Determining health-related quality of life and health state utility values of recurrent urinary tract infections in women.

INTRODUCTION AND HYPOTHESIS: Health state utility values estimate an individual's valuation of their health-related quality of life. Despite prevalence of recurrent urinary tract infections (rUTIs), the health state utility value of rUTIs is unknown. The primary aim was to determine the utility value of rUTIs using the standard gamble (SG). The secondary aim was to compare the SG utility value with that derived from the EuroQol 5 dimensions (EQ-5D) and visual analog scale (VAS). We hypothesized that a utility value would be successfully derived from the SG and would differ from that derived using the EQ-5D and VAS. METHODS: Nonpregnant, adult English-speaking female patients with a diagnosis of rUTI were recruited and completed the EQ-5D, VAS, and SG (n = 25). Utility values were evaluated using Wilcoxon signed-rank tests and Spearman's rho correlation. RESULTS: Health state utility values varied depending on the assessment tool used: EQ-5D 0.76 (IQR 0.52), VAS 0.70 (IQR 0.30), and SG 0.85 (IQR 0.25). There were differences between VAS and the other two assessment methods (p<0.001), as well as between EQ-5D and SG (p=0.013). Spearman correlation demonstrated a moderately positive correlation between EQ-5D and VAS values (r(25) = 0.59, p=0.0019). CONCLUSIONS: Our data suggest that 0.85 reflects the true health state utility value of rUTIs among nonpregnant adult English-speaking women. The utility value for recurrent UTIs is worse (lower) than that previously published for nonrecurrent UTIs, reflecting the ability of the SG to convey the compounding impact of recurrent disease. In this study, neither the EQ-5D nor the VAS produced results consistent with those found using the SG, which suggests limited validity in this population.

Evaluation of Changes in Microbiology and Periodontal Parameters During and After Fixed Orthodontic Appliances.

The objective of the study was to evaluate the changes in microbiology through quantitative analysis of aerobic and anaerobic colonies and periodontal measurements during and after 1 month of removal of fixed orthodontic appliances. This prospective study comprised 30 patients, aged 12-30 years seeking orthodontic treatment in the department of Orthodontics and Dentofacial Orthopaedics of People's College of Dental Sciences and Research Centre, Bhopal from May 2016 to November 2017. Microbiological samples (supra- and subgingival plaque) and periodontal measurements like bleeding on probing (BOP), periodontal pocket depth (PPD) with oral hygiene assessment indices {plaque index (PI), gingival index (GI)} were used at 2 time interval: when patient undergoing orthodontic treatment >12 month (baseline, T1) and 1 month after the removal of appliance (T2). Bacterial culture method used to detect aerobic and anaerobic colony forming units (CFU) and their ratio (aerobic/anaerobic). Data analyzed using paired t-test and chi-square test. There was a significant decrease in an aerobic and anaerobic CFU (both supra- and subgingivally) and increase in CFU ratio (relatively less anaerobes) (p≤0.05) at T2. Supragingival plaque sampling showed greater diminution in the CFU count as compared to the subgingival CFU, as these sites are more accessible for maintaining hygiene. Also, periodontal measurements showed significant decrement (PI, GI, PPD and BOP) at T2 (p≤0.05). Fixed orthodontic treatment has transient effect on periodontium as supra- and subgingival CFU count decreases and periodontal health was ameliorated after removal of appliances which was accompanied with periodontopathic bacteria and clinical periodontal signs of inflammation during treatment.

A Retrospective Case Series of a Novel Spinal Cord Stimulator Trial Technique with Less Displacement and Migration of the Trial Leads.

