Alcohol Consumption in Healthy OPRM1 G Allele Carriers and Its Association with Impulsive Behavior.

AIMS: A link between alcohol use disorders (AUD) and impulsivity is well established. As there is evidence for the heritability of AUD, the investigation of the underlying genetic disposition for both conditions is an important issue. An association between AUD and a coding single nucleotide polymorphism (SNP) (rs1799971 encoding an Asn40Asp amino acid substitution, A118G) within the µ-opioid receptor 1 gene (OPRM1) has been reported. Therefore we tested the association between the OPRM1 A118G polymorphism and drinking as well as impulsive behavior in social drinkers. METHODS: A total of 214 healthy male social drinkers were recruited. Each participant was genotyped for the OPRM1 A118G variant. Alcohol use was assessed with items of the Alcohol Use Disorders Identification Test (AUDIT). Impulsivity was assessed using the UPPS impulsive behavior scale. For statistical analyses, we considered correlations, t-tests and ordinal regression models using SPSS V21. RESULTS: In total, 49 out of 214 participants were carriers of the OPRM1 118G allele. On average the OPRM1 118G carriers showed a slightly higher propensity for alcohol drinking. Higher drinking frequency among the G allele carriers was linked with higher urgency and perseveration subscores of impulsivity. CONCLUSION: Our results suggest a genetically influenced higher propensity for alcohol drinking among social drinkers carrying the 118G allele of the OPRM1 gene. The positive correlation between urgency and a higher drinking frequency among the OPRM1 118G hint towards a functional meaning of the opioid system in the regulation of impulsivity.

[Epidural injection shows no advantages over oral medication and physiotherapy in the treatment of sciatica, irrespective of the duration of symptoms]. / Kein Vorteil der epiduralen Injektion vs. oraler Medikation und Physiotherapie bei Ischialgie, unabhängig von der Beschwerdedauer.

BACKGROUND: The study presented here investigated the short-term effectiveness of one-off lumbar caudal epidural injection (EI) in sciatica in relationship to the reported duration of pain. MATERIALS AND METHODS: This retrospective analysis involved 106 consecutive in-patients who received either conservative treatment (Group I) or an additional EI on the first day of their treatment (Group II). Both groups were divided according to the duration of symptoms at the time of admission (less than three months, or more than six months). Propensity score matching was performed for the whole collective and the resulting subgroups. This incorporated gender, age and pain intensity at the time of admission. The target parameter were changes on a visual analogue scale (VAS) of pain intensity on days D1, D3, and D10 depending on the respective treatment. A routine evaluation of the mental variables anxiety, depression and somatisation was performed as part of the examination upon admission and their relationship to the success of treatment was later assessed. RESULTS: The mean age of the patients was 61.7 (± 11.6) in Group I and 63.6 (± 13.6) in Group II. 59 % of the patients were female (n = 63). The Lasègue sign was prevalent in 45 % of Group I and 51 % of Group II. The intensity of pain on the day of admission was similar in both groups (7.0 ± 1.0 for Group I, 6.7 ± 1.8 for Group II). The length of stay on the ward was also similar in both groups (10.2 ± 3.9 and 9.4 ± 3.7 d, respectively). It was found that, independent of the duration of symptoms, injection treatment was significantly more effective than conservative treatment only in the early stages (D1 and D3, p < 0.001). No differences could be found in the expression of these mental variables between treatment groups, as these factors showed no influence on the results of therapy. CONCLUSIONS: In the context of acute treatment a once only lumbar caudal epidural injection represents at most a short-term effectiveness for the therapy of sciatica. The results presented here indicate that neither the duration of symptoms nor the measured psychometric variables show any effect on the success of therapy.

A practical framework for data management processes and their evaluation in population-based medical registries.

