Une double discordance cardiaque complexe décompensée, à propos d'un cas et revue de la littérature / A double cardiac discordance decompensated, about a case and review of the literature

La double discordance est une cardiopathie congénitale complexe extrêmement rare, elle se caractérise par une discordance auriculo-ventriculaire suivie d'une autre discordance ventriculo-artérielle. Son diagnostic est posé généralement à l'âge adulte par des examens d'imagerie. Son pronostic dépend essentiellement des autres malformations congénitales cardiaques associées, des arythmies et des troubles de la conduction, ainsi que de la fonction systolique du ventricule droit en position systémique. Nous rapportons le cas d'un patient âgé de 23 ans, porteur d'une cardiopathie congénitale complexe cyanogène. Il s'agit d'une double discordance associée à une large communication interventriculaire sous aortique avec un shunt inversé et une hypoplasie de l'artère pulmonaire. Ce diagnostic a été confirmé par l'imagerie multimodale. Non opéré, le patient a vu son stade fonctionnel s'aggraver rapidement avec une dyspnée qui est passée d'un stade I à un stade III-IV de la New York Heart Association (NYHA), et apparition de signes hypoxiques et congestifs. A travers cette observation, nous avons précisé les caractéristiques anatomocliniques de cette cardiopathie congénitale complexe cyanogène, son exploration, ses options thérapeutiques, ainsi que le rôle péjoratif de son association avec d'autres malformations congénitales.

Double discordance is an extremely rare complex congenital heart disease; It is characterized by atrioventricular discordance followed by another ventriculo-arterial discordance. Its diagnosis is usually made in adulthood by imaging examinations. Its prognosis depends mainly on other associated congenital heart defects, arrhythmias and disorders of the conduction, as well as systolic function of the right ventricle in the systemic position. We report the case of a 23-year-old patient with a complex cyanogen heart disease.It is a double discordance associated to an interventricular communication with reverse shunt and an hypoplasia of the pulmonary artery.This Diagnosis was confirmed in multimodal imaging. Non-operated, the patient saw his functional status worsen rapidly with dyspnea which went from stage I to stage III-IV of the New York Heart Association (NYHA), and appearance of hypoxic and congestive signs. Through this observation, we have clarified the anatomoclinical characteristics of this complex congenital cyanogens heart disease, the necessary explorations and the different therapeutic options, as well as the pejorative role of its association with other congenital malformations.

Effect of Chorionicity， Gestational Age at Birth and Birth Weight Discordance on Neonatal Outcomes in Twin Pregnancies / 中山大学学报(医学科学版)

ObjectiveTo investigate the effect of chorionicity， gestational age at birth and birth weight discordance on neonatal outcomes in twin pregnancies. MethodsWe conducted a population-based retrospective study of monochorionic diamniotic （MCDA） twin pregnancies and dichorionic diamniotic （DCDA） twin pregnancies who were admitted in the First Affiliated Hospital， Sun Yat-sen University from January 2015 to December 2020. A total of 1504 live-born twins were included， with 386 cases in MCDA group and 1118 cases in DCDA groups， respectively. The comparison of neonatal outcomes between MCDA and DCDA twins was performed using t-test， Wilcoxon rank sum test， Chi-square test or Fisher’s exact test. Logistic regression was performed to evaluate the effects of chorionicity， gestational age at birth， birth weight discordance and sex on neonatal outcomes. There were 168 live-born twins affected by inter-twin birth weight discordance≥25%， with 96 cases in MCDA group and 72 cases in DCDA groups， respectively. Logistic regression was performed to evaluate the effects of chorionicity， gestational age at birth， birth weight light or heavy （small twin or large twin） of the twin and sex on neonatal outcomes. ResultsAmong the 1 504 newborns， gestational age at birth was lower in MCDA group compared with DCDA group （P = 0.000）， and the degree of birth weight discordance was higher in MCDA group than that of the DCDA group （P = 0.001）. Birth asphyxia， respiratory distress syndrome （RDS）， bronchopulmonary dysplasia （BPD）， and sepsis were more frequency in MCDA group compared with DCDA group （P = 0.000， P = 0.000， P = 0.000， P = 0.000）. Low gestational age at birth was an independent risk factor for birth asphyxia， RDS， BPD， sepsis， necrotizing enterocolitis （NEC）≥stageⅡ， acute kidney injury （AKI）， retinopathy of prematurity （ROP）， and neonatal death respectively （P = 0.000， P = 0.000， P = 0.000， P = 0.000， P = 0.011， P = 0.000， P = 0.000， P = 0.000）. High degree of birth weight discordance was an independent risk factor for birth asphyxia， RDS， BPD， sepsis and ROP respectively （P = 0.045， P = 0.000， P = 0.000， P = 0.004， P = 0.017 ）. Chorionicity was not an independent risk factor for neonatal morbidity and death （P > 0.05）. Among the 168 twins with birth weight discordance ≥25%， low gestational age at birth was an independent risk factor for birth asphyxia， RDS， BPD， sepsis and ROP， respectively （P = 0.000， P = 0.000， P = 0.000， P = 0.000， P = 0.000）； small twin was an independent risk factor for birth asphyxia and BPD， respectively （ P = 0.013， P = 0.001）； chorionicity was not an independent risk factor for neonatal morbidity （P > 0.05）. ConclusionChorionicity was not an independent risk factor for adverse neonatal outcome in twin births. Low gestational age at birth and high degree of birth weight discordance were independent risk factor for adverse neonatal outcome in twin births. Small twins had increased risk of adverse neonatal outcome in twins with birth weight discordance ≥25%.