Background: Spinal cord stimulation is an established treatment option for certain chronic pain conditions which have been previously unresponsive to conservative therapies or potentially for a subset of patients who have not improved following spine surgery. Prior to permanent lead implantation, stimulator lead trials are performed to ensure adequate patient benefit. During these trials, one of the most common complications and reasons for failure is the displacement and migration of the trial leads, resulting in lost therapeutic coverage. Other complications include infection and dislodged bulky dressings. There is a paucity of literature describing an adequate procedural method to prevent these common complications. Objective: This study utilizes a series of 19 patients to evaluate a new technique for securing percutaneous spinal cord simulator trial leads, which may minimize dislodgement and migration complications and improve the rate of trial success. Study Design: Retrospective case series. Setting: New Jersey Medical School, Department of Anesthesiology, Pain Management Division. Methods: A retrospective chart review was conducted on 19 consecutive patients undergoing placement of the percutaneous thoracic spinal cord stimulator trial leads for pain associated with lumbar spine pathology over a two-year period (2010-2012). Results: Of the 19 patients in our cohort, there was one trial lead displacement, no lead migrations, and no site infections. Thirteen patients went on to permanent lead implantation. This improved trial lead placement technique had a high success rate with a low number of complications. Limitations: Small sample size, retrospective case series, and no control group for comparison. Conclusion: This case series was able to demonstrate that our described novel spinal cord stimulator trial lead placement and dressing technique can decrease the incidence of lead displacement and migration, thus improving trial success.

Loss of Subpodocytic Space Predicts Poor Response to Tacrolimus in Steroid-Resistant Calcineurin Inhibitor-Naïve Adult-Onset Primary Focal Segmental Glomerulosclerosis.

Focal segmental glomerulosclerosis (FSGS) is the most common cause of adult-onset nephrotic syndrome, but its pathophysiology is poorly understood. The question as to why only a subset of patients responds to treatment in unanswered. In the past few years, change of podocytic phenotype from stationary type in health to migratory type in disease has been described, of which loss of subpodocytic space is a surrogate marker. Diagnostic biopsies of adult-onset steroid-resistant calcineurin inhibitor-naïve primary FSGS cases, which were subsequently treated with tacrolimus were included in this retrospective study conducted from 2011 to 2013. The ultrastructure of all cases was studied in detail, especially in context to the presence or absence of subpodocytic space. In the present study, we have compared presence or absence of subpodocytic space in tacrolimus-responsive versus tacrolimus-resistant cases to identify potential electron microscopic features predictive of response to treatment, of which loss of subpodocytic space indicating migratory phenotype is the most important and consistent feature. The present series included 7 tacrolimus responsive cases (includes two cases with partial response) and seven tacrolimus-resistant cases. The tacrolimus-resistant patients were of older age, had a longer duration of illness, and a lower eGFR as compared to tacrolimus responsive cases. The subpodocytic space was preserved in patients on tacrolimus with complete remission and lost in patients with partial response and tacrolimus-resistant cases.

Monoclonal Gammopathy of Renal Significance Triggered by Viral E Hepatitis.

Monoclonal gammopathy of undetermined significance does not have end organ damage, but a proportion of cases manifest with renal injury when it is called monoclonal gammopathy of renal significance (MGRS). Herein, we describe a case of acute hepatitis E infection, which precipitated the development of MGRS. The patient underwent kidney biopsy for elevated creatinine with clinical suspicion of drug-induced interstitial nephritis. On light microscopy, there were periodic acid-Schiff negative-fractured casts in tubules with giant cell reaction around them. The tubular epithelial cells showed intracytoplasmic bile pigment. On direct immunofluorescence, casts showed kappa restriction. A diagnosis of bilirubin proximal tubulopathy and light chain cast nephropathy was made, and possibility of myeloma was suggested. On further evaluation, κ:λ ratio was 27, ß2 microglobulin was 8036 ng/ml, and bone marrow examination showed 5% plasma cells. There were no bony lesions, and serum calcium was 8.6 mg/dl. The present case is unique in two aspects. First, the patient developed MGRS triggered by acute hepatitis E in less than a month. Second, the MGRS lesion was manifested in the form of light chain cast nephropathy.

Szász-Durrmeyer operators involving Boas-Buck polynomials of blending type.

