen patients (10 men and 4 women) undergoing posterolateral lumbar arthrodesis and pedicle screw instrumentation were involved. The mean age was 54.7 years (range 31-75 years). Bone marrow aspirates were obtained from the vertebral body through the bilateral pedicle and were quantified relative to matched, bilateral aspirates from the iliac crest that were obtained from the same patient and at the same time. The mononuclear cell count and concentration of BMSCs were calculated and compared. Proliferation and osteoblastic differentiation of each of the BMSCs were characterized using biochemical and molecular biology techniques. Concentration (cells/mL) of BMSCs from VB and IC were 3.73 × 10(3) and 3.19 × 10(3), respectively (P > 0.05). VB and IC exhibited similar proliferation pattern at 3, 5 and 7 days, but BMSCs from the VB exhibited an increased mineralization staining with Alizarin Red S at 14 days. BMSCs from both anatomic sites expressed comparable levels of CD29, CD34, CD44, CD90 and CD105. VB and IC displayed similar levels of expression of ALP, type I collagen and osterix, but VB expressed higher level of osteocalcin and Runx-2, especially at 14 and 21 days. Our studies show that BMSCs from VB have osteogenic differentiation potential similar to IC. Based on these findings, we suggest that BMSCs from VB would be comparable candidates for osseous graft supplementation especially in spinal fusion procedures. [ABSTRACT FROM AUTHOR]

Objective: To prospectively evaluate the technical feasibility of percutaneous real-time contrast-enhanced ultrasound (CEUS) guided biopsy of focal hepatic lesions that are not confidently localised on B-mode US.Methods: The study included 44 patients (mean age, 61.3 years) whose biopsy target could not be confidently localised on B-mode US performed by two independent radiologists. Biopsy was attempted under the guidance of both CEUS and B-mode US simultaneously displayed on a single monitor. Final diagnosis was established based on the pathological examination of the biopsy specimen as well as on clinical and radiological follow-up.Results: The size and depth of the target lesions were 18.0 +/- 9.0 mm (mean +/- SD) and 41.8 +/- 17.2 mm respectively. Five patients with negative or indistinct CEUS findings did not undergo biopsy, while 39 patients completed the biopsy. In 38 of the 39 patients, the biopsy result was concordant with the final diagnosis. In the remaining one patient, the biopsy failed to prove metastasis. As there were six cases of technical failure, the technical success rate was 86% (38/44). The sensitivity in diagnosing malignancy was 88% (30/34).Conclusion: Real-time CEUS-guided biopsy is technically feasible for hepatic focal lesions that are not confidently localised on B-mode US. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD), one of the most common neurodegenerative disorders, is characterised by the loss of dopaminergic neurons in the substantia nigra pars compacta (SNpc) to the striatum (ST), and involves oxidative stress. Mulberry fruit from Morus alba L. (Moraceae) is commonly eaten, and has long been used in traditional oriental medicine. It contains well-known antioxidant agents such as anthocyanins. The present study examined the protective effects of 70% ethanol extract of mulberry fruit (ME) against neurotoxicity in in vitro and in vivo PD models. In SH-SY5Y cells stressed with 6-hydroxydopamine (6-OHDA), ME significantly protected the cells from neurotoxicity in a dose-dependent manner. Other assays demonstrated that the protective effect of ME was mediated by its antioxidant and anti-apoptotic effects, regulating reactive oxygen species and NO generation, Bcl-2 and Bax proteins, mitochondrial membrane depolarisation and caspase-3 activation. In mesencephalic primary cells stressed with 6-OHDA or 1-methyl-4-phenylpyridinium (MPP+), pre-treatment with ME also protected dopamine neurons, showing a wide range of effective concentrations in MPP+-induced toxicity. In the sub-acute mouse PD model induced by 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), ME showed a preventative effect against PD-like symptoms (bradykinesia) in the behavioural test and prevented MPTP-induced dopaminergic neuronal damage in an immunocytochemical analysis of the SNpc and ST. These results indicate that ME has neuroprotective effects in in vitro and in vivo PD models, and that it may be useful in preventing or treating PD. [ABSTRACT FROM AUTHOR]

