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BACKGROUND: No age-appropriate and disease-specific instrument currently exists to measure health-related quality of life in adolescents with psoriasis (patients aged 12-17 years). OBJECTIVES: To develop and provide preliminary validation of the Adolescent Psoriasis Quality of Life instrument. METHODS: Qualitative interviews with adolescents with psoriasis, parents of adolescents with psoriasis, and healthcare professionals informed the development of an initial item pool for the instrument, which was subsequently refined through cognitive interviews. Finally, data from an independent sample of adolescents with psoriasis (n = 50) were used for item reduction, scale construction and initial validation, using a combination of techniques from classical test theory and Rasch modelling. RESULTS: Rich qualitative data concerning health-related quality of life in adolescents with psoriasis (from 18 adolescents, 14 parents and four healthcare professionals), combined with cognitive interview testing (n = 12), resulted in a 41-item draft version. Item reduction led to the final version, a 17-item instrument consisting of two subscales showing good fit to their respective Rasch models: psychosocial impact (12 items) and the impact of physical symptoms and treatment (five items). All a priori stated hypotheses regarding construct validity were supported. Both subscales and the total scale showed acceptable test-retest reliabilities (intraclass correlations 0·97, 0·89 and 0·96) and internal consistencies (Cronbach's α 0·94, 0·81 and 0·95). CONCLUSIONS: The preliminary form of the Adolescent Psoriasis Quality of Life instrument shows promising psychometric properties. It can be used in daily clinical practice and research to support a patient-centred approach and inform treatment planning. What's already known about this topic? Health-related quality of life (HRQoL) instruments should be targeted towards narrowly defined age groups, as life contexts of children, adolescents and adults may differ substantially. Dermatology-specific instruments have been used to measure HRQoL in adolescents with psoriasis, but it is not known whether these instruments accurately capture all relevant HRQoL aspects in adolescent psoriasis. Age-appropriate and psoriasis-specific instruments may be more sensitive for HRQoL issues experienced by this unique group. What does this study add? The Adolescent Psoriasis Quality of Life instrument represents the first age-appropriate and disease-specific instrument for measuring HRQoL in adolescents (12-17 years old) with psoriasis. It is intended for use in daily clinical practice to support dermatologists and other healthcare professionals in providing optimal care for adolescents with psoriasis.

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The H2AX histone protein is rapidly phosphorylated at the serine-139 position (γH2AX) in response to a broad range of DNA lesions. γH2AX induction is one of the earliest events in the DNA damage response (DDR) and plays a central role in sensing and repairing DNA damage. Since its discovery, measuring γH2AX formation using numerous methods in in vitro and in vivo experiments has been an attractive endpoint for the detection of genotoxic agents. Our review focuses on validation studies performed using this biomarker to detect the genotoxicity of model chemicals using different methods. To date, nearly two hundred genotoxic and carcinogenic model chemicals have been shown to induce in vitro γH2AX in different cell lines by numerous laboratories. Based on 27 published reports comprising 329 tested chemicals, we compared the performance of the γH2AX assay with other genotoxic endpoints (Ames assay, micronucleus, HPRT and comet) regularly used for in vitro genotoxicity assessment. Notably, the γH2AX assay performs well (91% predictivity) and efficiently differentiates aneugenic and clastogenic compounds when coupled with the pH3 biomarker. Currently, no formal guidelines have been approved for the γH2AX assay for regular genotoxicity studies, but we suggest the γH2AX biomarker could be used as a new standard genotoxicity assay and discuss its future role in genotoxicity risk assessment.

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Aflatoxins are found as food contaminant and some of them demonstrate a carcinogenic effect. The aflatoxins biosynthetic pathway involves 15 successive steps. The aim of this study was to compare the toxicity of aflatoxins and their precursors in three human cell lines. We tested the four aflatoxins and two of their metabolites; three early metabolic precursors and two late biosynthetic precursors. Cyclopiazonic acid, synthesized in parallel with aflatoxins, was also tested. The cytotoxicity and the genotoxicity was evaluated with the γH2AX assay in three human cell lines with different bioactivation capacities. Our results indicated that the most genotoxic chemicals in the three cell lines were in decreasing order sterigmatocystin (ST), aflatoxin B1 (AFB1), aflatoxicol (AFL), aflatoxin G1 (AFG1) and versicolorin A (VERA). Aflatoxin M1 (AFM1) demonstrated genotoxic property in only one cell line. The other tested compounds did not demonstrate any genotoxic activity. Overall, our results suggested different genotoxic mechanisms of action for the tested compounds, involving specific bioactivation pathways. Moreover, some metabolic precursors of aflatoxins demonstrated genotoxic potential equivalent or greater to AFB1. This should be taking into account for the development of new strategies intended to reduce the aflatoxins exposure and for human risk assessment.