Imaging and pathological discordance amongst the plethora of breast lesions in breast biopsies

Introduction: Imaging-guided breast tissue biopsy has become an acceptable alternative to open surgical biopsy for nonpalpable breast lesions. Discussion of abnormal results of the correlation between imaging and pathological findings can be very challenging as it can assist in decision-making with regard to the further treatment options by arriving at a comprehensive diagnosis. Materials and Methods: This was a retrospective study. Radiological data from imaging-guided breast biopsies of 500 patients during a 6-year period was collected and classified by a specialist radiologist as per the BI-RADS format. Histopathology reports were studied and discordance analyzed. Results: A total of 500 cases were reviewed. Approximately 33% (168) cases fell into the BI-RADS 3 category, 24.4% (122) into the BI-RADS 4, and 37% (187) into BI-RADS 5 categories. Approximately 50% (n = 250) cases were benign, 2.6% (13) belonged to the high-risk category, and 47.4% (237) were malignant. The number of discordant cases was 12 (2.4%), mostly due to technical factors. Sensitivity of biopsies to detect malignancy was 85%, specificity was 96%, and accuracy of biopsy in diagnosing cancer was 90%. Discussion: The "triple assessment" is the most sensitive method for detecting early breast cancer. An effective communication pathway must be established between a clinician, radiologist, and pathologist for surgical excision in discordance as it carries a high prevalence of carcinoma in these lesions. Conclusion: In discordant cases, either due to abnormal results of imaging or of abnormal pathological findings, the final decision is based on two concordant findings, out of the three parameters. This involves a multidisciplinary breast conference and an active participation by the pathologist.

Discordance of Low-Density Lipoprotein Cholestrol and Non-High-Density Lipoprotein Cholestrol and Coronary Artery Disease Severity / Discordância entre Colesterol LDL e Não-HDL e Gravidade da Doença Arterial Coronária

Abstract Background: A sizeable proportion of patients have discordant low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C). Objectives: We assessed the relationship between discordance of LDL-C and non-HDL-C and coronary artery disease (CAD) severity. Methods: We retrospectively evaluated the data of 574 consecutive patients who underwent coronary angiography. Fasting serum lipid profiles were recorded, SYNTAX and Gensini scores were calculated to establish CAD complexity and severity. We determined the medians for LDL-C and non-HDL-C to examine the discordance between LDL-C and non-HDL-C. Discordance was defined as LDL-C greater than or equal to the median and non-HDL-C less than median; or LDL-C less than median and non-HDL-C greater than or equal to median. A p value < 0.05 was accepted as statistically significant. Results: LDL-C levels were strongly and positively correlated with non-HDL-C levels (r = 0.865, p < 0.001) but 15% of patients had discordance between LDL-C and non-HDL-C. The percentage of patients with a Gensini score of zero or SYNTAX score of zero did not differ between discordant or concordant groups (p = 0.837, p = 0.821, respectively). Mean Gensini and SYNTAX scores, percentage of patients with Gensini score ≥20 and SYNTAX score >22 were not different from group to group (p = 0.635, p = 0.733, p = 0.799, p = 0.891, respectively). Also, there was no statistically significant correlation between LDL-C and Gensini or SYNTAX scores in any of the discordant or concordant groups. Additionally, no correlation was found between non-HDL-C and Gensini or SYNTAX score. Conclusions: While there was discordance between LDL-C and non-HDL-C (15% of patients), there is no difference regarding CAD severity and complexity between discordant and concordant groups.

