Search

The text is a report on clinical imaging and electrophysiology in the field of Amyotrophic Lateral Sclerosis (ALS) and Frontotemporal Degeneration (FTD). It is authored by a large number of researchers from various institutions. The report provides a comprehensive overview of the current research and findings in the field, covering topics such as imaging techniques, electrophysiological measurements, and their applications in diagnosing and monitoring ALS and FTD. The report is a valuable resource for library patrons interested in understanding the latest advancements in clinical imaging and electrophysiology in ALS and FTD research. [Extracted from the article]

Spinal cord imaging in amyotrophic lateral sclerosis: historical concepts - novel techniques. Integrated magnetic resonance imaging and [11 C]-PBR28 positron emission tomographic imaging in amyotrophic lateral sclerosis. 1 Bashford J, Mills K, Shaw C. The evolving role of surface electromyography in amyotrophic lateral sclerosis: a systematic review. Comparison of Two Clinical Upper Motor Neuron Burden Rating Scales in ALS Using Quantitative Brain Imaging. [Extracted from the article]

• Fasciculation, myokymia and neuromyotonia are the core spontaneous phenomena of motor hyperexcitability. • Accurate characterisation is particularly important in amyotrophic lateral sclerosis, Isaacs syndrome and Morvan syndrome. • Advanced quantification by high-density surface electromyography could enhance biomarker development and therapeutic monitoring. Possessing a discrete functional repertoire, the anterior horn cell can be in one of two electrophysiological states: on or off. Usually under tight regulatory control by the central nervous system, a hierarchical network of these specialist neurons ensures muscular strength is coordinated, gradated and adaptable. However, spontaneous activation of these cells and their axons can result in abnormal muscular twitching. The muscular twitch is the common building block of several distinct clinical patterns, namely fasciculation, myokymia and neuromyotonia. When attempting to distinguish these entities electromyographically, their unique temporal and morphological profiles must be appreciated. Detection and quantification of burst duration, firing frequency, multiplet patterns and amplitude are informative. A common feature is their persistence during sleep. In this review, we explain the accepted terminology used to describe the spontaneous phenomena of motor hyperexcitability, highlighting potential pitfalls amidst a bemusing and complex collection of overlapping terms. We outline the relevance of these findings within the context of disease, principally amyotrophic lateral sclerosis, Isaacs syndrome and Morvan syndrome. In addition, we highlight the use of high-density surface electromyography, suggesting that more widespread use of this non-invasive technique is likely to provide an enhanced understanding of these motor hyperexcitability syndromes. [ABSTRACT FROM AUTHOR]

Purpose: The Exercise for Health trials were randomised, controlled trials designed to evaluate an 8-month pragmatic exercise intervention, commencing 6 weeks post-surgery for women with newly diagnosed breast cancer residing in urban or rural/regional Australia. For these exploratory analyses, the primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively.Methods: Consenting urban- (n = 194) and rural/regional-residing women (n = 143) were randomised to exercise (intervention delivered face-to-face or by telephone) or usual care. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for survival outcomes (exercise group, n = 207, 65% urban women; usual care group, n = 130, 46% urban women).Results: After a median follow-up of 8.3 years, there were 11 (5.3%) deaths in the exercise group compared with 15 (11.5%) deaths in the usual care group (OS HR for the exercise group: 0.45, 95% CI 0.20–0.96; p = 0.04). DFS events for the exercise versus usual care group were 25 (12.1%) and 23 (17.7%), respectively (HR: 0.66, 95% CI 0.38–1.17; p = 0.16). HRs for OS favoured exercise irrespective of age, body mass index, stage of disease, intervention compliance, and physical activity levels at 12 months post-diagnosis, although were stronger (p < 0.05) for younger women, women with stage II + disease, women with 1 + comorbidity at time of diagnosis, higher intervention compliance and for those who met national physical activity guidelines at 12 months post-diagnosis.Conclusion: An exercise intervention delivered during and beyond treatment for breast cancer, and that was designed to cater for all women irrespective of place of residence and access to health services, has clear potential to benefit survival. Trial numbers: ACT RN: 012606000233527; ACT RN: 12609000809235. [ABSTRACT FROM AUTHOR]

