BACKGROUND

A comparison of efficacy and safety between transradial and transfemoral approach for percutaneous coronary intervention (PCI) in bifurcations has not been done. This study evaluated feasibility of transradial PCI (TRI) and compared the immediate and followup results with transfemoral PCI (TFI) in bifurcations.

METHODS

One hundred and thirty-four consecutive patients with bifurcations were treated with PCI in our hospital from April 2004 to October 2005. Of these, there were 60 patients (88 lesions) in TRI group and 74 patients (101 lesions) in TFI group. Bifurcations type was classified according to the Institut Cardiovasculaire Paris Sud Classification.

RESULTS

TRI group had smaller stent diameter ((3.06 +/- 0.37) mm vs (3.18 +/- 0.35) mm, P = 0.023) and postprocedural in-stent minimum lumen diameter ((2.62 +/- 0.37) mm vs (2.74 +/- 0.41) mm, P = 0.029) than TFI, but there were not significant differences in in-stent subacute thrombosis rate (0% vs 1.0%, P = 0.349), target lesion revascularization (TLR) (0% vs 1.0%, P = 0.349) following procedure and thrombosis (2.3% vs 1.0%, P = 0.482), in-stent restenosis (12.5% vs 10.9%, P = 0.731), in-segment restenosis (17.0% vs 14.9%, P = 0.681), TLR (10.2% vs 13.9%, P = 0.446) and TLR-free cumulative survival rate (89.8% vs 86.1%, P = 0.787) at seven months followup. No death was reported in the two groups.

CONCLUSIONS

Transradial intervention is feasible and appears to be as effective and safe as transfemoral PCI in treatment of true bifurcational lesions.

The excessive use of plant protection products (PPPs) has given rise to issues of public and environmental health because of their toxicity. Reducing the use of toxic PPPs and replacing them with products that are less toxic for human health and the environment have become socially, environmentally and economically indispensable. In this article, we assess the plant protection practices of a small group of winegrowers practicing "integrated agriculture" in the south of France, in order to measure the benefit of using toxicity risk indicators as a decision-support tool for different players in land management. An analysis of plant protection practices using indicators of the risk to operator health and the environment (IRSA, IRTE), together with a frequency-of-treatment indicator (TFI), enabled us to (i) show the variability of these indicators depending on the production system and farmers' pesticide use strategies and (ii) calculate correlations between these indicators. This analysis of plant protection practices at different scales (farm, field), carried out in collaboration with the growers, enabled us to perform an initial validation of decision-support tools for determining risk management strategies regarding the use of pesticides.

BACKGROUND

Frail elderly have a higher risk of adverse outcomes, e.g., hospitalization,institutionalization, or premature death. The Tilburg Frailty Indicator (TFI) is a validated questionnaire for measuring frailty in independently living older people aged 70 years and over.

OBJECTIVE

Determining the prevalence of frailty among independently living young elderly, and examining which factors predict frailty among this target group.

METHODS

308 young elderly (58 to 64 years) completed the TFI before they visited the ambulatory health screening centre in Roosendaal. The TFI includes questions concerning physical, psychological and social frailty, and questions on possible determinants of frailty.

RESULTS

18-4% of the sample of young elderly was frail. Women scored significantly higher on psychological and social frailty. The determinants explained 37% of the frailty score. As expected,low income, an unhealthy lifestyle, multimorbidity, experiencing life events, and dissatisfaction with the living environment predicted frailty. The three frailty domains(physical, psychological, social) were affected by different determinants.

CONCLUSIONS

A substantial part of the young elderly in the sample turned out to be frail. The finding that the three domains of frailty are predicted by different determinants underlines the importance the importance of a broad perspective regarding the functioning of the individual older person.

BACKGROUND

This study evaluated whether progression-free interval (PFI) following primary chemotherapy (PCT) was predictive of overall survival (OS) after second-line chemotherapy in advanced/recurrent endometrial cancer (EC).

METHODS

This is a pooled analysis of patients who recurred after PCT and were treated with second-line chemotherapy on Gynecologic Oncology Group trials. PFI-1 measured from initiation of PCT to recurrence or treatment-free interval (TFI) measured from completion of PCT to initiation of second-line chemotherapy was evaluated in relation to clinical outcomes.