Resumo Fundamento: Uma proporção considerável de pacientes apresenta níveis discordantes de colesterol de lipoproteína de baixa densidade (LDL) e de não alta densidade (não HDL). Objetivos: Avaliar a relação da discordância entre colesterol LDL e não HDL com a gravidade da doença arterial coronariana (DAC). Métodos: Avaliamos retrospectivamente os dados de 574 pacientes submetidos consecutivamente à angiografia coronariana. Foram registrados os perfis lipídicos séricos em jejum, e depois foram calculados os escores SYNTAX e Gensini para estabelecer a complexidade e a gravidade da DAC. Determinamos as medianas para colesterol LDL e não-HDL para examinar a discordância entre ambos. Discordância foi definida como LDL maior ou igual à mediana e não-HDL menor que mediana; ou LDL menor que a mediana e não-HDL maior ou igual à mediana. Valor de p < 0,05 foi aceito como estatisticamente significante. Resultados: Os níveis de colesterol LDL estiveram forte e positivamente correlacionados com os níveis de colesterol não-HDL (r = 0,865, p < 0,001), mas 15% dos pacientes apresentaram discordância entre LDL e não-HDL. A porcentagem de pacientes com escore Gensini ou SYNTAX zero não diferiu entre os grupos discordantes ou concordantes (p = 0,837, p = 0,821, respectivamente). Escores médios de Gensini e SYNTAX, porcentagem de pacientes com escore Gensini ≥ 20 e SYNTAX > 22 não foram diferentes de grupo para grupo (p = 0,635, p = 0,733, p = 0,799, p = 0,891, respectivamente). Além disso, não houve correlação estatisticamente significativa entre os escores de cholesterol LDL e Gensini ou SYNTAX em nenhum dos grupos discordantes ou concordantes. Também não foi encontrada correlação entre cholesterol não HDL e escore Gensini ou SYNTAX. Conclusões: Embora tenha havido discordância entre colesterol LDL e não-HDL (15% dos pacientes), não há diferença quanto à gravidade e complexidade da DAC entre os grupos discordantes e concordantes.

La crítica del joven Lacan al paralelismo psicofísico en "De la Psicosis Paranoica en sus relaciones con la personalidad" / Young Lacan's criticism of the psychophysical parallelism in "De la psychose paranoïaque dans ses rapports avec la personnalité" / A crítica do jovem Lacan ao paralelismo psicofísico em "Da psicose paranoica em suas relações com a personalidade" / La critique du jeune Lacan concernant le parallélisme psychophysique dans «La psychose paranoïde dans ses relations avec la personnalité¼

En su tesis de 1932 titulada "De la psicosis paranoica en sus relaciones con la personalidad", Jacques Lacan emprende una crítica, esparcida en diversos lugares de la misma, al paralelismo psicofísico defendido por la tradición psiquiátrica. En este contexto y como clave para explicar tanto las psicosis paranoicas como la paranoia de autocastigo del caso Aimée, el joven psiquiatra expondrá una versión propia del paralelismo, apoyándose en dos autores: Jakob Von Uexküll y Baruch Spinoza. Intentaremos destacar este recorrido así como las consecuencias de un paralelismo propiamente lacaniano.

Em sua tese de 1932 intitulada "Da psicose paranoica em suas relações com a personalidade", Jacques Lacan empreende uma crítica, dispersa em vários lugares dela, ao paralelismo psicofísico defendido pela tradição psiquiátrica. Nesse contexto, e como chave para explicar tanto as psicoses paranoicas quanto a paranoia autopunitiva do caso Aimée, o jovem psiquiatra apresentará sua própria versão de paralelismo, baseada em dois autores: Jakob Von Uexküll e Baruch Spinoza. Procuraremos destacar essa jornada, bem como as consequências de um paralelismo propriamente lacaniano.

In his thesis of 1932 entitled "De la psychose paranoïaque dans ses rapports avec la personnalité" (Paranoid psychosis and its relation to the personality), Jacques Lacan criticizes, in a scattered manner throughout his work, the psychophysical parallelism supported by psychiatric tradition. In this context and as a key to explain both the paranoid psychoses and the self-punishing paranoia of Aimée's case, the young psychiatrist presents his own version of parallelism based on two authors: Jakob Von Uexküll and Baruch Spinoza. We aim to highlight this endeavor and the consequences of Lacan's own parallelism.

