Assessment of autonomic symptom scales in patients with neurodevelopmental diagnoses using electronic health record data.

Background: Sleep disturbances, gastrointestinal problems, and atypical heart rate are commonly observed in patients with autism spectrum disorder (ASD) and may relate to underlying function of the autonomic nervous system (ANS). The overall objective of the current study was to quantitatively characterize features of ANS function using symptom scales and available electronic health record (EHR) data in a clinically and genetically characterized pediatric cohort. Methods: We assessed features of ANS function via chart review of patient records adapted from items drawn from a clinical research questionnaire of autonomic symptoms. This procedure coded for the presence and/or absence of targeted symptoms and was completed in 3 groups of patients, including patients with a clinical neurodevelopmental diagnosis and identified genetic etiology (NPD, n=244), those with an ASD diagnosis with no known genetic cause (ASD, n=159), and age and sex matched controls (MC, n=213). Symptoms were assessed across four main categories: (1) Mood, Behavior, and Emotion; (2) Secretomotor, Sensory Integration; (3) Urinary, Gastrointestinal, and Digestion; and (4) Circulation, Thermoregulation, Circadian function, and Sleep/Wake cycles. Results: Chart review scores indicate an increased rate of autonomic symptoms across all four sections in our NPD group as compared to scores with ASD and/or MC. Additionally, we note several significant relationships between individual differences in autonomic symptoms and quantitative ASD traits. Conclusion: These results highlight EHR review as a potentially useful method for quantifying variance in symptoms adapted from a questionnaire or survey. Further, using this method indicates that autonomic features are more prevalent in children with genetic disorders conferring risk for ASD and other neurodevelopmental diagnoses.

A Comparison of Global Brain Volumetrics Obtained from CT versus MRI Using 2 Publicly Available Software Packages.

BACKGROUND AND PURPOSE: Brain volumetrics have historically been obtained from MR imaging data. However, advances in CT, along with refined publicly available software packages, may support tissue-level segmentations of clinical CT images. Here, brain volumetrics obtained by applying two publicly available software packages to paired CT-MR data are compared. MATERIALS AND METHODS: In a group of patients (n = 69; 35 men) who underwent both MR imaging and CT brain scans within 12 months of one another, brain tissue was segmented into WM, GM, and CSF compartments using 2 publicly available software packages: Statistical Parametric Mapping and FMRIB Software Library. A subset of patients with repeat imaging sessions was used to assess the repeatability of each segmentation. Regression analysis and Bland-Altman limits of agreement were used to determine the level of agreement between segmented volumes. RESULTS: Regression analysis showed good agreement between volumes derived from MR images versus those from CT. The correlation coefficients between the 2 methods were 0.93 and 0.98 for Statistical Parametric Mapping and FMRIB Software Library, respectively. Differences between global volumes were significant (P < .05) for all volumes compared within a given segmentation pipeline. WM bias was 36% (SD, 38%) and 18% (SD, 18%) for Statistical Parametric Mapping and FMRIB Software Library, respectively, and 10% (SD, 30%) and 6% (SD, 20%) for GM (bias ± limits of agreement), with CT overestimating WM and underestimating GM compared with MR imaging. Repeatability was good for all segmentations, with coefficients of variation of <10% for all volumes. CONCLUSIONS: The repeatability of CT segmentations using publicly available software is good, with good correlation with MR imaging. With careful study design and acknowledgment of measurement biases, CT may be a viable alternative to MR imaging in certain settings.

Higher scores on autonomic symptom scales in pediatric patients with neurodevelopmental disorders of known genetic etiology.

INTRODUCTION: Features of underlying autonomic dysfunction, including sleep disturbances, gastrointestinal problems, and atypical heart rate, have been reported in neurodevelopmental conditions, including autism spectrum disorder (ASD). The current cross-sectional, between-groups study aimed to quantify symptoms of autonomic dysfunction in a neurodevelopmental pediatric cohort characterized by clinical diagnoses as well as genetic etiology. METHOD: The Pediatric Autonomic Symptom Scales (PASS) questionnaire was used to assess autonomic features across a group of patients with clinical neurodevelopmental diagnoses (NPD; N = 90) and genetic etiologies. Patients were subdivided based on either having a clinical ASD diagnosis (NPD-ASD; n = 37) or other non-ASD neurodevelopmental diagnoses, such as intellectual disability without ASD, speech and language disorders, and/or attention deficit hyperactivity disorder (NPD-OTHER; n = 53). Analyses focused on characterizing differences between the NPD group compared to previously published reference samples, as well as differences between the two NPD subgroups (NPD-ASD and NPD-OTHER). RESULTS: Our results indicate higher PASS scores in our NPD cohort relative to children with and without ASD from a previously published cohort. However, we did not identify significant group differences between our NPD-ASD and NPD-OTHER subgroups. Furthermore, we find a significant relationship between quantitative ASD traits and symptoms of autonomic function. CONCLUSION: This work demonstrates the utility of capturing quantitative estimates of autonomic trait dimensions that may be significantly linked with psychosocial impairments and other core clinical features of ASD.