RESULTS

A total of 586 patients treated on 5 phase 3 PCT protocols were included. Baseline factors in primary setting associated with clinical outcome after PCT were also predictive of OS after second-line chemotherapy, including race, Gynecologic Oncology Group performance status, grade, and prior radiation therapy (P<.01). PFI-1 was the most significant factor predictive of survival after second-line chemotherapy, with a 30% reduction in the risk of death for PFI-1>6 months compared with ≤6 months (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.59-0.84 [P<.0001]) and median OS after second-line chemotherapy of 10 versus 5 months. A total of 275 patients treated on 9 phase 2 second-line chemotherapy protocols were also evaluated, and TFI)3 months was associated with a 25% reduction in the risk of death (HR, 0.75; 95% CI, 0.57-0.97 [P=.030]) and median OS after second-line chemotherapy of 10 versus 7 months compared with TFI≤3 months. The tumor response to second-line chemotherapy was 9.6% versus 5.8%; the difference was not statistically significant.

CONCLUSIONS

Time to recurrence after PCT is predictive of survival after recurrence in advanced/recurrent EC. However, there is no evidence that this variable can be used in selecting salvage chemotherapy.

BACKGROUND

: Hepatic iron stores in patients with chronic hepatitis C (CHC) may accelerate the progression to liver cirrhosis and hepatocellular carcinoma. Detection of soluble transferrin receptor (sTfR) allows for quantitative evaluation of intracellular iron stores, especially under circumstances of chronic inflammatory state, as CHC.

OBJECTIVE

: The aim of this study was to evaluate the concentration of sTfR as an indicator of intracellular iron stores in relation to serum iron management parameters in children with CHC and potential influence of treatment with IFN-alpha and ribavirin.

METHODS

: Fifteen children with diagnosed CHC were enrolled into the study, age range 6-17.5 years (mean 11.17+/-3.86 years), 11 boys and 4 girls. Children were treated with IFN-alpha (3MU/M(2) s.c. three times a week) and ribavirin (15mg/kg p.o. daily) for 12 months. sTfR level was detected by latex test N Latex sTfR (DADE Behring).

RESULTS

: Observation after 16 weeks of the treatment revealed significant increase of sTfR level (sTfRI=1.27mg/dl versus sTfRII=1.57mg/dl; p=0.002) and serum Tf (TfI=190.98+/-61.23mg/dl versus TfII=232.53+/-53.64mg/dl; p=0.019) with the decline in serum iron (Iron I=138.72+/-65.91 versus Iron II=104.98+/-22.12; p=0.049) and ferritin (Ferritin I=240.35+/-125.43mg/dl versus Ferritin II=145.65+/-78.87mg/dl; p=0.022). Patients with viral response to treatment developed higher, although not significant, sTfRII levels than nonresponders.

CONCLUSIONS

: Combined therapy with IFN-alpha and ribavirin causes an increase in sTfR level with decline in serum iron and ferritin, revealing intracellular reduction of iron stores depending on the result of treatment.

BACKGROUND

The transradial approach has gained increasing popularity for elective percutaneous coronary intervention. However, the safety and feasibility of transradial coronary intervention (TRI) in acute myocardial infarction (AMI) remains uncertain. Hence, a meta-analysis of randomized trials was performed to compare outcomes of TRI with transfemoral coronary intervention (TFI) in patients with AMI.

METHODS

A systematic review of the literature revealed seven randomized trials involving 1306 patients. Endpoints extracted were access site complications, major adverse cardiovascular events, major bleeding, and procedural success. Combined relative risks (RRs) across all studies and 95% confidence intervals (CIs) were computed. A two-sided α error of less than 0.05 was considered to be statistically significant.

RESULTS

Baseline characteristics were similar in both groups. Compared with patients undergoing TFI, risk of major adverse cardiovascular events (RR: 0.83, CI: 0.51-1.35; P=0.45) and major bleeding (RR: 0.51, CI: 0.20-1.26; P=0.14) was similar in patients undergoing TRI. The procedural success was similar with both approaches (RR: 0.99, CI: 0.96-1.02; P=0.59). However, incidence of access site complications was significantly lower in the TRI group (RR: 0.31, CI: 0.17-0.58; P<0.001).