Dans sa thèse de 1932 intitulée « De la psychose paranoïaque dans ses rapports avec la personnalité ¼, Jacques Lacan critique, de façon éparpillée dans le texte de sa thèse, le parallélisme psychophysique soutenu par la tradition psychiatrique. Dans ce contexte et comme clé pour expliquer à la fois les psychoses paranoïaques et la paranoïa auto-punissant du cas Aimée, le jeune psychiatre présentera sa propre version du parallélisme, basée sur deux auteurs : Jakob Von Uexküll et Baruch Spinoza. Cet article met en évidence cette entreprise, ainsi que les conséquences d'un parallélisme proprement lacanien.

In seiner 1932 verfassten Doktorarbeit „Über die paranoische Psychose in ihren Beziehungen zur Persönlichkeit und Frühe Schriften über die Paranoia" kritisiert Jacques Lacan wiederholt den psychophysischen Parallelismus, der damals von der psychiatrischen Tradition vertreten wurde. In diesem Zusammenhang und als Schlüssel zur Erklärung sowohl der paranoiden Psychosen als auch der selbstbestrafenden Paranoia des Falles Aimée entwickelt der junge Psychiater eine eigene Version des Parallelismus, welche auf zwei Autoren basiert, Jakob von Uexküll und Baruch Spinoza. Dieser Artikel beschreibt diesen Entwicklungsprozess und die Konsequenzen des Lacanianischen Parallelismus.

Evaluation of cepheid GeneXpert MTB/RIF assay for Mycobacterium tuberculosis detection and rifampicin resistance in clinical specimen

Background: Timely diagnosis and treatment of tuberculosis is important to treat the disease and to reduce transmission. The WHO recommends using GeneXpert MTB in developing, high-burden countries.  A study was conducted to evaluate the performance of Xpert assay for the detection of M. tuberculosis and rifampicin resistance in clinical specimen.Methods: About 615 consecutive samples were simultaneously subjected to culture and phenotypic drug susceptibility test for M. tuberculosis and analysis by GeneXpert assay. Confirmed Mycobacterium tuberculosis in a positive culture was used as a reference standard for TB diagnosis.Results: The assay achieved a sensitivity of 96.75% (268/277) and 76.47% (26/34) for smear positive and smear negative pulmonary specimen respectively. In extrapulmonary specimen, the sensitivity was 50% (1/2) and 42.8% (3/7) for smear positive and smear negative specimen respectively. An additional 48 M. tuberculosis were detected by Xpert assay which were smear and culture negative. The Xpert assay identified 100% of the phenotypic rifampicin susceptible isolates and 74.19% of the phenotypic rifampicin resistant isolates. Discordant results were seen in 8 (2.76%) isolates. 6 of these isolates were confirmed to be rifampicin resistant by the reference lab.Conclusions: Present study indicates that Xpert MTB/RIF assay is an effective and rapid tool for the rapid diagnosis of Mycobacterium tuberculosis. The sensitivity is comparable to culture in smear positive specimen but less sensitive than culture for smear negative specimen. In cases with high index of suspicion or discordance for rifampicin results, confirmation should be done by other methods due to false negative results on Xpert assay.

Effect of birth weight on retinopathy of prematurity in discordant twin pairs

Purpose: Since twin pairs with discordance have equal gestational age (GA), discordant twins may constitute an appropriate group to investigate the specific effect that birth weight (BW) has on the development of retinopathy of prematurity (ROP). The present study aims to investigate the effect of BW on any and severe stages of ROP development in twin pairs. Methods: Fifty-two discordant twin pairs (104 preterms) born ?32 gestational weeks, who were diagnosed with a minimum of 18% discordance between their BWs, were retrospectively analyzed. Twin pairs were separated into two groups based on the BW of each pair. The rate of any stage of ROP, Type 1 ROP, and perinatal risk factors were compared statistically among twin pairs. Results: The rate of any stage of ROP and Type 1 ROP was 24.0% and 4.8% in the whole group, respectively. A statistically significant difference was shown between lower and higher BW groups at any stage of ROP development (34.6% vs. 13.4%, P = 0.02). However, no difference was observed in Type 1 ROP development (7.7% vs. 1.9%, P = 0.17). No significant differences were found between twin pairs regarding neonatal morbidities. The number of small GA (SGA) infants in the smaller twin group was statistically higher than larger group and regression analysis showed that being SGA had significant correlation with any stage of ROP (odds ratio: 4.98, P = 0.02). Conclusion: This study showed that BW serves an effective role at any stage of ROP development in discordant twin pairs; however, no significant difference in terms of Type 1 ROP.