INTRODUCTION: We present a framework for data management processes in population-based medical registries. Existing guidelines lack the concreteness we deem necessary for them to be of practical use, especially concerning the establishment of new registries. Therefore, we propose adjustments and concretisations with regard to data quality, data privacy, data security and registry purposes. MATERIALS AND METHODS: First, we separately elaborate on the issues to be included into the framework and present proposals for their improvements. Thereafter, we provide a framework for medical registries based on quasi-standard-operation procedures. RESULTS: The main result is a concise and scientifically based framework that tries to be both broad and concrete. Within that framework, we distinguish between data acquisition, data storage and data presentation as sub-headings. We use the framework to categorise and evaluate the data management processes of a German cancer registry. DISCUSSION: The standardisation of data management processes in medical registries is important to guarantee high quality of the registered data, to enhance the realisation of purposes, to increase efficiency and to enable comparisons between registries. Our framework is destined to show how one central impediment for such standardisations - lack of practicality - can be addressed on scientific grounds.

Bagging, bumping, multiview, and active learning for record linkage with empirical results on patient identity data.

Record linkage or deduplication deals with the detection and deletion of duplicates in and across files. For this task, this paper introduces and evaluates two new machine-learning methods (bumping and multiview) together with bagging, a tree-based ensemble-approach. Whereas bumping represents a tree-based approach as well, multiview is based on the combination of different methods and the semi-supervised learning principle. After providing a theoretical background of the methods, initial empirical results on patient identity data are given. In the empirical evaluation, we calibrate the methods on three different kinds of training data. The results show that the smallest training data set, which is obtained by a simple active learning strategy, leads to the best results. Multiview can outperform the other methods only when all are calibrated on a randomly sampled training set; in all other cases, it performs worse. The results of bumping do not differ significantly from the overall best performing method bagging. We cautiously conclude that tree-based record linkage methods are likely to produce similar results because of the low-dimensionality (p≪n) and straightforwardness of the underlying problem. Multiview is possibly rather suitable for problems that are more sophisticated.

Active learning strategies for the deduplication of electronic patient data using classification trees.

INTRODUCTION: Supervised record linkage methods often require a clerical review to gain informative training data. Active learning means to actively prompt the user to label data with special characteristics in order to minimise the review costs. We conducted an empirical evaluation to investigate whether a simple active learning strategy using binary comparison patterns is sufficient or if string metrics together with a more sophisticated algorithm are necessary to achieve high accuracies with a small training set. MATERIAL AND METHODS: Based on medical registry data with different numbers of attributes, we used active learning to acquire training sets for classification trees, which were then used to classify the remaining data. Active learning for binary patterns means that every distinct comparison pattern represents a stratum from which one item is sampled. Active learning for patterns consisting of the Levenshtein string metric values uses an iterative process where the most informative and representative examples are added to the training set. In this context, we extended the active learning strategy by Sarawagi and Bhamidipaty (2002). RESULTS: On the original data set, active learning based on binary comparison patterns leads to the best results. When dropping four or six attributes, using string metrics leads to better results. In both cases, not more than 200 manually reviewed training examples are necessary. CONCLUSIONS: In record linkage applications where only forename, name and birthday are available as attributes, we suggest the sophisticated active learning strategy based on string metrics in order to achieve highly accurate results. We recommend the simple strategy if more attributes are available, as in our study. In both cases, active learning significantly reduces the amount of manual involvement in training data selection compared to usual record linkage settings.

Missing values in deduplication of electronic patient data.

INTRODUCTION: Systematic approaches to dealing with missing values in record linkage are still lacking. This article compares the ad-hoc treatment of unknown comparison values as 'unequal' with other and more sophisticated approaches. An empirical evaluation was conducted of the methods on real-world data as well as on simulated data based on them. MATERIAL AND METHODS: Cancer registry data and artificial data with increased numbers of missing values in a relevant variable are used for empirical comparisons. As a classification method, classification and regression trees were used. On the resulting binary comparison patterns, the following strategies for dealing with missingness are considered: imputation with unique values, sample-based imputation, reduced-model classification and complete-case induction. These approaches are evaluated according to the number of training data needed for induction and the F-scores achieved. RESULTS: The evaluations reveal that unique value imputation leads to the best results. Imputation with zero is preferred to imputation with 0.5, although the latter shows the highest median F-scores. Imputation with zero needs considerably less training data, it shows only slightly worse results and simplifies the computation by maintaining the binary structure of the data. CONCLUSIONS: The results support the ad-hoc solution for missing values 'replace NA by the value of inequality'. This conclusion is based on a limited amount of data and on a specific deduplication method. Nevertheless, the authors are confident that their results should be confirmed by other empirical analyses and applications.