Goals Of Work: Family caregivers play an important role in caring for cancer patients, but the impact of caregivers' unmet needs on the quality of end-of-life (EOL) care they deliver and on their workplace performance are less understood.Patients and Methods: We identified 1,662 family caregivers of cancer patients who had died at any of 17 hospitals in Korea during 2004. The caregivers answered a telephone questionnaire about needs that were not met when they delivered terminal cancer care and how those unmet their needs affected their workplace performance; they also answered the Quality Care Questionnaire-End of Life (QCQ-EOL).Results: Compared with caregivers who did not have unmet needs, caregivers who had unmet needs for symptom management, financial support, or community support showed poorer QCQ-EOL scores (P < 0.01). Caregivers who had unmet needs for financial support (adjusted odds ratio (aOR) = 7.55; 95% confidential interval (CI) 3.80-15.00), psychosocial support (aOR = 6.24; 95% CI 2.95-13.05), symptom management (aOR = 3.21; 95% CI 2.26-4.54), community support (aOR = 3.82; 95% CI 2.38-6.11), or religious support (aOR = 4.55; 95% CI 1.84-11.26) were more likely to experience work limitations. Caregivers of patients receiving conventional hospital care were more likely to have unmet needs for symptom management (aOR = 1.21; 95% CI 1.00-1.47), psychosocial support (aOR = 1.99; 95% CI 1.37-2.88), and religious support (aOR = 1.73; 95% CI 1.08-2.78) than those of patients receiving palliative hospice care.Conclusions: Caregivers' unmet needs negatively affected both the quality of EOL care they delivered and their workplace performance. More investment in caregiver support and public policies that meet caregiver needs are needed, and hospice use should be encouraged. [ABSTRACT FROM AUTHOR]

Objective: To examine patterns of cigarette and smokeless tobacco use before, during, and after pregnancy among Alaska Native (AN) and white women living in Alaska. Methods: We used data from the 2000-2003 population-based Pregnancy Risk Assessment Monitoring System to describe patterns of self-reported prenatal tobacco use among AN and white women. We used multiple variable logistic regression analysis to identify maternal factors associated with quitting and relapse. The final sample included 5,458 women. Results: During 2000-2003, the prevalence of any tobacco use before pregnancy was twofold higher among AN women than among white women (60.0 vs. 27.5%), and the prevalence of any tobacco use during pregnancy and after pregnancy were each nearly threefold higher. Of the 25.8% (SE 0.9) of white women who smoked before pregnancy, 49.0% (SE 2.1) reported that they quit during pregnancy and of those, 41.1% (SE 2.9) relapsed postpartum. Of the 38.5% (SE 0.9) of AN women who smoked before pregnancy, 35.7% (SE 1.4) quit, and of those 57.0% (SE 2.4) relapsed. Of the 14.2% of AN women who chewed tobacco before pregnancy, 15.7% (SE 1.7) quit, and of those, 52.9% (SE 5.9) relapsed. Conclusion: During 2000-2003, the prevalence of tobacco use was two to three times higher among AN women than among white women before, during, and after pregnancy. In addition, AN women had lower quit rates and higher relapse rates than white women. Comprehensive, culturally appropriate tobacco control approaches targeting AN women are needed to increase cessation during pregnancy and to decrease relapse. [ABSTRACT FROM AUTHOR]

Objectives: To determine the diagnostic value of the anterior chamber depth (ACD) of a globe as seen on CT for detecting open-globe injury.Methods: We enrolled 28 patients with unilateral open-globe injury confirmed by surgery and 28 controls with other types of orbital trauma. The diagnostic value of the difference of the ACDs between globes was evaluated by ROC analysis. The diagnostic performance of the following CT findings suggesting open-globe injury was also determined from independent analysis by two readers, i.e. change in the ACD and the globe contour, obvious volume loss of the globe, dislocated/deformed lens, intraocular foreign body/air and intraocular haemorrhage.Results: The ACD measurements were possible only in 15 patients with open-globe injuries. A difference in the ACDs > or =0.4 mm resulted in 0.85 of the area under the ROC curve with a sensitivity of 73% and specificity of 100% (p = 0.0001). The presence of one or more of the CT findings had a sensitivity of 92%, specificity of 85% and diagnostic accuracy of 89%.Conclusions: Change in the ACD is a helpful CT finding for detecting open-globe injury. A difference in the ACDs > or =0.4 mm is a helpful diagnostic criterion with excellent specificity. [ABSTRACT FROM AUTHOR]

