Neurologic Complications of Paget Disease of Bone

ObjectiveTo review the epidemiology, evaluation, and management of the neurologic complications associated with Paget disease of bone (PDB).MethodsWe reviewed the English-language medical literature using MEDLINE data sources from 1950 to August 2008 and manually searched cross-references from original articles and reviews. Search terms included “Paget* disease of bone” and “neurologic* complications,” “cranial nerve,” “spinal cord,” or “peripheral nerve.”ResultsSeveral neurologic problems in the central and peripheral nervous systems may complicate PDB. Up to 76% of patients may have some form of neurologic involvement. Neurologic complications can occur in patients with a long history of PDB as well as in patients with previously unrecognized disease. The primary mechanisms of nerve damage in PDB involving the spine are ischemic myelitis and compression due to bone hypertrophy. Evaluation includes determining the serum alkaline phosphatase level and imaging by radiography, bone scintigraphy, computed tomographic scanning, and, for lesions of the central nervous system, magnetic resonance imaging. If a soft-tissue mass is found, biopsy should be considered to exclude the presence of sarcoma. Treatment strategies include calcium, vitamin D, bisphosphonates, and possibly surgical intervention for refractory cases.ConclusionNeurologic sequelae of PDB may be underappreciated. Despite the paucity of data guiding treatment, zoledronic acid is a reasonable first-line therapy. Lack of response to treatment or relapse should prompt diagnostic reevaluation with a heightened suspicion for tumor. (Endocr Pract. 2009;15:158-166)     

Exploiting the functional and taxonomic structure of genomic data by probabilistic topic modeling

In this paper, we present a method that enable both homology-based approach and composition-based approach to further study the functional core (i.e., microbial core and gene core, correspondingly). In the proposed method, the identification of major functionality groups is achieved by generative topic modeling, which is able to extract useful information from unlabeled data. We first show that generative topic model can be used to model the taxon abundance information obtained by homology-based approach and study the microbial core. The model considers each sample as a “document,” which has a mixture of functional groups, while each functional group (also known as a “latent topic”) is a weight mixture of species. Therefore, estimating the generative topic model for taxon abundance data will uncover the distribution over latent functions (latent topic) in each sample. Second, we show that, generative topic model can also be used to study the genome-level composition of “N-mer” features (DNA subreads obtained by composition-based approaches). The model consider each genome as a mixture of latten genetic patterns (latent topics), while each functional pattern is a weighted mixture of the “N-mer” features, thus the existence of core genomes can be indicated by a set of common N-mer features. After studying the mutual information between latent topics and gene regions, we provide an explanation of the functional roles of uncovered latten genetic patterns. The experimental results demonstrate the effectiveness of proposed method.     

Comparison of electromyographic signals from monopolar current and potential amplifiers derived from a penniform muscle,the gastrocnemius medialis

Electromyograms (EMGs) are measured by bipolar surface electrodes that quantify potential differences. Bipolar potentials over penniform muscles may be associated with errors. Our assumption was that muscle activity can be quantified more reliably and with a higher spatial resolution using current measurements.The purpose of this work is: (a) to introduce the concept of current measurements to detect muscle activity, (b) to show the coherences observed over a segment of a typical penniform muscle, the gastrocnemius medialis where one would expect a synchronicity of the activation, and (c) to show the amount of mixing that is caused by the finite inter electrode resistance.A current amplifier was developed. EMGs were recorded at 40% of maximum voluntary contraction during isometric contractions of the gastrocnemius medialis. EMGs of twelve persons were recorded with an array of four peripheral and one central electrode. Monopolar EMGs were recorded for “all-potential”, “center at current” and “all-current” conditions. Coherence revealed the similarity of signals recorded from neighboring electrodes.Coherence was high for the “all-potential”, significant for the “current at center” condition and disappeared in the “all-current” condition.It was concluded that EMG array recordings strongly depends on the measurement configuration. The proposed current amplifier significantly improves spatial resolution of EMG array recordings because the inter-electrode cross talk is reduced.     

