Malignant melanoma of the rectum presenting as cloacogenic polyp: a case report.

Mucosal malignant melanomas are uncommon. It is rare for a primary mucosal melanoma to occur in the anorectal region. Anorectal polypoid mucosal prolapse however, is a relatively common condition. We report a case of malignant melanoma presenting as mucosal prolapse and inducing changes similar to inflammatory cloacogenic polyp.

[Pulmonary intravascular talcosis: A case report]. / Talcose intravasculaire pulmonaire : à propos d'un cas.

INTRODUCTION: Pulmonary intravascular talcosis is a rare condition occurring in intravenous drug users injecting oral medications. Talc results in a foreign-body granulomatous reaction giving a radiological haematogenic miliary appearance mimicking miliary tuberculosis. Drug users represent a population at risk for both these conditions and their distinction may be challenging. CASE REPORT: We reported the case of a man, 33 year-old, intravenous drug addict, detected by the health services because he was the partner of a person who died of contagious and multi-resistant tuberculosis. Chest X-ray and CT scan showed a typical miliary appearance. Despite negative microbiology, clinical diagnosis of miliary tuberculosis was retained. Due to the lack of radiological improvement despite appropriate antibiotic treatment, re-evaluation and trans-bronchial biopsy were undertaken. The presence of granulomas centered by birefringent foreign bodies in polarized light led to a diagnosis of pulmonary intravascular talcosis. CONCLUSION: In the presence of pulmonary miliary in an intravenous drug addict, intravascular talcosis should be suspected.

Genetic co-variance functions for live weight, feed intake, and efficiency measures in growing pigs.

The objective of the present study was to estimate genetic co-variance parameters pertaining to live weight, feed intake, and 2 efficiency traits (i.e., residual feed intake and residual daily gain) in a population of pigs over a defined growing phase using Legendre polynomial equations. The data set used consisted of 51,893 live weight records and 903,436 feed intake, residual feed intake (defined as the difference between an animal's actual feed intake and its expected feed intake), and residual daily gain (defined as the difference between an animal's actual growth rate and its expected growth rate) records from 10,201 growing pigs. Genetic co-variance parameters for all traits were estimated using random regression Legendre polynomials. Daily heritability estimates for live weight ranged from 0.25 ± 0.04 (d 73) to 0.50 ± 0.03 (d 122). Low to moderate heritability estimates were evident for feed intake, ranging from 0.07 ± 0.03 (d 66) to 0.25 ± 0.02 (d 170). The estimated heritability for residual feed intake was generally lower than those of both live weight and feed intake and ranged from 0.04 ± 0.01 (d 96) to 0.17 ± 0.02 (d 159). The heritability for feed intake and residual feed intake increased in the early stages of the test period and subsequently sharply declined, coinciding with older ages. Heritability estimates for residual daily gain ranged from 0.26 ± 0.03 (d 188) to 0.42 ± 0.03 (d 101). Genetic correlations within trait were strongest between adjacent ages but weakened as the interval between ages increased; however, the genetic correlations within all traits tended to strengthen between the extremes of the trajectory. Moderate to strong genetic correlations were evident among live weight, feed intake, and the efficiency traits, particularly in the early stage of the trial period (d 66 to 86), but weakened with age. Results from this study could be implemented into the national genetic evaluation for pigs, providing comprehensive information on the profile of growth and efficiency throughout the growing period of the animal's life, thus helping producers identify genetically superior animals.

Estimation of genetic (co)variances of Gompertz growth function parameters in pigs.