Background: The performance of the computer-aided detection (CAD) system can be determined by the sensitivity and false-positive marks rate, therefore these factors should be improved by upgrading the software version of the CAD system. Purpose: To compare retrospectively the performances of two software versions of a commercially available CAD system when applied to full-field digital mammograms for the detection of breast cancers in a screening group. Material and Methods: Versions 3.1 and 8.3 of a CAD software system (ImageChecker, R2 Technology) were applied to the full-field digital mammograms of 130 women (age range 36-80, mean age 53 years) with 130 breast cancers detected by screening. Results: The overall sensitivities of the version 3.1 and 8.3 CAD systems were 92.3% (120 of 130) and 96.2% (125 of 130) (P=0.025), respectively, and sensitivities for masses were 78.3% (36 of 46) and 89.1% (41 of 46) (P=0.024) and for microcalcifications 100% (84 of 84) and 100% (84 of 84), respectively. Version 8.3 correctly marked five lesions of invasive ductal carcinoma that were missed by version 3.1. Average numbers of false-positive marks per image were 0.38 (0.15 for calcifications, 0.23 for masses) for version 3.1 and 0.46 (0.13 for calcifications, 0.33 for masses) for version 8.3 (P=0.1420). Conclusion: The newer version 8.3 of the CAD system showed better overall sensitivity for the detection of breast cancer than version 3.1 due to its improved sensitivity for masses when applied to full-field digital mammograms. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the protective role of personal identity consolidation against health risk behaviors in college-attending emerging adults. METHODS: A multisite sample of 1546 college students completed measures of personal identity consolidation and recent risk behavior engagement. RESULTS: Multivariate Poisson regression indicated that personal identity consolidation was negatively related to binge drinking, illicit drug use, sexual risk behaviors, and risky driving. These findings were consistent across gender, ethnicity, and place of residence. CONCLUSIONS: A consolidated sense of personal identity may protect college-attending emerging adults from health-compromising behaviors. Health professionals could incorporate an identity development component into college health programming. [ABSTRACT FROM AUTHOR]

Purpose: The study purpose was to prospectively determine the accuracy of contrast-enhanced CT in diagnosing fatty liver using same-day biopsy as the reference standard.Materials and Methods: One hundred seventy-nine potential living liver donors underwent unenhanced and portal-phase contrast-enhanced hepatic CT and subsequent liver biopsy on the same day. Attenuation difference between the liver and the spleen on unenhanced (( pre ) L-S) and contrast-enhanced (( post ) L-S) images and blood-subtracted hepatic attenuation on contrast-enhanced images (( post ) L-B), calculated by [L - 0.3 x (0.75 x P + 0.25 x A)]/0.7 where L, P and A represent the attenuation of the liver, main portal vein and abdominal aorta, respectively, were obtained. The accuracy of these indices in diagnosing fatty liver according to various threshold levels, 5%-30% histological steatosis in increments of 5%, was compared using ROC analysis.Results: The area under the ROC curve for ( pre ) L-S, ( post ) L-S and ( post ) L-B was 0.663-0.918, 0.712-0.847 and 0.821-0.923, respectively, depending on the threshold levels of hepatic steatosis. The accuracy of ( pre ) L-S and ( post ) L-S did not differ (P >or= 0.054), despite a trend towards a lower accuracy with ( post ) L-S. ( post ) L-B yielded higher accuracy than ( pre ) L-S at threshold levels of 5% and 10% (P or= 0.144).Conclusion: Portal-phase contrast-enhanced CT has a similar, or even greater, accuracy than unenhanced CT in diagnosing fatty liver. [ABSTRACT FROM AUTHOR]

Goals Of Work: The goal of this study was to investigate the utilization of and attitudes toward life-sustaining treatments (LSTs) at the end of life.Materials and Methods: We identified 4,042 families of cancer patients who had died at any of 17 hospitals in Korea during 2004. Among those, we analyzed the interviews provided by 1,592 (39.4%) primary caregivers. Only women who provided information in baseline and follow-up point could be included for internal comparison.Main Results: Most caregivers did not discuss with their patient the option of utilizing the intensive care unit (ICU; 92.7%) or cardiopulmonary resuscitation (CPR; 93.7%) to prolong an ending life. Logistic regressions indicated that the ICU was more likely to be utilized when patients experienced an unexpected medical problem before dying, discussed the ICU with the family caregiver, or were low-educated. CPR was more likely to be used if the patient died within 6 months of diagnosis or the family caregiver was <65 years old. Family caregivers more likely to use the ICU if placed in the same situation again were those whose patients had a higher monthly income or died within 6 months of diagnosis, low-educated, or had utilized the ICU.Conclusions: Our findings underscore the importance of discussing LST with terminally ill patients based on adequate information. [ABSTRACT FROM AUTHOR]