Treatment of renal transplant recipients with low bone mineral density: a randomized prospective trial of alendronate, alfacalcidol, and alendronate combined with alfacalcidol.

We sought to compare the treatment modalities of alendronate, alfacalcidol, and alendronate combined with alfacalcidol in renal transplant recipients with low bone mineral density. Sixty-four kidney graft recipients (22 women, 42 men) were recruited to this study. Of these 64 patients, 9 served as the control group with T scores more than -1. The remaining 55 patients randomly assigned to treatment had T scores less than -1 and were assigned to 3 groups: group 1 received alfacalcidol (0.5 microg/d); group 2, alendronate (10 mg/d); and group 3, alendronate (10 mg/d) + alfacalcidol (0.5 microg/d per os). Twenty-five patients were allocated to alfacalcidol, 13 patients to alendronate, and 17 patients to alendronate + alfacalcidol treatment. Bone mineral densities of the lumbar spine and femoral neck were measured before and 12 months after treatment. The groups were compared for risk factors of osteoporosis, biochemistry, and bone mineral density. Kruskal-Wallis, one-way ANOVA, and Student t tests were used. With the alendronate + alfacalcidol group, bone mineral density at the lumbar spine significantly increased by 7.9% (P = .006) with a significant improvement in T score (P = .003). Bone mineral density at the femoral neck significantly increased by 8% in the alendronate + alfacalcidol group (P = .01) with a significant improvement in T score (P = .02). The use of a combination of alendronate and alfacalcidol seemed to be safe and more effective than the separate use of the 2 agents to improve bone mass in renal transplant recipients.

Pregnancy-associated plasma protein-A: evaluation of a new biomarker in renal transplant patients.

OBJECTIVE: Trophoblasts produce high concentrations of pregnancy-associated plasma protein-A (PAPP-A) during pregnancy. PAPP-A has been described as a new inflammatory marker and an independent risk factor for posttransplant cardiovascular risk. This study evaluated the clinical significance of PAPP-A in renal transplant patients. METHODS: The study included 78 adult renal transplant patients (56 men and 22 women) and 37 control subjects (27 men and 10 women). We determined serum PAPP-A, urea, creatinine, uric acid, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, 24-hour proteinuria, and C-reactive protein (CRP) levels. RESULTS: The PAPP-A level was significantly higher among renal transplant patients [median (interquartile range), 10.5 (6.4 to 15.4) mU/L] than the control group [3.9 (3.1 to 5.2) mU/L; P<.001]. There were significant positive correlations between serum PAPP-A levels and urea (r=.547, P=.001), creatinine (r=.497, P=.001), uric acid (r=.452, P=.001), and CRP values (r=.387, P=.001). The drugs used for immunosuppression in transplant patients (cyclosporine, tacrolimus, and others) did not significantly affect serum PAPP-A levels (P>.05). CONCLUSION: We concluded that PAPP-A level was elevated in renal transplant patients and that high levels of PAPP-A might be a prognostic marker owing to their close association with high serum levels of urea, creatinine, uric acid, and CRP.

Cellulitis as a manifestation of miliary tuberculosis in a renal transplant recipient.

Cutaneous involvement is an unusual presentation of tuberculosis (TB) and is rarely reported in renal transplant recipients. We describe a 37-year-old renal transplant recipient with disseminated Mycobacterium tuberculosis infection that presented as cellulitis. The organism was isolated from tissue and blood cultures. The patient was treated with quadruple anti-TB therapy for 12 months. Anti-TB therapy led to a complete resolution of TB lesions. We also provide a review of the literature on cutaneous TB in renal transplant recipients. Skin TB in renal transplant recipients usually occurs with nontuberculous mycobacteria. The spectrum of the skin lesions can be quite different and can mimic bacterial infections. Mycobacteriosis should always be included in the differential diagnosis of a skin lesion in renal transplant recipients.