The objective of this study was to estimate genetic (co)variances for the Gompertz growth function parameters, asymptotic mature weight (A), the ratio of mature weight to birthweight (B) and rate of maturation (k), using alternative modelling approaches. The data set consisted of 51 893 live weight records from 10 201 growing pigs. The growth of each pig was modelled using the Gompertz model employing either a two-step fixed effect or mixed model approach or a one-step mixed model approach using restricted maximum likelihood for the estimation of genetic (co)variance. Heritability estimates for the Gompertz growth function parameters, A (0.40), B (0.69) and k (0.45), were greatest for the one-step approach, compared with the two-step fixed effects approach, A (0.10), B (0.33) and k (0.13), and the two-step mixed model approach, A (0.17), B (0.32) and k (0.18). Inferred genetic correlations (i.e. correlations of estimated breeding values) between growth function parameters within models ranged from -0.78 to 0.76, and across models ranged from 0.28 to 0.73 for parameter A, 0.75 to 0.88 for parameter B and 0.09 to 0.37 for parameter k. Correlations between predicted daily sire live weights based on the Gompertz growth curve parameters' estimated breeding values from 60 to 200 days of age between all three modelled approaches were moderately to strongly correlated (0.75 to 0.95). Results from this study provide heritability estimates for biologically interpretable parameters of pig growth through the quantification of genetic (co)variances, thereby facilitating the estimation of breeding values for inclusion in breeding objectives to aid in breeding and selection decisions.

Comparison of psychotherapies for adult depression to pill placebo control groups: a meta-analysis.

BACKGROUND: The effects of antidepressants for treating depressive disorders have been overestimated because of selective publication of positive trials. Reanalyses that include unpublished trials have yielded reduced effect sizes. This in turn has led to claims that antidepressants have clinically insignificant advantages over placebo and that psychotherapy is therefore a better alternative. To test this, we conducted a meta-analysis of studies comparing psychotherapy with pill placebo. METHOD: Ten 10 studies comparing psychotherapies with pill placebo were identified. In total, 1240 patients were included in these studies. For each study, Hedges' g was calculated. Characteristics of the studies were extracted for subgroup and meta-regression analyses. RESULTS: The effect of psychotherapy compared to pill placebo at post-test was g = 0.25 [95% confidence interval (CI) 0.14-0.36, I² = 0%, 95% CI 0-58]. This effect size corresponds to a number needed to treat (NNT) of 7.14 (95% CI 5.00-12.82). The psychotherapy conditions scored 2.66 points lower on the Hamilton Depression Rating Scale (HAMD) than the placebo conditions, and 3.20 points lower on the Beck Depression Inventory (BDI). Some indications for publication bias were found (two missing studies). We found no significant differences between subgroups of the studies and in meta-regression analyses we found no significant association between baseline severity and effect size. CONCLUSIONS: Although there are differences between the role of placebo in psychotherapy and pharmacotherapy research, psychotherapy has an effect size that is comparable to that of antidepressant medications. Whether these effects should be deemed clinically relevant remains open to debate.

Genetics of milking characteristics in dairy cows.

Genetic selection for milking speed is feasible. The existence of a correlation structure between milking speed and milk yield, however, necessitates a selection strategy to increase milking speed with no repercussion on genetic merit for milk yield. Residual milking duration (RMD) and residual milking duration including somatic cell score (RMDS), defined as the residuals from a regression model of milking duration on milk yield or milk yield plus somatic cell score (SCS) have been advocated. The objective of this study was to undertake a first ever genetic analysis of these novel traits. Data on electronically recorded milking duration and other milking characteristics from 235 005 test-day records on 74 608 cows in 1075 Irish dairy herds were available. Variance components for the milking characteristic traits were estimated using animal linear mixed models and covariances with other performance traits, including udder-related type traits, were estimated using sire models. The heritability of milking duration, RMD and RMDS was 0.20, 0.22 and 0.18, respectively. There were little differences in the heritability of RMD or RMDS when defined using genetic regression. The genetic standard deviation of RMDS defined on the phenotypic or genetic level was 36.8 s and 37.6 s, respectively, clearly indicating considerable exploitable genetic variation in milking duration independent of both milk yield and SCS. The genetic correlation between phenotypically derived RMDS and milk yield was favourable (-0.43), but RMDS was unfavourably genetically correlated with SCS (-0.30); the genetic correlations with both traits when RMDS was defined at a genetic level were zero. RMDS defined at the phenotypic level was negatively (i.e. unfavourable) genetically correlated (-0.35; s.e. = 0.15) with mastitis; however, when defined using genetic regression, shorter RMDS was not associated with greater expected incidence of mastitis. RMDS, defined at the genetic level, is a useful heritable trait with ample genetic variation for inclusion in a national breeding strategy without influencing genetic gain in either milk yield or udder health.

Comparison of the Baska(®) mask with the single-use laryngeal mask airway in low-risk female patients undergoing ambulatory surgery.