Background: End-of-dose failure is commonly observed as therapeutic levels of sustained-release opioids fall. However, little is known about using these medications for cancer pain control. To determine the dosing frequency of sustained-release opioids (morphine, oxycodone, and transdermal fentanyl) and the prevalence of end-of-dose failure in clinical practice, a patient-reported survey was performed.Methods: A multicenter survey was conducted in 56 hospitals in Korea between June and November 2008.Results: The study enrolled 1,097 cancer outpatients who were prescribed oral sustained-release opioids (morphine or oxycodone) or transdermal fentanyl. Of the oral sustained-release opioid patients, 67.0% took oral sustained-release oral opioids twice daily, while 26.2% took them more than twice daily. Of the transdermal fentanyl patients, 88.8% wore the patch for 72 h. Of the enrolled patients, 48.3% experienced worsening pain just before the next sustained-release opioid dose, and 36.8% of these patients took medication earlier than the prescribed dosing schedule. Patients felt that oral sustained-release opioids gave adequate pain control lasting an average of 9.6 h, versus an average of 62.9 h for transdermal fentanyl.Conclusion: This survey demonstrated that sustained-release opioids are used by patients in a manner that is inconsistent with standard recommendations. End-of-dose failure is suggested to explain increased dosing frequency, and patients reported that adequate pain relief lasted for less time than was stated in the manufacturers' prescription recommendation. [ABSTRACT FROM AUTHOR]

