Psychological aspects of adductor spasmodic dysphonia: a prospective population controlled questionnaire study.

OBJECTIVE: To examine psychosocial concomitants, illness perceptions, and treatment perceptions in patients with adductor spasmodic dysphonia. DESIGN: Prospective controlled cohort study. SETTING: A tertiary care facility. PARTICIPANTS: Forty-nine out-patients (38 women, 11 men; average age of 52 years) with adductor spasmodic dysphonia completed a battery of reliable and validated psychometric assessment instruments. Control patients' data were derived from scores in questionnaires by samples in the formal Manuals of the questionnaires used. MAIN OUTCOME MEASURES: Psychosocial functioning, illness perceptions, and treatment perceptions. RESULTS: Scores on psychosocial measures were elevated in male patients especially, indicating levels of psychological morbidity significantly above those seen in the general population. Assessments of illness perceptions and treatment perceptions indicated that patients perceive that they have a very low degree of control over the disorder, and experience a high emotional impact from it. Voice Handicap Index scores illustrated substantial degrees of perceived handicap. CONCLUSIONS: Adductor spasmodic dysphonia is associated with significant negative psychosocial concomitants, coupled with low perceived control over the condition. Future research should elucidate the implications of illness perceptions and treatment perceptions for the biopsychosocial care of persons with adductor spasmodic dysphonia in order to improve self-management and enhance quality of life.

Is the loss of endothelial thrombomodulin involved in the mechanism of chronicity in late radiation enteropathy?

BACKGROUND AND PURPOSE: Radiation enteropathy is characterized by locally elevated levels of inflammatory and fibrogenic cytokines. Microvascular injury may sustain these alterations through persistent local hypercoagulopathy, platelet aggregation, leukocyte adhesion and release of biologically active mediators. This study assessed the relationship of endothelial thrombomodulin (TM), a key regulator of the protein C anticoagulant pathway and marker of endothelial function, with transforming growth factor beta (TGF-beta) immunoreactivity and morphologic alterations in radiation enteropathy. MATERIALS AND METHODS: Small bowel resection specimens from 9 patients with radiation enteropathy were analyzed by computerized quantitative immunohistochemistry using antibodies against TM, von Willebrand factor (vWF) and TGF-beta. Identical measurements were performed on intestinal resection specimens from otherwise healthy penetrating trauma victims and on archived small intestines. A previously validated image analysis technique was used to assess submucosal vessels for TM and vWF immunoreactivity, and the intestinal wall for total extracellular matrix-associated TGF-beta immunoreactivity. RESULTS: Specimens from irradiated patients showed prominent submucosal and subserosal thickening and fibrosis, and obliterative vasculopathy. Control specimens were histopathologically normal. Vascular density and vWF immunoreactivity were similar in radiation enteropathy patients and controls. The image-analysis techniques were highly reproducible, with correlation coefficients for repeated measurements ranging from 0.86 to 0.93. Radiation enteropathy specimens exhibited a highly significant reduction in the number and proportion of TM-positive submucosal vessels per unit area (P < 0.0001) and increased intestinal wall TGF-beta immunoreactivity (P = 0.002). CONCLUSIONS: These data support the theory that sustained endothelial dysfunction is involved in the molecular pathogenesis of radiation enteropathy, and point to TM as important in the chronic nature of radiation enteropathy and a potential target for prophylactic and therapeutic interventions.

Identification of components in waste streams by electrospray and tandem mass spectrometry.

