The Kuopio idiopathic normal pressure hydrocephalus protocol: initial outcome of 175 patients.

BACKGROUND: The Kuopio University Hospital (KUH) idiopathic normal pressure hydrocephalus (iNPH) cerebrospinal fluid (CSF) shunting protocol is described together with the initial outcomes of 175 patients with probable iNPH treated according to this protocol from a defined population. Our secondary aim was to display the variety of differential diagnoses referred to the KUH iNPH outpatient clinic from 2010 until 2017. METHODS: Patients were divided into four groups according to the prognostic tests: tap test (positive or negative) and infusion test (positive or negative). The short-term outcome was compared between groups. The 3-month outcome following shunt surgery was assessed by measuring gait speed improvement, using a 12-point iNPH grading scale (iNPHGS) and the 15D instrument. RESULTS: From 341 patients suspected of iNPH, 88 patients were excluded from further research mostly due to deviation from the protocol's gait assessment guidelines. Hence 253 patients with suspected iNPH were included in the study, 177/253 (70%) of whom were treated with a CSF shunt. A favorable clinical outcome following surgery was observed in 79-93% of patients depending on the prognostic group. A moderate association (Cramer's V = 0.32) was found between the gait speed improvement rate and the prognostic group (X2, p = 0.003). Patients with a positive tap test had the highest gait speed improvement rate (75%). In addition, an improvement in walking speed was observed in 4/11 patients who had both a negative tap test and a negative infusion test. Other outcome measures did not differ between the prognostic groups. Conditions other than iNPH were found in 25% of the patients referred to iNPH outpatient clinic, with the most prevalent being Alzheimer's disease. CONCLUSIONS: Our results emphasize the importance of a systematic diagnostic and prognostic workup especially in cases with an atypical presentation of iNPH. Additional diagnostic testing may be required, but should not delay adequate care. Active surgical treatment is recommended in patients with a high clinical probability of iNPH. Other neurological conditions contributed to most of the non iNPH diagnoses.

The effect of a probiotic blend on gastrointestinal symptoms in constipated patients: a double blind, randomised, placebo controlled 2-week trial.

Selected strains of lactobacilli and bifidobacteria are known to ameliorate constipation-related symptoms and have previously shown efficacy on digestive health. In this clinical trial, the safety and effectiveness of a probiotic blend containing lactobacilli and bifidobacteria were evaluated in adults with self-reported bloating and functional constipation. Constipation was diagnosed by the Rome III criteria. A total of 156 adults were randomised into this double-blind and placebo-controlled trial. Participants consumed the combination of Lactobacillus acidophilus NCFM (1010 cfu), Lactobacillus paracasei Lpc-37 (2.5×109 cfu), Bifidobacterium animalis subsp. lactis strains Bl-04 (2.5×109 cfu), Bi-07 (2.5×109 cfu) and HN019 (1010 cfu) (n=78), or placebo (microcrystalline cellulose) (n=78) for two weeks. After treatment the following were measured: primary outcome of bloating and secondary outcomes of colonic transit time, bowel movement frequency, stool consistency, other gastrointestinal symptoms (flatulence, abdominal pain, and burbling), constipation-related questionnaires (PAC-SYM and PAC-QoL) and product satisfaction. Faecal recovery of consumed strains was determined. The enrolled population was defined as constipated, however, the initial bloating severity was lower than in previous similar studies. No clinically significant observations related to the safety of the product were reported. Product efficacy was not shown in the primary analysis for bloating nor for the secondary efficacy analyses. The placebo functioned similarly as the probiotic product. In post-hoc analysis, a statistically significant decrease in flatulence in favour of the probiotic group was observed; day 7 (intention-to-treat (ITT): P=0.0313; per-protocol (PP): 0.0253) and on day 14 (ITT: P=0.0116; PP: P=0.0102) as measured by area under the curve (AUC) analysis. The mean AUC of all symptoms decreased in favour of the probiotic group, indicating less digestive discomfort. The study was registered at the ISRCTN registry (ISRCTN41607808).

Deterministic and statistical characterization of rigid frame porous materials from impedance tube measurements.

