Distinct Inflammation Biomarkers in Healthy Individuals and Patients with Schizophrenia: A Reliability Testing of Multiplex Cytokine Immunoassay by Bland-Altman Analysis

OBJECTIVE: Since the inflammatory process has been implicated in the pathophysiology of psychiatric disorder, an important issue emerging is to assess the test-retest reliability of cytokine measurement in healthy individuals and patients with schizophrenia. The objective of the present study was to investigate the test-retest reliability of bead-based multiplex immunoassay technology (BMIT) for cytokine measurement by using a Bland-Altman plot (BAP). METHODS: Twenty healthy individuals and twenty patients with schizophrenia were enrolled, and a 17-plex cytokine assay was used to measure inflammatory biomarkers at baseline and two weeks later. The test-retest reliability was examined by BAP, 95% limits of agreement (LOA), intraclass correlation coefficient (ICC), and coefficient of repeatability (CoR). RESULTS: In the healthy controls, only interleukin (IL)-2, IL-13, IL-10, IL-17, and macrophage inflammatory protein-1β showed excellent ICC. The BAP with 95% LOA determined that 13 cytokines showed acceptable 95% LOA for a 2-week test-retest reliability, and only IL-1β, IL-12 and tumor necrosis factor (TNF)-α had significant test-retest bias. The CoR of cytokines varied significantly, ranging from 1.72 to 218.1. Compared with healthy controls, patients with schizophrenia showed significantly higher levels of IL-5, IL-13, and TNF-α and significantly lower levels of IL-4, IL-12, and interferon-gamma (IFN-γ). Of these six cytokines, IL-12 and TNF-α were considered suboptimal reliability. CONCLUSION: The findings from ICC and CoR implied that the test-retest reliability of BMIT for cytokine measurement were suboptimal. However, the BAP with 95% LOA confirmed that BMIT can reliably distinguish schizophrenia from healthy individuals in cytokine measurement, while significant within-subject variation and between-group overlapping were evident in cytokine expression.

Disagreement between direct and indirect blood pressure measurements obtained from minipigs / 대한수의학회지

Blood pressure (BP) measurement plays a pivotal role in veterinary medicine for diagnosing cardiovascular disorders and monitoring anesthesia of animals. Although indirect BP measurement has been widely applied to monitor BP because of its convenience and non-invasiveness, it is still unclear whether indirect BP measurement is compatible with direct BP measurement in minipigs. In addition, the effect of animal posture during BP measurement is not well understood in minipigs despite its importance to cardiovascular performance. Therefore, both systolic and diastolic arterial BPs in minipigs were measured via femoral artery catheterization for direct BP measurement and using a compressive cuff as an indirect BP measurement under the dorsal or right lateral recumbent postures. Numerical values were processed by the Bland-Altman method to calculate the bias ± SD and the limits of agreement (LOA). In accordance with the American College of Veterinary Internal Medicine guidelines, the results between direct and indirect BP measurements were determined as apparent disagreements in both systolic and diastolic arterial BPs under all postures because of large bias ± SD and wide LOA. The results of the present will help prevent misinterpretation of the anesthetized patient's condition during monitoring of BP by indirect measurement.

Optimal Phase of Dynamic Computed Tomography for Reliable Size Measurement of Metastatic Neuroendocrine Tumors of the Liver: Comparison between Pre- and Post-Contrast Phases

OBJECTIVE: The reliability of size measurements of liver metastases from neuroendocrine tumors (NETs) on contrast-enhanced computed tomography (CT) phases made by different readers may be hampered due to transient, variable rim enhancement in arterial phase (AP) or portal venous phase (PVP) images. We aimed to assess the reliability of tumor size measurements in pre- and post-contrast scans. MATERIALS AND METHODS: The study coordinator selected target lesions according to Response Evaluation Criteria in Solid Tumors 1.1 guidelines in 44 consecutive patients with pathologically confirmed NET liver metastases. Two blinded readers measured the longest diameters of target lesions on pre-contrast, AP, and PVP images twice with a 4-week interval. Inter- and intra-observer agreements were evaluated using Bland-Altman plots and 95% limit of agreement (LOA) calculations. RESULTS: Of the 79 target lesions (approximate mean size of 3 cm), 45 showed rim enhancement. Inter-observer agreement assessed based on LOA was highest in pre-contrast CT images (−6.1–5.7 mm), followed by PVP (−7.9–7.1 mm) and AP (−8.5–7.4 mm) images. Intra-observer agreement showed the same trend: −2.8–2.9 mm and −2.9–2.9 mm for readers 1 and 2, respectively, on pre-contrast CT, −2.8–2.9 mm and −3.0–3.2 mm, respectively, on PVP, and −3.2–4.2 mm and −3.4–3.2 mm, respectively, on AP images. Mean tumor diameters differed significantly among the phases in the following increasing order: pre-contrast CT, PVP, and AP images. CONCLUSION: There was better inter- and intra-observer agreement in size measurements of NET liver metastases on precontrast scans than on AP and PVP scans. Pre-contrast CT may be the optimal for measuring NET liver metastases if its accuracy is proven.