The present paper introduces the Szász-Durrmeyer type operators based on Boas-Buck type polynomials which include Brenke type polynomials, Sheffer polynomials and Appell polynomials considered by Sucu et al. (Abstr. Appl. Anal. 2012:680340, 2012). We establish the moments of the operator and a Voronvskaja type asymptotic theorem and then proceed to studying the convergence of the operators with the help of Lipschitz type space and weighted modulus of continuity. Next, we obtain a direct approximation theorem with the aid of unified Ditzian-Totik modulus of smoothness. Furthermore, we study the approximation of functions whose derivatives are locally of bounded variation.

A new kind of Bernstein-Schurer-Stancu-Kantorovich-type operators based on q-integers.

Agrawal et al. (Boll. Unione Mat. Ital. 8:169-180, 2015) introduced a Stancu-type Kantorovich modification of the operators proposed by Ren and Zeng (Bull. Korean Math. Soc. 50(4):1145-1156, 2013) and studied a basic convergence theorem by using the Bohman-Korovokin criterion, the rate of convergence involving the modulus of continuity, and the Lipschitz function. The concern of this paper is to obtain Voronoskaja-type asymptotic result by calculating an estimate of fourth order central moment for these operators and discuss the rate of convergence for the bivariate case by using the complete and partial moduli of continuity and the degree of approximation by means of a Lipschitz-type function and the Peetre K-functional. Also, we consider the associated GBS (generalized Boolean sum) operators and estimate the rate of convergence for these operators with the help of a mixed modulus of smoothness. Furthermore, we show the rate of convergence of these operators (univariate case) to certain functions with the help of the illustrations using Maple algorithms and in the bivariate case, the rate of convergence of these operators is compared with the associated GBS operators by illustrative graphics.

Modified Stancu operators based on inverse Polya Eggenberger distribution.

In this paper, we construct a sequence of modified Stancu-Baskakov operators for a real valued function bounded on [Formula: see text], based on a function [Formula: see text]. This function [Formula: see text] is infinite times continuously differentiable on [Formula: see text] and satisfy the conditions [Formula: see text] and [Formula: see text] is bounded for all [Formula: see text]. We study the degree of approximation of these operators by means of the Peetre K-functional and the Ditzian-Totik modulus of smoothness. The quantitative Voronovskaja-type theorems are also established in terms of the first order Ditzian-Totik modulus of smoothness.

Anatomical and Morphological Characterization of the Nasopalatine Canal: A Cone-Beam Computed Tomography Study.

The anterior maxilla, also called pre-maxilla, is an area frequently requiring surgical interventions. Rehabilitation of this area remains a complex restorative challenge. The most prominent anatomical structure within the anterior maxilla is the Nasopalatine Canal. Thorough knowledge about this anatomical structure plays an important role in the successful outcomes of surgical procedures. This retrospective study was done to evaluate the anatomy and morphology of the Nasopalatine Canal using cone-beam computed tomography (CBCT). The study included 125 subjects aged between 15 and 78 years who were divided into the following 5 groups: i) 15-30 years, ii) 30-45 years, iii) 45-60 years, iv) 60-75 years, v) ≥75 years in the Department of Oral Medicine & Radiology, Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh, India from January 2012 to January 2015. Cone-beam computed tomography (CBCT) was performed using a standard exposure and patient positioning protocol. The data of the CBCT images were sliced in three dimensions. Image planes on the three axes (X, Y, and Z) were sequentially analyzed for the location, morphology and dimensions of the Nasopalatine Canal. The correlation of age and gender with all the variables were evaluated. ANOVA and Z-test was used. P value <0.05 was considered statistically significant. Males and females showed significant differences in the length of the canal and anterior bone width in the sagittal sections. Inverted L was identified as a new dimension to the morphological shape of Nasopalatine Canal in central Madhya Pradesh population. The present study highlighted important variability observed in the anatomy and morphology of the Nasopalatine Canal.

Salivary biochemical markers as potential acute toxicity parameters for acute radiation injury: A study on small experimental animals.