Study on the physical growth status of birthweight discordant twins under 4 years old / 中国实用儿科杂志

OBJECTIVE: To study the physical growth characteristics of birthweight discordant twins(BDT)under 4 years old. METHODS: The physical growth characteristics of BDT under 4 years old born from September 2010 to December 2017 in child health care system of Children's Hospital of Chongqing Medical University were analyzed retrospectively. R 3.5.3 was used to clean up the database,analyze the distribution of different degree of birthweight discordance,and draw the fitting curves. More than 20% of birth weight difference was taken as inclusive criteria of BDT. BDT were divided into preterm or full-term groups,and low birthweight or normal birthweight groups respectively. SPSS 19.0 software was used for statistical analysis. RESULTS: A total of 141 pairs of BDT were included,accounting for 15.4%(141/916). The degree of birthweight difference in premature BDT was higher than that of full-term BDT(t=3.820,P<0.001). The growth discordance of preterm BDT lasted longer. Physical growth of low/very low birthweight BDT was slower than that of normal birthweight BDT under 4 years old. The growth status of BDT didn't reach the average level of WHO growth chart by the time of the last follow-up. CONCLUSION: Birthweight discordance of twins could have longlasting effects on further growth and development. Preterm twins have higher degree of birthweight discordance,and the growth discordance lasts longer. Low birthweight is an important reason for growth retardation of the lighter BDT.Growth of BDT should be monitored regularly to increase follow-up compliance.

ER, PR and HER-2 discordances between primary and recurrent cancer and their impact on survival of breast cancer patient / 临床与实验病理学杂志

Purpose To assess the frequency of discordances in ER, PR and HER-2 status between primary and recurrent cancer and the impact of the discordance on breast cancer patient survival. Method Immunohistochemistry and/or fluorescent in situ hybridization was used to evaluate ER, PR and HER-2 status of primary and recurrent cancer in 62 breast cancer patients. The correlation between discordances in ER, PR and HER-2 receptors and clinicopathologic characteristics and patient survival was analyzed. Results Among 62 patients with breast recurrent cancer, discordance rate for ER, PR, and HER-2 was found in 6 (9.7％), 9 (14.5％) and 3 (4.8％) patients, respectively. During the follow-up period the ER-discordant cases had a poorer overall survival (median 29 months vs 44 months, P=0.021) and post-recurrence survival (median 6 months vs 15 months, P=0.027), compared with the concordant cases. No impact on overall survival or post-recurrence survival was observed for PR and HER-2 discordance when compared with the respective concordant cases (P> 0.05 for all).Conclusion Our results demonstrate an evident change regarding ER, PR and HER-2 between breast primary and recurrent cancer, and the ER unstable status in breast cancer suggust a worse prognosis.

Mechanical discordance between left atrium and left atrial appendage

During standard transesophageal echocardiographic examinations in sinus rhythm (SR) patients, the left atrial appendage (LAA) is not routinely assessed with Doppler. Despite having a SR, it is still possible to have irregular activity in the LAA. This situation is even more important for SR patients where assessment of the left atrium is often foregone. We describe a case where we encountered this situation and briefly review how to assess the left atrium and its appendage in such a case scenario.

Systematics of Clupeiformes and testing for ecological limits on species richness in a trans-marine/freshwater clade

Clupeiformes (herring, sardines, shad, anchovies and allies) are a globally distributed clade with nearly 400 marine, freshwater, and diadromous species. Although best known as filter feeding fishes that form large schools, this group occupies a diverse array of trophic guilds and habitats. Theory suggests that species richness in clades is modulated by ecological limits, which results in diversity-dependent clade growth, a pattern that most clades exhibit. As a trans-marine/freshwater clade that has undergone repeated transitions between marine and freshwaters, Clupeiformes are an excellent system for investigating the interplay between ecological diversity and macroevolutionary dynamics. In this study we review the systematics of Clupeiformes and explore discordance in phylogenetic relationships and divergence times between mitochondrial and nuclear loci. We then use comparative methods to test whether ecological limits regulate diversity in Clupeiformes. We find discordance in phylogenetic relationships at various taxonomic scales, but also considerable agreement between genomes. Our results suggest that trans-marine/freshwater clades are able to circumvent ecological limits on clade growth at regional, but not on local scales. Our study demonstrates that phylogenies are a critical link between ecology and macroevolutionary dynamics, and suggests habitat transitions can play a key role in shaping diversity patterns, particularly in the neotropics.(AU)