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BACKGROUND: Treatment and care of moderate-to-severe psoriasis require lifelong consultations with a dermatologist with close monitoring of systemic treatment. OBJECTIVES: To investigate the effect of patient-initiated care consultation (PICC) for patients with psoriasis in a dermatology outpatient clinic. METHODS: A prospective randomized controlled trial with patients on well-controlled systemic treatment randomized to either (i) the PICC group, where they participated in one annual consultation with a dermatologist but were able to initiate consultations when needed; or (ii) routine care, where they participated in a consultation every 12-16 weeks. The primary outcome was the Dermatology Life Quality Index (DLQI). Other outcomes were safety, patient adherence and satisfaction with healthcare assessed at baseline and after 52 weeks. The study was registered with clinical trials number NCT02382081. RESULTS: In total 150 patients were included, with 58·0% treated with biologics, 37·3% with methotrexate and 4·7% with acitretin. At week 52 no statistically significant mean difference between groups was detected in DLQI (0·28, 95% confidence interval -0·35 to 0·9) or Psoriasis Area and Severity Index (-0·24, 95% confidence interval -0·84 to 0·36). Patients in the PICC group requested 63% fewer consultations with a dermatologist: mean 2·5 ± 0·1 vs. 5·1 ± 0·6 (P = 0·001). Patient adherence and safety with treatment monitoring were equal between groups, but the PICC group was significantly better at attending consultations than the control group (P = 0·003). CONCLUSIONS: PICC offers additional clinical benefits over routine care, making patients less dependent on clinical visits. The intervention adds no harm to monitoring systemic treatment, and patients report high quality of life and satisfaction with healthcare.

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BACKGROUND: Caregivers must be aware of patients' current needs by providing care responsive to patients' values and preferences and by identifying what approach improves and encourages patients to participate in their treatment and disease management. Patients with psoriasis healthcare needs perhaps change as medical knowledge improves, new drugs emerge and the healthcare system improves its efficiency as a result of constant structural development. OBJECTIVES: To explore the unmet needs and health perceptions of people with psoriasis, regarding interaction with clinicians and the structure inherent to consultations in a hospital outpatient dermatological clinic. METHODS: A qualitative investigation with data generated from semi-structured interviews. Transcriptions were subsequently analysed using the template analysis method. RESULTS: Sixteen patients with psoriasis were interviewed. Challenges and dilemmas of patient-centred psoriasis care were identified. Patients have a strong need to be met as individuals as the burden of living with psoriasis goes beyond the skin. Patients strive for efficient treatment and ultimately dream of being cured of psoriasis. They prefer individualized health education in order to adjust their knowledge and self-management skills. These central issues are as yet rarely addressed in clinical consultations. CONCLUSIONS: Consultations with a standardized structure do not match the individual challenges and healthcare needs of patients with psoriasis. In order to achieve a more patient-centred approach, health professionals should implement minor structural changes to dermatological services to meet patients' current needs and invite dialogue about the patients' emotional well-being and concerns that go beyond biomedical factors, as well as offer individualized health education.

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BACKGROUND: Evidence indicates that care experiences for complex HF patients could be improved by simple organizational and process changes, rather than complex clinical mechanisms. This survey identifies care gaps and recommends simple changes. METHODS: The study utilized both quantitative and qualitative methods at The Ottawa Hospital, Geriatric Medical Unit during a three-month period. RESULTS: Nineteen patients (average age 85, 12 female) surveyed. Twelve participants lived alone. Fourteen lived in own home. Four patients had formal home-care services. Fifteen relied on family. Gaps were identified in in-patient practice, discharge plan, and discharge summary implementation feedback. Only five participants had seen cardiologist or specialist. Half of patients did not know if they were on a special HF diet. Participants did not recall receiving information on life expectancy but were comfortable discussing EoL care and dying. HF-specific management recommendations were mentioned in only 37% of discharge summaries to PCPs. CONCLUSION: The results provide the starting point for a quality assurance and process re-engineering program in GMU. Organization change is needed to develop and integrate a cardiogeriatric clinical framework to allow the cardiologist, geriatrician, and PCP to actively work as a team with the patient/caregiver to develop the optimal care plan pre- and post-discharge.

