Serum iPTH, calcium and phosphate, and the risk of mortality in a European haemodialysis population

Background. A number of US observational studies reported an increased mortality risk with higher intact parathyroid hormone (iPTH), calcium and/or phosphate. The existence of such a link in a European haemodialysis population was explored as part of the Analysing Data, Recognising Excellence and Optimising Outcomes (ARO) Chronic Kidney Disease (CKD) Research Initiative

Sea surface temperature and salinity variability at Bermuda during the end of the Little Ice Age

Author Posting. © American Geophysical Union, 2008. This article is posted here by permission of American Geophysical Union for personal use, not for redistribution. The definitive version was published in Paleoceanography 23 (2008): PA3203, doi:10.1029/2007PA001532.We use geochemical and isotope measurements on a 225-year old brain coral (Diploria labyrinthiformis) from the south shore of Bermuda (64°W, 32°N) to construct a record of decadal-to-centennial-scale climate variability. The coral was collected alive, and annual density bands visible in X radiographs delineate cold and warm seasons allowing for precise dating. Coral skeletons incorporate strontium (Sr) and calcium (Ca) in relative proportions inversely to the sea surface temperature (SST) in which the skeleton is secreted. Previous studies on this and other coral colonies from this region document the ability to reconstruct mean annual and wintertime SST using Sr/Ca measurements ( Goodkin et al., 2007 , 2005). The coral-based records of SST for the past 2 centuries show abrupt shifts at both decadal and centennial timescales and suggest that SST at the end of the Little Ice Age (between 1840 and 1860) was 1.5° ± 0.4°C colder than today (1990s). Coral-reconstructed SST has a greater magnitude change than does a gridded instrumental SST record from this region. This may result from several physical processes including high rates of mesoscale eddy propagation in this region. Oxygen isotope values (δ 18O) of the coral skeleton reflect changes in both temperature and the δ 18O of seawater (δOw), where δOw is proportional to sea surface salinity (SSS). We show in this study that mean annual and wintertime δ 18O of the carbonate (δOc) are correlated to both SST and SSS, but a robust, quantitative measure of SSS is not found with present calibration data. In combination, however, the Sr/Ca and δOc qualitatively reconstruct lower salinities at the end of the Little Ice Age relative to modern day. Temperature changes agree with other records from the Bermuda region. Radiative and atmospheric forcing may explain some of the SST variability, but the scales of implied changes in SST and SSS indicate large-scale ocean circulation impacts as well.A WHOI OCCI Fellowship (N.F.G.), and grants from NSF (OCE-0402728) and WHOI (N.F.G., K.A.H., A.L.C., and M.S.M.) supported this work

Reliability of videotaped observational gait analysis in patients with orthopedic impairments

BACKGROUND: In clinical practice, visual gait observation is often used to determine gait disorders and to evaluate treatment. Several reliability studies on observational gait analysis have been described in the literature and generally showed moderate reliability. However, patients with orthopedic disorders have received little attention. The objective of this study is to determine the reliability levels of visual observation of gait in patients with orthopedic disorders. METHODS: The gait of thirty patients referred to a physical therapist for gait treatment was videotaped. Ten raters, 4 experienced, 4 inexperienced and 2 experts, individually evaluated these videotaped gait patterns of the patients twice, by using a structured gait analysis form. Reliability levels were established by calculating the Intraclass Correlation Coefficient (ICC), using a two-way random design and based on absolute agreement. RESULTS: The inter-rater reliability among experienced raters (ICC = 0.42; 95%CI: 0.38–0.46) was comparable to that of the inexperienced raters (ICC = 0.40; 95%CI: 0.36–0.44). The expert raters reached a higher inter-rater reliability level (ICC = 0.54; 95%CI: 0.48–0.60). The average intra-rater reliability of the experienced raters was 0.63 (ICCs ranging from 0.57 to 0.70). The inexperienced raters reached an average intra-rater reliability of 0.57 (ICCs ranging from 0.52 to 0.62). The two expert raters attained ICC values of 0.70 and 0.74 respectively. CONCLUSION: Structured visual gait observation by use of a gait analysis form as described in this study was found to be moderately reliable. Clinical experience appears to increase the reliability of visual gait analysis

Efficacy of repeated intrathecal triamcinolone acetonide application in progressive multiple sclerosis patients with spinal symptoms