We compared the Baska(®) mask with the single-use classic laryngeal mask airway (cLMA) in 150 females at low risk for difficult tracheal intubation in a randomised, controlled clinical trial. We found that median (IQR [range]) seal pressure was significantly higher with the Baska mask compared with the cLMA (40 (34-40 [16-40]) vs 22 (18-25 [14-40]) cmH2O, respectively, p < 0.001), indicating a better seal. In contrast, the first time success rate for insertion of the Baska mask was lower than that seen with the cLMA (52/71 (73%) vs 77/99 (98%), respectively, p < 0.001). There were no differences in overall device insertion success rates (78/79 (99%) vs 68/71 (96%), respectively, p = 0.54). The Baska mask proved more difficult to insert, requiring more insertion attempts, taking longer to insert and had higher median (IQR [range]) insertion difficulty scores (1.6 (0.8-2.2 [0.1-5.6]) vs 0.5 (0.3-1.4 [0.1-4.0]), respectively, p < 0.001). There was also an increased rate of minor blood staining of the Baska mask after removal, but there were no differences in other complication rates, such as laryngospasm, or in the severity of throat discomfort. In conclusion, in clinical situations where the seal with the glottic aperture takes priority over ease of insertion, the Baska mask may provide a useful alternative to the cLMA.

Screening for depression and diabetes-related distress in a diabetes outpatient clinic.

AIMS: To investigate: (1) the willingness of patients with diabetes to participate in a screening programme; (2) the extent to which patients with diabetes who screen positive endorse need for psychosocial care; (3) the rate of referral to psychosocial care during screening vs. usual care. METHODS: Four hundred and ninety-nine patients with diabetes were invited to complete the Center for Epidemiologic Studies Depression and the Problem Areas in Diabetes questionnaires. Patients screening positive on either instrument were invited for an interview. One year after screening was withdrawn, rates of referral to psychosocial care were assessed from physician reports of patient referrals. RESULTS: In total, 349/499 (70%) patients with diabetes completed the questionnaire. Patients who did not take up the screening were younger, smoked more often and had higher HbA(1c) values. 'No-shows' for clinical appointments accounted for 74% of non-participation. Of the 104 (30% of 349) patients screening positive, 45 accepted an invitation for an interview. Finally, 36/104 (35%) would like a referral for psychological care. Seven per cent of patients were referred to psychological care during screening compared with 1% when screening was withdrawn. CONCLUSIONS: Results raise questions as to whether screening is the most efficient way to identify patients with psychological problems. Many patients did not take up the screening, especially those with low adherence to diabetes care in general. Furthermore, few patients screening positive wanted to be referred. Screening should be evaluated in the context of consideration of alternative ways to identify at-risk patients, including providing resources to deal with patients with already known adjustment and adherence problems.

Sleep and daily functioning during androgen deprivation therapy for prostate cancer.

A limited body of evidence suggests that sleep problems are common in prostate cancer patients undergoing androgen deprivation therapy, yet little is known about sleep characteristics and the effects of poor sleep on daily functioning in this population. This study assessed sleep in 60 prostate cancer patients taking androgen deprivation therapy with wrist actigraphy and daily diaries for 7 days. The Epworth Sleepiness Scale and the general version of the Functional Assessment of Cancer Therapy scale were also administered. On average, total sleep time was 5.9 (SD = 1.4) h, and sleep efficiency was 75% (SD = 12.0) as assessed by actigraphy. There was generally poor concordance between actigraphy and daily diary for most sleep metrics. Subjects reported awakening, on average, 2.7 times per night, most commonly for nocturia and hot flashes. Assessment of daily functioning showed that participants had mild daytime sleepiness, which was predicted by total sleep time (F(1,47) = 4.5, P= 0.04) General quality of life was not impaired. This study supports more research on the predictors of poor sleep in order to identify effective interventions.

Treatment of atypical depression: post-hoc analysis of a randomized controlled study testing the efficacy of sertraline and cognitive behavioural therapy in mildly depressed outpatients.