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The proteins ELN and FBN2 are important in extracellular matrix function. The ELN rs2071307 and FBN2 rs331079 gene variants have been associated with soft tissue pathologies. We aimed to determine whether these variants were predisposing factors for both Achilles tendinopathy (AT) and anterior cruciate ligament (ACL) ruptures. For the AT study, 135 cases (TEN group) and 239 asymptomatic controls were recruited. For the ACL rupture study our cohort consisted of 141 cases (ACL group) and 219 controls. Samples were genotyped for both the ELN rs2071307 and FBN2 rs331079 variants using TaqMan assays. Analysis of variance and chi-squared tests were used to determine whether either variant was associated with AT or ACL rupture with significance set at p<0.05. The GG genotype of the FBN2 variant was significantly over-represented within the TEN group (p=0.035; OR=1.83; 95% CI 1.04-3.25) compared to the CON group. We also found that the frequency of the G allele was significantly different between the TEN (p=0.017; OR=1.90; 95% CI 1.11-3.27) and ACL groups (p=0.047; OR=1.76; 95% CI 1.00-3.10) compared to controls. The ELN rs207137 variant was not associated with either AT or ACL rupture. In conclusion, DNA sequence variation within the FBN2 gene is associated with both AT and ACL rupture.

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We experimentally observed interference effects in elastic x-ray scattering from gas-phase HCl in the vicinity of the Cl K edge. Comparison to theory identifies these effects as interference effects between non-resonant elastic Thomson scattering and resonant Raman scattering. The results indicate the non-resonant Thomson and resonant Raman contributions are of comparable strength. The measurements also exhibit strong polarization dependence, allowing an easy identification of the resonant and non-resonant contributions.

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We present a combined experimental and theoretical study of isolated CH(3)Cl molecules using resonant inelastic x-ray scattering (RIXS). The high-resolution spectra allow extraction of information about nuclear dynamics in the core-excited molecule. Polarization-resolved RIXS spectra exhibit linear dichroism in the spin-orbit intensities, a result interpreted as due to chemical environment and singlet-triplet exchange in the molecular core levels. From analysis of the polarization-resolved data, Cl 2p(x, y) and 2p(z) electronic populations can be determined.

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Several studies have reported that transcranial direct current stimulation (tDCS), a non-invasive method of neuromodulation, enhances some aspects of working memory in healthy and Parkinson disease subjects. The aim of this study was to investigate the impact of anodal tDCS on recognition memory, working memory and selective attention in Alzheimer disease (AD). Ten patients with diagnosis of AD received three sessions of anodal tDCS (left dorsolateral prefrontal cortex, left temporal cortex and sham stimulation) with an intensity of 2 mA for 30 min. Sessions were performed in different days in a randomised order. The following tests were assessed during stimulation: Stroop, Digit Span and a Visual Recognition Memory task (VRM). The results showed a significant effect of stimulation condition on VRM (p = 0.0085), and post hoc analysis showed an improvement after temporal (p = 0.01) and prefrontal (p = 0.01) tDCS as compared with sham stimulation. There were no significant changes in attention as indexed by Stroop task performance. As far as is known, this is the first trial showing that tDCS can enhance a component of recognition memory. The potential mechanisms of action and the implications of these results are discussed.

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The authors evaluated a site-independent telemedicine system. Telemedicine may be limited by the need for fixed connectivity. Wireless and site-independent technologies eliminate this limitation. Twenty-five stroke patients underwent evaluations by remote and bedside examiners. Ten of 15 (67%) NIH Stroke Scale and 9 of 11 (82%) Modified NIH Stroke Scale items showed excellent interrater reliability. Spearman correlations were > or =0.93. This Internet system is reliable and valid. Further studies should assess its use in acute stroke.

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Giant-cell tumours of the sacrum are difficult to treat. Surgery carries a high risk of morbidity, local recurrence and mortality. Radiation is effective in some patients, but has a risk of malignant change. We evaluated the effectiveness of serial arterial embolisation as an alternative to surgery. Five patients with giant-cell tumours of the sacrum which had been primarily treated by serial embolisation were retrospectively reviewed for changes in the size of the tumour. In four the symptoms resolved with full return of function and arrest in the growth of the tumour. They remained free from growth, recurrence, or metastases at follow-up (4 to 17 years). One patient died from metastatic disease within 18 months of the initial diagnosis.

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Mycoplasma pneumoniae (MP) is a frequent cause of respiratory tract infection. Extra-pulmonary manifestations may be neurological with variable expression, encephalitis being the most frequent. Meningitis, myelitis or polyradiculoneuritis are also reported. The pathophysiology of neurological manifestations remains poorly understood. Although not isolated from cerebral tissue, MP was reportedly detected in cerebro-spinal fluid (CSF) on several occasions. We report the case of a five-year-old girl who presented with fever, then pneumonia, and later developed spastic quadriparesis. MP was identified as the causative agent, evidenced by the presence of specific antibodies in both serum and CSF. The identification of a central nervous syndrome associated with confirmed MP infection extends the list of similar cases documented in individuals younger than 17 years of age.