Highly polar, non-gas-chromatographable compounds have few unambiguous analysis protocols for environmental applications. A recent environmental investigation, concerning the identification of a non-gas-chromatographable yellow component in chemical waste water and in effluents from a biological wastewater treatment plant required the use of a number of analytical approaches. Electrospray mass spectrometry, tandem mass spectrometry, high-performance liquid chromatography, nuclear magnetic resonance, and molecular spectroscopy of commercial and synthesized chlorodinitrophenol isomers were required in order to identify the specific isomer causing the color. The present report summarizes the electrospray ionization and tandem mass spectrometric studies that were used. The mass spectrometric study shows that two different isomers of chlorodinitrophenol exhibit very different collision-induced dissociation (CID) spectra. Differences in the tandem mass spectra can be attributed to the different structures of the anions formed from these two different isomers. Instrumentation that uses electrospray ionization and produces CID mass spectra and optical absorption spectra in a single analysis may be required in order to produce highly specific information on non-gas-chromatographable compounds found in the environment.

Mass spectrometric investigation of minor products in the radiolysis of liquid cyclopentane.

The following substances have been identified as minor products in the gamma radiolysis of liquid cyclopentane at 3 X 10(22) eV total dose: 1,4-pentadiene; 2-pentene; cyclopentadiene; 1,3-pentadiene; ethyl cyclopentane; vinyl cyclopentane; n-heptane; n-octane; propyl cyclopentane; propenyl cyclopentane or propyl cyclopentene; n-decane; pentenyl cyclopentane or n-pentyl cyclopentene; n-pentyl cyclopentane; and cyclopentyl cyclopentene. The determination of these products was by parent mass number, gas chromatographic retention times, and/or boiling points of the compounds. Ultraviolet spectroscopic studies of the radiolysis of solutions of cyclopentadiene in cyclopentane are also described.

The effect of flurbiprofen on steady-state plasma lithium levels.

STUDY OBJECTIVE: To evaluate the effects of flurbiprofen therapy on the pharmacokinetics of lithium. DESIGN: Placebo-controlled, single-blind, crossover study. SETTING: University-affiliated hospital. PATIENTS: Eleven healthy women with bipolar disorder. INTERVENTIONS: The subjects received therapeutic doses of lithium administered as an immediate-release capsule every 12 hours. In addition, they received one placebo tablet every 12 hours during phase I and flurbiprofen 100 mg every 12 hours during phase II of the study. MEASUREMENTS AND MAIN RESULTS: Steady-state pharmacokinetic parameters were measured for each phase. Lithium trough plasma concentration (Cmin) and area under the curve were statistically significantly increased (p < 0.05) when patients received flurbiprofen. Flurbiprofen also caused decreases in lithium clearance and 24-hour lithium urine excretion, although the changes did not reach statistical significance. Clinically significant increases in Cmin appeared to be associated with a greater than 1000-microgram/24 hour decrease in urinary excretion of prostaglandin E2. CONCLUSION: Patients with clinically normal renal function may experience an increase in lithium levels with the initiation of flurbiprofen therapy.

Differential effect of radiation on endothelial cell function in rectal cancer and normal rectum.

BACKGROUND: Chronic radiation injury of the intestine is associated with significant underexpression of a potent physiological anticoagulant, endothelial cell thrombomodulin (TM). This study compared early and late radiation-induced changes in endothelial TM, urokinase plasminogen activator (uPA), and transforming growth factor beta (TGF-beta) in normal rectum and tumors. METHODS: Rectal resection specimens from 27 patients were analyzed: Nine patients underwent primary resection of rectal cancer, 11 tumors were resected after neo-adjuvant radiotherapy, and 7 because of local recurrence after prior resection and adjuvant radiotherapy. TM, uPA, and extracellular matrix-associated TGF-beta, immunoreactivity were assessed using computerized image analysis. RESULTS: Multivariate analysis revealed that tumors had more TM-positive vessels (P = 0.003), more uPA-positive cells (P <0.001), and higher TGF-beta immunoreactivity levels (P <0.001) than normal rectum. Preoperative irradiation was associated with decreased proportions of TM-positive vessels in tumors (P = 0.003) and normal rectum (P <0.001). Irradiated tumors had fewer uPA-positive cells (P = 0.003) and less TGF-beta immunoreactivity (P = 0.001) than unirradiated tumors. The proportion of TM-positive vessels in irradiated rectum from patients with recurrence was decreased (P = 0.03), whereas the recurrent (ie, unirradiated) tumors did not differ from primary tumors in terms of TM, TGF-beta, or uPA immunoreactivity. CONCLUSIONS: The results support a role for endothelial dysfunction in the pathogenesis of radiation proctitis. Maintaining endothelial cell anticoagulant function may be a potential method to optimize the therapeutic ratio of adjuvant radiotherapy of rectal cancer.