Osteoporosis after renal transplantation.

This study was performed to determine risk factors associated with osteoporosis that develops after renal transplantation. Sixty-five kidney graft recipients were included in this study. They were divided into four groups according to the time since transplantation: Group 1 (< 1 year; n = 26), group 2 (1-3 years; n = 16), group 3 (3-5 years; n = 12) and group 4 (> 5 years; n = 11). These groups were matched according to probable risk factors for osteoporosis, findings of serum biochemistry, biochemical markers of bone turnover and measurements of bone mineral density. One way ANOVA test and Kruskal-Wallis test were used for statistical analysis. Osteoporosis was found in 22 recipients (33.8%). There were significant differences in recipient age, cumulative steroid dose, and episodes of acute rejection between the four groups. Increasing age, cumulative steroid dose and episodes of acute rejection were found to be risk factors for osteoporosis in our study.

Osteoporosis after renal transplantation / Osteoporosis después del trasplante renal

This study was performed to determine risk factors associated with osteoporosis that develops after renal transplantation. Sixty-five kidney graft recipients were included in this study. They were divided into four groups according to the time since transplantation : Group 1 (< 1 year ; n = 26 ), group 2 (1 – 3 years ; n = 16), group 3 (3-5 years ; n = 12) and group 4 (> 5 years ; n = 11). These groups were matched according to probable risk factors for osteoporosis, findings of serum biochemistry, biochemical markers of bone turnover and measurements of bone mineral density. One way ANOVA test and Kruskal-Wallis test were used for statistical analysis. Osteoporosis was found in 22 recipients (33.8%). There were significant differences in recipient age, cumulative steroid dose, and episodes of acute rejection between the four groups. Increasing age, cumulative steroid dose and episodes of acute rejection were found to be risk factors for osteoporosis in our study (AU)

Este estudio tuvo como objetivo determinar factores de riesgo asociados a osteoporosis que se desarrolla después del trasplante renal. En este estudio se incluyeron 65 pacientes portadores de un trasplante renal. Se dividieron en 4 grupos de acuerdo al tiempo desde el trasplante: Grupo 1 (< 1 año; n = 26), grupo 2 (1-3 años; n = 16), grupo 3 (3 a 5 años = 12) y grupo 4 (> 5 años; n = 11). Todos los grupos se ajustaron de acuerdo a probables factores de riesgo de osteoporosis, marcadores bioquímicos, marcadores de recambio óseo y densidad mineral ósea. El análisis estadístico se realizó por medio de ANOVA y mediante el test Kruskal-Wallis. Se encontró osteoporosis en un total de 22 receptores de trasplante de riñón (33,8%). La edad de recepción del trasplante, la dosis acumulada de esteroides y los episodios de rechazo agudo de trasplante renal fueron estadísticamente significativos entre los cuatro grupos. El aumento de la edad, la dosis acumulada de esteroides y los episodios de rechazo agudo fueron factores de riesgo de osteoporosis en nuestro estudio (AU)

Chylous ascites after liver transplantation with mesentero-portal jump graft.

Chylous effusions and lymphatic leaks occur after trauma, malignant disease, primary lymphatic disorders, and parasitosis, and rarely after abdominal surgery. Chylous ascites after orthotopic liver transplantation is a rare complication. We report a case of chylous ascites occurring after hepatic transplantation with a mesentero-portal venous jump graft, successfully treated with conservative management.

Protective covering of surgical wounds with honey impedes tumor implantation.