Reliability and Validity of a New Method for Isometric Back Extensor Strength Evaluation Using A Hand-Held Dynamometer

OBJECTIVE: To investigate the reliability and validity of a new method for isometric back extensor strength measurement using a portable dynamometer. METHODS: A chair equipped with a small portable dynamometer was designed (Power Track II Commander Muscle Tester). A total of 15 men (mean age, 34.8±7.5 years) and 15 women (mean age, 33.1±5.5 years) with no current back problems or previous history of back surgery were recruited. Subjects were asked to push the back of the chair while seated, and their isometric back extensor strength was measured by the portable dynamometer. Test-retest reliability was assessed with intraclass correlation coefficient (ICC). For the validity assessment, isometric back extensor strength of all subjects was measured by a widely used physical performance evaluation instrument, BTE PrimusRS system. The limit of agreement (LoA) from the Bland-Altman plot was evaluated between two methods. RESULTS: The test-retest reliability was excellent (ICC=0.82; 95% confidence interval, 0.65–0.91). The Bland-Altman plots demonstrated acceptable agreement between the two methods: the lower 95% LoA was −63.1 N and the upper 95% LoA was 61.1 N. CONCLUSION: This study shows that isometric back extensor strength measurement using a portable dynamometer has good reliability and validity.

Comparison of Anterior Segment Measurements between Dual and Single Scheimpflug Camera

PURPOSE: To assess the degree of agreement of two rotating Scheimpflug cameras, Galilei G6 and Pentacam HR, in measuring corneal refractive power (K), anterior chamber depth (ACD), and central corneal thickness (CCT). METHODS: Measurement agreement was assessed in 40 eyes of 40 outpatients at our hospital. Measurements of anterior and posterior corneal refractive power (K), ACD, and CCT were compared between the Galilei G6 and Pentacam HR. RESULTS: For Galilei G6 (4 mm), Pentacam HR (3 mm) and Pentacam HR (4 mm), the anterior corneal refractive powers (K) were 44.35 ± 1.38 D, 44.09 ± 1.32 D, and 44.12 ± 1.35 D, respectively, and the posterior corneal refractive powers (K) were 6.39 ± 0.23 D, 6.45 ± 0.23 D, 6.45 ± 0.22 D. The differences in the results were statistically significant. The average ACD measurements using Galilei G6 and Pentacam HR were 3.26 ± 0.42 mm and 3.17 ± 0.42 mm, respectively, and the average CCT measurements were 556.65 ± 30.12 µm and 553.78 ± 29.42 µm. The differences in the measurements were statistically significant. In addition, ACD 95% limits of agreement (LoA) between Galilei G6 and Pentacam HR were in the range of -0.14~0.32 mm, and CCT 95% LoA were in the range of -12.54~18.29 µm. CONCLUSIONS: There were significant differences in measurements of anterior and posterior corneal refractive power (K), ACD, and CCT between the two cameras. Agreement analysis suggests that Galilei G6 and Pentacam HR should not be used interchangeably.

Comparison of Anterior Segment Measurements between Dual and Single Scheimpflug Camera