BACKGROUND: There are controversial results on the efficacy of the abandoned, intrathecal predominant methylprednisolone application in multiple sclerosis (MS) in contrast to the proven effectiveness in intractable postherpetic neuralgia. METHODS: We performed an analysis of the efficacy of the application of 40 mg of the sustained release steroid triamcinolone acetonide (TCA). We intrathecally injected in sterile saline dissolved TCA six times within three weeks on a regular basis every third day in 161 hospitalized primary and predominant secondary progressive MS patients with spinal symptoms. The MS patients did not experience an acute onset of exacerbation or recent distinct increased progression of symptoms. We simultaneously scored the MS patients with the EDSS and the Barthel index, estimated the walking distance and measured somatosensory evoked potentials. Additionally the MS patients received a standardized rehabilitation treatment. RESULTS: EDSS score and Barthel index improved, walking distance increased, latencies of somatosensory evoked potentials of the median and tibial nerves shortened in all MS patients with serial evaluation (p < 0.0001 for all variables). Side effects were rare, five patients stopped TCA application due to onset of a post lumbar puncture syndrome. CONCLUSIONS: Repeated intrathecal TCA application improves spinal symptoms, walking distance and SSEP latencies in progressive MS patients in this uncontrolled study. Future trials should evaluate the long-term benefit of this invasive treatment

Hand-held echocardiography: added value in clinical cardiological assessment

BACKGROUND: The ultrasonic industry has recently produced echocardiographic Hand Held Devices (miniaturized, compact and battery-equipped echocardiographic systems). Their potential usefulness has been successfully assessed in a wide range of clinical conditions. The aim of the study was to verify if the routine use of a basic model of echocardiographic Hand Held Device (HHD) could be an important diagnostic tool during outpatient cardiologic consulting or in non-cardiologic hospital sections. METHODS: 87 consecutive patients were included in this study; they underwent routine physical examination, resting ECG and echocardiographic evaluation using a basic model of HHD performed by trained echocardiographists; the cardiologist, whenever possible, formulated a diagnosis. The percentage of subjects in whom the findings were judged reasonably adequate for final diagnostic and therapeutic conclusions was used to quantify the "conclusiveness" of HHD evaluation. Successively, all patients underwent a second echocardiographic evaluation, by an examiner with similar echocardiographic experience, performed using a Standard Echo Device (SED). The agreement between the first and the second echocardiographic exam was also assessed. RESULTS: Mean examination time was 6.7 ± 1.5 min. using HHD vs. 13.6 ± 2.4 min. using SED. The echocardiographic examination performed using HHD was considered satisfactory in 74/87 patients (85.1% conclusiveness). Among the 74 patients for whom the examination was conclusive, the diagnosis was concordant with that obtained with the SED examination in 62 cases (83.8% agreement). CONCLUSION: HHD may generally allow a reliable cardiologic basic evaluation of outpatient or subjects admitted to non-cardiologic sections, more specifically in particular subgroups of patients, with a gain in terms of time, shortening patient waiting lists and reducing healthy costs

Multi-class glioma segmentation on real-world data with missing MRI sequences: comparison of three deep learning algorithms

This study tests the generalisability of three Brain Tumor Segmentation (BraTS) challenge models using a multi-center dataset of varying image quality and incomplete MRI datasets. In this retrospective study, DeepMedic, no-new-Unet (nn-Unet), and NVIDIA-net (nv-Net) were trained and tested using manual segmentations from preoperative MRI of glioblastoma (GBM) and low-grade gliomas (LGG) from the BraTS 2021 dataset (1251 in total), in addition to 275 GBM and 205 LGG acquired clinically across 12 hospitals worldwide. Data was split into 80% training, 5% validation, and 15% internal test data. An additional external test-set of 158 GBM and 69 LGG was used to assess generalisability to other hospitals’ data. All models’ median Dice similarity coefficient (DSC) for both test sets were within, or higher than, previously reported human inter-rater agreement (range of 0.74–0.85). For both test sets, nn-Unet achieved the highest DSC (internal = 0.86, external = 0.93) and the lowest Hausdorff distances (10.07, 13.87 mm, respectively) for all tumor classes (p < 0.001). By applying Sparsified training, missing MRI sequences did not statistically affect the performance. nn-Unet achieves accurate segmentations in clinical settings even in the presence of incomplete MRI datasets. This facilitates future clinical adoption of automated glioma segmentation, which could help inform treatment planning and glioma monitoring