HYPOTHESIS: Tumor implantation (TI) development at the surgical wound following cancer surgery is still an unresolved concern. Trocar site recurrence, which is likely a form of TI, has become one of the most controversial topics and, with the widespread acceptance of laparoscopic surgery, has caused renewed interest in questions about TI. Honey has positive effects on wound healing. Physiological and chemical properties of honey might prevent TI when applied locally. DESIGN, INTERVENTIONS, AND MAIN OUTCOME MEASURES: Sixty BALB/c strain mice, divided into 2 groups, were wounded in the posterior neck area. Group 1 mice formed the control group, and group 2 mice had wounds coated with honey before and after tumor inoculation. All wounds were inoculated with transplantable Ehrlich ascites tumor. The presence of TI was confirmed in the wounded area by histopathological examination on the 10th day. RESULTS: Tumor implantation was achieved in all group 1 animals and verified by palpable mass and histopathological examination. In group 2 mice, although TI could not be detected macroscopically, it was revealed by pathological examination in 8 cases. Tumor implantation was less likely in group 2 mice (8 of 30 vs 30 of 30; P<.001). CONCLUSIONS: Tumor implantation was markedly decreased by the application of honey pre- and postoperatively. It is possible that the physiological and chemical properties of honey protected wounds against TI. Honey could be used as a wound barrier against TI during pneumoperitoneum in laparoscopic oncological surgery and in other fields of oncological surgery.

Can laparoscopy be performed safely early after laparotomy?

Early subsequent laparotomy has high morbidity and mortality rates. The majority of these procedures, such as control of intraabdominal bleeding, management of intraabdominal sepsis, assessment of bowel viability, or anastomotic suture line, which are performed during early subsequent laparotomy, can be managed safely by laparoscopy, with resultant decreased mortality and morbidity rates. However, fear of dehiscence and ventral hernia prevents widespread use of laparoscopy. The aim of this experimental study was to compare the deleterious effects of subsequent laparotomy with laparoscopy in abdominal wounds during the early postceliotomy period. A 4-cm median laparotomy was performed in 120 Wistar-Albino rats that were classified into three groups. The control group (1) did not receive additional treatment. On the third postoperative day, early subsequent laparotomy and pneumoperitoneum were performed in group 2 and group 3 rats, respectively. Ten rats from each group were selected randomly and killed after 5 days, 1 week, 2 weeks, and 4 weeks. Bursting pressure and tensile strength of the abdominal wound were assessed. Results of the study showed impaired abdominal wound healing in subsequent laparotomy group rats (group 2) (P < 0.05). Pneumoperitoneum did not cause statistical differences in wound healing parameters when compared with control group rats (P > 0.05). In conclusion, pneumoperitoneum does not affect abdominal wound healing adversely, but early subsequent laparotomy impairs wound healing severely. Laparoscopy would be an alternative to high-risk early subsequent relaparotomy.

The effects of hyperbaric oxygen on normal and ischemic colon anastomoses.

BACKGROUND: Leakage from colonic anastomoses is a major complication causing increased mortality and morbidity, and ischemia is a well-known cause of this event. Inadequate tissue oxygenation could be reversed by using hyperbaric oxygen. This study was designed to investigate the effects of hyperbaric oxygen on the healing of ischemic and normal colon anastomoses in the rat model. METHODS: Standardized left colon resection 3 cm above the peritoneal reflection and colonic anastomosis were performed in 40 Wistar rats divided into four groups. The control group (I) received no further treatment. To mimic ischemia, 2 cm mesocolon was ligated on either site of the anastomosis in group II and IV rats. Hyperbaric oxygen therapy was started immediately after surgery in group III and IV rats (therapeutic groups). All animals were sacrificed on the fourth postoperative day. After careful relaparotomy, in situ bursting pressure was measured. The hydroxyproline contents of the anastomotic segments in equal length were determined. RESULTS: The hydroxyproline assay revealed that rats in group II with ischemic colonic anastomosis have significantly lower levels (P <0.05). The highest levels are in the group III rats with normal colonic anastomosis treated by hyperbaric oxygen (P <0.05). There was no significant difference in hydroxyproline levels between group II and group IV animals (P >0.05). Group III animals had significantly higher bursting pressures than any other group (P <0.05). Group II rats had lowest bursting pressures (P <0.05). Group IV animals had significantly higher levels than group II (P <0.05). Mean bursting pressure values both in groups III and IV and hydroxyproline levels in group III were significantly increased by hyperbaric oxygen therapy (P <0.05). CONCLUSIONS: Ischemia impairs anastomotic healing. Hyperbaric oxygen increases anastomotic healing of both normal and ischemic colonic anastomosis and reverses ischemic damage. This study demonstrated that hyperbaric oxygen improves anastomotic healing.