Purpose: Cancer survivors have been reported to receive less care for other conditions than the general population; however, it is not clear whether patients' behavior also contribute to this. The present study was performed to examine cancer survivors' adherence to antihypertensive medication and factors associated with it, compared to the general population.Methods: We used pharmacy claims and enrollment data from the National Health Insurance, which covers 97% of the Korean population. In total, 2,455,193 subjects, including 12,636 (0.5%) cancer survivors, who were prescribed antihypertensive medications during the calendar year 2004 were identified. A cumulative medication adherence of 80% or above was defined as appropriate medication adherence. Two separate multiple logistic regressions were developed to compare the proportion of appropriate adherence between two populations and to identify factors affecting medication adherence in cancer survivors.Results: Cancer survivors were less likely to have an appropriate medication adherence than the general population (adjusted odds ratio = 0.85; 95% CI, 0.82-0.88). Significant variation was observed in medication adherence according to cancer type. Several other factors, such as older age, low income, living in a rural area, and antihypertensive medication duration, also affected antihypertensive medication adherence. Contrary to the general population, younger survivors showed higher adherence.Conclusions: Clinicians involved in survivor care should check patient adherence to antihypertensive medication, as well as assess the possible reasons for nonadherence. Further studies are warranted to determine the reasons for nonadherence and to establish effective interventions in this vulnerable population. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To examine trends in prenatal cigarette smoking and smokeless tobacco use among Alaska Native (AN) and white women in Alaska. METHODS: Using 1996-2003 data from the population-based Pregnancy Risk Assessment Monitoring System, we determined trends in self-reported prenatal tobacco use among AN and white women and used chi-square tests and multiple variable logistic regression analysis to identify maternal factors associated with prenatal tobacco use. RESULTS: Over the study period, prevalence of any tobacco use during pregnancy declined by 27% among AN women (from 55.8 to 40.9%) (P < 0.0001) and by 17% among white women (from 18.8 to 15.6%) (P < 0.0001). In 2003, among AN women the prevalence of self-reported smokeless tobacco use was 16.9%, cigarette smoking was 25.7%, and any tobacco use was 40.9%; corresponding values for white women were 0.4, 15.0, and 15.6%, respectively. Western Alaska had the highest prevalence of tobacco use. CONCLUSION: The prevalence of tobacco use decreased between 1996 and 2003, but remained higher among AN women than white women, especially for smokeless tobacco. Support for cessation interventions targeting pregnant women should be made a public health priority in Alaska. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To provide a current estimate of the prevalence of prepregnancy obesity in the United States. METHODS: We analyzed 2004-2005 data from 26 states and New York City (n = 75,403 women) participating in the Pregnancy Risk Assessment Monitoring System, an ongoing, population-based surveillance system that collects information on maternal behaviors associated with pregnancy. Information was obtained from questionnaires self-administered after delivery or from linked birth certificates; prepregnancy body mass index was based on self-reported weight and height. Data were weighted to provide representative estimates of all women delivering a live birth in each particular state. RESULTS: In this study, about one in five women who delivered were obese; in some state, race/ethnicity, and Medicaid status subgroups, the prevalence was as high as one-third. State-specific prevalence varied widely and ranged from 13.9 to 25.1%. Black women had an obesity prevalence about 70% higher than white and Hispanic women (black: 29.1%; white: 17.4%; Hispanic: 17.4%); however, these race-specific rates varied notably by location. Obesity prevalence was 50% higher among women whose delivery was paid for by Medicaid than by other means (e.g., private insurance, cash, HMO). CONCLUSION: This prevalence makes maternal obesity and its resulting maternal morbidities (e.g., gestational diabetes mellitus) a common risk factor for a complicated pregnancy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to analyze the differences of soluble endoglin (sEng) and transforming growth factor-beta1 (TGF-beta1) according to preeclamptic complications and to investigate the correlation between these factors and the clinical symptoms of preeclampsia. Method: We estimated the levels of sEng and TGF-beta1 in plasma collected in the second trimester at the time of genetic amniocentesis from 60 women who subsequently developed preeclampsia and 124 contemporaneous normotensive women. Results: sEng levels were higher in cases than in controls, whereas TGF-beta1 levels were lower (P < 0.001). sEng levels, but not TGF-beta1 levels, were higher in cases with severe or preterm delivery than in cases with mild preeclampsia or term delivery (P < 0.001) and were increased in cases destined to deliver a small gestational age neonate (P < 0.001). Moreover, sEng levels, but not TGF-beta1 levels, showed a positive correlation with maximum diastolic and systolic blood pressure (r = 0.57, P < 0.001; and r = 0.33, P < 0.001, respectively) and proteinuria (r = 0.42, P < 0.001). Conclusion: Early midtrimester plasma levels of sEng are predictive of subsequence occurrence and severity of preeclampsia, in terms of severity of hypertension and proteinuria, prematurity, and association with small for gestational age neonates. [ABSTRACT FROM AUTHOR]

Objective: To develop a tool for assessing the performance of primary care services in South Korea from the patient's perspective and to test the validity of the tool under the conceptual framework of the recently developed definition of primary care in Korea.Design: Item development for questionnaire and a cross-sectional survey for tool validation at 16 primary care clinics. All family physicians included in this study were required to have practiced at their current clinic for at least 2 years.Participants: A nine expert panel was assembled for tool development and patients (or guardians) who had visited their primary care clinic on six or more occasions over a period of more than 6 months participated in the survey.Main Outcome Measures: Scores corresponding to each domain of primary care.Results: A total of 722 effective data sets were used for the analysis. Five items were eliminated from the preliminary 30-item tool after expert discussions at two seminars. Another four items were eliminated by principle component analysis. For each of the four domains (comprehensiveness, coordination function, personalized care, and family/community orientation), tests of scaling assumptions were well satisfied by all Likert-scaled measures. On the other hand, 'first contact' turned out to be a composite domain with five independent single-item scales.Conclusion: The Korean primary care assessment tool (version 1) consists of four multi-item scales and one composite scale. Widespread application of this tool will provide an empirical basis for the measurement, monitoring and continuous improvement of primary care in South Korea. [ABSTRACT FROM AUTHOR]