DNA damage and repair in Fuchs endothelial corneal dystrophy

Fuchs endothelial corneal dystrophy (FECD) is a slowly progressive eye disease leading to blindness, mostly affecting people above 40 years old. The only known method of curing FECD is corneal transplantation. The disease is characterized by the presence of extracellular deposits called “cornea guttata”, apoptosis of corneal endothelial cells, dysfunction of Descement’s membrane and corneal edema. Oxidative stress is suggested to play a role in FECD pathogenesis. Reactive oxygen species produced during the stress may damage biomolecules, including DNA. In the present study we evaluated the extent of endogenous DNA damage, including oxidatively modified DNA bases, and damage induced by hydrogen peroxide as well as the kinetics of DNA repair in peripheral blood mononuclear cells of 50 patients with FECD and 43 age-matched controls without visual disturbances. To quantify DNA damage and repair we used the alkaline comet assay technique with the enzymes recognizing oxidative DNA damage, hOGG1 and EndoIII. We did not observe differences in the extent of endogenous and hydrogen peroxide-induced DNA damage between FECD patients and controls. However, we found a lower efficacy of DNA repair in FECD patients as compared with control individuals. The results obtained suggest that the lowering of the DNA repair capacity may be one of the mechanisms underlying the role of oxidative stress in the FECD pathology.     

Cultural and biological evolutionary processes, selection for a trait under complex transmission.

We consider the evolution of a trait, which is under both genetic and phenotypic transmission. An individual is always born in one state but can be converted to the other before reaching adulthood. If the conversion takes place by a learning process, the native state is called “unskilled,” and that acquired by learning is called “skilled.” If phenotypic conversion takes place by way of infection, the native state is uninfected, and can be converted to infected. Native and converted phenotypes may be subject to selection; acquiring a skill may lead to selective advantage of skilled versus unskilled, while contracting a disease may involve a selective disadvantage. Conversion probability is a function of the parental phenotypes. In some of our models we assume that only one parent has teaching ability (or transmits the disease) and in others we consider more general situations. The probability of learning (or of taking the disease) may be determined by the individual's genotype. A diallelic locus is considered. The evolution of the genotypes and the phenotypes is studied in a variety of situations. Equilibria, and in a few simple cases the dynamics of the phenotypes and genotypes in the population are given. The usual equilibrium for heterozygote advantage is found to depend, in the present case, on the parameters of the learning process. Oscillatory equilibria and more than one stable equilibrium can exist in certain circumstances. Even in the absence of genotypic differences for the conversion probability gene frequencies may change.     

Quantifying DNA damage induced by ionizing radiation and hyperthermia using single DNA molecule imaging

Ionizing radiation (IR) is a common mode of cancer therapy, where DNA damage is the major reason of cell death. Here, we use an assay based on fluorescence imaging of single damaged DNA molecules isolated from radiated lymphocytes, to quantify IR induced DNA damage. The assay uses a cocktail of DNA-repair enzymes that recognizes and excises DNA lesions and then a polymerase and a ligase incorporate fluorescent nucleotides at the damage sites, resulting in a fluorescent “spot” at each site. The individual fluorescent spots can then be counted along single stretched DNA molecules and the global level of DNA damage can be quantified. Our results demonstrate that inclusion of the human apurinic/apyrimidinic endonuclease 1 (APE1) in the enzyme cocktail increases the sensitivity of the assay for detection of IR induced damage significantly. This optimized assay also allowed detection of a cooperative increase in DNA damage when IR was combined with mild hyperthermia, which is sometimes used as an adjuvant in IR therapy. Finally, we discuss how the method may be used to identify patients that are sensitive to IR and other types of DNA damaging agents.     

Aplastic anemia,cellular and molecular aspects

Aplastic anemia (AA) is an autoimmune disorder characterized by bone marrow and peripheral blood pancytopenia. Different environmental and genetical conditions could be effective in an outbreak of this disease. The exact pathogenesis of this disease, however, is still idiopathic. The present study is based on Pubmed database information (2002–2021) using the words “Aplastic Anemia,” “Hematopoietic Stem Cells niche,” “Signaling pathway,” “Cytokines,” and “Immuno cells.” In this disease, both hematopoietic stem cells and mesenchymal stromal cells are impaired, which is associated with impaired hematopoiesis and decreased hematopoietic cells. Inflammatory cytokines increase, which changes the ratio of T lymphocytes and leads to disease progression. In addition, the most common mechanism of AA is damage by the immune system, which leads to increased apoptosis in progenitor cells. We have shown in this review that the disease involves quantitative defects in stem cell numbers and qualitative abnormalities in the function of these cells and the activity of many different cellular and molecular factors can damage hematopoietic cells and the protective substrate of these cells in this disease.     