Adherence of elderly patients.to treatment with pentoxifylline.

A study of adherence to treatment was conducted by 179 general practitioners in elderly outpatients with geriatric cerebral symptomatology treated with pentoxifylline. The drug was provided in 2 different randomized packages, with or without memory-aid stickers (also randomized). Compliance was assessed by pill count after 1 mo of treatment. Clinical evolution was assessed by a digit-span test, and by filling in 9 "relative" visual analogue scales of aggravation--improvement. Side effects were recorded from patient complaints. Leftover drug was brought back by 83.1% of patients, and this proportion was influenced neither by packaging type nor memory-aid stickers. Compliance was considered good (fewer than 30 tablets returned) in 62% of patients, and was not influenced by either packaging types or stickers. Peaks of pill count were evident at multiples of packaging units (10 or 40 according to type). Compliance was not related to age or sex, but was related to memory score. There was a correlation between compliance and clinical improvement, and a significant inverse correlation between the former and the frequency of side effects.

Long-term results of treatment for glomus jugulare and glomus vagale tumors with radiotherapy.

Since 1954, 39 cases of glomus jugulare or vagale tumor have been treated by the authors with radiotherapy. The initial results with orthovoltage (280 kV) therapy were unpredictable, but 30 patients with 32 tumors treated with megavoltage radiotherapy (Cobalt-60 [60Co] or linear accelerator) have shown either no evidence of recurrence or complications, with one exception, or died of causes unrelated to their glomus tumor. Megavoltage radiotherapy is recommended for primary treatment of all glomus tumors that present with evidence of bone invasion or nerve involvement.

Radiotherapy. The mainstay in the treatment of early glottic carcinoma.

Early squamous cell carcinoma of the glottis may be effectively treated with surgery or radiation therapy. Controversy exists as to whether radiation therapy effects survival at the expense of vocal function by ultimately requiring more total laryngectomies for salvage of local tumor recurrence. This study reviewed the medical records of 185 patients with T1 or T2, NO invasive squamous cell carcinoma of the glottis treated with primary radiation therapy between 1969 and 1984. All patients were followed up for a minimum of 5 years after completion of therapy. One hundred sixty-one patients met the criteria for local control analysis. Radiation therapy controlled disease in 93% (105 of 113) of patients with T1 lesions and 73% (38 of 48) of those with T2 tumors. Ultimate control of disease for T1 and T2 lesions, including surgical salvage, was 111 (98%) of 113 and 44 (92%) of 48 patients, respectively. The rate of successful surgical salvage was 75% (T1) and 70% (T2). The T2 lesions with impaired vocal cord mobility or anterior commissure disease were identified as being at increased risk for recurrence after primary radiation therapy. Overall voice preservation was 90%. Our data demonstrate that radiation therapy effects disease-free survival rates that are comparable to those produced by surgery, without sacrificing voice. Although a small percentage of patients with selected early glottic lesions may be more effectively treated with primary conservation surgery, these data do not support a change in philosophy concerning primary treatment of early glottic cancer with radiation therapy.

Interstitial radiation in the treatment of carcinoma of the tonsillar region.

From 1964 to 1972, 69 patients were treated for carcinoma of the tonsillar region; all have been followed for at least 4 years. Sixteen patients (23%) had second primaries, and in 11 they were clearly the cause of death. No irradiated patient has died from primary recurrence after 2 years. The overall 3 year determinate survival rate (NED) for patients treated curatively was 63% (32/51). Twenty-four patients had interstitial implants after preliminary external radiation (usually 4,000 rad in 4 weeks). Local control (2+ years) was obtained in at least 82% (18/22); two clearly had recurrence. Of 12 stage I or II patients, 11 survived at least 2 years without evidence of disease; of 12 stage III or IV patients, seven did. Survival could have been improved by more aggressive management of neck nodes, as shown by results for the patients treated since 1969. While small superficial ulcers frequently occurred in the group with implants, all healed spontaneously in 1--6 months; there were no serious complications. The main advantages of implantation are reduction in serious complications and xerostomia.

Treatment of cervical carcinoma.

A comparison of cervical carcinoma survived data is made between a large specialized cancer treatment center, M.D. Anderson, and a general regional medical center with 15,000 inpatient admissions and over 250,000 outpatient visits per year. End results are identical and did not depend on the percentage of time spent by the gynecologists or radiation therapists on problems of pelvic cancer.

[Methodology of a cooperative study of response predictors in ambulatory depressive syndrome treated with nomifensine]. / Méthologie d'une étude coopérative des prédicteurs de réponse dans des syndromes dépressifs ambulatoires traités par la nomifensine.

A multicentric therapeutic survey on ambulatory depressive patients has been designed so as to get data allowing response-prediction. The protocol included:--selection of non psychotic ambulatory depressive patients--one month's treatment with nomifensine--collection of data consisting mainly in a series of visual analogue scales, scored by a phisician and given in several random orders to avoid error of proximity. Data treatment indluded:--a step of checking and codification--the study of relations between global appraisal and characteristics of subjects--the study of initial profile of responders and non-responders, using discriminant analysis and correspondance factorial analysis.