PURPOSE: To assess the degree of agreement of two rotating Scheimpflug cameras, Galilei G6 and Pentacam HR, in measuring corneal refractive power (K), anterior chamber depth (ACD), and central corneal thickness (CCT). METHODS: Measurement agreement was assessed in 40 eyes of 40 outpatients at our hospital. Measurements of anterior and posterior corneal refractive power (K), ACD, and CCT were compared between the Galilei G6 and Pentacam HR. RESULTS: For Galilei G6 (4 mm), Pentacam HR (3 mm) and Pentacam HR (4 mm), the anterior corneal refractive powers (K) were 44.35 ± 1.38 D, 44.09 ± 1.32 D, and 44.12 ± 1.35 D, respectively, and the posterior corneal refractive powers (K) were 6.39 ± 0.23 D, 6.45 ± 0.23 D, 6.45 ± 0.22 D. The differences in the results were statistically significant. The average ACD measurements using Galilei G6 and Pentacam HR were 3.26 ± 0.42 mm and 3.17 ± 0.42 mm, respectively, and the average CCT measurements were 556.65 ± 30.12 µm and 553.78 ± 29.42 µm. The differences in the measurements were statistically significant. In addition, ACD 95% limits of agreement (LoA) between Galilei G6 and Pentacam HR were in the range of -0.14~0.32 mm, and CCT 95% LoA were in the range of -12.54~18.29 µm. CONCLUSIONS: There were significant differences in measurements of anterior and posterior corneal refractive power (K), ACD, and CCT between the two cameras. Agreement analysis suggests that Galilei G6 and Pentacam HR should not be used interchangeably.

Measurement of Corneal Power and Astigmatism Using Placido-based Videokeratography and Comparison with Other Keratometers

PURPOSE: In the present study, the repeatability and reproducibility of the corneal power and astigmatism measurements using placido-based video keratography were evaluated and the agreement with other keratometers were compared. METHODS: This prospective study included 45 patients (45 eyes) scheduled to undergo cataract surgery between November 2015 and January 2016. Three sets of corneal power and astigmatism were measured using placido-based video keratometer (Keratograph® 5M), automatic keratometer (KR-8900®), manual keratometer (B×L manual keratometer®), Placido-scanning-slit keratometer (ORBscan II®), Scheimpflug keratometer (Pentacam®), and low coherence interferometry (Lenstar LS900®). Reliability of each device was analyzed using the coefficient of variation, standard deviation and intraclass correlation coefficient. Repeated measures analysis of variance was used to analyze the interdevice comparison of mean absolute difference. The agreement between the devices was evaluated with 95% limits of agreement (LoA) and Bland-Altman plots. RESULTS: The mean corneal power, astigmatism and power vector analysis (J₀, J₄₅) were not significantly different among devices (p > 0.05). In the Bland-Altman plot analysis, the 95% LoA of corneal power, J₀, and J45 when comparing Keratograph® 5M with others ranged from -0.78 to 0.55 D, from -0.42 to 0.45 D, and from -0.39 to 0.47 D, respectively. CONCLUSIONS: Keratograph® 5M showed good repeatability and reproducibility of corneal power and astigmatism measurements and was interchangeable with other keratometers.

Comparison of Central Corneal Thickness and Anterior Chamber Depth Measured Using Three Different Devices

PURPOSE: To compare measurements of central corneal thickness (CCT) and anterior chamber depth (ACD) obtained using Galilei(TM), Pentacam(R) (Oculus, Wetzlar, Germany) and Lenstar(R) (Haag-Streit, Koeniz, Switzerland) and analyze the measurement agreements. METHODS: CCT and ACD were measured using Galilei(TM), Pentacam(R) and Lenstar(R) in 47 eyes of 25 healthy subjects. The measurements were compared among the 3 devices. RESULTS: The average CCT measurements using Galilei(TM), Pentacam(R) and Lenstar(R) were 552.6 +/- 29.41 microm, 543.9 +/- 30.50 microm and 537.5 +/- 30.26 microm, respectively. The measurements significantly correlated with each other (r > 0.9, p 0.9, p < 0.001), but were statistically significantly different (p = 0.034). The CCT 95% limits of agreement (LoA) between Galilei(TM) and Pentacam(R), Pentacam(R) and Lenstar(R) and Lenstar(R) and Galilei(TM) were 31.95 microm, 44.76 microm and 46.57 microm, respectively and 95% ACD LoA were 0.46 mm, 0.32 mm and 0.28 mm, respectively. CONCLUSIONS: CCT and ACD measured using the 3 devices were highly correlated with each other but the measurements were statistically different. Therefore, the measurements were not interchangeable and these differences should be considered in clinical use.

Epidural Lysis of Adhesions

As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.

Subconjunctival Loa loa worm: first case report in Brazil / Verme subconjuntival da espécie Loa loa: primeiro caso no Brasil

We report the first case of ocular infestation by Loa loa in Brazil. Loiasis is caused by infestation with Loa loa, a filarial parasite originally found in the rainforests of western and central Africa. It is transmitted by the bite of the fly Chrysops and has been recently described in other places other than Africa, in African immigrants or travellers. Our case is a 33 year-old woman from Cameroon who was living in São Paulo, Brazil, for 5 years. She was asymptomatic until one morning she started feeling "something moving" in the left eye. Under topical anesthesia, on the slit lamp, a moving worm was removed from the subconjunctival space, which later was confirmed to be a male Loa loa adult specimen. Blood tests revealed microfilaraemia of 129 mf/mL. The patient was treated with 400 mg oral albendazole for 3 weeks and 60 mg prednisone. This report illustrates an unusual ocular disease, which is extremely rare outside of Africa, but easily diagnosed and treated. Ophthalmologists should be aware of it, in face of an increasingly globalized world.