Two-enzyme active transport in vitro with ph induced asymmetrical functional structures.: III. Discussions based on numerical treatments of the time-dependent evolutions

Three complementary models have been considered in which pH gradients (step function. linear pH or linear H^?) impose asymmetry on a two-enzyme mixture. If the “combined pH dependences” of enzymes is pro-asymmetrical, the pH gradient induces an asymmetrical distribution of potential activities (“latent” asymmetry of functional structure). When substrate is added, “developed” asymmetry of effective activities appears which results in “substrate space wave” and pumping when the catalysed reaction couple is “inversible”. It is shown that only one steady state exists for a given boundary condition and is attained when the “combined effective activity” of enzymes is nil: the stationary flux with symmetrical boundaries or the stationary load with moving boundaries is proportional to “effective global activities” of enzymes. “Equivalent square models” could be proposed that would be able to describe “functional” or “permanent” structure pumps as well. These models belong to the thermodynamic branch and the asymmetrical “space wave” substrate concentration profiles obtained must be distinguished from dissipative structures. It appears that such primary active transport pumps are chemical equivalents of heat pumps.     

Identification of unknowns within a probabilistic system: The diagnostic value of attributes

Using a data base underpinned by probability considerations in which a variety of attributes, some of which may be quantitative, are recorded for a number of “operational taxonomic units” (OTUs), a key system is described by which an unnamed specimen may quickly be identified. The concept of “diagnostic power” is introduced, by which each attribute is evaluated in terms of its potential contribution to identifying the unnamed specimen. Besides coverage of different types of attributes and the introduction of “diagnostic power”, the system has the advantages of incorporating multiple values of an attribute for each OTU and offering short-cuts to identification.     

Quality control of mitochondria during aging: Is there a good and a bad side of mitochondrial dynamics?

Maintenance of functional mitochondria is essential in order to prevent degenerative processes leading to disease and aging. Mitochondrial dynamics plays a crucial role in ensuring mitochondrial quality but may also generate and spread molecular damage through a population of mitochondria. Computational simulations suggest that this dynamics is advantageous when mitochondria are not or only marginally damaged. In contrast, at a higher degree of damage, mitochondrial dynamics may be disadvantageous. Deceleration of fusion‐fission cycles could be one way to adapt to this situation and to delay a further decline in mitochondrial quality. However, this adaptive response makes the mitochondrial network more vulnerable to additional molecular damage. The “mitochondrial infectious damage adaptation” (MIDA) model explains a number of inconsistent and counterintuitive data such as the “clonal expansion” of mutant mitochondrial DNA. We propose that mitochondrial dynamics is a double‐edged sword and suggest ways to test this experimentally.     

The impact of heat waves on children’s health: a systematic review

Young children are thought to be particularly sensitive to heat waves, but relatively less research attention has been paid to this field to date. A systematic review was conducted to elucidate the relationship between heat waves and children’s health. Literature published up to August 2012 were identified using the following MeSH terms and keywords: “heatwave”, “heat wave”, “child health”, “morbidity”, “hospital admission”, “emergency department visit”, “family practice”, “primary health care”, “death” and “mortality”. Of the 628 publications identified, 12 met the selection criteria. The existing literature does not consistently suggest that mortality among children increases significantly during heat waves, even though infants were associated with more heat-related deaths. Exposure to heat waves in the perinatal period may pose a threat to children’s health. Pediatric diseases or conditions associated with heat waves include renal disease, respiratory disease, electrolyte imbalance and fever. Future research should focus on how to develop a consistent definition of a heat wave from a children’s health perspective, identifying the best measure of children’s exposure to heat waves, exploring sensitive outcome measures to quantify the impact of heat waves on children, evaluating the possible impacts of heat waves on children’s birth outcomes, and understanding the differences in vulnerability to heat waves among children of different ages and from different income countries. Projection of the children’s disease burden caused by heat waves under climate change scenarios, and development of effective heat wave mitigation and adaptation strategies that incorporate other child protective health measures, are also strongly recommended.     