A method to characterize macroscopically homogeneous rigid frame porous media from impedance tube measurements by deterministic and statistical inversion is presented. Equivalent density and bulk modulus of the samples are reconstructed with the scattering matrix formalism, and are then linked to its physical parameters via the Johnson-Champoux-Allard-Lafarge model. The model includes six parameters, namely the porosity, tortuosity, viscous and characteristic lengths, and static flow and thermal permeabilities. The parameters are estimated from the measurements in two ways. The first one is a deterministic procedure that finds the model parameters by minimizing a cost function in the least squares sense. The second approach is based on statistical inversion. It can be used to assess the validity of the least squares estimate, but also presents several advantages since it provides valuable information on the uncertainty and correlation between the parameters. Five porous samples with a range of pore properties are tested, and the pore parameter estimates given by the proposed inversion processes are compared to those given by other characterization methods. Joint parameter distributions are shown to demonstrate the correlations. Results show that the proposed methods find reliable parameter and uncertainty estimates to the six pore parameters quickly with minimal user input.

Proximal humeral fractures in Sweden-a registry-based study.

Proximal humeral fracture is the third most common osteoporotic fracture. To our knowledge, this is the first nationwide population-based registry study in adults that includes both inpatient and outpatient visits. Thus, we were able to report the true incidence rates and trends in the treatment of proximal humeral fractures. INTRODUCTION: Proximal humeral fractures are among the most common osteoporotic fractures. Valid epidemiologic population-based data, including both inpatient and outpatient visits, however, are lacking. METHODS: To investigate the Swedish national incidence rates and treatment trends of proximal humeral fractures, we obtained data from the Swedish Hospital Discharge Register between 2001 and 2012. All adult patients (≥18 years of age) in the Swedish Hospital Discharge Register were included. Outpatient visits have been included in the register since 2001. RESULTS: We identified 98,770 patients (women n = 72,063; 73 %) with proximal humeral fractures between 2001 and 2012. In 2001, the sex-specific incidence of proximal humeral fractures was 134.5 per 100,000 person-years for women and 49.2 for men. In 2012, the corresponding values were 174.6 for women and 68.1 for men, increasing 30 % in women and 39 % in men. A total of 17,013 surgical procedures were conducted between 2001 and 2012. Open reduction and internal fixation with a plate was the most common procedure (n = 5050, 30 %), followed by endoprosthetic implantation (n = 3962, 23 %) and intramedullary nailing (n = 3376, 20 %). The proportion of surgically treated patients increased from 12.1 % in 2001 to 16.8 % in 2012 for women and from 15.1 % in 2001 to 17.1 % in 2012 for men. CONCLUSION: The Swedish national incidence of proximal humeral fractures has been increasing, although it seems to have peaked in the elderly population during 2008-2010. The rate of surgical treatment has increased substantially, particularly open reduction and internal fixation with a plate. To our knowledge, this is the first nationwide epidemiologic study for Sweden reporting the incidence of proximal humeral fractures and including all inpatient and outpatient visits.

Obstetric risk factors for early-onset schizophrenia in a Finnish birth cohort.

OBJECTIVE: Although case-control investigations have shown an association between obstetric complications and schizophrenia, particularly among patients with early onsets, cohort studies have mostly failed to confirm this effect. The authors examined whether a history of fetal hypoxia and other obstetric complications elevated risk for early-onset schizophrenia in a 1955 Helsinki birth cohort. METHOD: The subjects were 80 randomly selected patients with schizophrenia (36 with early and 44 with later onsets) representative of all available probands in the cohort, 61 of their nonschizophrenic siblings, and 56 demographically matched nonpsychiatric comparison subjects. Psychiatric diagnoses were obtained from structured clinical interviews, and obstetric data were taken from standardized, prospectively ascertained obstetric records. A score for hypoxia-associated obstetric complications was entered into logistic regression models, along with measures of prenatal infection and fetal growth retardation. RESULTS: Hypoxia-associated obstetric complications significantly increased the odds of early-onset schizophrenia but not of later-onset schizophrenia or unaffected sibling status, after prenatal infection and fetal growth retardation were taken into account. CONCLUSIONS: These findings support an association between obstetric complications and increased risk for early-onset schizophrenia. The authors advance a model whereby the neurotoxic effects of fetal hypoxia may lead to an early onset of schizophrenia due to premature cortical synaptic pruning.

School performance in Finnish children and later development of schizophrenia: a population-based longitudinal study.