Clupeiformes (apapás, sardinhas e manjubas) são um clado globalmente distribuído com quase 400 espécies marinhas, de água doce e diádromas. Embora mais conhecida pela presença de peixes filtradores formadores de cardumes, este grupo apresenta uma diversidade de guilda e habitats tróficos. A teoria sugere que a riqueza de espécies em clados é modulada por limites ecológicos, o que resulta em um crescimento dependente da diversidade, um padrão que a maioria dos clados exibem. Como um clado que sofreu repetidas transições entre águas marinhas e as águas doces, os clupeiformes são um excelente grupo para investigar a interação entre a diversidade ecológica e a dinâmica macroevolutiva. Neste estudo, revisamos a sistemática de Clupeiformes e exploramos a discordância nas relações filogenéticas e os tempos de divergência entre loci mitocondriais e nucleares. Em seguida, utilizamos métodos comparativos para testar se os limites ecológicos regulam a diversidade em Clupeiformes. Encontramos discordância nas relações filogenéticas em várias escalas taxonômicas, mas também considerável concordância entre os genomas. Nossos resultados sugerem que clados que sofreram sucessivas transições entre águas marinhas e águas doces são capazes de contornar os limites ecológicos do crescimento durante a sua diversificação em escala global, mas não localmente. Nosso estudo demonstra que as filogenias apresentam um vínculo crítico entre a ecologia e a dinâmica macroevolutiva, e sugere que as transições de hábitats podem desempenhar um papel fundamental na modelagem dos padrões de diversidade, particularmente no neotrópico.(AU)

Value of ultrasonography in predicting the birth weight discordance of twin pregnancy / 上海交通大学学报（医学版）

Objective·To identify the relationship between the estimated fetal weight (EFW) discordance and birth weight (BW) discordance, and evaluate the accuracy of ultrasonography in predicting birth weight discordance (△BW) of twin pregnancy. Methods·The ultrasound was used to detect the growth of twins at different gestational weeks and the data were analyzed to compare the difference between EFW discordance (△EFW) and ?BW. Results·About 15.9 percent of twins (totally 277 cases) had severe △BW (△BW ≥20%) in our study, and the percentages of dichorionic-diamniotic twin (DCDA) and monochorionic-diamniotic twin (MCDA) were 68.2% and 31.8%, respectively (P>0.01). Compared with △EFW in other gestational weeks,△EFW last time before parturition was most consistent of △BW. Furthermore, the negative predictive value of MCDA was highest (94%) at 22-24 gestational weeks. Conclusion·Twin △BW was relatively better predicted by △EFW last time before parturition. Twin pregnancy without severe △EFW (△EFW<20%), especially MCDA with △EFW<20% at 22-24 weeks, had low probability of selective intrauterine growth restriction in the future.

The Relationship between Maternal Age at Birth and Intertwin Birth Weight Discordance in Korea

PURPOSE: To compare the relationship between intertwin birth weight discordance and maternal age at birth. METHODS: There were 51,726 pairs of twins born from 2007 to 2014 according to the birth certificate data of Korea Statistics (3,701,806 births). The data were excluded due to extra marital births, home births, and teenage births. Birth weight discordance rate (%) was calculated according to the following formula: (larger birth weight - smaller birth weight)/(birth weight of the larger twin) ×100. The odds ratio of intertwin birth weight discordance rate (≥25%) in maternal age at birth was calculated by logistic regression adjusted by the year of birth, gestational age, maternal education, infantile gender and paternal age. RESULTS: The mean birth weight of the heavier twin and that of the lighter twin were 2.536 kg and 2.254 kg, respectively. The mean birth weight difference of intertwins was 0.282 kg. The mean birth weight discordance rate by maternal age was 10.5 percent for maternal ages between 20 and 29 years, 11.0 percent for between 30 and 34 years, and 11.4 percent for 35 years and older. The frequency of birth weight discordance level of ≥25 percent increased as the maternal age increased. The rate of birth weight discordance (≥25%) was 7.7 percent for maternal ages between 20 and 29 years, 8.3 percent for between 30 and 34 years, and 8.7 percent in for 35 years and older. Compared with women from 20 to 29 years of age, the odds ratio of ≥25 percent discordance was 1.094 (95% confidence interval: 1.005~1.190) for 30 to 34 years, and 1.164 (1.401~1.301) for 35 years and older. The odds ratio of ≥25 percent discordance for the different-sexed twins was higher than that of the same-sexed twins in overall maternal age groups of 20 to 29 years, 30 to 34 years, and 35 years and older. CONCLUSION: The risk of birth weight discordance level of ≥25 percent was associated with the older maternal age. More research is required to understand the risk factors of intertwin birth weight discordance for older women.