CONCLUSIONS

The meta-analysis suggests that TRI may be superior to TFI in reducing access site complications in patients with AMI. However, there is no difference in procedural success and major bleeding between the two groups.

Previous studies using reciprocal crosses between the spontaneously hypertensive rat (SHR) and the normotensive Wistar-Kyoto (WKY) strain suggested a role for the Y chromosome in the SHR's exaggerated preference for saline solutions. We have reexamined the role of the Y chromosome in the salt preference of the SHR using a consomic strain derived from SHR and Brown Norway (BN-Lx) progenitors. We also studied congenic lines in which regions of BN-Lx chromosomes 8 and 20 had been introgressed into the SHR genome. Animals were given a choice of water and 0.9% saline to drink over a period of 7 days and their total fluid intake (TFI; water plus saline) and saline preference (proportion of the TFI taken as saline) calculated. SHR bearing the BN-Lx Y chromosome had a significantly reduced saline preference when compared to progenitor SHR. Evidence was also found for the existence of a region on chromosome 8, which influences fluid intake in the SHR. The causative genes involved in these effects however remain to be determined.

The purpose of this study was to assess the prevalence and severity of dental fluorosis in 513 primary school children in Nairobi. The clinical examination was performed in a room with natural daylight using Thylstrup & Fejerskov's index (TFI). Overall, 18% of 6-8-yr-olds had dental fluorosis in the primary dentition and 76% of 13-15-yr-olds in the permanent dentition. There was no significant sex difference (P>> 0.05) in either the prevalence or the severity of fluorosis. In children with mixed dentition, the prevalence and severity of fluorosis was higher in the permanent teeth. In the permanent dentition, no clear difference was demonstrable in the severity between the anterior and the posterior teeth. The degree of fluorosis in most of the children in the area served with river water (0.2-0.4 ppm F-) was of a very mild form. However, in the area served with borehole waters, 48% of the children and 40% of the teeth were found to have TFI scores>> or = 5. Measures to reduce dental fluorosis are necessary in the latter area.

Tumor of follicular infundibulum (TFI) is currently believed to be a benign epithelial neoplasm with follicular differentiation. It has been suggested that TFI is associated with dermal scarring, but further investigation is needed to confirm this correlation. To approach this question, a retrospective study was presented, a total of 67 cases (64 lesions) were found in a search covering cases over a 10-year period. Overall, the presence of histological dermal scarring was noted in 34 of 64 (53.13%) cases. Of the cases where TFI was an incidental finding, the presence of dermal scarring was noted in 13 of 18 (72.22%) cases. Meanwhile, of the cases where TFI was the main diagnosis, the presence of dermal scarring was noted in 12 of 34 (35.29%) cases. This suggests that TFI may, in some cases, represent an epidermal reaction pattern to dermal scarring.

OBJECTIVE

This study was aimed at determining dental fluorosis prevalence and severity amongst 6-13-year-old students residing in Medellin, Colombia.

METHODS

A descriptive study was carried out on 1,330 students attending 34 public schools in the city of Medellin. Two dentists trained in dental fluorosis diagnosis performed the examinations were after the teeth had been brushed. Teeth were dried with gauze, isolated with cotton pellets and visually examined in natural light. The Thylstrup and Fejerskov index (TFI) was used for rating fluorosis.

RESULTS

Dental fluorosis prevalence was 81 % (TFI)1); 46.4 % was related to mild dental fluorosis (TFITFITFI >5). TFI>> or = 1 was found in 21 % of the children being examined in at least 50 % of their teeth.

CONCLUSIONS

Dental fluorosis prevalence level was found to be high in Medellín, Colombia; health authorities should thus focus their attention on preventing this problem.

OBJECTIVE

Laser-induced fluorescence spectroscopy (LIFS) may be capable of guiding laser angioplasty by discriminating normal and atherosclerotic artery and by determining catheter-tissue environment. Previous optical multichannel analyzer based LIFS systems have been expensive and cumbersome. To simplify LIFS, a system based on photomultiplier tubes was developed and evaluated.