BACKGROUND: We examined whether children who are diagnosed as having schizophrenia in adulthood could be distinguished from their peers on performance in elementary school. METHODS: We used a case-control study design nested within a population-based birth cohort of all individuals born in Helsinki, Finland, between January 1, 1951, and December 31, 1960. Case ascertainment was from 3 national health care registers. Elementary school records were obtained for 400 children who were diagnosed as having schizophrenia in adulthood and for 408 controls. Results were analyzed for the 4 years of schooling (ages 7-11 years) that were common to all pupils. School subjects were entered into a principal components analysis and produced 3 factors: academic, nonacademic, and behavioral. These factors were compared between cases and controls after adjusting for sex and social group. Eligibility for high school and progression to high school were investigated among cases and controls. RESULTS: Cases performed significantly worse than controls only on the nonacademic factor (which loaded sports and handicrafts). There were no differences between the groups on the academic or behavioral factors, and there were no significant clinical correlates of factor scores. Cases were significantly less likely than controls to progress to high school, despite similar eligibility. CONCLUSIONS: Poor performance in sports and handicrafts during elementary school, which may indicate a motor coordination deficit, appears to be a risk factor for later schizophrenia. Poor academic performance in elementary school was not a risk factor for schizophrenia in this study. Lack of expected progression to high school among cases, despite good academic grades, provides evidence for deteriorating premorbid functional adjustment in schizophrenia.

Quantitation of the relationship between tester cell number inoculated and SOS-inducing potency of 4-nitroquinoline-1-oxide (4-NQO) in an automated version of the SOS chromotest.

The SOS chromotest is a simple quantitative short-term bacterial assay for the detection of genotoxic activity of pure compounds or complex samples. On the basis of consecutive experiments aimed at demonstrating the relationship between the inoculum size and the outcome of the test using 4-nitroquinoline-1-oxide (4-NQO) as model genotoxin. It is shown that within the suitable range of the cell number there is a negative correlation between the number of tester cells and test sensitivity. Moreover, it could be demonstrated that the peak of the dose response curve, i.e., the maximal induction factor, is systematically influenced by the actual value of the ratio of beta-galactosidase to alkaline phosphatase enzyme activities at a 4-NQO concentration of zero. Last but not least, some simple statistical data describing the performance of the automated version of the SOS chromotest are also given.

[Characteristics of the mutagenic and toxic effects of ethylene imine and its oligomers. Comparative study in the automated SOS-chromotest system and in standard bacterial test systems]. / Zakonomernosti mutagennogo i toksicheskogo deistviia étilenimina i ego oligomerov. Sravnitel'noe izuchenie v avtomatizirovannoi sisteme SOS-khromotest i v standartnykh bakterial'nykh test-sistemakh.

Raising total positive charge of a chemical mutagen does increase its local concentration in the area of biological target-DNA, and, as a consequence, causes increase in the rate of interaction of a mutagen with the target. Experimental evidence of this idea has been obtained in three test systems: the Ames test, Trp+ reversions in Escherichia coli WP2 and in the automated "SOS-chromotest" system with E. coli PQ 37 ("Labsystems", Finland).

Genotoxicity assessment of the plasmacytomagenic agent pristane (2.6.10.14-tetramethylpentadecane) and four related alkanes by the SOS chromotest.

The most extensively studied model of plasmacytomagenesis is the induction of plasmacytomas in BALB/c mice by i.p. injections of mineral oil or, chemically more defined, by several branched alkanes such as pristane (2.6.10.14-tetramethylpentadecane), phytane (2.6.10.14-tetramethylhexadecane), and 7-n-hexyloctadecane. The available evidence suggests that the primary biologic action of these plasmacytomagenic agents is to induce the formation of a chronic granulomatous tissue, the histological matrix of plasmacytoma development. However, certain genotoxic effects caused by the presence of these substances can not be ruled out a priori. Pristane, 2-methyldodecane, and 1.3-di-tert-butyl-5-methyl-cyclohexane as well as perhydroanthracene and hexahydrodibenzsuberane were proofed as potential genotoxic agents by the SOS chromotest, a quantitative bacterial colorimetric assay for genotoxins. The substances tested did not express any sign of genotoxicity, but exerted toxic effects to the E. coli tester strain.

A microassay of O2 concentrations based on oxygen-induced chemiluminescence in anaerobic lipoxygenase reactions.

The preparation of chemiluminescence probes for assaying O2 concentrations in microsamples is described. This probe is based on an anaerobic lipoxygenase-linoleate system continuously generating reactive intermediates which in a spontaneous reaction with added O2 yield an excited species. The resulting chemiluminescence signals are highly reproducible upon repeated sample application and unaffected by even large variations in the contents of lipoxygenase-1 and linoleic acid. The linear assay range is between 0.25 and 25 nmol of O2. The assay system described is stable for 90 +/- 10 min, irrespective of the number of samples added, and the probe can be regenerated thereafter by adding linoleic acid.