BACKGROUND: The Baylor Profound Mental Status Examination (BPMSE) was modeled to provide a brief patient-derived rating scale for staging and tracking patients with severe stages of Alzheimer's disease (AD). METHODS: The BPMSE was administered to 91 patients with probable AD (Korean version of the MMSE less than 16) according to the National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer's Disease and Related Disorders Association criteria. The patients were also evaluated using the Korean version of the Severe Impairment Battery (SIB-Ko), Clinical Dementia Rating (CDR), Global Deterioration Scale (GDS), Barthel Activities of Daily Living (B-ADL), the Korean version of the Instrumental Activities of Daily Living (K-IADL), the Korean version of the Neuropsychiatric Inventory (K-NPI) and the Functional Assessment Staging (FAST). RESULTS: There were significant correlations between the BPMSE- Ko and K-MMSE scores (r = 0.66, p < 0.001) and between the BPMSE-Ko and SIB-Ko scores (r = 0.83, p < 0.001). The BPMSE-Ko correlated with the CDR, GDS, B-ADL, K-IADL, K-NPI and FAST scores (p < 0.001). The BPMSE-Ko scores continued to decline even after the K-MMSE reached values near 0. CONCLUSIONS: The BPMSE-Ko is a time efficient and useful tool to measure cognitive function in patients with severe AD. [ABSTRACT FROM AUTHOR]

The assumption that heritage language fluency is an essential component of ethnic identity, and that both factors are important predictors of school effort, was tested across two ethnic groups spanning multiple generations of immigrants. The sample consisted of 207 immigrant Chinese (first- and second-generation) and 354 Mexican (first-, second-, and third-generation) adolescents. The findings demonstrate that heritage language fluency is an important component of ethnic identity for second-generation Mexican adolescents, but not for second-generation Chinese adolescents. Thus, for this latter group, it may not be appropriate to use identity measures that assess heritage language fluency as a part of the general dimension of ethnic identity. The findings also show that higher reading and writing skills in Spanish are significant predictors of school effort for all three generations of Mexican adolescents; in addition, higher ethnic identity exploration is related to the school effort of second-generation Mexican adolescents. [ABSTRACT FROM AUTHOR]

Objective: Among Alzheimer disease (AD) patients enrolled in a clinical trial, the authors assessed the ability of a standardized capacity assessment procedure to identify persons who are capable of giving their own informed consent.Design: Cross-sectional interview.Setting: Thirteen sites participating in a randomized and placebo controlled study of simvastatin for the treatment of mild to moderate AD.Participants: Persons with mild to moderate AD and their study partners enrolled in the simvastatin clinical trial.Measurements: Interviews to assess decision-making capacity using the MacArthur Competency Assessment Tool for Clinical Research (MacCAT-CR).Results: Judges blinded to the subject's clinical status had a high rate of agreement on patients capable of giving their own informed consent (kappa = 0.73). The understanding subscale had the best receiver operator characteristic and an analysis of positive and negative predictive values over a range of hypothetical prevalences of incapacity to consent demonstrated the value of a range of understanding cut-points.Conclusion: Among mild to moderate AD patients, enrolled in an actual clinical trial, these results suggest evidence based guidelines for using the MacCAT-CR understanding subscale to help guide judgments about whether a patient has the capacity to consent. [ABSTRACT FROM AUTHOR]

Treating young patients with femoral head osteonecrosis (ON) remains challenging. Anatomic stems were introduced in the 1980s and 1990s to improve the proximal canal fit in an attempt to enhance long-term implant survival, an important aspect of treating young patients. We began using one design in 1993 and asked three questions to confirm whether the design criteria improved outcomes in patients with ON: (1) What is the long term survivorship of these implants?; (2) What is the amount and rate of wear?; and (3) What is the incidence of osteolysis? We retrospectively reviewed 56 patients (69 hips) who underwent THA for femoral head ON with a cementless anatomic stem proximally coated with hydroxyapatite. Four patients (four hips) were lost to followup and 16 patients (19 hips) died. In the remaining 36 patients (46 hips) the minimum followup was 10 years (mean, 11.2 years; range, 10-13 years). The mean age at operation was 48.6 years. The average Harris hip score at last followup was 87 points. Worst-case survivorship was 58.1% at 13 years and best-case was 93.3%. The average linear wear of the polyethylene liner was 2.02 mm and the average annual wear was 0.18 mm per year. Thirty-seven hips (80%) had femoral osteolysis and 14 (30%) had acetabular osteolysis. One patient who had extensive femoral osteolysis and stem loosening was revised at 11.2 years postoperatively. The high rates of polyethylene wear and osteolysis are of concern. [ABSTRACT FROM AUTHOR]