Este é o primeiro relato na literatura nacional e internacional de infestação ocular por Loa loa no Brasil. A loíase é uma filariose causada pelo parasita Loa loa, encontrado nas florestas tropicais da África equatorial. A transmissão se dá pela picada do mosquito Chrysops e casos têm sido descritos em países não africanos, em imigrantes e viajantes. O presente caso trata-se de uma paciente de 33 anos natural de Camarões e residente em São Paulo, Brasil, há 5 anos. Até então assintomática, uma manhã sentiu algo "se mexendo" em seu olho esquerdo. Sob anestesia tópica, na lâmpada de fenda, um verme altamente móvel foi removido do espaço subconjuntival e enviado para identificação, que confirmou tratar-se de um espécime macho adulto de Loa loa. Testes sanguíneos revelaram microfilaremia de 129 mf/mL. A paciente foi tratada com albendazol 400 mg e prednisona 60 mg esquema regressivo por 3 semanas. Este relato ilustra uma doença excepcionalmente rara no Brasil, e praticamente desconhecida dos oftalmologistas em nosso país.

Treatment of Late Onset Ankylosing Spondylitis with TNF Antagonist: A Case Series / 대한류마티스학회지

Ankylosing spondylitis is a disease that shows a young age of onset (less than 40 years old), inflammatory back pain, sacroiliitis and a strong association with HLA-B27. Yet some recently reported cases have presented with a late age of onset (more than 55 years old), atypical clinical presentations and a low response to NSAIDs, and this has also been named late onset spondyloarthropathy (LOSPA). As compared with early onset spondyloarthropathy (EOSPA), the LOSPA patients more frequently suffer with combined peripheral arthritis and inflammatory systemic symptoms and a high ESR and CRP level, but they lack the typical axial symptoms. Yet there have been few reports about late onset ankylosing spondylitis (LOAS). The previous cases of LOSPA and LOAS were managed with NSAIDs, steroids, methotrexate and sulfasalazine, but none were managed with TNF antagonists. LOAS is rare and difficult for management because of the patients' older age and the lack of experiences with this malady, so we report here on the four cases of LOAS that were successfully treated by TNF antagonists.

Live Adult Loa-Loa in the Anterior Chamber of a Nigerian female

Background: Live adult loa loa is not usually found in the anterior chamber of the eye. Where this occurs the diagnosis may be missed because of its rare occurrence. As such there has to be a high index of suspicion to be able to make a diagnosis of ocular loaiasis. Aim: To report a case of live adult loa-loa in the anterior chamber of the left eye of a 23-year-old Nigerian female and discuss the management and visual outcome following treatment. Setting: Department of Ophthalmology; University of Port-Harcourt Teaching Hospital; Port Harcourt. Case Report: A case report of live adult loa-loa in the anterior chamber of a 23-year-old Nigerian female is here presented. In May 2006; a 23 year old female presented at the Eye Clinic with a 3-week history of pain; itching and redness and a one-week history of poor vision in the left eye. Her presenting visual acuity was hand movement on the left and 6/5 on the right. She had a steamy cornea with a sluggishly reactive pupil and an elevated left intra-ocular pressure. An initial diagnosis of pan-uveitis with secondary glaucoma was made and patient commenced on treatment. Patient came back two days and a live adult loa-loa was extracted from the anterior chamber of the left eye. Patient's vision however remained at Counting Fingers despite aggressive treatment with topical and systemic steroids; and systemic diethylcabamazine. Conclusion: Ophthalmologist working in this environment should entertain loaiasis as a differential diagnosis of uveitis since it could masquerade as one and also know the current mode of treatment