METHODS

Tissue fluorescence was induced by a helium cadmium laser (wavelength = 325 nm, power = 0.2-0.5 mW), collected by clinical multifiber laser angioplasty catheters and directed through one of two filters (10 nm bandpass, 380 nm or 440 nm peak transmission) to a photomultiplier tube. An LIFS ratio was defined as the relative intensity at 380:440 nm after calibration with an elastin fluorescence spectrum; 157 coronary artery cadaveric specimens were evaluated spectroscopically and histologically. To evaluate the utility of LIFS to optimize catheter position by determining catheter-tissue contact, by determining saline dilution of blood, and by orienting eccentric multifiber catheters a new variable, the total fluorescence intensity (TFI) was defined as the sum of arterial fluorescence intensities at 380 nm and 440 nm. TFI was recorded in vitro through multifiber catheters from 20 arterial specimens in vitro in blood and evaluated as a function of the catheter-to-tissue distance (d) over a range from 0 to 400 mu.

RESULTS

Defining normal specimens as those with an intimal thickness < or = 200 mu, and atherosclerotic as those with an intimal thickness>> 200 mu, 47/50 (94%) normal and 85/107 (79%) atherosclerotic specimens were correctly classified using a threshold LIFS ratio of 2.0. Mean (+/- SE) normal ratio was 1.76 +/- 0.02 and mean atherosclerotic ratio was 2.78 +/- 0.08 (P < or = 0.01). The classification accuracy of atherosclerotic specimens increased with intimal thickness so that 95% of atherosclerotic specimens (69/73) with intimal thickness>> or = 400 mu were correctly classified. TFI was capable of determining catheter-tissue contact as maximal TFI was recorded with the catheter in contact with the tissue (d = 0 mu) and decreased markedly with distance (to 52 +/- 6% at d = 100 mu, 19 +/- 4% at d = 200 mu, and 3 +/- 1% at d = 300 mu). TFI was recorded from ten arterial specimens in blood/saline mixtures ranging in hematocrit from 0% (saline) to 50% (whole blood). TFI was capable of detecting saline hemodilution of blood as TFI decreased markedly at higher hematocrits such that TFI could only by recorded at hematocrits < 10% for catheter-to-tissue distances>> or = 300 mu. TFI was recorded through ecentric multifiber catheters from 25 arterial specimens and eval-uated as a function of the degree of catheter-tissue overlap. TFI was capable of detecting maximal catheter-tissue overlap as TFI correlated linearly with the area (A) of overlap (TFI = 1.12 A + .07, r = 0.92).

CONCLUSIONS

By discriminating atherosclerotic from normal tissue and by confirming catheter-tissue contact and saline hemodilution, fluorescence feedback should minimize irradiation of normal tissue and/or blood and enhance the safety and efficacy of laser angioplasty.