Factors Contributing to Discordance between the 2011 ACR/EULAR Criteria and Physician Clinical Judgment for the Identification of Remission in Patients with Rheumatoid Arthritis

Remission is a primary end point of in clinical practice and trials of treatments for rheumatoid arthritis (RA). The 2011 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) remission criteria were developed to provide a consensus definition of remission. This study aimed to assess the concordance between the new remission criteria and the physician’s clinical judgment of remission and also to identify factors that affect the discordance between these two approaches. A total of 3,209 patients with RA were included from the KORean Observational Study Network for Arthritis (KORONA) database. The frequency of remission was evaluated based on each approach. The agreement between the results was estimated by Cohen's kappa (κ). Patients with remission according to the 2011 ACR/EULAR criteria (i.e. the Boolean criteria) and/or physician judgment (n = 855) were divided into three groups: concordant remission, the Boolean criteria only, and physician judgment only. Multinomial logistic regression analysis was used to identify factors responsible for the assignment of patients with remission to one of the discordant groups rather than the concordant group. The remission rates using the Boolean criteria and physician judgment were 10.5% and 19.9%, respectively. The agreement between two approaches for remission was low (κ = 0.226) and the concordant remission rate was only 5.5% (n = 177). Pain affected classification in both discordant groups, whereas fatigue was associated with remission only by physician clinical judgment. The Boolean criteria were more stringent than clinical judgment. Patient subjective symptoms such as pain and fatigue were associated with discordance between the two approaches.

Factors Influencing the Diagnostic Accuracy of Acoustic Radiation Force Impulse Elastography in Patients with Chronic Hepatitis B

BACKGROUND/AIMS: To determine factors predictive of discordance in staging liver fibrosis using liver biopsy (LB) and acoustic radiation force impulse (ARFI) elastography in patients with chronic hepatitis B (CHB). METHODS: Consecutive patients with CHB who underwent LB and ARFI elastography on the same day from November 2010 to March 2013 were prospectively recruited from three tertiary hospitals. RESULTS: We analyzed 105 patients (median age of 47 years). The F0-1, F2, F3, and F4 fibrosis stages were identified in 27 (25.7%), 27 (25.7%), 21 (20.0%), and 30 (28.6%) patients, respectively. The areas under the receiver operating characteristics curves for ARFI elastography in assessing ≥F2, ≥F3, and F4 was 0.814, 0.848, and 0.752, respectively. The discordance of at least one stage between LB and ARFI was observed in 68 patients (64.8%) and of at least two stages in 16 patients (15.2%). In a multivariate analysis, advanced fibrosis stage (F3-4) was the only factor that was negatively correlated with one-stage discordance (p=0.042). Moreover, advanced fibrosis stage was negatively (p=0.016) correlated and body mass index (BMI) was positively (p=0.006) correlated with two-stage discordance. CONCLUSIONS: Advanced fibrosis stage (F3-4) was a predictor of nondiscordance between LB and ARFI elastography; BMI also influenced the accuracy of ARFI elastography.

Doppler assessment of fetal aortic isthmus flow in twin

OBJECTIVE: The purpose of this study was to investigate the aortic isthmus (AoI) flow difference between larger fetus and smaller fetus of twin; and to evaluate the predictive value of early diagnosis of hemodynamic change in twin growth. METHODS: This prospective study on 49 pairs of twin fetuses was performed to obtain AoI blood flow data. Cases with structural or chromosomal abnormalities and co-twin death were excluded. The interval from examination to delivery was within 4 weeks and 3 cases over 4 weeks interval were re-examined. Assessment of fetal AoI Doppler parameters were peak systolic velocity (PSV), end-diastolic velocity, times-averaged maximum velocities, pulsatility index (PI), and resistance index (RI). According to the direction of the diastolic flow in the AoI, antegrade and retrograde flow were made and was used to analyze the perinatal outcomes of each fetus. The predictive value of AoI Doppler parameters in predicting fetal growth was obtained by using ANOVA and logistic regression analysis of quantitative variables in each fetus of twins. RESULTS: There were significant differences in the gestational weeks at delivery, birth weight and the incidence of growth discordance over 20% or more between monochorionic twin and dichorionic twin. The AoI PI and RI were significantly higher in smaller fetus than in larger regardless of chorionicity. Retrograde flow was noted in 8 of 98 cases (8.2%) and the only one case was of the larger fetus and the others were smaller fetuses of twin. Significant correlations were found between the AoI PI and birthweight (P=0.018) and between the PSV and growth discordance (P=0.032). In monochorionic twin, linear correlation was shown between the AoI PI and birthweight (P=0.004) and between AoI PI and growth discordance (P=0.031). Also, the meaningful correlation between the PSV and birthweight (P=0.036) was found by using logistic regression analyses. CONCLUSION: On the basis of our observation, AoI PI has revealed their hemodynamic status and this result may improve the understanding of growth patterns in twins.

