Improving Prenatal Diagnosis of Coarctation of the Aorta

Background

The purpose of the study was to evaluate the association between fetal echocardiographic measurements and the need for intervention (primary coarctation repair, staged coarctation repair, or catheter intervention) in prenatally diagnosed coarctation of the aorta.

Treatment Fidelity of a Nurse-Led Motivational Interviewing-Based Pre-Treatment in Pain Rehabilitation

Treatment fidelity and proficiency of a nurse-led motivational interviewing (MI)-based pre-treatment and control condition was evaluated. A random sample was scored by means of the Motivational Interviewing Treatment Integrity (MITI) scale, and a second rater was in charge. MI fidelity was satisfactory for three out of five ratings. Most mean ratings were higher in the MI-based intervention, but differences were not statistically significant. The threshold for beginning MI proficiency was only exceeded for one score and one additional measure. In general, higher levels of fidelity in the intervention condition confirmed that MI was partially applied there. Although the quality of MI delivery as well as mixed inter-rater reliabilities of the fidelity scores leaves room for improvement, robust findings between the two raters were found. These results suggest the need for rigor selection of MI counselors on beforehand, and continuous supervision. Furthermore, fidelity check in studies using MI is needed.     

Chromosome abnormalities in oral squamous cell carcinomas

Strong evidence in favour of the somatic mutation theory of cancer, which states that genomic rearrangements are early and essential events in tumour development, has during the past two decades been obtained from both cytogenetic and molecular genetic studies of neoplastic cells. More than 14,000 neoplasms with acquired clonal chromosome aberrations have been reported; the majority have, however, been haematological malignancies, whereas still little is known about the karyology of the quantitatively more important carcinomas. For oral squamous cell carcinomas (SCC), which constitute a substantial subset of human malignancies, only 63 short-term cultured tumours with karyotypic aberrations have been described. Simple numerical changes, mostly -Y, +Y, or +7, have been detected as the sole anomalies in 19 tumours, but these aberrations are probably not causally related to the neoplastic process. The remaining 44 SCC have had structural changes of varying complexity, often together with numerical aberrations. An assessment of the karyotypic imbalances resulting from these aberrations reveals that chromosomes 9, 13, 18 and Y are recurrently lost, and that deletions frequently involve chromosome arms 3p, 7q, 8p, 11q, 17p and the short arms of all acrocentric chromosomes. The chromosomal breakpoints in structural rearrangements frequently involve the centromeric regions of chromosomes 1, 3, 8, 14 and 15 as well as bands 1p22, 11q13 and 19p13. At least one of these bands has been rearranged in 70% of SCC with structural aberrations and they probably contain loci of importance in oral squamous cell carcinogenesis. A comparison of data obtained from oral and other types of SCC--laryngeal, oesophageal, lung, cervical, and anal canal--indicates that some of the events in the multistep process of SCC development involve the same genetic pathways irrespective of site of origin.     

Motor cortex stimulation in neuropathic pain. Correlations between analgesic effect and hemodynamic changes in the brain. A PET study

To investigate brain mechanisms whereby electrical stimulation of the motor cortex (MCS) may induce pain relief in patients with neuropathic pain, cerebral blood flow (CBF) changes were studied using H2O PET in 19 consecutive patients treated with MCS for refractory neuropathic pain. Patients were studied in three conditions, (a) before MCS (Baseline, stimulator stopped 4 weeks before), (b) during a 35-min period of MCS and (c) during a 75-min period after MCS had been discontinued (OFF). Compared to Baseline, turning on the stimulator was associated with CBF increase in the contralateral (anterior) midcingulate cortex (aMCC, BA24 and 32) and in the dorso-lateral prefrontal (BA10) cortices. The most important changes of CBF were observed in the 75 min after discontinuation of MCS (OFF). This post-stimulation period was associated with CBF increases in a large set of cortical and subcortical regions (from posterior MCC (pMCC) to pregenual (pg) ACC, orbitofrontal cortex, putamen, thalami, posterior cingulate and prefrontal areas) and in the brainstem (mesencephalon/periaqueductal grey (PAG) and pons). CBF changes in the post-stimulation period correlated with pain relief. Functional connectivity analysis showed significant correlation between pgACC and PAG, basal ganglia, and lower pons activities, supporting the activation of descending ACC-to-PAG connections. MCS may act in part through descending (top-down) inhibitory controls that involve prefrontal, orbitofrontal and ACC as well as basal ganglia, thalamus and brainstem. These hemodynamic changes are lengthened and might therefore underlie the long-lasting clinical effects that largely outlast the actual stimulation periods.