We investigated cardiac muscle behavior after inhibition of either sarcoplasmic reticulum (SR) Ca2+ release or SR Ca2+ uptake. Mechanics of 35 rat papillary muscles were studied after either ryanodine 10(-7) M (n = 11) or cyclopiazonic acid (CPA) 10(-5) M (n = 14) and compared with a control group containing the solvent alone (n = 10). We measured the maximum extent of shortening (delta L) of the preloaded twitch (delta Lp), and the normalized total force (TF) of the full isometric twitch (TFi). The peak lengthening velocity (Vl) of the preloaded twitch (Vlp) and the normalized negative peak force derivative of the fully isometric twitch (-DFi) tested the lusitropic state. With the influence of shortening and/or load on relaxation taken into account, analysis of relaxation was performed using 1) Vlp-to-delta Lp and magnitude of -DFi-to-TFi ratios and 2) slopes of the Vl-delta L and magnitude of -DF-TF relationships over the entire continuum of load. Ca(2+)-release inhibition with ryanodine induced a negative inotropic effect and a decrease in Vlp from 2.7 +/- 0.2 to 1.4 +/- 0.2 Lmax/S, where Lmax is the initial length at the peak of the length-active tension curve (P < 0.001). The Vlp-to-delta Lp ratio and the slope of the Vl-delta L relationship were preserved, indicating that ryanodine was devoid of intrinsic relaxant effect under isotonic conditions. Ca(2+)-uptake inhibition with CPA had no inotropic effect but decreased Vlp from 2.9 +/- 0.1 to 2.2 +/- 0.1 Lmax/s (P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Deletions of the long arm of chromosome 6 are known to occur at relatively low frequency (3-6%) in chronic lymphocytic leukemia (CLL), and they are more frequently observed in 6q21. Few data have been reported regarding other bands on 6q involved by cytogenetic alterations in CLL. The cytogenetic study was performed in nuclei and metaphases obtained after stimulation with a combination of CpG-oligonucleotide DSP30 and interleukin-2. Four bacterial artificial chromosome (BAC) clones mapping regions in bands 6q16, 6q23, 6q25, 6q27 were used as probes for fluorescence in situ hybridization in 107 CLL cases in order to analyze the occurrence and localization of 6q aberrations. We identified 11 cases (10.2%) with 6q deletion of 107 patients studied with CLL. The trends of survival curves and the treatment-free intervals (TFI) of patients with deletion suggest a better outcome than the other cytogenetic risk groups. We observed two subgroups with 6q deletion as the sole anomaly: two cases with 6q16 deletion, and three cases with 6q25.2-27 deletion. There were differences of age, stage, and TFI between both subgroups. By using BAC probes, we observed that 6q deletion has a higher frequency in CLL and is linked with a good prognosis. In addition, it was observed that the deletion in 6q16 appears to be the most frequent and, if present as the only abnormality, it could be associated with a most widespread disease.

In B-cell chronic lymphocytic leukemia (B-CLL), somatic mutation of IgVH genes defines a subgroup with favorable prognosis, whereas the absence of IgVH mutations is correlated with a worse outcome. Mutations of the BCL-6 gene are also observed in a subset of B-CLL, but the clinical significance of this molecular alteration remains uncertain. We examined the distribution of IgVH and BCL-6 gene mutations in 95 well-characterized patients with Binet stage A B-CLL, and correlated them with clinical, laboratory, cytogenetic findings and disease progression. Mutations of the BCL-6 gene were observed only in cases harboring mutated IgVH. Unexpectedly, coexistence of IgVH and BCL-6 mutations was correlated with shorter treatment-free interval (TFI) compared to cases harboring only IgVH mutation (median, 55 months vs not reached; P=0.01), resembling the clinical course of unmutated IgVH cases (median TFI, 44 months). As expected, deletions of 17p13 (P53 locus) and 11q22 (ATM locus) were observed in cases with unmutated IgVH, except one patient who showed mutations of both IgVH and BCL-6. No other statistically significant differences were observed among the genetic subgroups. Our data indicate that BCL-6 mutations identify a subgroup of Binet stage A B-CLL patients with a high risk of progression despite the presence of mutated IgVH gene.

The aim of this study was to evaluate the psychometric properties of patient-reported visual analogue scale (VAS) ratings. All of the participants (100 Polish-speaking adults) completed a Tinnitus Functional Index (TFI) once and a 4-component VAS twice over a period of 3 days. Spearman's correlation coefficients between the VAS score and global TFI ranged from ρ = 0.52 for VAS-coping (VAS-C) to ρ = 0.81 for VAS-annoyance (VAS-A). Using the Bland-Altman method, the agreement ranged from 93% for VAS-A to 96% for VAS-distress (VAS-D). Interclass correlation coefficients ranged from 0.67 for VAS-C to 0.90 for VAS-A. The VAS cutoff points representing significant tinnitus severity ranged from 45 points for VAS-C to 66 points for VAS-D. VAS scales are a valid and reliable brief screening tool for obtaining quick information about tinnitus.