OBJECTIVE: Atypical features are common among depressed primary care patients, but clinical trials testing the efficacy of psychopharmacological and/or psychotherapeutic treatment are lacking. This paper examines the efficacy of sertraline and cognitive behavioural therapy (CBT) among depressed patients with atypical features. SUBJECTS AND METHODS: Analyses involve a double-blind comparison of sertraline versus placebo (N=47) and a single-blind comparison between CBT versus a guided self-help group (GSG) (N=48), with primary efficacy endpoints being the Inventory of Depressive Symptomatology (IDS(C)) and Hamilton Depression Scale (HAMD-17). RESULTS: In intent-to-treat (ITT) analyses, the decrease on the IDS(C) scale (and HAMD-17) was greater after CBT compared to GSG: p=0.01 (HAMD-17: p=0.01). The difference between selective serotonin reuptake inhibitors (SSRI) versus placebo was not significant: p=0.22 (HAMD-17: p=0.36). LIMITATIONS: The number of cases in each treatment group was small, thereby limiting statistical power. Patients medicated with sertraline were 10 to 15 years younger than those included in the other groups of treatment. CONCLUSIONS: CBT may be an effective alternative to GSG for mildly depressed patients with atypical features. Although SSRI were not superior to placebo, it would be premature to rule out SSRI as efficacious in atypical depression.

Evidence for associations between the purinergic receptor P2X(7) (P2RX7) and toxoplasmosis.

Congenital Toxoplasma gondii infection can result in intracranial calcification, hydrocephalus and retinochoroiditis. Acquired infection is commonly associated with ocular disease. Pathology is characterized by strong proinflammatory responses. Ligation of ATP by purinergic receptor P2X(7), encoded by P2RX7, stimulates proinflammatory cytokines and can lead directly to killing of intracellular pathogens. To determine whether P2X(7) has a role in susceptibility to congenital toxoplasmosis, we examined polymorphisms at P2RX7 in 149 child/parent trios from North America. We found association (FBAT Z-scores +/-2.429; P=0.015) between the derived C(+)G(-) allele (f=0.68; OR=2.06; 95% CI: 1.14-3.75) at single-nucleotide polymorphism (SNP) rs1718119 (1068T>C; Thr-348-Ala), and a second synonymous variant rs1621388 in linkage disequilibrium with it, and clinical signs of disease per se. Analysis of clinical subgroups showed no association with hydrocephalus, with effect sizes for associations with retinal disease and brain calcifications enhanced (OR=3.0-4.25; 0.004

Should indeterminate lung lesions reported on staging CT scans influence the management of patients with colorectal cancer?

OBJECTIVE: The aim of this study was to determine the significance of indeterminate lung lesions reported from staging CT scans on patients with colorectal cancer. METHOD: CT-scan reports of 439 patients were reviewed to identify patients in which indeterminate lung lesion had been reported. The tumour, node, metastasis (TNM) stage of these patients was recorded together with any follow-up scan reports or multidisciplinary team (MDT) discussions regarding these lesions. RESULTS: Twenty-three patients had definite lung metastases. Forty-five patients had indeterminate lung lesions. Of these, 22 patients had N1 or N2 disease, 20 had N0 disease and three patients were not operated on due to comorbidity. Of these 45 patients, 30 had further follow-up scans. In 19, the indeterminate lesions were unchanged and were therefore downgraded to benign lesions. The lesions had progressed or new lesions had developed in five. These patients were therefore shown to have metastatic lung disease. All five of these patients had N1 or N2 disease. One patient had a primary rather than metastatic lung lesion. Follow-up scans showed the lesion to be no longer present in five. Of the remainder, One patient declined further follow up. Three patients did not have a follow up scan for reasons not mentioned in their records. Two patients were not scanned because further MDT review of the original scans showed that the lesions were not metastases. Four patients died before follow up scans were done. (one postoperative myocardial infarction (MI), one postoperative sepsis, one postoperative cerebrovascular accident (CVA) and one inferior vena cava (IVC) obstruction). Five patients have not yet had follow-up scan at the time of writing. CONCLUSION: Since the introduction of spiral CT scanners, smaller lesions are being seen at the time of preoperative staging. Our study concludes that only a small proportion of indeterminate lung lesions did develop into definite metastases and those that did had node positive disease. Indeterminate lung lesions are not a reason to delay surgery for colorectal cancer.