BACKGROUND/AIMS: The possible influence of apolipoprotein E (ApoE) genotype on the response to acetylcholinesterase inhibitor therapy in patients with Alzheimer's disease (AD) remains a matter of controversy. In order to address this issue, we investigated the effects of ApoE genotype on the clinical response to donepezil in patients with mild to moderate AD. METHODS: An open study was carried out in 51 patients with probable AD who were treated with 5-10 mg of donepezil per day for 48 weeks. RESULTS: Eighteen (35.3%) of the 51 patients had 1 or 2 ApoE epsilon4 alleles. ApoE epsilon4 carriers with AD showed a mean 1.1-point increase from the baseline score of 23.9 on the 70-point Alzheimer's Disease Assessment Scale-Cognitive Component at 48 weeks, while the ApoE epsilon4 noncarrier group showed a 3.1-point increase from the baseline score of 22.5 (p = 0.03). The ApoE epsilon4 carrier group exhibited a mean 0.13-point worsening from the baseline score of 0.97 on the Korean Instrumental Activities of Daily Living at 48 weeks, while the ApoE epsilon4 noncarrier group exhibited a 0.17-point worsening from the baseline score of 0.64 (p = 0.05). CONCLUSION: AD patients who carry the ApoE epsilon4 allele may respond more favorably to donepezil than epsilon4 noncarriers. [ABSTRACT FROM AUTHOR]

Cost effectiveness is becoming an increasingly important factor for stakeholders faced with decisions about adding a new vaccine into national immunization programmes versus alternative use of resources. Evaluating cost effectiveness, taking into account the relevant biological, clinical, epidemiological and economic factors of a vaccination programme, generally requires use of a model. This review examines the modelling approaches used in cost-effectiveness analyses (CEAs) of vaccination programmes.After overviewing the key attributes of models used in CEAs, a framework for categorising theoretical models is presented. Categories are based on three main attributes: static/dynamic; stochastic/deterministic; and aggregate/individual based. This framework was applied to a systematic review of CEAs of all currently available vaccines for the period of 1976 to May 2007. The systematic review identified 276 CEAs of vaccination programmes. The great majority (83%) of CEAs were conducted in the setting of high-income countries. Only a few vaccines were widely studied, with 57% of available CEAs being focused on the varicella, influenza, hepatitis A, hepatitis B or pneumococcal vaccine. Several time trends were evident, indicating that the number of vaccine CEAs being published is increasing; the main health outcome measures are moving away from the number of cases prevented towards quality-adjusted and unadjusted life-years gained, and more complex models are beginning to be used. The modelling approach was often not adequately described. Of the 208 CEAs that could be categorized according to the framework, around 90% were deterministic, aggregate-level static models. Although a dynamic transmission model is required to account for herd-immunity effects, only 23 of the CEAs were dynamic. None of the CEAs were individual based. To improve communication about the cost effectiveness of vaccination programmes, we believe the first step is for analysts to be more transparent with each other. A clear description of the model type using consistent terminology and justification for the model choice must begin to accompany all CEAs. As a minimum, we urge modellers to provide an explicit statement about the following attributes: static/dynamic; stochastic/deterministic; aggregate/individual based; open/closed. Where relevant, time intervals (discrete/continuous) and (non)linearity should also be described. Enhanced methods of assessing model performance and validity are also required. Our results emphasize the need to improve modelling methods for CEAs of vaccination programmes; specifically, model choice, construction, assessment and validation. [ABSTRACT FROM AUTHOR]

This longitudinal study examined whether supportive parenting mediates relations between parent–child differences in cultural orientation (generational dissonance) and depressive symptoms with a sample of 451 first and second generation Chinese American parents and adolescents (12–15 years old at time 1). Using a person-centered approach, meaningful typologies of cultural orientation were derived for fathers, mothers, and adolescents. Overall, results provided support, though qualified, for the notion that generational dissonance is linked to depressive symptoms through decreased supportive parenting. In general, having a parent with a bicultural profile seemed to be most advantageous if adolescents similarly had a bicultural profile, whereas more American oriented adolescents with more Chinese oriented parents reported the least supportive parenting and most depressive symptoms. Directions for future research and the benefits of using a person-centered approach in research of acculturation and generational dissonance are discussed. [ABSTRACT FROM AUTHOR]