Subconjuctival Loa loa with Calabar Swelling

Loa loa is unique among the human filariae in that adult worms are occasionally visible during subconjuntival migration. A 29-yr-old African female student, living in Korea for the past 5 yr without ever visiting her home country, presented with acute eyelid swelling and a sensation of motion on the left eyeball. Her symptoms started one day earlier and became worse over time. Examination revealed a threadlike worm beneath the left upper bulbar conjunctiva with mild eyelid swelling as well as painless swelling of the right forearm. Upon exposure to slit-lamp illumination, a sudden movement of the worm toward the fornix was noted. After surgical extraction, parasitologic analysis confirmed the worm to be a female adult Loa loa with the vulva at the extreme anterior end. On blood smear, the microfilariae had characteristic features of Loa loa, including sheath and body nuclei up to the tip of the tail. The patient also showed eosinophilia (37%) measuring 4,100/microliter. She took ivermectin (200 microgram/kg) as a single dose and suffered from a mild fever and chills for one day. This patient, to the best of our knowledge, is the first case of subconjunctival loiasis with Calabar swelling in Korea.

Loa loa in the anterior chamber of the eye: a case report.

An unusual case of loiasis from Assam is reported here. Loa loa is a subcutaneous filarial parasite of man and is transmitted to humans by chrysops flies. The patient presented with foreign body sensation and visual disturbances of the right eye. Examination revealed a white coiled structure in the cornea. Routine blood and other investigations were within normal limits. A live adult worm was extracted and identity was confirmed by microscopy to be Loa loa. Patient was treated with diethylcarbamazine and steroid. We found this case interesting as the worm was present in the anterior chamber--an unusual site and there were no other positive findings besides the lone worm.

A clinical comparison between early-onset and late-onset asthma in the elderly / 대한내과학회지

BACKGROUND: The asthma mortality has risen during last decades, especially in the elderly. This study was performed to investigate whether newly-developed asthma in the elderly has any difference in clinical features relating to asthma severity compared to early-onset asthma (EOA). METHODS: Thirty-three asthma patients (> or = 60 years-old) hospitalized due to severe attack were classified to late-onset (LOA) when their asthma developed after the age of 60 and the remaining to EOA. Data obtained from their medical records were analyzed retrospectively. RESULTS: Ten out of the 33 patients (30.3%) were LOA. Duration of asthma was significantly longer in EOA (21.6+/-14.8 years vs. 2.9+/-2.4 years, p<0.001). There were no significant differences between both groups in age, sex, atopy history (personal and familial), sinusitis, and peripheral blood eosinophils. However, EOA showed more smoking history and frequent exacerbations following URI-like symptoms (p<0.05, respectively), and higher serum total IgE level (geographic mean: 228 vs. 20 IU/mL, p<0.001). Life-threatening asthma attack was developed more frequently (89.5% vs. 40%, p<0.05), and the lung function measurements obtained just before discharge were significantly lower (FEV1/FVC: 54.8+/-10.1% vs. 64.6+/-11.7%, p<0.05) in EOA. Severity of chronic asthma was significantly more severe in EOA (moderate to severe persistent asthma: 95.6% vs. 60.0%, p<0.05). CONCLUSION: Many elderly asthmatics develop asthma newly in their old age. EOA is more related to atopic allergy, and seems to have more severe and long-standing asthma leading to chronic persistent airflow obstruction.

The effect of flap operation and metronidazole gel combined therapy on the treatment of the juvenile periodontitis / 대한치주과학회지

The aim of the study was to investigate the effect of surgical therapy combined with the usage of metronidazole gel in the treatment of juvenile periodontitis by comparing clinical indices of flap operation along with application of metronidazole gel and flap operation only. Comparing clinical indices of the baseline, 3 months after surgery, 6 months after surgery statistically, the results are as follows; 1. Bleeding on probing (BOP) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p0.05). However, there was no statistically significant difference in these groups (p>0.05). 2. Pocket probing depth (PPD) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p0.05). However, there was no statistically significant difference in these groups (p>0.05). 3. Loss of attachment level(LOA) was decreased significantly both in the experimental group and the control group at 3 months after surgery (p0.05). In conclusion, flap operation was effective on the treatment of juvenile periodontitis. However, combined therapy of metronidazole gel could not give rise to any significant adjunctive effect on the treatment outcome.

Parasitismo exótico en becarios / Exotin parasitism in foreign fellow holders

Se realiza una exposición de los casos notificados como parasitismo exótico en becarios extranjeros, radicados en la provincia de Villa Clara, en el período comprendido entre 1992 y 1997. Los casos positivos son varones en su mayoría; los parásitos más frecuentes fueron el Schistosoma haematobium, el Schistosoma mansoni y la Filaria loa-loa. Se mantiene el pesquisaje de estas afecciones y otras que pudieran presentarse para evitar su propagación en el país