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Despite the severity of ankle syndesmosis injuries, it has been argued that they are relatively poorly detected. This study investigated the interrater reliability of four orthopaedic tests for ankle syndesmosis injury and assessed their ability to predict the extended recovery times that have been reported as a consequence of this injury. Nine physiotherapists, working in random pairings, examined 53 subjects, all receiving treatment for ankle injury at two private clinics. Each subject was tested by two physiotherapists who independently performed the palpation test, external rotation test, squeeze test, and dorsiflexion-compression test. Kappa coefficient testing indicated that the external rotation test had the best interrater reliability (kappa = 0.75). The squeeze test was found to have moderate reliability (kappa = 0.50), and the palpation and dorsiflexion-compression tests both had only fair reliability (kappa = 0.36). The degree of pair-wise association between the results of the four tests was low (phi < or = 0.30 for all test combinations), suggesting that if all four tests were performed on the same subject, it was not likely that they would achieve similar results. Follow-up interviews were conducted to determine the time taken for subjects to walk 10 m without pain and, for sports injuries, the time taken to return to training and then to competition. For each test, Mann-Whitney U values showed no significant difference between the recovery times of subjects with positive or negative test results, although subjects with recovery times markedly longer than normal were detected by three of the four tests. When an either/or combination of the external rotation and dorsiflexion-compression tests was considered, subjects with a positive test result took significantly longer to return to playing sports.

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The fragile X syndrome, the most common form of inherited mental retardation, is characterized by unique genetic mechanisms, which include amplification of a CGG repeat and abnormal DNA methylation. Direct DNA analysis of fragile X mutations has already shown its clear superiority for postnatal and prenatal diagnosis of the disorder and for carrier detection. In this, paper the authors report on the results of DNA analysis in families with familial mental retardation. They present the various alternatives (probe/enzymes combinations) for Southern blot based diagnosis and protocols which gave optimal results for detection of patients segregating for fragile X syndrome. Totally, 36 members from 10 families were analyzed by Southern blotting, including 18 mentally affected patients. No CGG expansion was detected in 9 clinically affected patients of 5 families. Expansion of the CGG repeats was found in 9 clinically and cytogenetically affected males, in 5 unaffected carriers of premutation, and in 1 carrier of full mutation in the remaining 5 families. Carriers represented mothers of the patients. These results correlated with cytogenetic and clinical expression of fragile X syndrome. The application of the method for diagnosis of the disease is discussed. (Tab. 2, Fig. 3, Ref. 21.)

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The Child and Adolescent Psychiatry Service of the William S. Hall Psychiatric Institute, Columbia, South Carolina, routinely administers the MMPI to the parents of children and adolescents in outpatient psychiatric treatment. The MMPI data obtained from parents during the (1970-74) and (1975-79) periods (N = 342) have been analyzed from two perspectives. MMPI critical item endorsement and MMPI clinical scale changes have been evaluated statistically through a comparison of parents in the two time periods. Both the increase in clinical scale elevations and shift in critical item endorsement suggest a parent population in which mothers are suffering considerably more psychological distress or psychopathology than fathers during the last 5 years. The findings indicate the need for cross-clinic replications of the present investigation in order to establish the reliability of the current findings.

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Sinus node (SN) and atrioventricular node (AVN) function were evaluated in 49 patients with secundum type atrial septal defect (ASD). Automaticity and conduction system function were assessed by intracardiac recording of the AH and HV intervals at rest, corrected SN recovery time, sinoatrial conduction time, AVN refractory period and the ability of the AVN to conduct rapidly paced atrial beats to the ventricles. Electrophysiologic abnormalities were found in 41% of the 34 patients who were studied before surgery. However, no preoperative abnormalities were present in children younger than 2.5 years. If only children older than 2.5 years were analyzed, the incidence of conduction abnormalities was similar for the patients studied before operation (62%) and those studied after operation (71%). The size and ejection fractions of the right and left ventricles, the magnitude of shunt flow and the size of the ASD did not differ between the patients with and those without electrophysiologic abnormalities. AVN dysfunction was present in 40% of the patients who were studied after surgical repair. While this frequency was more than twice the preoperative incidence of AVN dysfunction, it was not statistically significant. The data suggest that patient age is the major factor that influences the presence of conduction system dysfunction in patients with ASD.

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