Epidemiological and clinical features, response to HAART, and survival in HIV-infected patients diagnosed at the age of 50 or more

BACKGROUND: Over the last years, the mean age of subjects with HIV infection and AIDS is increasing. Moreover, some epidemiological and clinical differences between younger and older HIV-infected individuals have been observed. However, since introduction of HAART therapy, there are controversial results regarding their response to HAART. The aim of the present study is to evaluate epidemiological and clinical features, response to HAART, and survival in elderly HIV-infected patients with regard to younger HIV-infected patients. METHODS: A prospective cohort study (1998–2003) was performed on patients from Sabadell Hospital, in Northeast of Spain. The cohort includes newly attended HIV-infected patients since January 1, 1998. For the purpose of this analysis, data was censured at December 31, 2003. Taking into account age at time of diagnosis, it was considered 36 HIV-positive people aged 50 years or more (Group 1, G1) and 419 HIV-positive people aged 13–40 years (Group 2, G2). Epidemiological, clinical, biological and therapy data are recorded. Statistical analysis was performed using Chi-squared test and Fisher exact test, Mann-Whitney U test, Kaplan-Meier, Log Rank test, and Two-Way ANOVA from random factors. RESULTS: G1 showed higher proportion of men than G2. The most common risk factors in G1 were heterosexual transmission (P = 0.01) and having sex with men or women (P < 0.001). G1 and G2 show parallel profiles through the time regarding immunological response (P = 0.989) and virological response (P = 0.074). However, older people showed lower CD4 cell counts at first clinic visit (P < 0.001) and, eventually, they did not achieve the same counts as G2. G1 presented faster progression to AIDS (P < 0.001) and shorter survival (P < 0.001). CONCLUSION: Older patients have different epidemiological features. Their immunological and virological responses are good. However, older patients do not achieve the same CD4 cell counts likely due to they have lower counts at first clinic visit. Thus, it is essential physicians know older HIV-infected patients features to consider the possibility of HIV infection in these patients with the aim of treatment would not be delayed

A comprehensive assessment of cerebellar damage in multiple sclerosis using diffusion tractography and volumetric analysis

Background: White matter (WM) and grey matter (GM) brain damage in multiple sclerosis (MS) is widespread, but the extent of cerebellar involvement and impact on disability needs to be clarified

Multidecadal climate variability over northern France during the past 500 years and its relation to large-scale atmospheric circulation

(IF 3.76; Q1)International audienceWe examine secular changes and multidecadal climate variability on a seasonal scale in northern France over the last 500 years and examine the extent to which they are driven by large‐scale atmospheric variability. Multiscale trend analysis and segmentation procedures show statistically significant increases of winter and spring precipitation amounts in Paris since the end of the 19th century. This changes the seasonal precipitation distribution from one with a pronounced summer peak at the end of the Little Ice Age to an almost uniform distribution in the 20th century. This switch is linked to an early warming trend in winter temperature. Changes in spring precipitation are also correlated with winter precipitation for time scales greater than 50 years, which suggests a seasonal persistence. Hydrological modelling results show similar rising trends in river flow for the Seine at Paris. However, such secular trends in the seasonal climatic conditions over northern France are substantially modulated by irregular multidecadal (50–80 years) fluctuations. Furthermore, since the end of the 19th century, we find an increasing variance in multidecadal hydroclimatic winter and spring, and this coincides with an increase in the multidecadal North Atlantic Oscillation (NAO) variability, suggesting a significant influence of large‐scale atmospheric circulation patterns. However, multidecadal NAO variability has decreased in summer. Using Empirical Orthogonal Function analysis, we detect multidecadal North Atlantic sea‐level pressure anomalies, which are significantly linked to the NAO during the Modern period. In particular, a south‐eastward (south‐westward) shift of the Icelandic Low (Azores High) drives substantial multidecadal changes in spring. Wetter springs are likely to be driven by potential changes in moisture advection from the Atlantic, in response to northward shifts of North Atlantic storm tracks over European regions, linked to periods of positive NAO. Similar, but smaller, changes in rainfall are observed in winter