Researchers have been evaluating several biodosimetric/screening approaches to assess acute radiation injury, related to mass causality. Keeping in mind this background, we hypothesized that effect of whole-body irradiation in single fraction in graded doses can affect the secretion of various salivary components that could be used as acute radiation injury/toxicity marker, which can be used in screening of large population at the time of nuclear accidents/disaster. Thirty Sprague Dawley rats treated with whole-body cobalt-60 gamma irradiation of dose 1-5 Gy (dose rate: 0.95 Gy/min) were included in this study. Whole mixed saliva was collected from all animals before and after radiation up to 72 h postradiation. Saliva was analyzed for electrolytes, total protein, urea, and amylase. Intragroup comparison of salivary parameters at different radiation doses showed significant differences. Potassium was significantly increased as the dose increased from 1 Gy to 5 Gy (p < 0.01) with effect size of difference (r > 0.5). Sodium was significantly altered after 3-5 Gy (p < 0.01, r > 0.5), except 1 and 2 Gy, whereas changes in sodium level were nonsignificant (p > 0.5). Urea, total protein, and amylase levels were also significantly increased as the radiation dose increased (p < 0.01) with large effect size of difference (r > 0.5). This study suggests that salivary parameters were sensitive toward radiation even at low radiation dose which can be used as a predictor of radiation injury.

Associations of FPG, A1C and disease duration with protein markers of oxidative damage and antioxidative defense in type 2 diabetes and diabetic retinopathy.

PURPOSE: To investigate the role of protein oxidative damage and antioxidant defense in relationship to hyperglycemia measured as fasting plasma glucose (FPG), glycated hemoglobin (A1C), and duration of disease in type 2 diabetes mellitus (DM) and diabetic retinopathy (DR). METHODS: This study recruited 23 non-diabetic subjects, 16 DM patients without any complications and 18 DR patients. The serum ischemia modified albumin (IMA) and glutathione (GSH) levels were measured. The IMA results were corrected for serum albumin. Between-group differences were studied by analysis of variance and between-variable associations were studied by Spearman's and partial correlations. RESULTS: IMA and cIMA values were elevated, whereas GSH was decreased in both patient groups vs controls (P<0.05), and the increase in IMA formation is not related to serum albumin changes. DR patients have much severe oxidative stress (OS) status with high IMA and cIMA, and low GSH than in the DM group (P<0.05). Both FPG and A1C levels were positively associated with IMA in DM group, while in the DR group, duration of disease too had a positive association with IMA. The antioxidant GSH had negative correlations with FPG (r=-0.52, P=0.02) and IMA (r=-0.49, P=0.03) in the DR group. Partial correlation analyses predicted mutual or independent associations among parameters. CONCLUSIONS: Severe OS in DR has been associated with increased FPG, A1C, and disease duration. Both hyperglycemia and elevated oxidative damage detected as IMA are collectively associated with depleted GSH status. Our study unravels the need for monitoring of OS in addition to standard glycemic management in DR.

Intramuscular Hibernoma: A Rare Tumour in Buttock.

Hibernomas are benign tumours of brown fat that does not recur after complete excision. These tumours are found most often in adults and most commonly in thigh. Four morphologic variants of hibernoma are identified: typical, myxoid, spindle cell, and lipoma-like. The most common histologic type is typical variant. In this report, we present the clinical, morphological features and discuss the differential diagnosis of a typical variant of intramuscular hibernoma.

Mesenchymal Stem Cells and Co-stimulation Blockade Enhance Bone Marrow Engraftment and Induce Immunological Tolerance.

BACKGROUND: Organ transplantation currently requires long-term immunosuppression. This is associated with multiple complications including infection, malignancy and other toxicities. Immunologic tolerance is considered the optimal solution to these limitations. OBJECTIVE: To develop a simple and non-toxic regimen to induce mixed chimerism and tolerance using mesenchymal stem cell (MSC) in a murine model. METHODS: Wild type C57BL6 (H2D(k)) and Bal/C (H2D(d)) mice were used as donors and recipients, respectively. We studied to achieve tolerance to skin grafts (SG) through mixed chimerism (MC) by simultaneous skin graft and non-myeloablative donor bone marrow transplantation (DBMT) +/- MSC. All recipients received rapamycin and CTLA-4 Ig without radiation. RESULTS: DBMT+MSC combined with co-stimulation blockage and rapamycin led to stable mixed chimerism, expansion of Tregs population and donor-specific skin graft tolerance. The flow cytometry analysis revealed that recipient mice developed 15%-85% chimerism. The skin allografts survived for a long time. Elimination of MSC failed to induce mixed chimerism and tolerance. CONCLUSION: Our results demonstrate that donor-specific immune tolerance can be effectively induced by non-myeloablative DBMT-MSC combination without any additional cytoreductive treatment. This approach provides a promising and non-toxic allograft tolerance strategy.