Die Eh da‐Initiative

The “Eh da”‐Initiative: more space for Biological Diversity in Cultural Landscapes The “Eh da”‐initiative is based on the principle that definite land in cultural landscapes is “available anyway” (what ?eh da“ means in German) and has the potential for ecological upgrading without relevant limitations of land use. “Eh da” could be the acronym “Ecological habitat development areas.” This land is located in open landscapes: along waysides, on uncropped plots in farmland, it could be communal lawn and other land categories. The initiative uses geodata in order to detect and quantify “Eh da”‐sites. According to an analysis based on geodata in selected landscapes “Eh da”‐land constitutes 2–6 per cent of the total area of Germany. “Eh da“‐sites are mostly narrow, longitudinal and spread like a net all over the landscape. Mainly insects and other invertebrate animals can be supported by upgrading of “Eh da”‐land. Since these sites often form corridors, they may be part of communal biodiversity protection initiatives under the perspective of ecological networks, or they may be used for distinct projects. Communication is a key element of any local initiative in which not only the ecological upgrading options, but also potential trade‐offs (like increase of agricultural pests and weeds, neophyta and pyrrolizidine containing or allergenic plants) should be discussed.     

Epsilon wave: A review of historical aspects

The epsilon wave of the electrocardiogram (ECG) together with fragmented QRS (fQRS), the terminal conduction delay, incomplete right bundle branch block (IRBBB) and complete/advanced RBBB (CRBBB) of peripheral origin are part of a spectrum of ventricular depolarization abnormalities of arrhythmogenic cardiomyopathy (AC). Although the epsilon wave is considered a major diagnostic criterion for AC since 2010 (AC Task Force Criteria), its diagnostic value is limited because it is a sign of the later stage of the disease. It would be more appropriate to say that the epsilon wave is a “hallmark” of AC, but is of low diagnostic sensitivity. Although the epsilon wave has high specificity for AC, it can be present in other pathological conditions. In this update we will cover the nomenclature, association with disease states and electrocardiographic aspects of the epsilon wave.     

Modeling Human Exposure to Phthalate Esters: A Comparison of Indirect and Biomonitoring Estimation Methods

Humans are potentially exposed to phthalate esters (PEs) through ingestion, inhalation, and dermal contact. Studies quantifying exposure to PEs include “biomarker studies” and “indirect studies.” Biomarker studies use measurements of PE metabolites in urine to back-calculate exposure to the parent diester, while indirect studies use the concentration of the PE in each medium of exposure and the rate of intake of that medium to quantify intake of the PE. In this review, exposure estimates from biomarker and indirect studies are compiled and compared for seven PEs to determine if there are regional differences and if there is a preferred approach. The indirect and biomarker methods generally agree with each other within an order of magnitude and discrepancies are explained by difficulties in accounting for use of consumer products, uncertainty concerning absorption, regional differences, and temporal changes. No single method is preferred for estimating intake of all PEs; it is suggested that biomarker estimates be used for low molecular weight PEs for which it is difficult to quantify all sources of exposure and either indirect or biomarker methods be used for higher molecular weight PEs. The indirect methods are useful in identifying sources of exposure while the biomarker methods quantify exposure.     