Just noticeable differences in 2D and 3D bar charts: a psychophysical analysis of chart readability.

The comparative readability of 2-dimensional (2D) and 3-dimensional (3D) bar charts was assessed using the method of constant stimuli, and the corresponding Weber constants and just-noticeable-differences were computed. It was predicted that the just-noticeable-difference for 3D charts would be larger than for 2D charts. 36 bar charts (18 2D and 18 3D) were prepared for individual presentation on an overhead projector. Each chart contained two bars, one of standard size (25 units) and a second that varied in size from 24 to 26 units in increments of 0.25 units (1% of the standard). 57 undergraduates in psychology were shown the 36 charts in a random sequence for 3 sec. each, separated by 3-sec. intervals. Participants recorded comparative size judgements of bars for each chart. Multivariate analyses identify an advantage in accuracy (in the order of magnitude of approximately 10%) for 2D rather than 3D bar charts, after controlling for sex, age, and use of corrective lenses. The computed Weber constants for these judgements were similar to those computed for visual intensity over 100 years ago, but--as predicted--the just-noticeable-difference for 3D charts was larger (implying that larger differences are needed on 3D charts to distinguish closely related bars). Furthermore, the use of traditional psychophysical approaches (such as the method of constant stimuli) in assessing graphical aids would appear to be justified.

Attention focus, trait anxiety and pain perception in patients undergoing colposcopy.

Few studies have compared the relative efficacy of attention-focus strategies in reducing clinical pain. Colposcopy, a medical diagnostic examination performed to identify premalignant cervical cell changes, elicits both anxiety and pain in patients, while allowing little or no behavioural control over the event. Employing a multi-group experimental design, the present study sought to investigate how different types of attention-focus strategies impacted upon pain perception, state anxiety and affect, in a sample of 123 colposcopy patients. Patients were randomly assigned to one of three groups: sensory focusing, active distraction and undirected control. Psychometric measures of pre-colposcopy pain expectancy and dispositional trait anxiety were also taken, in order to assess whether these factors further contributed to outcomes. Overall, when controlling for pain expectancy and trait anxiety, self-reported pain intensity, sensory pain and affective pain did not differ across groups. Further, there were no significant between-group differences in colposcopy-related state anxiety or affect. However, pre-colposcopy psychometric measures were found to be predictive of a range of outcomes. Pre-colposcopy pain expectancy, but not trait anxiety, was found to be positively related to colposcopy-related pain. It was further demonstrated that heightened state anxiety following colposcopy was due to experienced pain and pain unpleasantness, rather than to aspects of the pre-colposcopy prediction of pain. The results have implications for management of acute clinical pain.

Selective preconcentration of polynuclear aromatic hydrocarbons and polychlorinated biphenyls by in situ metal hydroxide precipitation.

An investigation of selective concentration of analytes from aqueous samples by in situ magnesium hydroxide precipitation, as described by Faltusz, has yielded the following results: the method is selective for polycyclic aromatic hydrocarbons and polychlorinated biphenyls of higher molecular weight: it discriminates strongly against acidic molecules, and other neutral and basic molecules are only partially recovered; a variety of metal hydroxides could evidently be used in this method, but magnesium appears to have practical advantages over some of the others; the reproducibility of analyses on pure water samples is acceptable (ca.20% relative standard deviation), but the results from natural samples show lower recovery and wider variability; a preliminary test, in which this method was used to discriminate against major amounts of interfering solutes, shows promise that this technique might have unique advantages in certain situations.