The association between government healthcare spending and maternal mortality in the European Union, 1981-2010: a retrospective study.

OBJECTIVE: To determine the association between reductions in government healthcare spending (GHS) on maternal mortality in 24 countries in the European Union (EU) over a 30-year period, 1981-2010. DESIGN: Retrospective study. SETTING AND POPULATION: Twenty-four EU countries (a total population of 419 million as of 2010). METHODS: We used multivariate regression analysis, controlling for country-specific differences in healthcare, infrastructure, population size and demographic structure. GHS was measured as a percentage of gross domestic product. Five-year lag-time analyses were performed to estimate longer standing effects. MAIN OUTCOME MEASURES: Maternal mortality rates. RESULTS: An annual 1% decrease in GHS is associated with significant rises in maternal mortality rates [regression coefficient [R] 0.0177, P = 0.0021, 95% confidence interval [95% CI] 0.0065-0.0289]. For every annual 1% decrease in GHS, we estimate 89 excess maternal deaths in the EU, a 10.6% annual increase in maternal mortality. The impact on maternal mortality was sustained for up to 1 year (R 0.0150, P = 0.0034, 95% CI 0.0050-0.0250). The associations remained significant after accounting for economic, infrastructure and hospital resource controls, in addition to out-of-pocket expenditure, private health spending and total fertility rate. However, accounting for births attended by skilled staff removed the significance of these effects. CONCLUSIONS: Reductions in GHS were significantly associated with increased maternal mortality rates, which may occur through changes in the provision of skilled health professionals attending births. Examples of reduced GHS such as the implementation of austerity measures and budgetary reductions are likely to worsen maternal mortality in the EU.

Mapping QTLs for opaque2 modifiers influencing the tryptophan content in quality protein maize using genomic and candidate gene-based SSRs of lysine and tryptophan metabolic pathway.

KEY MESSAGE: The mapping analysis resulted in identification of five significant QTLs for opaque2 modifiers influencing the tryptophan content in quality protein maize using functional and genomic SSR markers. Quality protein maize (QPM) was developed by selecting genetic modifiers that convert opaque2 mutant containing high lysine and tryptophan. There are several unlinked opaque2 modifier loci (Opm) in QPM whose location, nature and mode of action are not clear. To identify these Opm QTLs, we developed a population of 218 F2:3 individuals from a cross between VQL2 and VQL8, two isogenic QPM inbreds significantly differing in tryptophan content. Based on the data of the F2:3 population, five significant QTLs on chromosomes 5, 7 and 9 with LOD values more than 2.5 were identified and together explained 38.6 % of the total phenotypic variance (R (2)). The Wx1 gene which has influence on the amino acid composition of the maize endosperm was mapped on chromosome 9 near the marker phi022 and also validated by bulk analysis. The QTL near the SSR marker ZmASK3, developed from the aspartate kinase 2 gene of the lysine pathway, mapped on chromosome 5 and had LOD of 2.7 with R (2) of 5.1 %. On chromosome 9, the QTL between the loci umc1430 and bnlg1401 had an LOD of 4.5 with R (2) of 9.1 %, whereas the QTL between the loci bnlg1401 and phi022 had an LOD of 4.2 with R (2) of 8.4 %. The third QTL was observed to be close to the marker umc2207 with an LOD of 4.8 and R (2) of 8.4 %. The identified QTLs will be very useful in the marker-assisted back-cross breeding and transgressive breeding for the development of QPM maize.