Clinical evaluation of reproductive ability of rams

Clinical evaluation of reproductive ability of rams is an integral part of sheep health management programs. The majority of problems adversely affecting the reproductive ability of rams can be easily detected with clinical evaluation. The procedure is easy to perform, has a small cost and does not require specialized support from a veterinary laboratory. As a management procedure, the method should be applied two months before the breeding season, in order to detect problems, which would adversely affect the reproductive ability of rams. It should also be performed when selecting ram-lambs as replacement sires in a flock; their first evaluation should be performed at weaning, followed by another two examinations: two to four months later and before the first mating season of these rams. The method should also be performed before the purchase of any ram as sire in a flock. Regular monitoring of reproductive ability of rams in a flock contributes to early diagnosis of disorders. As a diagnostic procedure, the method should be performed during the investigation of reproductive problems within a flock. During the evaluation of reproductive ability of rams, various clinical findings can be detected and their importance can vary. In general, rams should be in good condition and have healthy genitalia, normal libido and the ability to mate the ewes. Clinical evaluation of rams is performed in the following stages: (a) history-taking, (b) evaluation of the ratio “ewe:ram” in the flock, (c) general clinical examination, (d) clinical examination of the genitalia, (e) ultrasonographic examination of the genitalia and (f) evaluation of libido. Veterinary advice is important, in order to incorporate the clinical evaluation of reproductive ability of rams into the health management of sheep flocks.     

The interpretation of mean transit time measurements for multiphase tissue systems

A model-independent proof of the central-volume principle for multiphase tissue systems is presented. This derivation emphasizes the transport processes which occur within the system, and the physical constraints which the system must satisfy for valid application of the principle. These constraints include: (i) the fluid flowing into the system must be equivalentlylabelled; (ii) the system under study must be part of a larger system which has no diffusive inlets or outlets. The derivation shows that the definition of the volume of distribution and the choice of appropriate partition coefficients for evaluation of this quantity, are independent of any assumption concerning tracer equilibrium between phases as a whole. A less restrictive definition of equivalent labelling also results from the proof.The relationship between the mean transit times measured by global residue detection and by “snapshot” outflow detection is derived. If diffusion of tracer across the boundaries of the monitored system is significant compared to convective transport, then these two transit times will not have identical values.The conditions under which valid measurements of regional, i.e. local, physiological variables can be performed by residue detection are also discussed, and it is shown that regional residue-detection measurements may be used to assess variations in anatomical structure throughout a larger region. However, the use of the height/area method for calculating regional perfusion can lead to error when tracer enters the detector field by diffusion, as opposed to convection, or when a significant amount of diffusion occurs before tracer enters the observed region.     

On ROC analysis with nonbinary reference standard

Statistical methods for the evaluation of the accuracy of diagnostic tests usually assume a binary true disease status. However, this assumption may not be realistic in practical settings in which “disease” is defined by dichotomizing continuous or ordinal categorical measures using a pre‐specified threshold value. In this paper, we focus on the analysis of studies in which both the diagnostic test and the reference standard are reported as continuous measures. We propose a semiparametric model for estimating the sensitivity, specificity, and the ROC curve as functions of reference standard thresholds. Under suitable order restrictions on the mean of the test result variable, fitting is done via two alternative approaches: isotonic regression and monotone smoothing splines. The model provides the basis to assess the effect of varying reference standard threshold on the performance of a diagnostic test. An example to evaluate the ability of the maximal SUV‐lean (standardized uptake value normalized to lean body mass) in predicting axillary node involvement in women diagnosed with breast cancer is presented.     

Management of “psychosomatic” problems in clinical practice

Skilled interviewing and investigation are essential in the diagnosis and treatment of “psychosomatic” illness, the term “psychosomatic” being used in its more colloquial sense to refer to illness characterized by somatic symptoms and related psychopathologic disorders but without organic disease.Treatment of these patients is difficult. They respond best to a psychologically oriented physician who is able and willing to take final responsibility for both physical and psychological care. The hazards of ignoring the psychosocial dimension in patient management are emphasized. Although the family physician generally is the most appropriate therapist, there may be a role for a “liaison physician”, a specially trained consultant who is thoroughly familiar with both physical and psychological processes and their interaction.     

Variation in the Trajectories of Depressive Symptoms: Results from the Americans' Changing Lives Study

This study examines the association between race and depressive symptoms over a 16‐year study period. The analysis is based on the responses of 3,485 African-American and White respondents from four waves of the Americans' Changing Lives Panel Study. Growth mixture modeling was used to identify latent trajectory classes based on the reported levels of depressive symptoms over 16 years. Four latent trajectory classes were identified: two “high-risk” groups and two “low-risk” groups. Findings show the heterogeneity among and within racial groups in their trajectories of depressive symptoms and the distinct demographic and social relationship predictors for symptom trajectories.