The aim of this study was to examine whether acute nerve compression damages an axonal transport system based on microtubules and how the fibers recover after the compression. A 5-mm segment of the tibial nerve of male wistar rat was compressed with a specially designed clip. Functional recovery was assessed using Tibial Nerve Functional Index (TFI). Rats were sacrificed each day from Day 0 to Day 2 and every 2 days between Day 4 and Day 10. For immunohistochemical analysis of the tibial nerve, the proximal uncompressed, the middle compressed, and the distal uncompressed segments of each section were assessed under immunofluoroscent microscopy for anti-dynein, anti-tubulin, and anti-neurofilament antibodies staining. In rats whose tibial nerve was compressed by 25 g/mm2 of pressure for 5 min, staining of dynein and mirotubules in the compressed portion were obscure on Days 4-8, suggesting that the microtubules based axonal transport system was temporarily damaged, while neurofilaments were retained. In contrast, in the distal portion, anti-neurofilament staining showed no abnormality throughout the experimental period, indicating that Wallerian degeneration did not occur. We conclude that acute nerve compression can cause transient damage to the axonal transport system in nerve fibers without Wallerian degeneration.

OBJECTIVE

An analysis of differentially expressed genes (DEGs) between bladder transitional cell carcinoma (TCC) and the surrounding urothelium to help identify what lies behind the mechanism of multifocal tumor development has not yet been performed. We sought to find a new DEG related to the development of bladder TCC.

METHODS

Thirty-nine bladder TCC tissues paired with normal-appearing urothelium tissues obtained from the same patient were used as subjects. Initially, we compared the messenger RNA (mRNA) profiles between normal-appearing urothelium and TCC tissue of 1 patient by using annealing control primer (ACP)-based GeneFishing polymerase chain reaction (PCR) and selective amplification of family members (SAFM) PCR to identify potential DEGs. To validate the results of the ACP data, reverse transcriptase-polymerase chain reaction (RT-PCR) was performed on those of all 39 patients.

RESULTS

Among the several DEGs discovered in the ACP data, 1 DEG was chosen as the candidate for the RT-PCR, that is present or markedly upregulated in normal-appearing urothelial tissue compared with TCC tissue. Gene sequence searching revealed that this DEG is chicken ovalbumin upstream promoter-transcription factor I (COUP-TFI). Downregulation of COUP-TFI mRNA expression in TCC tissue compared to normal-appearing urothelium tissue of the same patient, irrespective of tumor stage and grade, was confirmed by RT-PCR in 39 patients.

CONCLUSIONS

Our results suggest that the loss of COUP-TFI may play a role in the transition from normal epithelium to TCC. Further characterization of the COUP-TFI gene is expected to give us informations about bladder TCC tumorigenesis.

OBJECTIVE

The aim of this trial was to investigate the efficacy and toxicity of a relative high-dose of topotecan combined with carboplatin in recurrent or persistent epithelial ovarian cancer (EOC).

METHODS

Patients participating in this phase II trial received topotecan at a dose of 1.0 mg/m(2)/day intravenously (IV) on days 1 to 5 in combination with carboplatin AUC 5 IV on day 5, every 21 days. The primary outcome was response rate (RR) and the toxicity. The secondary measurements were duration of response, time to progression (TTP) and overall survival (OS).

RESULTS

Fifty-nine patients entered the study and 53 were assessable for response. For this study, 260 courses of topotecan and carboplatin were given (median, 4 per patient; range, 1-8). The overall RR was 26.4%. The median duration of response and TTP were 7 and 6 months, respectively. The median OS was 19 months with a median follow-up period of 14 months. Initial platinum sensitivity and treatment free interval (TFI)>>or=6 months were associated with RR and OS. In the platinum-sensitive group, RR and OS were 40.0% and 25 months, whereas in the platinum-resistant group, these were 8.7% and 11 months, respectively. Grade 4 neutropenia occurred in 40.7% of the patients, and grade 4 thrombocytopenia was seen in 32.2% with a bleeding event in two patients. Nonhematologic toxicities were mild. There were no drug-related toxic deaths.

CONCLUSIONS

The relative high-dose of topotecan combined with carboplatin was feasible and produced modest activity in recurrent or persistent EOC. The RR and survival data appear promising for the initially platinum-sensitive cohort and thus this regimen may be considered for further development in this patient.