The Discordance of Intra-twin Birth Weight by Infantile Gender and Birth Order in Korea; 2008-2013 / 대한주산의학회잡지

PURPOSE: To investigate the incidence of intra-twin birth weight discordance and its association with infantile gender and birth order. METHODS: We used the data of birth from 2008 to 2013 of Korea Statistics (38,140 pairs of twins). Adjusted logistic regression analyses were performed to describe the birth weight discordance (> or =25%) according to infantile gender and birth order (twin A: 1st, twin B: 2nd). Birth weight discordance was calculated as 100 x (birth weight difference/birth weight of the heavier twin). RESULTS: Twin A (mean 2.431 kg) was heavier than twin B (mean 2.359 kg), and the weight difference was 0.281 kg on average. Overall incidence of birth weight discordance was 8.3 percent. The incidence of discordance was 8.8 percent among unlike-sexed pairs and 8.0 percent among like-sexed pairs. Twins with birth weight A> or =B (10.2 percent) showed higher incidence of discordance than twins with birth weight A or =B) as compared to like-sexed twins (female-female) with birth weight (A

Triple-negative breast cancer that progressed as estrogen receptor-positive skin metastases

No abstract available.

El término «locuras discordantes¼ de Ph. Chaslin y el concepto de «escisión esquizofrénica¼ de E. Bleuler / Ph. Chaslin's term \"discordant follies\" and E. Bleuler's concep of \"schizofphrenic splitting\"

En este artículo se consideran tres puntos. En primer lugar, se esquematiza el libro sobre semiología mental de Phillipe Chaslin basada en el análisis de los signos de los casos clínicos concretos y de los «tipos clínicos¼, entre los cuales describe las «locuras discordantes¼. En segundo lugar,se analiza el concepto de «escisión¼ (Spaltung) esquizofrénica de Eugen Bleuler como uno de sus «síntomas fundamentales¼ mediante el cual se describió el orden psíquico infraestructural, cuya naturaleza exige un método semiológico específico. Finalmente, se analiza la afirmación hecha por Bleuler de que podía haber utilizado el término «discordancia¼ para su concepto de «escisión esquizofrénica¼ y lo que esto significa.

Factors Affecting Discordance between Sputum Smear and Culture Conversion Rates In Newly Diagnosed Pulmonary Tuberculosis: A Retrospective Study in Developing Country.

Aims: To assess the performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs among newly diagnosed smear positive pulmonary TB patients. Study Design: This study was conducted prospectively among newly diagnosed smear positive pulmonary TB patients. Place and Duration of Study: Queen Savang Vadhana Memorial Hospital and Chonburi Regional Hospital, Chonburi province, Thailand during April 2010 and July 2012. Methodology: Sputum AFB smear, culture and drug susceptibility test were performed at the time of diagnosis, the second and the fifth month of treatment. Baseline characteristic, clinical and laboratory parameters, treatment regimens and adverse events were recorded. Descriptive statistics and multiple logistic regression analysis were applied as appropriate. The performance of sputum AFB smear for monitoring treatment response and outcome of anti-tuberculous drugs was done using culture as the gold standard. Results: Of 297 eligible pulmonary TB cases, majorities were male (72.4%) with median age of 39 years, illiterate to low educated (52.6%) and earning low income (77.5%). Cough was the most common symptom (91.2%) and cavity was present in 31.1%. At the second month, 17.0% of patients had discordance between sputum AFB smear and culture. High bacilli load (adjusted OR=2.38, CI=1.09-5.18), and hearing alteration (adjusted OR=10.98, CI=1.79-67.28) were significant predictors. Hypoalbuminemia was significantly more severe in patients with false positive AFB smear (P=.04). Sensitivity and specificity for AFB smear were 44.7% and 89.6% at the second month and 57.1% and 97.5% at the fifth month, respectively. MDR-TB was diagnosed in 1.0% and success rate was 77.1%. Conclusions: Baseline AFB smear ≥ 2+ and hypoalbuminemia as well as adverse events during intensive phase are strongly recommended as the criteria to prioritize culture and DST for new smear positive pulmonary TB patients with positive AFB smear at the second and the third month of treatment in developing countries.