While decision analysis has the potential to improve treatment decisions, the quality of patient specific data has hindered its development. Experience with the General Practice Research Database (GPRD) indicated the possibility of generating such data. The example developed concerns the probability of recurrent stroke and the risks and benefits of treatment with aspirin. Eight criteria were systematically applied to identify suitable patients from the 664,241 cohort of patients in the West Midlands GPRD. The risk of recurrent stroke was estimated using survival analysis, yielding multivariate hazard ratios for 960 patient profiles. These were used to populate a decision analysis model. The study highlights how decision analysis can introduce evidence-based information into the consultation. Data can be transformed into information for the increasingly complex world of general practice. This can clarify the risks and benefits of prescribing, assist GP--patient dialogue and promote shared decision-making. [ABSTRACT FROM AUTHOR]

Mantle cell lymphoma (MCL) is rarely cured with either conventional-dose chemotherapy or autografting. Recent evidence suggests that anti-CD20 monoclonal antibody therapy (rituximab) in combination with chemotherapy may improve the response rate. We report a pilot study of autografting using busulfan?–?melphalan conditioning followed by rituximab in 9 patients (median age 52 years) with chemosensitive MCL. Rituximab was given for 4 doses of 375?mg/m 2 between 4 and 10 weeks post-transplant. Three of 5 patients autografted after induction therapy remain alive in clinical and molecular complete remission at 33?–?50 months post-transplant. Only 1 of 4 patients autografted after relapse remains in complete remission. Two of the 3 patients with persistent marrow molecular positivity post-autograft became negative after rituximab therapy. Molecular negativity was first observed in 2 patients only after rituximab therapy. Overall, 2 patients have relapsed and the remaining 3 died of late-onset respiratory failure, probably reflecting infection and/or aggressive conditioning in an older patient population. These preliminary results, together with a review of the literature, suggest that the combination of autografting and rituximab may lead to durable molecular remissions in patients with chemosensitive MCL. Further studies are required to clarify whether the administration of rituximab: (1) is optimal pre- or post-autograft and (2) impacts on the incidence of infection and idiopathic pneumonitis in this context. [ABSTRACT FROM AUTHOR]

Summary:The purpose of this investigation was to evaluate the impact of undertaking peripheral blood stem cell transplantation (PBST) on quality of life (QoL), and to determine the effect of participating in a mixed-type, moderate-intensity exercise program on QoL. It was also an objective to determine the relationship between peak aerobic capacity and QoL in PBST patients. QoL was assessed via the CARES questionnaire and peak aerobic capacity by a maximal graded treadmill test, pretransplant (PI), post transplant (PII) and following a 12-week intervention period (PIII). At PII, 12 patients were divided equally into a control or exercise intervention group. Undergoing a PBST was associated with a statistically but not clinically significant decline in QoL (P<0.05). Following the intervention, exercising patients demonstrated an improved QoL when compared with pretransplant ratings (P<0.01) and nonexercising transplant patients (P<0.05). Moreover, peak aerobic capacity and QoL were correlated (P<0.05). The findings demonstrated that exercise participation following oncology treatment is associated with a reduction in the number and severity of endorsed problems, which in turn leads to improvements in global, physical and psychosocial QoL. Furthermore, a relationship between fitness and QoL exists, with those experiencing higher levels of fitness also demonstrating higher QoL.Bone Marrow Transplantation (2004) 33, 553-558. doi:10.1038/sj.bmt.1704378 Published online 12 January 2004 [ABSTRACT FROM AUTHOR]

OBJECTIVE: To develop and evaluate in primary care a computerised decision support system for the management of stroke patients based upon 'patient profile decision analysis'. DESIGN: The decision support system incorporated the findings of 960 Markov models examining the decision to prescribe aspirin in the secondary prevention of stroke. The models reflected each combination of nine risk factors that determined a patient's profile. The evaluation comprised a qualitative interview and a questionnaire administered before and after the general practitioners (GPs) were given access to the support system. SETTING: Primary care. PARTICIPANTS: 15 GPs from the West Midlands. MAIN OUTCOME MEASURES: Decision certainty scoring of hypothetical patient vignettes. Qualitative perceptions of the applicability and acceptability of the system for primary care. RESULTS: After using the system, GPs were more certain of their decision making and made decisions more in line with national guidelines. Quantitative results further suggested that the system made decision making easier, improved feelings of being supported, improved the quality of decision making and increased satisfaction. Qualitative themes included that GPs thought the system could clarify their own decision making and improve GP-patient dialogue. CONCLUSIONS: The feasibility of individualised decision analysis for general practice has been questioned. Patient profile decision analysis, however, may be a valuable means of harnessing some of the advantages of the methodology to produce more patient-specific guidelines for primary care. [ABSTRACT FROM AUTHOR]