Calsequestrin is a sarcoplasmic reticulum protein, which plays a predominant role in diastolic Ca2+-storage in the mammalian heart. The present study was designed to define the gene structure, developmental and tissue specific expression of the murine, cardiac isoform of calsequestrin. Two sets of genomic libraries (lambda phage and PAC) were screened using the mouse cardiac calsequestrin cDNA, and several overlapping clones were isolated. These clones were characterized using restriction enzyme digestion, Southern blotting and partial sequencing. The cardiac calsequestrin gene consists of 11 exons and its 5' flanking region is characterized by the presence of a TATA-like box, muscle specific promoter elements such as 7 E-boxes, 1 MEF-2, 1 MCBF and 1 Repeat (musS) motifs, as well as several muscle non-specific transcriptional elements (AP-2A, NRE1, NRE2, p53, Spel and TFI-IIA). Expression of the cardiac isoform of calsequestrin was first detected on day 11 pre-birth and approached adult levels by day 4 post-birth. Expression of cardiac calsequestrin was also detected in adult fast-twitch skeletal muscle, thyroid, testis and epididymis tissues. This genomic characterization of cardiac calsequestrin may form the basis for further evaluation of its regulatory role in Ca2+ homeostasis and contractility in the murine heart.

OBJECTIVE

To assess change in tinnitus severity after stapedectomy using the validated Tinnitus Functional Index (TFI) at 1 and 6 months in 2 cohorts of subjects with otosclerosis with different preoperative (TFIpre) distress levels.

METHODS

Prospective within-subjects repeated measures.

METHODS

Twenty-six subjects completed the study between January 2012 and April 2013. Demographic information, preoperative and postoperative audiometric data at 1 month, and TFI scores measured preoperatively within 1 month of stapedectomy and postoperatively at 1 and 6 months were captured and analyzed.

RESULTS

Stapedectomy has its largest effect on tinnitus severity reduction within the first month of surgery. Cohort A (TFIpre>> 15, n = 16) ΔTFI mean and median values were ∼20 for the intervals preoperatively to 1 month and preoperatively to 6 months (p values < 0.01) and dropped to ∼0 for the interval between 1 and 6 months postoperatively. Cohort B (TFIpre < 15, n = 10) ΔTFI mean and median values were ∼0 for all time intervals (all pairwise comparison p values>> 0.05).

CONCLUSIONS

Stapedectomy in patients with otosclerosis with more than a small problem with tinnitus (TFIpre>> 15) will reduce severity by at least 1 clinical category in ∼85% of cases within 6 months of surgery. The majority of patients will experience stable tinnitus suppression within the first postoperative month. In patients with no tinnitus or less than a small problem with tinnitus (TFIpre < 15), stapedectomy carries a 10% risk of transient worsening of tinnitus at 1 month, which resolves by the sixth postoperative month.

OBJECTIVE

The Tinnitus Functional Index (TFI) has been optimised as a diagnostic tool for quantifying the functional impact of tinnitus in US veteran and civilian groups. However, the TFI has not been fully evaluated for use in other English-speaking clinical populations despite its increasingly popular uptake. Here, a prospective multi-site longitudinal validation study was conducted to evaluate psychometric properties relevant to the UK clinical population. Guided by quality criteria for the measurement properties of health-related questionnaires, we specifically evaluated three diagnostic properties relating to the degree to which the TFI (i) covers the eight dimensions proposed to be important for diagnosis, (ii) reliably distinguishes individual differences in severity of tinnitus, and (iii) reliably measures the functional impact of tinnitus. We also examine whether clinically meaningful interpretations of the scores can be produced for the UK population.

METHODS

Twelve National Health Service audiology clinics across the UK recruited 255 tinnitus patients to complete questionnaires at four time-intervals, from initial clinical assessment and then over a nine-month period. Patients completed the TFI, the Tinnitus Handicap Inventory (THI), tinnitus case history questions, a Global rating of Perceived Problem with tinnitus and a Clinical Global Impression of perceived change in tinnitus. Baseline TFI data were used to examine the factor structure, construct validity and interpretability of the TFI. Follow-up TFI data were used to examine reliability.