Presents information on a study that investigated the potential of the General Practice Research Database for communicable disease surveillance using head lice as example. Methodology of the study; Results and discussion on the study.

Herpes simplex virus (HSV) infection occurs worldwide but its epidemiology varies between different countries and between groups of individuals. Seroprevalence of HSV-1 and HSV-2 antibodies is a more accurate method of determining epidemiology of this infection.In this cross-sectional study, 467 blood samples were obtained from women attending the genitourinary medicine clinic (GUM) and antenatal clinic (ANC) in Middlesbrough, England. Analysis of their blood samples showed that 69.5% GUM patients had HSV-1 antibodies and the figure was 54.5% in the ANC patients, p<0.0001, with odds ratio 1.9 (95% CI 1.30 to 2.78) for higher prevalence in the GUM group. Also, for HSV-2 antibodies, the seroprevalence was 21.6% for GUM and 8.1% for ANC patients, p<0.0001, with an odds ratio of 3.13 (95% CI 1.70 to 6.02) for higher prevalence in the GUM group. The overall prevalence for HSV-1 is 63.2% and for HSV-2 is 15.8%. Many of these patients were asymptomatic and constitute a potential source for spreading the virus.Knowledge of HSV seroprevalence can help in planning sexual health promotion strategies. [ABSTRACT FROM PUBLISHER]

• 32 interventional clinical trials in ALS have employed at least one neurophysiological outcome measure. • The characteristics and experience of ten neurophysiological techniques used in these trials are summarised and evaluated. • Future trial design would benefit from a more standardised and refined neurophysiological toolkit. We collated all interventional clinical trials in amyotrophic lateral sclerosis (ALS), which utilised at least one neurophysiological technique as a primary or secondary outcome measure. By identifying the strengths and limitations of these studies, we aim to guide study design in future trials. We conducted and reported this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Eight databases were searched from inception. In total, 703 studies were retrieved for screening and eligibility assessment. Dating back to 1986, 32 eligible interventional clinical trials were identified, recruiting a median of 30 patients per completed trial. The most widely employed neurophysiological techniques were electromyography, motor unit number estimation (including motor unit number index), neurophysiological index and transcranial magnetic stimulation (including resting motor threshold and short-interval intracortical inhibition). Almost 40% of trials reported a positive outcome with respect to at least one neurophysiological measure. The interventions targeted either ion channels, immune mechanisms or neuronal metabolic pathways. Neurophysiology offers many promising biomarkers that can be utilised as outcome measures in interventional clinical trials in ALS. When selecting the most appropriate technique, key considerations include methodological standardisation, target engagement and logistical burden. Future trial design in ALS would benefit from a standardised, updated and easily accessible repository of neurophysiological outcome measures. [ABSTRACT FROM AUTHOR]

Several methods have been put forward for screening people for Chlamydia trachomatis infection of the urogenital tract. It is often believed that culture is the gold standard. However, newer and faster methods are being developed. This study reports the result from the comparison of two methods. [ABSTRACT FROM PUBLISHER]

In the original publication of the article, under the heading Discussion, 1st paragraph, the sentence that reads as, “Nonetheless, our observed improvements of over 50% for OS and over 30% for DFS (HRs: 0.45 and 0.66, respectively) are consistent with results from other available studies” should read as “Nonetheless, our observed improvements of over 50% for OS and DFS (HRs: 0.45 and 0.66, respectively) are consistent with results from other available studies.” Under the heading Discussion, 3rd paragraph, the sentence that reads as “We cannot discount the possibility …such as education, income and access to care [1, 7]” should read as “We cannot discount the possibility…such as education, income and access to care, which ultimately have on survival outcomes [1, 7].” [ABSTRACT FROM AUTHOR]