RESULTS

Confirmatory factor analysis suggested that of the eight subscales (factors) initially established for the TFI, the 'Auditory' subscale did not contribute to the overall construct 'functional impact of tinnitus', and a modified seven-factor model (TFI-22) better fit the variance in the patient scores. Both the global 25-item TFI and the global TFI-22 scores showed exceptionally high internal consistency (α ≥ 0.95), high construct validity with the THI (r = 0.80) and high test-retest reliability (ICC = 0.87). Test-retest agreement however was only deemed to be borderline acceptable (89%). Receiver Operator Characteristic analysis indicated the 25-item TFI and TFI-22 has excellent ability to distinguish between different levels of impact (Area under the curve>> 0.7).

CONCLUSIONS

The TFI was confirmed to cover multiple symptom domains, measuring a multi-domain construct of tinnitus, and satisfies a range of psychometric requirements for a good clinical measure, including having excellent reliability, stability over time and sensitivity to individual differences in tinnitus severity. However, a modified seven-factor structure without the Auditory subscale (TFI-22) is recommended for calculating a global composite score for UK patients. Using patients' experience and Receiver Operator Characteristic analysis, a grading system was presented which identifies the distinct grades of tinnitus impact in the UK clinical population that is broadly comparable to the US-based system.

The effect of spineless cactus intake (Opuntia ficus-indica) on blood glucose (BG) levels in lactating sows and its impact on daily and total feed intake (dFI-1 and TFI, respectively), body weight loss (BWL), and weaning-estrus interval length (WEI) were evaluated. Thirty-four hybrid (Yorkshire × Landrace × Pietrain) sows in lactation phase were used. Sows were divided into two groups: G1 (n = 17) where they received commercial feed and G2 (n = 17) provided with commercial feed plus an average of 2.0 ± 0.5 kg spineless cactus, based on a sow's body weight. The variables evaluated were BG, dFI-1, TFI, BWL, and WEI. Statistical analysis was performed by using a fixed and mixed model methodology, under a repeated measurements experiment. Group effects were found on all analyzed variables (P < 0.05). The BG was lower in G2 (55.2 and 64.5 mg/dL pre- and post-prandial, respectively), compared to that in G1 (70.9 and 80.1 mg/dL pre- and post-prandial, respectively) (P < 0.05). G2 showed better performance than G1 for dFI-1, BWL, and WEI (P < 0.05) whose averages were 5.5 ± 1.8 kg, 7.4 ± 4.5%, and 5.3 ± 1.2 days, respectively. Averages for these variables in G1 were 4.7 ± 1.5 kg, 16.8 ± 4.6%, and 6.1 ± 1.6 days, respectively. Intake of spineless cactus reduced BG levels in lactating sows, generating greater dFI-1, lower BWL at the end of lactation, and a lower WEI.

OBJECTIVE

To compare clinical outcomes between transradial (TRI) and transfemoral intervention (TFI) in primary percutaneous coronary intervention (PCI) in patients with ST elevation myocardial infarction (STEMI) with or without shock.

BACKGROUND

TRI for STEMI has benefits in TRI high volume centers. However, TRI has not been reported for STEMI with shock even in such centers.

METHODS

We retrospectively studied 425 STEMI patients who underwent primary PCI. Patients were divided into four groups according to approach site and presence of cardiogenic shock, including TRI without shock (TR group, n = 273), TRI with shock (TRS group, n = 38), TFI without shock (TF group, n = 71), and TFI with shock (TFS group, n = 43).

RESULTS

PCI success rates were similar among the four groups. The TR group was superior to the TF group in terms of shorter cath lab to first device activation time, and lower access site complications, and 30-day mortality rates (1.1% vs. 11.3%, P < 0.001). In shock patients, cardiopulmonary arrest was commonly observed in both the TRS and TFS groups (42.1% and 51.2%, respectively). The TRS group showed a trend toward a shorter door to first device activation time compared to the TFS group and lower access site complications; however, 30-day mortality rate was 28.9% in TRS and 25.6% in TFS group (P = 0.7).

CONCLUSIONS

In TRI high volume center, TRI for STEMI was safe and feasible as a default approach. TRI could be applied to severe shock patients with similar clinical outcome to TFI.